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

{"title":"Clinical criteria for the assessment of a permanent shunting after endovascularly treated aneurysmal subarachnoid hemorrhage (aSAH): Endovascular Risk of Shunt Score (EROS-Score).","authors":"Bastian Stemmer, Stefan Schiele, Gernot Müller, Björn Sommer, Ehab Shiban, Dorothee Mielke, Volkmar Heidecke","doi":"10.1055/a-2848-6936","DOIUrl":"https://doi.org/10.1055/a-2848-6936","url":null,"abstract":"<p><p>OBJECTIVE An exact classification for estimating the risk of shunt dependent hydrocephalus (SDHC) after endovascularly treated aneurysmal subarachnoid hemorrhage (aSAH) is still missing, although studies underline that the type of aneurysm care (clipping/ coiling) has a decisive influence on the development of a SDHC. METHODS A total of 91 patients were selected who underwent an endovascularly treated aSAH at the Department of Neurosurgery of the University Hospital Augsburg from January 2010 to July 2015. Clinical variables, radiographic features and amount of cerebrospinal fluid (CSF) drainage via external ventricular drainage (EVD) were included in the scoring process. We determined the optimal cutoff values by an univariate logistic regression for each dichotomized variable and the Akaike Information Criterion (AIC). Finally, the EROS-Score was established. RESULTS A ventricular Score > 0,6 (p <0.001), poor GCS (< 10; p = 0.001), age over 46 years (p <0.001), cerebral vasospasm (p <0.001) and a CSF drainage volume over 180 ml per day (p = 0.001) in the first week of treatment, were identified to be risk factors of shunt dependency. Out of these independent risk factors the Endovascular Risk of Shunt Score (EROS-Score) was developed. The Area under the receiver operating curve (AUROC score = 0.90) shows a good performance of this score. Patients with > 3 points showed a significantly high risk of shunt dependency. CONCLUSION The EROS score is easy to determine and showed a good predictive value in the investigated patient population. Prospective validation is still needed.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633607","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":"Temporal stem anatomy. Photorealistic surface scanning anatomical and 3D tractography study.","authors":"Francesco Carbone, Milko Milev, Martin Trandzhiev, Lili Laleva, Ivan Maslarski, Daniele Armocida, Michael Wolf-Vollenbröker, Jan Frederick Cornelius, Matteo de Notaris, Vladimir Nakov, Toma Spiriev","doi":"10.1055/a-2848-8345","DOIUrl":"https://doi.org/10.1055/a-2848-8345","url":null,"abstract":"<p><strong>Background: </strong>The temporal stem is a critical structure within the brain, connecting the frontal, temporal, and occipital lobes via various fiber tracts. This study aims to evaluate the use of photogrammetry surface scanning and MRI-based tractography in presenting the layered anatomy of the fibers comprising the temporal stem.</p><p><strong>Object: </strong>To clearly present the layered anatomy of the fibers comprising the temporal stem through photogrammetry surface scanning methods and MRI-based tractography studies.</p><p><strong>Materials and methods: </strong>Three body-donor-based brain dissections were documented with photogrammetry surface scanning and compared to MRI-based diffusion tensor imaging tractography. High-resolution 3D models were created using both techniques to visualize the layered fiber architecture of the temporal stem. Tractography data were processed using DSI Studio software based on population-averaged white matter templates from open-access databases.</p><p><strong>Results: </strong>Seven photorealistic 3D models were generated through photogrammetry, complemented by detailed coronal sections of MRI-based 3D tractography model. These models revealed the anatomical organization of critical fiber tracts, including the inferior fronto-occipital fasciculus, uncinate fasciculus, anterior commissure, and Meyer's loop of the optic radiation.</p><p><strong>Conclusion: </strong>The temporal stem is a crucial anatomical region comprising important white matter tracts. Their layered anatomical course can be clearly demonstrated by stratigraphical dissections and surface scanning methods, as well as augmented with 3D segmentation of MRI data. White matter dissection perfectly fits photogrammetry, permitting stratification and creating a truly interactive experience allowing a more precise 3D representation of individual fibers, their orientation, and position, surpassing the limitations of 2D representations of anatomy.