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

{"title":"Brain Abscess: A Comparison of Surgical Outcomes between Conventional Burr Hole Aspiration and Endoscope-Assisted Evacuation.","authors":"Md Farhad Ahmed, Sumon Rana, Kanij Fatema Ishrat Zahan, Shirazum Munira, Mohammad Shafiqul Islam, Monzurul Haque, Bhavya Pahwa, Levent Aydin, Giuseppe Emmanuele Umana, Bipin Chaurasia","doi":"10.1055/a-2175-3018","DOIUrl":"10.1055/a-2175-3018","url":null,"abstract":"<p><strong>Background: </strong> Brain abscesses are a major health problem with significant morbidity and mortality rates. The objective of this study was to compare the surgical efficacy of endoscope-assisted evacuation of a brain abscess with that of single burr hole aspiration in a tertiary health care center.</p><p><strong>Methods: </strong> This single-center nonrandomized clinical study was conducted during the period from July 2020 to December 2021. Male and female patients younger than 30 years who presented with brain abscess were enrolled in this study. They were divided into two groups and treated with two different techniques: conventional burr hole aspiration group and endoscope-assisted evacuation group.</p><p><strong>Results: </strong> Thirty patients were enrolled in this study. The mean age was 13.0 ± 6.3 years in the burr hole group and 13.1 ± 6.4 years in the endoscope-assisted group. There was ≥75.0% evacuation of brain abscess on postoperative day 1 in 13 (92.9%) patients in the endoscope-assisted group and in 5 (33.3%) patients in the burr hole group. The mortality rate was 6.7% in both groups. The mean residual volume on postoperative day 30 was 0.75 mL in the endoscope-assisted group and 1.75 mL in the burr hole aspiration group. No patients treated with endoscope-assisted evacuation required a repeat surgery, whereas five patients (33.3%) treated with the conventional burr hole method required a repeat surgery.</p><p><strong>Conclusions: </strong> This study showed that the endoscope-assisted procedure has a better rate of abscess evacuation, lower residual risk, and less chance of repeat surgeries than the conventional burr hole procedure.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"12-16"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10285692","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":"Ventriculoperitoneal Shunt Surgery in Pediatrics: Does Preoperative Skin Antisepsis with Chlorhexidine/Alcohol Reduce Postoperative Shunt Infection Rate?","authors":"Ahmed Shawky Ammar, Hossam Elnoamany, Hany Elkholy","doi":"10.1055/a-2265-9325","DOIUrl":"10.1055/a-2265-9325","url":null,"abstract":"<p><strong>Background: </strong> In pediatrics, shunt infection is considered the most common complication of ventriculoperitoneal (VP) shunt insertion and the main cause of shunt failure. Careful surgical technique and hygienic skin preparations are highly important for prevention of shunt infections. Our objective was to assess the significance of using preoperative chlorhexidine/alcohol as a skin antiseptic in reducing the infection rate in pediatric VP shunts surgery.</p><p><strong>Methods: </strong> We conducted a retrospective, case control study of 80 pediatric patients with active hydrocephalus. The control group (a single step of preoperative skin antisepsis using povidone-iodine and isopropyl alcohol) comprised 40 patients who underwent a shunt surgery between January 2019 and June 2020 and the study group (two steps of preoperative skin antisepsis using 2% chlorhexidine gluconate in 70% isopropyl alcohol as a first step followed by povidone-iodine as a second step) comprised 40 patients who underwent a shunt surgery between July 2020 and January 2022.</p><p><strong>Results: </strong> Shunt infection was encountered in 11 (13.7%) patients. It was significantly higher in preterm babies (<i>p</i> = 0.010), patients with a previous shunt revision (<i>p</i> < 0.001), and those with a previous shunt infection (<i>p</i> < 0.001). The incidence of infection was 22.5% in the control group and 5% in study group, with a statistically significant difference (<i>p</i> = 0.023).</p><p><strong>Conclusions: </strong> Two steps of preoperative skin antisepsis, first using chlorhexidine/alcohol and then povidone-iodine scrub solution, may significantly reduce the infection rate in pediatric VP shunt surgeries.