Journal of neurosurgical sciences最新文献

{"title":"The clinical challenge of subarachnoid hemorrhage associated with multiple aneurysms when the bleeding source is not certainly identifiable.","authors":"Carmelo L Sturiale, Anna M Auricchio, Benjamin Skrap, Vito Stifano, Alessio Albanese","doi":"10.23736/S0390-5616.21.05609-5","DOIUrl":"10.23736/S0390-5616.21.05609-5","url":null,"abstract":"<p><strong>Background: </strong>Multiple intracranial aneurysms (IAs) are encountered in 20-30% of the subarachnoid hemorrhages (SAH). Neuroimaging and clinical examination are usually sufficient to detect the bleeding source, but sometimes it can be misdiagnosed with catastrophic consequences.</p><p><strong>Methods: </strong>We reviewed our diagnostic work-up for all patients admitted from January 2016 to December 2020 for SAH with multiple IAs accounting for our rate of diagnostic failure. Then, we grouped the patients into 4 categories according to aneurysms topography and described our operative protocol in case of uncertain bleeding origin.</p><p><strong>Results: </strong>Sixty-two patients harboring 161 IAs were included. The bleeding source was identified in 56 patients (90.3%), who harbored other 81 bystander aneurysms. In 6 cases (9.7%) with a total of 24 aneurysms we failed the bleeding source identification. According to IAs topography, we grouped the IAs multiplicity in: 1) anterior plus posterior circulation IAs; 2) multiple posterior circulation IAs; 3) bilateral anterior circulation IAs; and 4) multiple ipsilateral anterior circulation IAs. In case of unidentified bleeding source, key-elements favoring the simultaneous multiple IAs treatment were their number, morphology, topography, clinicians' experience, and management modality as endovascular treatment allows a faster exclusion of multiple IAs distant one each other compared with surgery. MCA involvement represented the more frequent reason to prefer multiple clipping rather than multiple coiling.</p><p><strong>Conclusions: </strong>In a small percentage of patients with SAH with multiple IAs, bleeding source identification can be difficult. Until the routinely availability of new tools such as vessel wall imaging or computational fluid dynamics, an experienced neurovascular team and strategies aiming to simultaneously exclude multiple IAs remain mandatory.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39612066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of pediatric intracranial cerebral cavernous malformations: a 10-year single-center experience.","authors":"Tommaso Calloni, Andrea Carai, Francesco Lioi, Marilou Cavaliere, Alessandro DE Benedictis, Sabrina Rossi, Franco Randi, Maria C Rossi Espagnet, Marina Trivisano, Claudia Cesario, Elisa Pisaneschi, Alessandra Marasi, Alessandra Savioli, Carlo G Giussani, Carlo E Marras","doi":"10.23736/S0390-5616.22.05574-6","DOIUrl":"10.23736/S0390-5616.22.05574-6","url":null,"abstract":"<p><strong>Background: </strong>Cerebral cavernous malformations (CCMs) are low-flow vascular malformations made up of dilated vascular spaces without intervening parenchyma that can occur throughout the central nervous system. CCMs can occur sporadically or in familial forms. Presentation is diverse, ranging from incidental discovery of asymptomatic CCMs to drug-resistant epilepsy and hemorrhages.</p><p><strong>Methods: </strong>We describe the surgical management of CCMs in pediatric patients at Bambino Gesù Children's Hospital in Rome over the last 10 years. The cases have been stratified based on the clinical presentation and the relevant literature is discussed accordingly.</p><p><strong>Results: </strong>We discuss the rationale and technique used in these cases based on their presentation, as well as the generally positive outcomes we achieved with early surgical management, use of intraoperative ultrasound (ioUS) and intraoperative neuromonitoring.</p><p><strong>Conclusions: </strong>Surgical management of pediatric CCMs is a safe and effective strategy, low rates of postoperative morbidity and partial resection were observed.