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633636","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 Rare Presentation of Concurrent Typical, Atypical, and Aggressive Thoracic Vertebral Hemangiomas: Insights into Histological Variability and Multidisciplinary Management.","authors":"J S R G Saran, Mahesh M, Ravikumar Tv, Harshith Gopinath, Pavan Kumar M","doi":"10.1055/a-2790-5191","DOIUrl":"10.1055/a-2790-5191","url":null,"abstract":"<p><p>Vertebral hemangiomas are typically benign and asymptomatic, but a small subset, known as aggressive vertebral hemangiomas, may present with neurological deficits due to extraosseous extension and spinal cord compression. These cases require timely diagnosis and a multidisciplinary management approach.A 42-year-old man presented with acute-onset severe mid-back pain for 2 months. Neurological examination revealed exaggerated reflexes without motor or sensory deficits. Magnetic resonance imaging showed expansile lesions at T7, T9, and T10, with additional angiomatous lesions at T3 and T4. T7 and T10 lesions caused spinal cord compression. Preoperative embolization of T7 and T10 was performed using polidocanol. The patient subsequently underwent vertebroplasty at T7, T9, and T10 levels, pedicle screw fixation from T4 to T11, posterior decompression at T6 to T7 and T9 to T10. Intraoperative biopsies revealed a cavernous hemangioma at T7 and a capillary hemangioma at T9. No malignancy was foundPostoperative recovery was uneventful, with early mobilization and significant functional improvement. At 2-year follow-up, the patient had no pain or neurological symptoms, and radiographs showed stable fixation with no recurrence.Aggressive vertebral hemangiomas, though rare, should be considered in patients with progressive neurological symptoms. Early diagnosis, embolization, surgical decompression, and stabilization can yield excellent outcomes.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003810","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":"Morphological Analysis of the Intervertebral Foramen and Feasibility of Transforaminal Full-Endoscopic Spine Surgery.","authors":"Masahiro Kashima, Fumitake Tezuka, Naoyuki Yoshida, Takashi Chikawa, Shunji Nakano, Toru Maeda, Koichi Sairyo","doi":"10.1055/a-2749-5771","DOIUrl":"https://doi.org/10.1055/a-2749-5771","url":null,"abstract":"<p><p>Transforaminal full-endoscopic spine surgery (TF-FESS) is a minimally invasive surgical procedure for lumbar spinal disease; however, it is technically demanding in patients with foraminal stenosis because of anatomical problems. This procedure has unique surgery-related complications, such as exiting nerve root injury, causing postoperative dysesthesia or muscle weakness, resulting in a poor clinical outcome. Therefore, we have to avoid this complication. The objective of this study was to analyze the morphology of the intervertebral foramen and assess the feasibility of TF-FESS.We retrospectively reviewed the multiplanar abdominal computed tomography (CT) scans obtained for 800 consecutive patients (400 consecutive males, 400 consecutive females) at our hospitals between January 2016 and December 2018. Patients with lumbar scoliosis (Cobb angle >5 degrees), spondylolisthesis, or vertebral fracture, as well as those with a history of lumbar spinal surgery, were excluded. We evaluated the average values for disc height, position of the superior articular process (SAP), foraminal distance, foraminal area, and SAP facet contact from L1/L2 to L5/S1 on both sides in reconstructed sagittal views. A total of 8,000 intervertebral foramina were analyzed. The correlation between the disc height and these parameters was assessed at each spinal level.At the L1/L2, L2/L3, L3/L4, L4/L5, and L5/S1 levels, the mean disc height was 5.4 mm, 6.4 mm, 7.1 mm, 7.1 mm, and 5.9 mm, respectively. The SAP position, as the distance above the line of the inferior margin of the upper vertebral body, decreased from L1/L2 to L3/L4 and increased from L3/L4 to L5/S1. The respective foraminal distances were the shortest at L4/L5. The foraminal area decreased toward the lower levels. The SAP facet contact was decreasing from L1/L2 to L4/L5. There was a negative correlation between the disc height and the SAP position, and positive correlations of disc height with the foraminal area and the SAP facet contact.The results of the SAP position, the foraminal distance, and the foraminal area suggest that TF-FESS would be technically more difficult at a lower intervertebral disc level because of resection of a larger amount of the SAP. Foraminal stenosis would develop easily when a disc has collapsed. About half of the facet contact could be maintained even if the SAP is resected completely during TF-FESS, especially at a lower lumbar level.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592701","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":"https://doi.org/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 intra-operative 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>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":""},"PeriodicalIF":0.8,"publicationDate":"2026-03-30","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":"Supraorbital and Endonasal Approaches: Tailoring Surgical Techniques for Tuberculum Sellae Meningiomas Based on Preoperative Grading Systems-Minimally Invasive Approaches for Tuberculum Sellae Meningiomas.","authors":"Riccardo Antonio Ricciuti, Fabrizio Mancini, Riccardo Paracino, Matteo Maria Ottaviani, Pierfrancesco De Domenico, Serena Pagano, Francesca Romana Barbieri, Daniele Marruzzo, Stefano Vecchioni, Carlo Conti","doi":"10.1055/a-2479-4598","DOIUrl":"10.1055/a-2479-4598","url":null,"abstract":"<p><p>Tuberculum sellae meningiomas (TSMs) tend to compress the optic apparatus and an ideal surgical route, whether transcranial or endonasal, is still debated. Another issue is if the minimally invasive supraorbital (SO) approach offers the same results compared with the more invasive craniotomies. Aiming to