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"65-72"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139712417","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":"The Enigma of Basilar Artery Dissections Secondary to Vasospasm Following Subarachnoid Hemorrhage. Exploration of the Unknown Effect of Superior Cervical Ganglia: A Preliminary Experimental Study.","authors":"Mete Zeynal, Mehmet Hakan Sahin, Ayhan Kanat, Mehmet Kursat Karadag, Sare Sipal, Saban Ergene, Mehmet Dumlu Aydin","doi":"10.1055/a-2104-1520","DOIUrl":"10.1055/a-2104-1520","url":null,"abstract":"<p><strong>Background: </strong> Life-threatening basilar artery dissection (BAD) can be seen following subarachnoid hemorrhage (SAH), but it is not clear whether SAH causes dissection, or not. This study aims to investigate the relationship between degenerative changes in the superior cervical ganglia and the dissection rate of the basilar artery.</p><p><strong>Method: </strong> In this study, after 3 weeks of experimental SAH, animals were decapitated. Eighteen rabbits were divided into three groups according to their vasospasm indices. The basilar arteries were examined by anatomical and histopathologic methods.</p><p><strong>Results: </strong> Basilar dissection with high vasospasm index (VSI) value (VSI > 3) was detected in six animals (group I); severe basilar edema and moderate VSI value (>2.4) were detected in seven rabbits (group II); and slight VSI value (<1.5) was detected in five subjects (group III). The degenerated neuron densities of the superior cervical ganglia were 12 ± 4 n/mm³ in group I, 41 ± 8 n/mm³ in group II, and 276 ± 78 n/mm³ in group III. The dissected surface values/lumen values were calculated as (42 ± 1)/(64 ± 11) in G-I, (21 ± 6)/(89 ± 17) in group II, and (3 ± 1)/(102 ± 24) in group III. If we look at these ratios as a percentage, it was 62% in group I, 23% in group II, and 5% in group III.</p><p><strong>Conclusion: </strong> Inverse relationship between the degenerated neuron densities of the superior cervical ganglia and the dissected surface values of the basilar artery was observed. Common knowledge is that BAD may lead to SAH; however, this study indicates that SAH is the cause of BAD.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"56-64"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9561997","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":"Pineal Apoplexy: Highlighting the Causes, Treatment, and Outcome.","authors":"Oday Atallah, Bipin Chaurasia, Amr Badary, Lucio De Maria, Yasser F Almealawy, Wireko Andrew Awuah, Wahab Moustafa, Anil Ergen, Marco Maria Fontanella","doi":"10.1055/s-0044-1786538","DOIUrl":"10.1055/s-0044-1786538","url":null,"abstract":"<p><strong>Background: </strong> Pineal apoplexy, alternatively referred to as pineal hemorrhage or pineal gland hemorrhagic stroke, is an infrequent pathologic condition characterized by bleeding within the pineal gland. In this review, we encompass the primary factors contributing to this uncommon ailment.</p><p><strong>Methods: </strong> The retrieval of pertinent research, including patients with pineal apoplexy, was conducted through PubMed, Google Scholar, and Scopus databases. This study exclusively incorporated comprehensive articles written in the English language. The search encompassed the MeSH terms \"pineal apoplexy\" and \"pineal hemorrhage.\"</p><p><strong>Results: </strong> A total of 41 articles were identified, encompassing a collective sample size of 57 patients. The median age of the patients in the study was 30 years, with a range spanning from 1 to 73 years. There were 27 males, representing 47.4% of the participants. The study identified the most often reported symptoms as headache (49; 86%), nausea/vomiting (19; 33.3%), and Parinaud's syndrome (16; 28.1%). The treatment options encompass several approaches, including open resection, shunting, ventriculostomy, endoscopic aspiration, and conservative care. In the conducted study, a notable number of patients, amounting to 45 cases (78.9%), indicated an amelioration of their symptoms upon their discharge.</p><p><strong>Conclusion: </strong> Data from a cohort of 57 cases provide insights into symptoms, lesions, treatments, and outcomes. Management approaches range from conservative measures to surgical interventions, with prognosis hinged on timely intervention. This investigation serves as a valuable resource for clinicians and researchers, underscoring the need for early diagnosis before permanent neurologic dysfunction happens and tailored treatments for optimal outcomes in pineal apoplexy cases.