Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献

{"title":"Non-dysraphic cervicothoracic intramedullary lipoma: A case report and literature review","authors":"Rayan R. Salahaldin ,&nbsp;Mais E. Abubaker ,&nbsp;Hala A. Samhan ,&nbsp;Alaa K. Erikat ,&nbsp;Basel A. Zaben ,&nbsp;Hadi Dababseh ,&nbsp;Sami Hussein ,&nbsp;Mohand Abulihya","doi":"10.1016/j.inat.2026.102203","DOIUrl":"10.1016/j.inat.2026.102203","url":null,"abstract":"<div><h3>Introduction</h3><div>Intramedullary spinal cord lipomas are rare, comprising less than 1% of all intramedullary spinal tumors. Most are associated with spinal dysraphism, especially in the lumbosacral region. Non-dysraphic intramedullary lipomas, particularly in the cervicothoracic spine, are exceptionally rare.</div><div>Case presentation</div><div>We present a 36-year-old female with a recurrent intramedullary lipoma at the C6–T2 level, initially resected in 2019. She developed progressive weakness, numbness, gait instability, and sphincter dysfunction over two years. MRI revealed a recurrent, intradural fat-signal lesion compressing the spinal cord. She underwent subtotal resection with tumor debulking using the Cavitron Ultrasonic Surgical Aspirator (CUSA). Postoperatively, she showed partial neurological improvement but developed bilateral lower limb paraplegia. She was referred to a specialized rehabilitation center.</div></div><div><h3>Discussion</h3><div>Non-dysraphic intramedullary lipomas present diagnostic and therapeutic challenges due to their rarity and intimate involvement with spinal cord tissue. MRI is the diagnostic modality of choice. Surgery is typically reserved for symptomatic cases, with subtotal resection favored to minimize neurological risk. Despite intervention, recurrence and further decline remain concerns.</div></div><div><h3>Conclusion</h3><div>Non-dysraphic cervicothoracic intramedullary lipomas require individualized surgical strategies and long-term rehabilitation. This case highlights the complexity of managing these rare lesions and underscores the importance of balancing decompression with neurological preservation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102203"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of outcomes following decompressive craniectomy for traumatic brain injury: a multicenter prospective cohort study in Addis Ababa, Ethiopia","authors":"Kedir D. Guduru ,&nbsp;Mikiyas G. Teferi ,&nbsp;Helina K. Teklehaimanot ,&nbsp;Mersha A. Woldemariam ,&nbsp;Abat Baleh ,&nbsp;Surafel M. Mendere","doi":"10.1016/j.inat.2025.102167","DOIUrl":"10.1016/j.inat.2025.102167","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic brain injury is a leading cause of trauma deaths worldwide. In low- and middle-income countries, neuromonitoring is limited. Decompressive craniectomy is used as a last-resort intervention. This study assessed outcomes and key predictors in Ethiopia.</div></div><div><h3>Objectives</h3><div>To measure 3-month outcomes after decompressive craniectomy for traumatic brain injury and identify clinical and radiologic predictors.</div></div><div><h3>Methods</h3><div>A multicenter prospective cohort was conducted in Addis Ababa from January 2023 to September 2024. Ninety-four patients underwent surgery and were followed for 90 days. Outcomes were measured with the Extended Glasgow Outcome Score, grouped as favorable (≥5) or unfavorable (&lt;5). Variables with initial associations were tested in multivariable models.</div></div><div><h3>Results</h3><div>Of 94 patients, 80 were male and the mean age was 38.9 years. At 3 months, 55.3 percent had favorable outcomes, 13.8 percent had unfavorable outcomes, and 30.9 percent died. Severe presentation, non-reactive pupils, unstable vital signs, poor response to osmotic diuretics, intraoperative hypotension, vasopressor need, and low postoperative Glasgow Coma Scale scores were linked to worse outcomes.