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43448810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low serum albumin as a risk factor for delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage: eICU collaborative research database analysis.","authors":"Alis J Dicpinigaitis, Vincent P Galea, Tolga Sursal, Hussein Al-Shammari, Eric Feldstein, Syed Ali, Serena Wong, Christian Bowers, Christian Becker, Jared Pisapia, Carrie Muh, Simon Hanft, Rachana Tyagi, Stephan A Mayer, Chirag D Gandhi, Fawaz Al-Mufti","doi":"10.23736/S0390-5616.22.05604-1","DOIUrl":"10.23736/S0390-5616.22.05604-1","url":null,"abstract":"<p><strong>Background: </strong>Delayed cerebral ischemia (DCI) represents a devastating complication of aneurysmal subarachnoid hemorrhage (aSAH) and is a significant predictor of morbidity and mortality. Recent studies have implicated inflammatory processes in the pathogenesis of DCI.</p><p><strong>Methods: </strong>aSAH patient data were retrospectively obtained from the eICU Collaborative Research Database (eICU CRD). Multivariable logistic regression models and receiver operating characteristic (ROC) curve analyses were employed to assess the association between low serum albumin (<3.4 g/dL) and clinical endpoints: DCI and in-hospital mortality.</p><p><strong>Results: </strong>Among 276 aSAH patients included in the analysis, 35.5% (N.=98) presented with low serum albumin levels and demonstrated a higher incidence of DCI (18.4% vs. 8.4%, OR=2.45, 95% CI=1.17, 5.10; P=0.017) and in-hospital mortality (27.6% vs. 16.3%, OR=1.95, 95% CI=1.08, 3.54; P=0.027) compared to patients with normal admission albumin values. In a multivariable model controlling for age and World Federation of Neurosurgical Societies grade, low serum albumin remained significantly associated with DCI (OR=2.52, 95% CI=1.18, 5.36; P=0.017), but not with in-hospital mortality. A combined model for prediction of DCI, encompassing known risk factors in addition to low serum albumin, achieved an area under the curve of 0.65 (sensitivity = 0.55, specificity = 0.75).</p><p><strong>Conclusions: </strong>Serum albumin, a routine and inexpensive laboratory measurement, may potentially aid in the identification of patients with aSAH at risk for the development of DCI.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40409120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An understimated maneuver for oculomotor nerve palsy due to posterior communicating artery aneurysm: the opening of the anterior petroclinoid ligament. A technical note.","authors":"Biagia LA Pira, Veronica Picotti, Alessandro Frati, Alessandro Pesce, Giancarlo D'Andrea","doi":"10.23736/S0390-5616.23.06020-4","DOIUrl":"10.23736/S0390-5616.23.06020-4","url":null,"abstract":"<p><p>Posterior communicating artery aneurysms (PcomAs) present with oculomotor nerve (OMN) palsy in 20-30% of cases, and the sudden onset of OMN palsy has to raise the suspicion of rupture, until proven otherwise. The surgical technique is described in a stepwise fashion. An illustrative case is reported: a 57-year-old female was admitted to our department with the diagnosis of a right sided-PcomA. Three months before the admission, when she harbored with the acute onset of complete ptosis, diplopia, orbital pain, impairment of the medial, upward, and downward gaze, with no pupil dysfunction. The origin of the Pcom and the neck of the aneurysm were easily identified and the aneurysm was clipped. Then, we followed the OMN and cut for less than 4 mm the above-lying anterior petroclinoid ligament (APL) to obtain nerve release. Although few cases are described in the literature, and ours represents a single case, we support that this maneuver should be introduced in the clinical practice of expert neurosurgeons dealing with vascular pathologies, such as the opening of the falciform ligament occurs for the decompression of the optical nerve.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9467722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental cold exposure precipitating Moyamoya disease.","authors":"Shambaditya DAS, Alak Pandit, Biman K Ray, Arindam Santra, Souvik Dubey","doi":"10.23736/S0390-5616.23.06149-0","DOIUrl":"10.23736/S0390-5616.23.06149-0","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71482573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normal-appearing naming-related functional activation in incidentally discovered low-grade gliomas: a single institution study.","authors":"Elisa Cargnelutti, Tamara Ius, Miran Skrap, Barbara Tomasino","doi":"10.23736/S0390-5616.21.05508-9","DOIUrl":"10.23736/S0390-5616.21.05508-9","url":null,"abstract":"<p><strong>Background: </strong>Incidentally discovered low-grade gliomas (iLGGs) represent a rare neurological condition, which is associated with a good clinical status and usually preserved - or borderline - cognitive functions; only recently, knowledge has increased on their development and clinical features. Better understanding these aspects is fundamental to set up the most appropriate clinical protocol.