Journal of neurological surgery. Part A, Central European neurosurgery最新文献

{"title":"Role of Multimodal Use of Surgery Adjuncts for Overall Survival of Patients with Supratentorial WHO Grade 4 Gliomas.","authors":"Tomasz Czernicki, Edyta Maj, Przemysław Kunert","doi":"10.1055/a-2926-6144","DOIUrl":"10.1055/a-2926-6144","url":null,"abstract":"<p><strong>Background: </strong>In recent years, numerous advanced techniques supporting surgery (TSS) have been utilized to maximize glioma resection. However, the impact of the multimodal use of TSS, such as awake surgery, intraoperative neurophysiological monitoring, neuronavigation, fluorescence-guided surgery, functional magnetic resonance imaging m(fMRI), and diffusion tensor tractography (DTT), on improving overall survival (OS) remains uncertain.</p><p><strong>Methods: </strong>In retrospective analysis of 81 patients with supratentorial WHO grade 4 gliomas, we assessed the effect of age, sex, tumor location, number of TSS used, extent of resection (EOR), postoperative Karnofsky performance scale (KPS), IDH1 status, and use of postoperative adjuvant therapy (PAT), i.e., radiotherapy and chemotherapy, on overall survival. Kaplan-Meyer plots with F-Cox test and Cox proportional hazards model were used for univariate and multivariate survival analyses.</p><p><strong>Results: </strong>We used none, one, two, three, or four TSS in 30, 20, 15, 9, and 7 patients, respectively. The number of TSS used (none vs. 1-2 vs. 3-4) correlated with OS in eloquent areas (<i>p</i> = 0.029, univariate; <i>p</i> = 0.006, multivariate) with median survival of 194, 364, and 674 days, respectively, whereas no correlation was observed in non-eloquent areas. In univariate analysis but not in multivariate analysis, significant factors for OS in gliomas in eloquent areas were younger age (<i>p</i> = 0.026), EOR (gross total vs. subtotal vs. partial resection) (<i>p</i> = 0.015), and PAT use (<i>p</i> = 0.00066), and in gliomas in non-eloquent areas were EOR (<i>p</i> = 0.01), postoperative KPS (≥70 vs. <70) (<i>p</i> = 0.023), and PAT use (<i>p</i> = 0.015).</p><p><strong>Conclusion: </strong>The simultaneous use of multiple TSS appears to be associated with improved overall survival in patients with supratentorial WHO grade 4 gliomas in eloquent areas, in contrast to non-eloquent areas.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"449-461"},"PeriodicalIF":0.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648637","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":"Significance of High-Intensity Zones in Lumbar Discs: A Correlation with Endoscopic Findings.","authors":"Shutaro Fujimoto, Takafumi Ohshima, Shunsuke Tamaki, Kosuke Sugiura, Makoto Takeuchi, Masatoshi Morimoto, Fumitake Tezuka, Kazuta Yamashita, Koichi Sairyo, Atsushi Teramoto","doi":"10.1055/a-2846-3487","DOIUrl":"10.1055/a-2846-3487","url":null,"abstract":"<p><strong>Background and study aims: </strong>The high-intensity zone (HIZ) in a lumbar intervertebral disc on T2-weighted magnetic resonance images has been associated with discogenic low back pain. However, its clinical significance remains uncertain. Histological studies reveal inflammatory changes surrounding the HIZ, suggesting a potential link to disc degeneration. Recent advancements in full-endoscopic spine surgery (FESS) have enabled more detailed intradiscal observations. The purpose of this study is to examine the characteristics of endoscopic findings in the HIZ.</p><p><strong>Materials and methods: </strong>Eighty-six patients who underwent FESS between January 2020 and August 2022 were investigated. We defined intradiscal bleeding and/or inflammation as \"red annulus fibrosus\" (RAF) and compared its occurrence between patients with HIZ and without HIZ. In 45 patients with HIZ, the ratio of the signal intensity of the HIZ to that of cerebrospinal fluid (the HIZ/CSF ratio) was compared according to RAF status.</p><p><strong>Results: </strong>RAF was observed in 54.7% of all patients, with a higher prevalence in those with an HIZ (73.3 vs. 34.1%, <i>p</i> < 0.01). The HIZ/CSF ratio was significantly higher in patients with RAF than in those without RAF (0.64 vs. 0.46, <i>p</i> = 0.03). The receiver-operating characteristic curve for the ability of the HIZ/CSF ratio to predict intradiscal bleeding had an area under the curve of 0.74, with a cutoff value of 0.48 providing 72.7% sensitivity and 66.7% specificity.</p><p><strong>Conclusion: </strong>Intradiscal bleeding and inflammation were observed more often in patients with an HIZ, suggesting an association with degenerative changes. An HIZ/CSF ratio > 0.48 on preoperative magnetic resonance images may predict intradiscal bleeding.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"444-448"},"PeriodicalIF":0.