</div></div><div><h3>Conclusion</h3><div>Certain clinical and intraoperative factors predict poor outcomes after decompressive craniectomy for traumatic brain injury in Ethiopia. Early identification of these factors may guide treatment and resource allocation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102167"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collagen synthesis and MicroRNA interaction in degenerative lumbar canal stenosis","authors":"İsa İsaoğlu ,&nbsp;Özlem Delen ,&nbsp;Zeynep Banu Doğanlar ,&nbsp;Oğuzhan Doğanlar ,&nbsp;Emre Delen","doi":"10.1016/j.inat.2025.102172","DOIUrl":"10.1016/j.inat.2025.102172","url":null,"abstract":"<div><h3>Background</h3><div>To investigate the potential interaction between collagen synthesis and microRNAs in ligamentum flavum (LF) obtained from patients with degenerative lumbar canal stenosis (DLCS).</div></div><div><h3>Methods</h3><div>A total of thirty-two human LF specimens were divided into two groups, each based on the diagnosis as follows: 20 from patients with DLCS and 12 from patients those with lumbar disc herniation (LDH). Fibrosis was graded into four levels according to the accumulation of decreased elastin fibres and increased collagen fibres, which can be observed using the Masson’s trichrome staining. Expression of the collagens (COL1A1, COL1A2, COL3A1, COL5A1, COL5A2, COL6A1, COL8A1), associated proteins (extracellular matrix protein tenascin XB-TNXB, solute carrier family 39 member 13-SLC39A13, and procollagen N proteinase ADAMTS-2; and micro-ribonucleic acids (miR-27B, miR-29B, miR-143, and miR-221) were measured by quantitative real-time polymerase chain reaction (qRT-PCR) analysis. Western blot analysis was performed to determine the levels of COL1, COL3, COL5, COL6A1, and COL8A1. DLCS patients have higher fibrosis score than the LDH patients.</div></div><div><h3>Results</h3><div>DLCS patients have higher fibrosis score than the LDH patients. qRT-PCR analysis demonstrated that strongly upregulated mRNA levels of COL1A, COL1A2, COL3A1, ADAMTS2, miR-29B, and miR-143. However, protein expressions of COL1, COL3, COL6A, and COL8A1 is also upregulated.</div></div><div><h3>Conclusions</h3><div>Our results identified miR-29B and miR-143 regulation of COL synthesis of the LF fibrosis.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102172"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative analysis of bulk and single-cell transcriptomes uncovers fibroblast-driven modulation of aneurysm stability","authors":"Wu-zhi Wei ,&nbsp;Shu-jie Fu ,&nbsp;Jin-zhou Zhu ,&nbsp;Xue-zhun Xiong ,&nbsp;Si Zhu ,&nbsp;Ze-hua Lei","doi":"10.1016/j.inat.2025.102179","DOIUrl":"10.1016/j.inat.2025.102179","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial aneurysm (IA) is characterized by vascular wall remodeling and extracellular matrix (ECM) dysregulation, leading to aneurysm formation and rupture. Fibroblasts, key regulators of ECM homeostasis, have been implicated in IA pathogenesis, but their functional heterogeneity and molecular mechanisms remain poorly defined.</div></div><div><h3>Methods</h3><div>In this study, we integrated bulk and single-cell RNA sequencing datasets to investigate fibroblast subpopulations involved in IA progression. Using the GSE122897 dataset, we applied DESeq2 for differential expression analysis and WGCNA to construct gene co-expression networks. Hub genes were screened via MCODE and subjected to functional enrichment analysis. Their expression was subsequently validated in the GSE193533 mouse IA single-cell dataset, which included sham, formed, and ruptured aneurysm samples. Fibroblasts were reclustered to explore subtype heterogeneity and functional dynamics.</div></div><div><h3>Results</h3><div>Two upregulated gene co-expression modules were identified: an ECM remodeling module and a cilium/cytoskeleton organization module. Hub gene analysis revealed 14 key genes, including COL5A1, FSTL1, PRRX2, and ADAMTS2, which were enriched in pathways related to collagen metabolism, ECM organization, and epithelial apoptosis. Re-clustering of fibroblasts revealed two distinct subtypes: C1 and C2. The C1 subtype, characterized by high expression of FSTL1, likely contributes to a persistent inflammatory state and pathological remodeling, potentially exacerbating vessel wall weakening. In contrast, the C2 subtype, characterized by high expression of ADAMTS2 and PRRX2, appears to orchestrate a protective response. Clinically, our findings highlight the imbalance between these fibroblast states as a potential determinant of aneurysm stability. Strategies aimed at preserving the ADAMTS2-driven reparative capacity or inhibiting FSTL1-mediated remodeling may represent novel therapeutic avenues to prevent IA rupture.