Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献

{"title":"Transdiscal L5-S1 screws without transpedicular L5 screws in the treatment of adult L5-S1 spondylolisthesis – report on two cases and review of the literature","authors":"Dimo Yankov ,&nbsp;Georgi Apostolov ,&nbsp;Ivo Kehayov ,&nbsp;Dilyan Ferdinandov","doi":"10.1016/j.inat.2026.102226","DOIUrl":"10.1016/j.inat.2026.102226","url":null,"abstract":"<div><div>There are several well-established techniques for the operative treatment of symptomatic L5-S1 spondylolisthesis. Standard surgical approaches typically include an interbody cage for posterior, transforaminal, or anterior interbody fusion, L5 pedicle screws, and sacral fixation. In adult high-grade spondylolisthesis, the L5-S1 intervertebral disc is often severely narrowed or completely degenerated, with only residual fibrous components attached to the vertebral bodies. Such cases are usually treated by in-situ fixation. Attempting to sufficiently distract the discal surfaces for interbody device implantation presents a significant technical challenge, and the resulting distraction and reduction may potentially injure the L5 nerve roots passing through the anteriorly displaced neuroforamina. The direct pediculo-body fusion technique has been somewhat forgotten due to the emergence of more complicated and expensive instrumentation options that promise better fusion rates and fewer complications. We present two cases where a modification of the original Grob technique was applied and discuss the rationale for patient selection. Both patients achieved complete symptom resolution. No surgical complications were observed. Evidence of bony interbody fusion was confirmed at the 3-month follow-up.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102226"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419831","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":"Neurosurgical readmissions as a key performance indicator: A Single-Center analysis of causes, patterns, and clinical relevance","authors":"Hosam Al-Jehani ,&nbsp;Ahmed Hafez Mousa ,&nbsp;Usama Elhadi ,&nbsp;Wisam Issawi ,&nbsp;Abdulrahman Anazi","doi":"10.1016/j.inat.2026.102242","DOIUrl":"10.1016/j.inat.2026.102242","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Thirty-day hospital readmission is widely promoted as a quality metric and key performance indicator (KPI). In neurosurgery, however, the relationship between readmission and quality of care is complex, as many readmissions are planned or reflect the natural progression of the disease rather than preventable adverse events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To describe the pattern, causes, and timelines of neurosurgical readmissions in a tertiary academic center and to critically appraise the suitability of 30-day readmission as a KPI for neurosurgical services.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We performed a retrospective review of all admissions to the neurosurgery department at King Fahad Hospital of the University, Al-Khobar, Saudi Arabia, between October 2016 and September 2017. Demographic and clinical data were extracted from medical records, including diagnosis, procedures, in-hospital course, length of stay (LOS), discharge disposition, 30-day readmission, indication for readmission, and subspecialty category (tumor, hydrocephalus/ventriculoperitoneal shunt [HCP/VPS], vascular, spine, traumatic brain injury [TBI]). Readmissions were classified as: definitive treatment, infection, CSF-leak/VPS-related, palliative/terminal care, or diagnostic work-up. Descriptive statistics were used to summarize readmission rates and timelines.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Over the 12-month period, 314 neurosurgical admissions were recorded; 68 represented readmissions within 30 days, yielding a crude readmission rate of 22%. The most frequent indication for readmission was planned definitive treatment (42%), followed by CSF-leak/VPS-related problems (27%), infection (20%), palliative/terminal care (7%), and further diagnostic work-up (4%) (&lt;span&gt;&lt;span&gt;Fig. 1&lt;/span&gt;&lt;/span&gt;). When readmissions for scheduled definitive treatment were excluded, 48 “unplanned” readmissions remained (15% of all admissions). In this subset, CSF-related complications predominated (47%), followed by infection (34%), palliative care (13%) and additional work-up (6%) (&lt;span&gt;&lt;span&gt;Fig. 2&lt;/span&gt;&lt;/span&gt;).