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"85-98"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141093751","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":"Elevated HSPB1 Expression Is Associated with a Poor Prognosis in Glioblastoma Multiforme Patients.","authors":"Zhihua Wang, Zhaohua Fang, Yongping Gui, Bin Xi, Zhiping Xie","doi":"10.1055/s-0043-1777761","DOIUrl":"10.1055/s-0043-1777761","url":null,"abstract":"<p><strong>Background: </strong> Glioblastoma multiforme (GBM) is a highly aggressive form of brain cancer. This study investigated the clinical predictive value of heat shock protein β1 (HSPB1) in patients with GBM.</p><p><strong>Methods: </strong> A correlation was established between HSPB1 expression and GBM progression using data from The Cancer Genome Atlas (TCGA) dataset, Chinese Glioma Genome Atlas dataset, Gene Expression Omnibus dataset, and Human Protein Atlas database. A survival analysis was conducted and an HSPB1-based nomogram was constructed to evaluate the prognostic value of HSPB1 in patients with GBM.</p><p><strong>Results: </strong> Based on TCGA data mining, we discovered that HSPB1 was significantly elevated in patients with GBM and may reflect their response to immunotherapy. In survival analysis, it appeared to have a predictive role in the prognosis of patients with GBM. Five signaling pathways were significantly enriched in the high HSPB1 expression phenotype according to the gene set enrichment analysis. In addition, a significant association was found between HSPB1 expression and immune checkpoints, tumor immune infiltration, tumor immune microenvironment, and immune cell markers in glioma. Overall, our results suggest that HSPB1 may regulate the function of immune cells, serve as a new immunotherapy target, and predict the response to immunotherapy in patients with GBM.</p><p><strong>Conclusion: </strong> HSPB1 appears to serve as a potential predictor of the clinical prognosis and response to immunotherapy in patients with GBM. It may be possible to identify patients who are likely to benefit from immunotherapy by assessing the expression level of HSPB1.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"17-29"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498290","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":"Radiosurgery as a Stand-Alone Treatment Option for Cerebral Dural Arteriovenous Fistulas: The Vienna Series.","authors":"Beate Kranawetter, Anna Cho, Dorian Hirschmann, Philipp Göbl, Christian Dorfer, Karl Rössler, Philippe Dodier, Wei-Te Wang, Brigitte Gatterbauer, Andreas Gruber, Klaus Kitz, Josa M Frischer","doi":"10.1055/a-2235-5256","DOIUrl":"10.1055/a-2235-5256","url":null,"abstract":"<p><strong>Background: </strong> Gamma Knife radiosurgery (GKRS) has been demonstrated to be an effective and safe treatment method for dural arteriovenous fistulas (DAVFs). However, only few studies, mostly with limited patient numbers, have evaluated radiosurgery as a sole and upfront treatment option for DAVFs.</p><p><strong>Methods: </strong> Thirty-three DAVF patients treated with GKRS as a stand-alone management at our institution between January 1992 and January 2020 were included in this study. Obliteration rates, time to obliteration, neurologic outcome, and complications were evaluated retrospectively.</p><p><strong>Results: </strong> Complete overall obliteration was achieved in 20/28 (71%) patients. The postradiosurgery actuarial rates of obliteration at 2, 5, and 10 years were 53, 71, and 85%, respectively. No difference in time to obliteration between carotid-cavernous fistulas (CCFs; 14/28, 50%, 17 months; 95% confidence interval [CI]: 7.4-27.2) and non-CCFs (NCCFs; 14/28, 50%, 37 months; 95% CI: 34.7-38.5; <i>p</i> = 0.111) were found. Overall, the neurologic outcome in our series was highly favorable at the time of the last follow-up. A complete resolution of symptoms was seen in two-thirds (20/30, 67%) of patients. One patient with multiple DAVFs suffered from an intracranial hemorrhage of the <i>untreated</i> lesion and died during the follow-up period, resulting in a yearly bleeding risk of 0.5%. No complications after radiosurgery were observed in our series.</p><p><strong>Conclusion: </strong> Our results show that GKRS is a safe and effective stand-alone management option for selected DAVF patients.