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102179"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular treatment for a ruptured basilar tip aneurysm via direct puncture of the V1 segment of the vertebral Artery: A case report","authors":"Yusuke Mochida ,&nbsp;Tsubasa Okuyama ,&nbsp;Hiromichi Oishi ,&nbsp;Satoshi Ishige ,&nbsp;Toshio Machida","doi":"10.1016/j.inat.2025.102180","DOIUrl":"10.1016/j.inat.2025.102180","url":null,"abstract":"<div><h3>Background</h3><div>Direct microsurgical treatment of basilar tip aneurysms is technically challenging due to the deep location and critical surrounding vasculature. Although endovascular treatment is increasingly preferred, vascular access can be problematic in elderly patients with tortuous or stenotic vessels.</div><div>Case Description.</div><div>An 86-year-old woman developed a subarachnoid hemorrhage due to a ruptured basilar tip aneurysm. Conventional femoral and radial artery approaches failed due to severe tortuosity and a type III aortic arch. We attempted endovascular access via direct puncture of the right vertebral artery (VA) V1 segment. A viable puncture site proximal to the C6 transverse process was confirmed on preoperative three-dimensional computed tomography angiography. Through a supraclavicular incision, the right VA V1 segment was exposed and punctured. A guiding sheath was advanced; however, angiography revealed flow stagnation, possibly caused by compression or exacerbation of preexisting stenosis. We discontinued the procedure to avoid ischemic complications. The patient recovered gradually with conservative management and was discharged to a rehabilitation facility with a modified Rankin Scale score of 3.</div></div><div><h3>Conclusion</h3><div>Direct puncture of the vertebral artery V1 segment is a feasible alternative for endovascular access when standard routes are inaccessible. However, cervical surgical manipulation may transiently cause dysphagia; therefore, careful postoperative management is required. Moreover, careful device selection is crucial to avoid vascular flow compromise, and smaller profile systems may reduce the risk of ischemia.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102180"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infantile dermoid cyst on top of anterior fontanelle mimicking encephalocele, a case report and literature review","authors":"Mohammed Alra’e,&nbsp;Ahmad J. Abdallah,&nbsp;Maaweya Jabareen,&nbsp;Wasef Alhroub,&nbsp;Ibrahim Kattoush","doi":"10.1016/j.inat.2025.102168","DOIUrl":"10.1016/j.inat.2025.102168","url":null,"abstract":"<div><h3>Background</h3><div>Dermoid cyst is defined as a benign congenital tumor caused by sequestration of germ cells in the embryonic fusion lines during development. Dermoid cysts are lined with simple squamous epithelium and filled with keratin and other skin appendages. They can be present at birth or later on. They are among the most common pediatric tumors, particularly in the head and neck regions. When present in the head, they should be differentiated from other lesions, such as encephalocele. Imaging studies and surgical consultation are important before managing such cases.</div></div><div><h3>Case presentation</h3><div>An 8-month-old female patient presented with swelling over the anterior fontanelle, mimicking encephalocele. The history was significant to duodenal atresia. The swelling started to appear few days after birth. After performing CT scan and MRI, the neurosurgeon attempted to aspirate the cyst for histopathologic examination, but this failed, and surgical excision was planned. Surgical excision of the lesion was performed, and histopathological examination revealed a diagnosis of dermoid cyst. This underscores the importance of ruling out any intracranial communication before performing any procedure in such lesions.</div></div><div><h3>Discussion</h3><div>Dermoid cyst is essentially a pediatric tumor. It is important to keep in mind dermoid cysts in the differential diagnosis of head and neck swellings, particularly the anterior fontanelle swellings. When lying over the head, it is of paramount importance to rule out intracranial communication by imaging studies before proceeding into the surgical intervention.