</p><p><strong>Methods: </strong>We used fMRI to conduct an exploratory investigation of the effects of iLGG growth on the brain and the potential occurrence of early rearrangement in the functional network associated with object naming. We compared this group of 13 patients with an iLGG in the left hemisphere (maximum lesion overlap in the left inferior frontal gyrus and median tumor volume 12 cm³) and with preserved naming skills with that of a healthy control group.</p><p><strong>Results: </strong>No significant differences were observed in the functional activations between the two groups, but a cluster in the controls vs. patients contrast mainly located in the right lateral visual cortex. As this region is unspecific for object naming and no significant changes emerged when checking for covariates, we concluded that iLGG growth did not affect the functional network and plasticity-related reorganization did not occur yet. We attributed this finding to iLGG features, such as small tumor size at the diagnosis and lack or minimal infiltration.</p><p><strong>Conclusions: </strong>These findings are preliminary, and we recommend future investigation to replicate them and test generalizability to other functional networks. Understanding the potential functional effects of iLGG growth is fundamental for the choice of the most appropriate treatment.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39612063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genotoxic parameters of human degenerated intervertebral discs are linked to the pathogenesis of disc degeneration.","authors":"Charles A Carazzo, Manuela Peletti-Figueiró, Natalia Fontana Nicoletti, Fernando J Scariot, Sérgio Echeverrigaray, Asdrubal Falavigna","doi":"10.23736/S0390-5616.22.05553-9","DOIUrl":"10.23736/S0390-5616.22.05553-9","url":null,"abstract":"<p><strong>Background: </strong>Degenerative disc disease (DDD) is a prevalent disorder that brings great incapacity and morbidity to the world's population. Its pathophysiology is not fully understood. DNA damage can influence this process, but so far, there have been few studies to evaluate this topic and its true importance in DDD, as well as whether there is a relation between degeneration grade and DNA damage. The objective of this study is to evaluate the degree of damage to the DNA and the relation to the severity of DDD and measure its response to this insult compared to live/dead cell parameters and reactive oxygen species activity in human discs.</p><p><strong>Methods: </strong>An experimental study was performed with 15 patients with grade IV or V Pfirrmann classification who underwent spinal surgery. Five patients were operated on two levels, resulting in 20 samples that were submitted to the comet assay to measure DNA damage. Of these, six samples were submitted to flow cytometry, and apoptosis, necrosis, cell membrane integrity, intracellular esterase activity, reactive oxygen species (ROS), caspase 3 and mitochondrial membrane potential were evaluated.</p><p><strong>Results: </strong>All samples had DNA damage, and the average of index damage (ID) was 78.1 (SD±65.11) and frequency damage (FD) was 49.3% (SD±26.05%). There was no statistical difference between the Pfirrmann grades and genotoxic damage. Likewise, all samples that underwent flow cytometry showed apoptosis and ROS to many different degrees.</p><p><strong>Conclusions: </strong>DNA damage occurs in high-grade degeneration of human discs and contributes to activation of the apoptosis pathway and ROS production that can accelerate disc degeneration.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48626181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clear neuroimaging margin at the brain-tumor interface is associated with gross total resection and longer survival in non-enhancing diffuse gliomas.","authors":"Anand A Dharia, Domenico A Gattozzi, Joseph S Domino, Adam G Rouse, Roukoz B Chamoun","doi":"10.23736/S0390-5616.24.06221-0","DOIUrl":"https://doi.org/10.23736/S0390-5616.24.06221-0","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to determine whether the presence of distinct glioma margins on preoperative imaging is correlated with improved intraoperative identification of tumor-brain interfaces and overall improved surgical outcomes of non-enhancing gliomas.