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654303","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":"Surgery in the Semi-Sitting Position: A Worldwide Survey among Neurosurgeons.","authors":"Arif Abdulbaki, Osamah Almarzooq, Bipin Chaurasia, Amir Samii, Madjid Samii, Joachim K Krauss, Shadi Al-Afif","doi":"10.1055/a-2930-4165","DOIUrl":"10.1055/a-2930-4165","url":null,"abstract":"<p><strong>Introduction: </strong>The semi-sitting position in neurosurgery remains a topic of debate. Despite advantages such as improved surgical accessibility and visibility, it is associated with risks such as venous air embolism. This study provides an overview of the current use, benefits, challenges, and future prospects of the semi-sitting position, based on insights from a sample of international neurosurgeons.</p><p><strong>Methods: </strong>A structured questionnaire was distributed via social media channels to neurosurgeons worldwide, collecting data on demographics, usage frequency, indications, reasons for use or nonuse, feared complications, alternative positions, and treated pathologies. Responses from 141 neurosurgeons were analyzed, comparing developed and developing countries.</p><p><strong>Results: </strong>Overall, 81.6% of neurosurgeons reported using the semi-sitting position, with a significantly higher frequency in developed countries (<i>p</i> < 0.001). A total of 97.9% of participants used this position for infratentorial pathologies. Major barriers included fear of complications (44.3%), insufficient anesthesia team training (42.9%), and lack of appropriate equipment (31.4%). Significant regional differences were observed, with training deficits (<i>p</i> = 0.007), lack of equipment (<i>p</i> = 0.001), and limited experience (<i>p</i> = 0.008) reported more frequently in developing countries. Perioperative monitoring practices showed variability; however, most modalities did not differ significantly between groups, including intraoperative transesophageal echocardiography (<i>p</i> = 0.091). Among nonusers, 44% expressed willingness to adopt the semi-sitting position with appropriate training and support.</p><p><strong>Conclusion: </strong>Despite its challenges, the semi-sitting position offers significant advantages for specific neurosurgical procedures. Successful implementation requires an experienced surgical and anesthesiology team. Efforts to enhance training, improve technology, and provide adequate infrastructure could facilitate broader adoption of the semi-sitting position.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"462-470"},"PeriodicalIF":0.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887944","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":"Endoscopic Endonasal Resection of a Pure Optic Canal Cavernous Malformation Presenting as Progressive Optic Neuropathy.","authors":"Daisuke Tanioka, Jyunichiro Kizaki, Ikuya Natori, Yusuke Kobayashi, Tsubasa Tanaka, Yoichi Morofuji, Seiya Fukuoka, Hidetoshi Onda, Mayumi Homma, Masafumi Takimoto","doi":"10.1055/a-2926-6052","DOIUrl":"10.1055/a-2926-6052","url":null,"abstract":"<p><strong>Background and objective: </strong>Cavernous malformations (CMs) are relatively common in the brain parenchyma, whereas lesions strictly confined to the optic canal are exceptionally rare. Although only a few intracanalicular vascular malformations have been reported, detailed descriptions of pure optic canal CMs remain scarce. We report a pure optic canal CM successfully managed by endoscopic endonasal surgery to further highlight the surgical feasibility and clinical efficacy of this strategy.</p><p><strong>Case description: </strong>A 48-year-old woman presented with a 3-month history of progressive right visual decline that accelerated shortly before admission. Ophthalmological examinations showed decreased best-corrected visual acuity, a relative afferent pupillary defect, concentric visual field narrowing, and thinning of the ganglion cell layer on optical coherence tomography. Magnetic resonance imaging (MRI) demonstrated a well-circumscribed, homogeneously gadolinium-enhancing mass entirely within the right optic canal, whereas computed tomography showed no calcification or canal enlargement. Vision improved transiently after systemic corticosteroids but relapsed with tapering, suggesting a compressive lesion. Given the rapid progression of vision loss, endoscopic endonasal surgery was conducted.</p><p><strong>Results: </strong>Through a right nasal approach, the optic canal was unroofed and a dark-reddish, well-circumscribed lesion with minimal adhesion was removed en bloc. There was negligible blood loss and no intraoperative or postoperative cerebrospinal fluid leakage. A CM was confirmed by histopathology. Postoperatively, visual acuity and field recovered fully, and MRI confirmed gross total resection with complete decompression of the optic nerve.</p><p><strong>Conclusion: </strong>This case adds an additional well-documented example of a pure optic canal CM and supports the endoscopic endonasal approach as a safe and useful option for achieving complete resection with excellent visual recovery.