&lt;/div&gt;&lt;div&gt;Neuro-oncology diagnoses accounted for the largest proportion of readmissions (34%), followed by HCP/VPS-related pathology (27%), vascular disease (20%), spine disorders (16%) and TBI (3%) (&lt;span&gt;&lt;span&gt;Fig. 4&lt;/span&gt;&lt;/span&gt;). Vascular patients had the longest primary LOS (mean 21 days, maximum 121 days) and the longest average interval to readmission (59 days, maximum 190 days). The longest readmission LOS was observed in HCP/VPS patients (mean 19 days), while the maximum readmission LOS reached 76 days in tumor patients (&lt;span&gt;&lt;span&gt;Table 1&lt;/span&gt;&lt;/span&gt;; &lt;span&gt;&lt;span&gt;Fig. 5–6&lt;/span&gt;&lt;/span&gt;). Among patients with more than one readmission, CSF-related problems and infections remained the dominant drivers, and a notable proportion exhibited multiple etiologies (“double” readmissions) (&lt;span&gt;&lt;span&gt;Fig. 3&lt;/span&gt;&lt;/span&gt;).&lt;/div&gt;&lt;/div&gt;&lt;","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102242"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421122","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":"Study of microneurosurgical anatomy of middle cerebral artery in human cadaveric brain in the North Indian population","authors":"Ashutosh Jha,&nbsp;Monica Narayanaswamy,&nbsp;Ajay Choudhary","doi":"10.1016/j.inat.2026.102221","DOIUrl":"10.1016/j.inat.2026.102221","url":null,"abstract":"<div><div>The understanding of normal brain anatomy and its intricate variations in vascular and other minute brain structures has dramatically improved over the past few years, facilitated by the phenomenal advancements made in the field of microneurosurgery. Cadaveric microdissection is of immense help, as it forms the basis of our understanding of the brain’s complex structures.</div><div>Aim: Study of the microsurgical Anatomy of the Middle Cerebral Artery in the Human Cadaveric Brain in the North Indian population.</div><div>Materials and methods: Fifteen fresh adult cadavers of both genders were studied in the Anatomy dissection hall of the ABVIMS, and Dr. R.M.L. Hospital, New Delhi, between 01-01-2021 and 15-04-2022. The entire examination was conducted under magnification, with a 10x zoom.</div><div>Results: The average length of the M1 segment was 16.36 ± 2.973 mm. The average length of M1 in bifurcating cases was 15.32 mm. The average length of M1 in trifurcating cases was 19.25 mm. 33.33% had one early branch, 46.6% had two early branches, and 20.0% had three early branches. MCA bifurcated into superior and inferior trunks in 22 cases (73.3%). MCA trifurcated into superior, middle, and inferior trunks in 8 cases (26.6%). The angular artery was the largest cortical artery in 53.4% of cases. The temporo-occipital artery was the largest cortical artery in 46.6% of cases. The early branch to the frontal lobe was 20%. The average number of M1 segment perforators was 9.2.</div><div>Conclusion: The detailed knowledge of microsurgical anatomy of MCA and its variations is important for neurosurgeons dealing with MCA aneurysm management.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102221"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421156","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":"Combined transarterial and transvenous Onyx embolization approach for anterior cranial fossa dural arteriovenous fistulas with a pial feeder: Reports of two cases","authors":"Ryota Sakurai ,&nbsp;Tomoaki Terada ,&nbsp;Hiroo Yamaga ,&nbsp;Takeru Umemura ,&nbsp;Toru Kurokawa ,&nbsp;Yuko Tanaka","doi":"10.1016/j.inat.2025.102174","DOIUrl":"10.1016/j.inat.2025.102174","url":null,"abstract":"<div><div>Anterior cranial fossa (ACF) dural arteriovenous fistulas (dAVFs) associated with pial arterial supply are rare, and the appropriate endovascular treatment remains uncertain for this type of dAVFs. Certain patterns of pial arterial supply have been associated with an increased risk of hemorrhage and may complicate endovascular strategies.