</p><p><strong>Methods: </strong>This is a retrospective study of all primary glioma resections at our institution between 2000-2020. Tumors with contrast enhancement or with final pathology other than diffuse infiltrative glial neoplasm (WHO II or WHO III) were excluded. Tumors were stratified into two groups: those with distinct radiographical borders between tumor and brain, and those with ill-defined radiographical margins. Multivariate analysis was performed to determine the impact of clear preoperative margins on the primary outcome of gross-total resection.</p><p><strong>Results: </strong>Within the study period, 59 patients met inclusion criteria, of which 31 (53%) had distinct margins. These patients were predominantly younger (37.6 vs. 48.1 years, P=0.007). Tumor and other patient characteristics were similar in both cohorts, including gender, laterality, size, location, tumor type, grade, and surgical adjuncts utilized (P>0.05). Multivariate regression identified that distinct preoperative margins correlated with increased rates of gross total resection (P=0.02). Distinct margins on preoperative neuroimaging also correlated positively with surgeon identification of intra-operative margins (P<0.0001), fewer deaths over the study period (P=0.01), and longer overall survival (P=0.03).</p><p><strong>Conclusions: </strong>Distinct glioma-parenchyma margins on preoperative imaging are associated with improved surgical resection for diffuse gliomas, as distinct margins may correlate with distinguishable glioma-brain interfaces intraoperatively. Further prospective studies may discover additional clinical uses for these findings.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative seizures during neuro-oncological supratentorial surgery: the role of prophylaxis with levetiracetam and intraoperative monitoring in a consecutive series of 353 patients.","authors":"Francesca Battista, Giovanni Muscas, Alberto Parenti, Maddalena Spalletti, Cristiana Martinelli, Riccardo Carrai, Andrea Amadori, Alessandro Della Puppa","doi":"10.23736/S0390-5616.24.06154-X","DOIUrl":"https://doi.org/10.23736/S0390-5616.24.06154-X","url":null,"abstract":"<p><strong>Background: </strong>The aim of this paper was to understand the role of prophylaxis with levetiracetam at skin incision in preventing convulsive intraoperative seizures (IOS) during neurosurgical procedures with and without intraoperative neuromonitoring (IONM).</p><p><strong>Methods: </strong>Authors retrospectively reviewed the Institutional database for cases of supratentorial brain tumors undergoing surgical resection performed from January 2021 to October 2022. Patients were operated on both under general anesthesia and awake, using motor-evoked potentials (MEP) and direct cortical stimulation for cortical mapping. 1000 mg ev of Levetiracetam before skin incision in case of a history of seizures was administrated. We excluded all infratentorial cases.</p><p><strong>Results: </strong>Three hundred fisty three consecutive cases were retrieved. IOS occurred in 22 patients (6.2%). Prophylaxis with Levetiracetam was administered in 149 patients, and IOS occurred in 16 cases (10.7%) in this group of patients. The IOS rate in the case of no Levetiracetam prophylaxis administration (3.5%) was significantly lower (P<0.001, OR=3.38 [1.35-8.45], RR=3.12 [1.32-7.41]). The Penfield technique stimulation evoked seven of all 22 IOS reported (31.8%) (P=0.006, RR 5.4 [1.44 -20.58], OR 21 [2.3-183.9]), and the train-of-five technique stimulation caused two of all registered IOS (8.7%) (P=0.2, RR 2.3 [0.99-5.67], OR 6.5 [0.55-76.17]). Transcranial MEPs evoked no IOS.</p><p><strong>Conclusions: </strong>Under levetiracetam prophylaxis, the IOS rate was not significantly lower than in the group of patients without Levetiracetam prophylaxis, regardless of the histology of the tumor and IONM. Neither the transcranial stimulation (MEP) nor train-of-five technique stimulation increases the risk of convulsive IOS, as Penfield technique stimulation does.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurosurgical research in LMIC: a bitter truth.","authors":"Bipin Chaurasia","doi":"10.23736/S0390-5616.23.06138-6","DOIUrl":"10.23736/S0390-5616.23.06138-6","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41135814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}