</div></div><div><h3>Conclusion</h3><div>Dermoid cysts are common pediatric tumors. Proper diagnosis and surgical intervention are important in this type of tumors before complicating intracranial extension.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102168"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary intracerebral Ewing sarcoma featuring curvilinear calcification: a case report","authors":"Xiujiao Wei ,&nbsp;Jimei Meng ,&nbsp;Qinghong Duan","doi":"10.1016/j.inat.2025.102166","DOIUrl":"10.1016/j.inat.2025.102166","url":null,"abstract":"<div><div>Ewing sarcoma (EWS) is a highly aggressive malignant tumor that primarily affects bones and soft tissues, with primary intracerebral cases being exceptionally rare. While sporadic cases have been reported, a systematic analysis of their radiological features—particularly calcification patterns—is lacking. We present what we believe to be the first case of a right parieto-occipital EWS exhibiting characteristic curvilinear calcification. A comparative review of 8 intracerebral EWS cases revealed that while cystic changes are common (75 %), curvilinear calcification is unique, and marked enhancement is a consistent finding. Our patient was treated with craniotomy, VDC/IE chemotherapy, and IMRT, and achieved no evidence of disease at 12-month follow-up. This systematic contextualization highlights that curvilinear calcification is a novel diagnostic clue for intracerebral EWS, which generally has a favorable outcome with multimodal therapy.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102166"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcortical functional cognitive hubs assessed by intraoperative neuropsychological protocol in awake surgery","authors":"I. Trujillo-Pozo ,&nbsp;J.L. Narros-Giménez ,&nbsp;R. Alcántara-Bernal ,&nbsp;T. Del-Águila-Puntas ,&nbsp;P. Cancela-Caro ,&nbsp;I. Martín-Schrader","doi":"10.1016/j.inat.2026.102210","DOIUrl":"10.1016/j.inat.2026.102210","url":null,"abstract":"<div><div>Awake patient surgery for glioma resection aims to achieve the widest possible resection while ensuring that postoperative deficits do not compromise the patient’s quality of life. This report presents the case of a 40-year-old right-handed man with a left frontal lobe lesion consistent with a probable low-grade glial tumour. A preoperative neuropsychological assessment was performed to establish the patient’s baseline cognitive functioning and to plan a comprehensive, individualised intraoperative neuropsychological protocol. Bipolar cortical stimulation and deep monopolar stimulation of the white matter were employed. During bipolar cortical stimulation, three language-blocking sites were identified at the posteroinferior margin of the lesion, corresponding to Broca’s area. In addition, involuntary directional eye movements contralateral to the stimulated area were observed, suggesting involvement of the frontal eye field region.</div><div>Using neuropsychological tasks in combination with deep monopolar white matter stimulation, alterations in motor sequencing, autobiographical memory, naming, verbal automatisms, and calculation were recorded. These alterations occurred when different points of the deep white matter were stimulated, particularly in regions between the supplementary motor area and the precentral gyrus.</div><div>Overall, these findings suggest that complex and flexible cognitive, behavioural, and emotional functions can be identified during awake surgery. Our work highlights the need to develop intraoperative tasks that enhance patient safety during the neurosurgical procedure while minimising false-positive findings. Furthermore, white matter stimulation provides valuable insight into the interconnected network systems that support brain function. An additional consideration is the optimisation of direct electrical stimulation parameters, which may further improve the reliability of intraoperative mapping.