guide approach selection, preoperative grading systems have been described.All cases of TSMs treated from 2013 to 2018 by extended endoscopic endonasal approach (EEA) or SO approach have been reviewed and classified according to three preoperative grading systems: McDermott scale, Optic Nerve Laterality Score, and Yaşargil criteria.A total of 15 patients with TSMs were treated with the EEA (<i>n</i> = 6) or the SO (<i>n</i> = 9) approach. Globally, gross total resection was obtained in 87% (<i>n</i> = 13) of cases and was higher with the SO (100%, <i>n</i> = 9) compared with the EEA (67%, <i>n</i> = 4). Visual function improved in all but one patient (<i>n</i> = 14). Compared with the EEA group, patients treated by the SO approach had larger tumors (32.3 mm vs. 24.5 mm), a higher rate of optic canal invasion (4/9 vs. 0/6), and arterial encasement (6/9 vs. 1/5). Patients with McDermott total points of 1 to 2 (7/15) were treated mainly by the EEA; all patients with McDermott total score of ≥3 (8/15) were treated by the SO approach. All patients with optic canal invasion (4/15) and lateral extension of the tumor (ONL score = 1-3) were treated by the SO approach.The SO and EEA are two minimally invasive approaches safe and effective for treating TSMs. For tumors with lateral extension (optic nerve laterality [ONL] score = 1-3), larger diameter (>30-35 mm), vascular encasement, or optic canal involvement (McDermott total point = 2-3), the SO craniotomy is preferred. For small and median tumors with no optic canal invasion or vascular encasement (McDermott total point = 1-2), the EEA represents a valid option.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"69-76"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682066","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":"Management and Outcomes of Ganglion Cysts of the Posterior Longitudinal Ligament: A Systematic Review of Diagnostic and Surgical Approaches.","authors":"Gianluca Scalia, Francesca Graziano, Salvatore Marrone, Gianluca Ferini, Eliana Giurato, Giovanni Federico Nicoletti, Gianluca Galvano, Giuseppe Emmanuele Umana","doi":"10.1055/a-2642-7869","DOIUrl":"10.1055/a-2642-7869","url":null,"abstract":"<p><p>Ganglion cysts of the posterior longitudinal ligament (PLL) are a rare cause of lumbar radicular pain and claudication, primarily affecting young athletic males. These cysts are often linked to repetitive trauma and degenerative changes in the PLL, potentially aggravated by disc degeneration. Diagnosis is typically achieved through magnetic resonance imaging (MRI), with surgical excision being the preferred treatment in symptomatic cases. This systematic review consolidates the current knowledge on PLL ganglion cysts, examining clinical characteristics, diagnostic findings, and surgical outcomes to provide a basis for future research and clinical management.A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science, including studies from inception to June 2024. Search terms included \"ganglion cyst,\" \"posterior longitudinal ligament,\" \"PLL,\" and \"lumbar spine,\" among others. Studies published in English and French were reviewed if they reported on ganglion cysts of the PLL with clinical or radiological data. Data on demographics, symptoms, imaging findings, treatment approaches, outcomes, and follow-up were extracted. Due to the heterogeneity of the included studies, a narrative synthesis was performed, focusing on clinical presentation, diagnostic criteria, surgical techniques, and recurrence rates.A total of 14 studies comprising 20 patients were analyzed. The majority (90%) were male, with a mean age of 30.2 years (standard deviation [SD] = 11.47). The most common presenting symptom was radicular pain, primarily left-sided (70%). Disc degeneration was reported in 85% of cases, supporting a link between degenerative disc disease and PLL cyst formation. MRI revealed hypointense cysts on T1-weighted images and hyperintense on T2, aiding in differentiation from other intraspinal pathologies. Surgical excision was performed in all cases, with hemilaminectomy (50%) and interlaminar approaches (40%) being the most common techniques. Minimally invasive endoscopic methods were used in one case. Complete recovery was reported in 65% of patients, with a mean follow-up of 13.8 months (SD = 12.1). Recurrence data were limited due to inconsistent follow-up.This systematic review highlights the clinical and imaging characteristics of PLL ganglion cysts, with MRI as a critical tool for diagnosis. Surgical management, particularly hemilaminectomy and interlaminar approaches, is effective in providing symptom relief and preventing recurrence. Although minimally invasive techniques show promise, further research is needed to confirm their efficacy. Given the rarity of PLL cysts, tailored treatment and larger studies with standardized follow-up are essential to improve understanding and management of this condition.