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"476-483"},"PeriodicalIF":0.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887904","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":"Trends, Insights, and Challenges in the Treatment of Trigeminal Neuralgia: A Bibliometric Analysis of the Top 200 Most Influential Articles.","authors":"Selnan J Wuyep, Theodora Kontaxi, Andreas K Demetriades","doi":"10.1055/a-2801-9880","DOIUrl":"10.1055/a-2801-9880","url":null,"abstract":"<p><strong>Objective: </strong>This bibliometric analysis aims to identify and evaluate the top 200 most influential articles on the treatment of trigeminal neuralgia (TN), encompassing both pharmacological and surgical interventions. The study seeks to provide a comprehensive overview of research trends, international collaborations, and citation metrics to inform future research and clinical practice.</p><p><strong>Methods: </strong>A systematic search was conducted in November 2024 using the Web of Science (WoS) database, focusing on articles related to TN treatment. Articles were filtered by language (English) and type (original articles and reviews), excluding letters, errata, and conference abstracts. The top 200 most-cited articles were selected and analyzed using the Bibliometrix R package and biblioshiny web application. Data on authorship, institutions, countries, journals, keywords, and citations were extracted and analyzed.</p><p><strong>Results: </strong>The 200 articles, published between 1953 and 2021, were cited a total of 23,059 times, with an average of 115.3 citations per article. The majority (73%) were published in the 21st century, with the most productive year being 2002. Surgical management was the focus of 56.5% of the articles, with microvascular decompression (MVD) being the most studied surgical technique (25.5%). Pharmacological management was addressed in 18% of the articles. The United States contributed the most articles (39%), followed by the United Kingdom (12.5%) and Italy (5.5%). The most prolific journals were the <i>Journal of Neurosurgery</i> (21.5%) and <i>Neurosurgery</i> (19.5%). Key trends included a shift toward prospective studies and a decline in radiosurgery-focused research in the last decade.</p><p><strong>Conclusion: </strong>This analysis highlights the dominance of surgical approaches, particularly MVD, in TN research, with a significant underrepresentation of pharmacological and minimally invasive treatments. The findings underscore the need for more international collaborations, particularly with low- and middle-income countries, and a greater focus on comparative effectiveness research, pharmacological studies, and basic science to address existing gaps in TN management.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"413-438"},"PeriodicalIF":0.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105842","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":"Mini-Invasive Neurosurgical Treatment of Subdural Empyema: A Two-Patient Case Series.","authors":"Ejona Rifat Isakaj Lilamani, Aurora Arben Muça, Arben Jonuz Rroji, Artid Agron Lame, Arba Firdus Cecia, Mithat Ismail Demneri, Arsen Haki Seferi, Ridvan Hamid Alimehmeti","doi":"10.1055/a-2931-1083","DOIUrl":"10.1055/a-2931-1083","url":null,"abstract":"<p><strong>Background: </strong>Subdural empyema is a neurosurgical emergency traditionally managed with craniotomy and prolonged intravenous antibiotic therapy. Minimally invasive approaches may represent an alternative in selected cases, particularly when combined with timely diagnosis and targeted antimicrobial treatment.</p><p><strong>Patients: </strong>We report two cases of subdural empyema treated with minimally invasive burr-hole evacuation.</p><p><strong>Case 1: </strong>A 22-year-old man with developmental anomalies and postischemic stroke history presented with intermittent high fever for 2 weeks. Rapid neurological deterioration over 24 hours led to coma (Glasgow Coma Scale 5). Cranial computed tomography (CT) revealed a right-sided subdural empyema with significant mass effect. Emergency burr-hole evacuation was performed, followed by broad-spectrum antibiotics later tailored to <i>Staphylococcus aureus</i>.</p><p><strong>Case 2: </strong>A 40-year-old man presented with hypertensive intracranial syndrome and febrile episodes for 1 week. CT and magnetic resonance imaging revealed a left hemispheric subdural collection suggestive of empyema, likely secondary to otitis media from suspected <i>Streptococcus anginosus</i>. Burr-hole evacuation and empiric triple antibiotic therapy were initiated.</p><p><strong>Results: </strong>In both cases, postoperative imaging confirmed complete evacuation without residual collection. The first patient required prolonged intensive care with gradual neurological improvement over several weeks, whereas the second patient achieved immediate postoperative recovery. At 2-year radiological follow-up, no recurrence was observed in either patient.