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"48-55"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048916","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":"Comparing Three-dimensional and Two-dimensional Preoperative Planning for Lumbar Transpedicular Screw Placement: A Retrospective Study.","authors":"Hüseyin Doğu, Anas Abdallah, Ali O Muçuoğlu, Nail Demirel, N Mehmet Elmadağ","doi":"10.1055/a-2175-3215","DOIUrl":"10.1055/a-2175-3215","url":null,"abstract":"<p><strong>Background: </strong> Transpedicular screw (TPS) misplacement is still a nightmare for spine surgeons. Preoperative planning is one of the methods that a surgeon could use to minimize this complication. This study aims to compare the efficacy of three-dimensional (3D) and two-dimensional (2D) preoperative planning in posterior lumbar TPSs placement performed using the freehand technique.</p><p><strong>Patients and methods: </strong> Patients who underwent posterior TPSs placement for degenerative lumbar spondylolisthesis or spinal stenosis using the freehand technique between November 2021 and October 2022 were evaluated retrospectively. In total, 33 and 30 patients who met the inclusion criteria were consecutively operated on with preoperative 2D and 3D planning, respectively. The patients were divided into the 2D preoperative planning group (2DG) and 3D preoperative planning group (3DG) and the two groups were compared.</p><p><strong>Results: </strong> Sixty-three patients were operated during the study period. There was no significant difference between the groups regarding blood transfusion, operation time, and radiation exposure. Although the accuracy of TPSs positioning was 94.2 and 96.5% in the 2DG and 3DG, respectively, the difference between the groups was not statistically significant. The upper facet joint violation rate was 12.8% (<i>n</i> = 20) in the 2DG versus 3.5% (<i>n</i> = 5) in the 3DG (<i>p</i> = 0.006). All L4 TPSs were inserted with their standard entry points without any modification (<i>p</i> < 0.0001; relative/risk ratio = 0.64). The modification rate was higher in L1, L2, and L5 TPSs (<i>p</i> < 0.0001; <i>χ</i> ² = 24.7).</p><p><strong>Conclusion: </strong> For patients with degenerative lumbar diseases, 3D preoperative planning in posterior lumbar instrumentation surgeries performed with the freehand technique decreased the upper facet joint violation rate.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10670382","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":"Stand-Alone Percutaneous Pedicle Screw Lumbar Fixation to Indirectly Decompress the Neural Elements in Spinal Stenosis: A Radiographic Assessment Case Series.","authors":"Roberto Gazzeri, Konstantinos Panagiotopoulos, Marcelo Galarza, Matteo Luigi Giuseppe Leoni, Umberto Agrillo","doi":"10.1055/s-0043-1777751","DOIUrl":"10.1055/s-0043-1777751","url":null,"abstract":"<p><strong>Background: </strong> The ideal surgical treatment of lumbar canal stenosis remains controversial. Although decompressive open surgery has been widely used with good clinical outcome, minimally invasive indirect decompression techniques have been developed to avoid the complications associated with open approaches. The purpose of this study was to evaluate the radiologic outcome and safety of the indirect decompression achieved with stand-alone percutaneous pedicle screw fixation in the surgical treatment of lumbar degenerative pathologies.</p><p><strong>Methods: </strong> Twenty-eight patients presenting with spinal degenerative diseases including concomitant central and/or lateral stenosis were treated with stand-alone percutaneous pedicle screw fixation. Radiographic measurements were made on axial and sagittal magnetic resonance (MR) images, performed before surgery and after a mean follow-up period of 25.2 months. Measurements included spinal canal and foraminal areas, and anteroposterior canal diameter.</p><p><strong>Results: </strong> Percutaneous screw fixation was performed in 35 spinal levels. Measurements on the follow-up MR images showed statistically significant increase in the cross-sectional area of the spinal canal and the neural foramen, from a mean of 88.22 and 61.05 mm² preoperatively to 141.52 and 92.18 mm² at final follow-up, respectively. The sagittal central canal diameter increased from a mean of 4.9 to 9.1 mm at final follow-up. Visual analog scale (VAS) pain score and Oswestry Disability Index (ODI) both improved significantly after surgery (<i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong> Stand-alone percutaneous pedicle screw fixation is a safe and effective technique for indirect decompression of the spinal canal and neural foramina in lumbar degenerative diseases. This minimally invasive technique may provide the necessary decompression in cases of common degenerative lumbar disorders with ligamentous stenosis.