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"142-153"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086347","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 Screening Protocol for Idiopathic Normal Pressure Hydrocephalus: Reducing Underdiagnosis, Relieving the Economic Burden for the Health Systems, while Improving the Quality of Life of our Patients.","authors":"Gianpaolo Petrella, Silvia Ciarlo, Giuseppe Demichele, Edvige Iaboni, Daniele Armocida, Maurizio Salvati, Angelo Pompucci, Alessandro Pesce","doi":"10.1055/a-2649-7805","DOIUrl":"10.1055/a-2649-7805","url":null,"abstract":"<p><p>Idiopathic normal pressure hydrocephalus (iNPH) is a common condition affecting the elderly. Numerous investigations highlight that its period-prevalence could be underestimated, as well as the economic burden of the missed treatments. The objective of the present investigation is to determine if a cohort of radiologically suspected iNPH patients presents the clinical landmarks of this condition, and to estimate the economic burden of these potentially missed diagnoses.We recorded age, sex, reason to access emergency rooms of our community hospitals, values of Evans' Index, callosal Angle, presence of disproportionately enlarged subarachnoid space hydrocephalus and obvious ventricular enlargement. We telephoned the patients who presented at least two radiological signs of iNPH and administered the idiopathic normal-pressure hydrocephalus grading scale (iNPHGS), to assess the severity of signs and symptoms linked to iNPH, to understand if a strong radiological suspect had a clinical correlation.Among the 308 brain computed tomography scans of a week, a total of 21 agreed to be enrolled in the present investigation. When administering iNPHGS questionnaire to radiologically suspected iNPH, 17/21 patients (80.1%) scored ≥1 in at least two of the three iNPHGS subscales. The scores of the three subscales were strongly associated to each other. The estimated monthly and yearly health-related costs may be EUR 4'799'440 and 57.59 million of Euros, respectively.There is an association between the radiological features of iNPH and the scores of iNPHGS. The period-prevalence could be 5.51%, implying high health care costs, with significant societal impact, and reduced quality of life in patients suffering from undiagnosed iNPH.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"115-124"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584197","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":"Biology, Physics, and Genetics of Intracranial Aneurysm Formation: A Review.","authors":"Karolina Ćmiel-Smorzyk, Piotr Ładziński, Wojciech Kaspera","doi":"10.1055/a-1994-8560","DOIUrl":"10.1055/a-1994-8560","url":null,"abstract":"<p><p>Intracranial aneurysms (IAs) are persistent, localized dilatations of the arterial wall that are found in ∼3% of the general population. The most severe complication of IAs is rupture, which results in devastating consequences such as subarachnoid hemorrhage and brain damage with serious neurologic sequelae. Numerous studies have characterized the mechanisms underlying IA development and growth and identified several environmental modifiable (smoking, hypertension) and nonmodifiable risk factors (related to the histology of cerebral arteries and genetic factors) in its pathogenesis. Hemodynamic stress also likely plays a crucial role in the formation of IAs and is conditioned by the geometry and morphology of the vessel tree, but its role in the natural history of unruptured IAs remains poorly understood; it is believed that changes in blood flow might generate the hemodynamic forces that are responsible for damage to the vascular wall and vessel remodeling that lead to IA formation. This review summarizes the most relevant data on the current theories on the formation of IAs, with particular emphasis on the roles of special conditions resulting from the microscopic anatomy of intracranial arteries, hemodynamic factors, bifurcation morphometry, inflammatory pathways, and the genetic factors involved in IA formation.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"125-141"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12912909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10431125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined One-Step Hybrid Treatment for a Pediatric Giant Internal Carotid Artery Aneurysm: A Case Report.","authors":"Giacomo Pavesi, Julian S Rechberger, Elena Millesi, Selene M Cavallo, Fabio Serpico, Adelaide Valluzzi, Stefano Vallone, Corrado Iaccarino, Stavros Dimitriadis","doi":"10.1055/a-2479-5297","DOIUrl":"10.1055/a-2479-5297","url":null,"abstract":"<p><p>Giant intracranial aneurysms 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 pediatric internal carotid artery (ICA) giant aneurysm that can be an optimal solution to manage such challenging cases.An 11-year-old boy presented with rapid onset right hemiparesis and left eyelid ptosis. A 3-month history of headache associated with sporadic vomit was reported. A giant, unruptured, left ICA aneurysm was detected on imaging. The patient underwent surgical trapping of the aneurysm. Intraoperative DSA showed residual backflow from the posterior communicating artery and coils were placed to completely exclude the aneurysm. At 18-month follow-up, the patient showed a complete recovery and magnetic resonance imaging showed a progressive reduction of the sac aneurysm.Due to their morphological 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":"154-160"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","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}