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102210"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successive thoracic anterolateral intervertebral disc herniations with ossification-fusion: a cadaveric case analysis with MRI and clinical review","authors":"Logan D. Tlam ,&nbsp;Joseph X. Anders ,&nbsp;Maggie M. Minett ,&nbsp;Chad J. Hungerford ,&nbsp;Ethan L. Snow","doi":"10.1016/j.inat.2025.102162","DOIUrl":"10.1016/j.inat.2025.102162","url":null,"abstract":"<div><h3>Background</h3><div>Intervertebral discs (IVDs) permit resilient deformability and shock absorption between vertebrae. IVD herniation from damage or disease most commonly occurs in the lumbar and cervical spines, in the posterolateral direction, and to a single IVD. This investigation seeks to examine a unique case of successive thoracic anterolateral IVD herniations with gross and magnetic resonance imaging (MRI) analyses and present the case with a literature-based clinical narrative.</div></div><div><h3>Methods</h3><div>The case was discovered in an adult human cadaver. T1-weighted MRI was performed on the implicated spine, and serial cross-sectioning was completed through each IVD. The herniations were photographed at each stage, and linear parameters of the spinal pathologies were measured.</div></div><div><h3>Results</h3><div>The ossified herniations extruded 11.1 ± 2.1 mm from the typical IVD border, and the ossified bridging over the vertebral bodies extruded 6.9 ± 2.6 mm from the typical vertebral body border. The extrusions displaced the functionality of the anterior longitudinal ligament 7.37 mm left of midline, and comparison of gross in situ and cross-sectional imaging with MRI illustrated the extent of IVD herniation and vertebral fusion in the clinical perspective.</div></div><div><h3>Conclusions</h3><div>The present cadaveric case involving multiple uncommon features of IVD herniation accompanied by MRI and clinical narrative may enhance clinical awareness among spine specialists, particularly in recognizing uncommon presentations of thoracic IVD ossification and vertebral hyperostosis. This report may also serve as a valuable reference for to clinical anatomists, Doctors of Chiropractic Medicine, spine neurosurgeons, and other healthcare experts when discussing or treating related patient cases.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102162"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior auricular artery-to-middle cerebral artery side-to-side microvascular anastomosis","authors":"Zongyu Xiao ,&nbsp;Ji Wang ,&nbsp;Liang He ,&nbsp;Yulun Huang","doi":"10.1016/j.inat.2025.102157","DOIUrl":"10.1016/j.inat.2025.102157","url":null,"abstract":"<div><h3>Background</h3><div>In rare cases, the superficial temporal artery (STA) is not the optimal donor vessel for extracranial-intracranial (EC-IC) bypass procedures. This situation can arise due to factors such as congenital abnormalities, hypoplastic development, trauma-related alterations, or prior surgical interventions. In such scenarios, a well-developed robust and sizable posterior auricular artery (PAA) can be considered a viable alternative for facilitating EC-IC revascularization surgeries.</div></div><div><h3>Objective</h3><div>To assess the feasibility of the surgical technique for posterior auricular artery (PAA) and middle cerebral artery (MCA) side-to-side (S-S) microvascular anastomosis, and to explore the blood flow distribution patterns following the establishment of PAA-MCA S-S anastomosis.</div></div><div><h3>Results</h3><div>A PAA-MCA S-S microvascular anastomosis was successfully performed. Intraoperatively, indocyanine green videoangiography (ICG-VA) confirmed immediate anastomotic patency, which was further validated by digital subtraction angiography (DSA). The recipient MCA received blood flow from two directions: antegrade blood flow originated from the proximal preanastomotic PAA, whereas retrograde blood flow traveled from the distal postanastomotic PAA via the ipsilateral and contralateral OAs.</div></div><div><h3>Conclusions</h3><div>Side-to-side microvascular anastomosis between the posterior auricular artery and middle cerebral artery is an effective alternative revascularization strategy in moyamoya disease. This approach optimizes the blood supply to the recipient MCA territory through dual-directional flow from the donor PAA, enhancing hemodynamic augmentation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102157"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}