</p><p><strong>Conclusion: </strong>Minimally invasive burr-hole evacuation, combined with culture-guided antibiotic therapy, can be effective in selected cases of subdural empyema, yielding favorable clinical and radiological outcomes.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"484-489"},"PeriodicalIF":0.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850860","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":"Study of the Spread of Scarring along the Damaged Area of the Limb Nerve after Gunshot and Explosive Injuries.","authors":"Serhii Strafun, Serhii Savosko, Andrii Lysak, Olexandr Grabovyi, Anna Kyrpychova","doi":"10.1055/a-2797-9932","DOIUrl":"10.1055/a-2797-9932","url":null,"abstract":"<p><strong>Background: </strong>Determining the true size or extent of the nerve defect after damage and excision of the posttraumatic neuroma is fundamental in the microsurgical treatment of the patient. It is assumed that the length of the scar in the nerve may depend on the nature of the combat wound of the limb, gunshot, or mine-explosive. Determining the extent of scarring in the nerve in cases of these two types of injury may provide an opportunity to establish a relationship with the type of injury or to disprove such a relationship. This should help in the surgical treatment tactics.</p><p><strong>Methods: </strong>Fifty samples of damaged peripheral nerves were studied, including 36 nerves of the upper limb and 14 nerves of the lower limb. Microsurgical operations were performed after the injury in an average of 5.4 ± 0.4 months (min = 2 months, max = 17 months). The specifics of scarring in the nerve were investigated by histochemical method, and the specific density of collagen at different distances was calculated. A map of scarring was created for each nerve sample to determine the length of the scar.</p><p><strong>Results: </strong>Based on the mapping of nerve samples, the average length of the scar was determined, which reached 40 to 50 mm in the nerves (Me = 35.5 mm, Q1 = 30.0, Q3 = 55.2, min = 19 mm, max = 120 mm). That length was 37.5 ± 5.5 mm (mean = 30.0) after a gunshot wound and 43.5 ± 8.0 mm (mean = 36.0) after mine-explosive wound. Morphological features of nerve scarring after these two types of damage did not differ (<i>p</i> = 0.29), neither in length nor in scar density.</p><p><strong>Conclusion: </strong>When calculating the true defect of the nerve, one should take into account the spread of the scarring process in the nerve, which in a combat wound is approximately 30 to 50 mm. The length of the scar in the nerve does not depend on the nature of the striking projectile, which proves the critical importance of the energy of the injury.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"406-412"},"PeriodicalIF":0.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097218","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":"Meyer Type III Vertical Atlantoaxial Distraction with Complete Ligamentous Disruption: A Case Report and Surgical Management.","authors":"Ali Hammed, Veit Braun","doi":"10.1055/a-2846-5094","DOIUrl":"10.1055/a-2846-5094","url":null,"abstract":"<p><strong>Background: </strong>Vertical atlantoaxial distraction (AAD) represents a rare and severe form of craniocervical injury caused by high-energy trauma. It involves vertical separation of the atlas and axis due to complete rupture of the ligamentous stabilizers and poses an immediate risk of neurological or vascular compromise.</p><p><strong>Case description: </strong>A 33-year-old male sustained multiple injuries following a suicidal jump from 10 m, including a Type III vertical AAD with 6 mm distraction between the C1 and C2 lateral masses. Imaging revealed complete rupture of the alar, apical, and posterior longitudinal ligaments, bilateral facet joint capsule disruption, and a Gehweiler Type I anterior arch fracture of C1. A traumatic dural tear with suspected cerebrospinal fluid (CSF) leak was also identified. Initial anterior stabilization was performed with mini-fragment screws, followed by delayed posterior C1/C2 fusion via transarticular screws 1 week later due to clinical instability. Intraoperative correction of a 10-degree C1-C2 rotational deformity was achieved, and dural repair was completed using TachoSil and muscle graft. The patient remained neurologically intact and had an uneventful recovery. Follow-up imaging at 1 year demonstrated stable alignment of the construct without signs of hardware loosening, failure, or new neurological findings. At the 6-year follow-up, the patient remained neurologically intact with preserved cervical rotation up to 50 degrees.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic complexity and management challenges associated with vertical AAD. A classification-based surgical strategy supported by high-resolution imaging and intraoperative navigation led to successful stabilization and excellent neurological outcome.