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"38-47"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138803788","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":"COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy.","authors":"Dana Hutton, Belal Mohamed, Khalid Mehmood, James Magro, Himanshu Shekhar, Anna Solth, Heinke Pulhorn, David Bennett, Mohamed Okasha","doi":"10.1055/a-2206-2718","DOIUrl":"10.1055/a-2206-2718","url":null,"abstract":"<p><strong>Background: </strong> Between individual patients with lumbar disk prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with nontolerable pain after at least 8 to 12 weeks of conservative management, or significant neurologic deficit. Channeling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiskectomy. This left many LDP patients previously considered to be surgical candidates with conservative-only options in the interim. To our knowledge, we are the first center to report the specific impact of the peri- and postpandemic period on waiting list times, delayed elective microdiskectomy, and the incidence of spontaneous LDP resolution.</p><p><strong>Methods: </strong> Retrospective case series of a prospectively collected electronic departmental database identified LDP patients who would have been impacted by the COVID-19 pandemic at some point in their care pathway (March 2020-February 2022). Further information was obtained from electronic patient records.</p><p><strong>Results: </strong> In total, 139 LDP patients were listed for elective microdiskectomy at the time of postponement of elective surgery. Over a third of LDP patients (<i>n</i> = 47, 33.8%), in shared decision with the responsible neurosurgeon, had their rescheduled microdiskectomy canceled due to clinical improvement (14.1%), radiologic regression (6.5%), or both (12.2%).</p><p><strong>Conclusion: </strong> Our single-center retrospective analysis revealed that for over a third of LDP patients, the prolonged postpandemic waiting list times for elective microdiskectomy resulted in their surgery not taking place either due to spontaneous clinical improvement or proven radiologic regression. Considering this, a prolonged conservative approach to LDP may be appropriate in some patients, allowing time for natural resolution, while avoiding perioperative risks.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"30-37"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71521836","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":"Combined one-step hybrid treatment for a paediatric giant internal carotid artery aneurysm: a case report.","authors":"Giacomo Pavesi, Julian S Rechberger, Elena Millesi, Selene Marika Cavallo, Fabio Serpico, Adelaide Valluzzi, Stefano Vallone, Corrado Iaccarino, Stavros Dimitrias","doi":"10.1055/a-2479-5297","DOIUrl":"https://doi.org/10.1055/a-2479-5297","url":null,"abstract":"<p><p>Background Giant intracranial aneurysms (GIAs) require complex treatment strategies including clipping, coiling, stenting, parent artery occlusion, bypass, or combined procedures. Neurovascular hybrid operating rooms (h-OR) combine a conventional operating theatre with high-resolution digital subtraction angiography (DSA). We describe a one-step combined surgical and endovascular treatment in a h-OR for a paediatric internal carotid artery giant aneurysm that can be an optimal solution to manage challenging cases, such as giant aneurysms. Case Description An 11-year-old boy presented with rapid onset right hemiparesis and left eyelid ptosis. A three months history of headache associated with sporadic vomit was reported. A giant, unruptured, left internal carotid artery aneurysm (ICA) was detected on imaging. The patient underwent surgical trapping of the aneurysm. Intraoperative DSA showed residual backflow from the posterior communicating artery (PComA) and coils were placed to completely exclude the aneurysm. At 18 months follow up, the patient showed a complete recovery and MRI showed a progressive reduction of the sac aneurysm. Conclusions Due to their morphologic variability, intracranial giant aneurysms may require a different procedural strategy instead of direct clipping or coiling. The introduction of h-OR allows combined treatments to be performed simultaneously in the same room setting. The present case shows that combined treatment in a neurovascular h-OR can be an optimal solution to manage challenging cases, such as giant aneurysms, reducing operative time with the added benefit of selecting an appropriate strategy adjustment in a multidisciplinary effort.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716409","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}