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"471-475"},"PeriodicalIF":0.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639220","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":"A Novel Diamond-Shaped Anatomical Model to Learn the In Vivo Endoscopic Anatomy of the Posterior Third Ventricle.","authors":"Mazen Zaher, Joseph Ifrach, Isabel Dory, Howard Warren Goldman, Alan R Turtz","doi":"10.1055/a-2841-9723","DOIUrl":"10.1055/a-2841-9723","url":null,"abstract":"<p><strong>Background: </strong>Technological advancements have allowed a safe endoscopic approach to the posterior third ventricle. This approach provides a unique view of the pineal region from an anterior perspective that many neurosurgeons are unfamiliar with. Understanding the normal endoscopic anatomy can help with surgical orientation when encountering pathological derangements in this region. Early intraoperative observations of the normal posterior third ventricle with low-resolution fiberscopes were interpreted as having a diamond shape that led to the development of a model used for education over time.</p><p><strong>Objective: </strong>This study aimed to describe a simple anatomical model of the normal endoscopic anatomy of the posterior third ventricle, along with some of its pathologic variations.</p><p><strong>Materials and methods: </strong>Digital illustrations were used to enhance the first-generation, low-resolution fiberscopic images that led to a geometrical teaching model.</p><p><strong>Results: </strong>Illustrations effectively enhanced the early observations of the posterior third ventricular relationships in geometric terms and validated the diamond-shaped model.</p><p><strong>Conclusion: </strong>Digitally enhanced illustrations of low-resolution images developed from early observations with first-generation fiberscopes validated the endoscopic geometric appearance of the posterior third ventricle as a diamond. The diamond model presented is a useful educational tool for learning and understanding the anatomy of the posterior wall of the third ventricle.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"439-443"},"PeriodicalIF":0.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581570","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":"Giant Multiloculated Cystic Trochlear Nerve Schwannoma Between the Tentorial Leaflets: Case Report and Systematic Review.","authors":"Umut Tan Sevgi, Umid Sulaimanov, Ufuk Erginoglu, Ali Riaz, Benjamin Lee, Abdullah Keles, Mustafa Kemal Baskaya","doi":"10.1055/a-2983-9214","DOIUrl":"https://doi.org/10.1055/a-2983-9214","url":null,"abstract":"<p><strong>Background: </strong>Trochlear nerve schwannomas (TNSs) are exceptionally rare benign tumors, accounting for a very small fraction of intracranial schwannomas. Due to their deep locations and slow growth, they often reach a considerable size before diagnosis. Giant or multiloculated cystic variants are exceptionally uncommon and present significant diagnostic and surgical challenges.</p><p><strong>Methods: </strong>A 32-year-old female presented with headache and dizziness but no diplopia. Magnetic resonance imaging revealed a giant multiloculated cystic lesion extending from the posterior fossa to the right temporal lobe, causing obstructive hydrocephalus. The mass was removed through a right paramedian supracerebellar transtentorial approach under intraoperative neurophysiological monitoring. The tumor was confined between the two tentorium leaflets with the trochlear nerve entering and exiting the lesion. Gross total resection was achieved with an uneventful postoperative course. Histopathology confirmed a World Health Organization Grade I schwannoma with Antoni A-B architecture and diffuse S-100 positivity. A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, identifying forty-six surgically treated cases, analyzed together with the present case (n = 46).</p><p><strong>Results: </strong>Mean age was 44.7 years with an approximately equal sex distribution. Most tumors (76.1%) were located in the ambient or crural cisterns, followed by the quadrigeminal cistern (10.8%) and cisterno-cavernous region (8.7%). Diplopia and trochlear nerve palsy were the most common presenting symptoms. Gross total resection was achieved in 80.4% of patients, while postoperative trochlear palsy occurred in 60.8%. No malignant transformation or early recurrence was reported.</p><p><strong>Conclusion: </strong>This case represents one of the largest TNSs described and the second known lesion arising between the tentorial leaflets. Awareness of this unique anatomic configuration is essential for accurate preoperative diagnosis and surgical planning. A meticulous, anatomy-guided microsurgical approach enables complete resection while preserving neurological function in select cases.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224404","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}