</div><div>We present two cases of ACF dAVFs with pial arterial supply that were successfully treated with Onyx transarterial embolization (TAE) and transvenous embolization (TVE). In both cases, the arterial feeders originated from the ethmoidal arteries and pial arterial supply from branches of the anterior cerebral artery (ACA), with venous drainage via the fronto-orbital vein into the superior sagittal sinus (SSS). The microcatheters were navigated through both transarterial and transvenous routes close to the shunt point. TAE using Onyx from a unilateral posterior ethmoidal artery was first performed to safely reduce arterial inflow and occlude the entire shunt while avoiding excessive reflux, if possible. However, the pial arterial supply remained patent. Subsequent TVE from the fronto-orbital vein led to Onyx retrograde penetration into the pial arterial supply and the draining vein, achieving complete obliteration of the fistulas in both cases. A combined TAE and TVE approach for ACF dAVFs with pial arterial supply seems to be effective in obliterating the draining vein, so-called foot of the vein, as well as the pial arterial supply in a retrograde fashion and in preventing hemorrhagic complications related to the residual pial arterial supply.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102174"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978165","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":"Prevalence of burnout syndrome in Brazilian neurosurgery residents: A nationwide questionnaire-based survey","authors":"Rhuann Pontes dos Santos Silva ,&nbsp;Isadora Gomes Mesquita ,&nbsp;Louise Makaren Oliveira ,&nbsp;Marcia Mitie Nagumo ,&nbsp;Julia Costa Justo ,&nbsp;Gabriela Fernandes de Oliveira Pessoa ,&nbsp;Eberval Gadelha ,&nbsp;Luis Alencar Borba ,&nbsp;Cleice Mara Goncalves Coelho ,&nbsp;Jonas Byk ,&nbsp;Juscimar Carneiro ,&nbsp;Otávio da Cunha Ferreira Neto ,&nbsp;José Marcus Rotta ,&nbsp;Wellingson Silva Paiva ,&nbsp;Robson Luis Oliveira de Amorim","doi":"10.1016/j.inat.2025.102160","DOIUrl":"10.1016/j.inat.2025.102160","url":null,"abstract":"<div><h3>Background</h3><div>Burnout syndrome (BS) is a significant issue among neurosurgery residents, resulting from chronic emotional and interpersonal stressors. Characterized by emotional exhaustion, depersonalization, and low personal accomplishment, BS can lead to decreased productivity, interpersonal relationships, and medical errors.</div></div><div><h3>Objective</h3><div>This study aims to analyze the prevalence of BS among Brazilian neurosurgery residents and identify associated factors.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study using the Maslach Burnout Inventory (MBI) and questionnaires covering sociodemographic information, mental health, and job satisfaction.</div></div><div><h3>Results</h3><div>The study surveyed all Brazilian neurosurgery residency programs, with 118 out of 600 residents (19.6 %) responding. The prevalence of BS was 64.1 %, and 94.9 % had at least one high domain. Third-year residents exhibited the highest rate of burnout (79.2 %). Gender significantly influenced burnout rates, with males showing higher levels. Additionally, dissatisfaction with personal life and insufficient physical exercise were associated with increased likelihood of burnout. They also exhibited higher dissatisfaction with their academic productivity, time for study, and balance between professional and personal life. Suicidal ideation was reported by 16.1 % of residents but was not statistically associated with BS. Multivariate analysis showed that only male sex was an independent variable of having BS (OR 2.97 95CI 1.005–8.78, p = 0.049). Also, those with BS were less likely to choose neurosurgery again (OR 0.22 95CI 0.06–0.78, p = 0.02) or recommend it as a specialty (OR 0.32 95CI 0.11–0.93, p = 0.03)</div></div><div><h3>Conclusion</h3><div>This study highlights the high prevalence of BS among Brazilian neurosurgery residents, indicating a need for targeted interventions to address these stressors and improve resident well-being.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102160"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978164","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":"Evaluation of early surgical outcomes for posterior fossa lesions using the far lateral approach: Single-surgeon series from Vietnam","authors":"Duy Pham ,&nbsp;Son Tung Tran ,&nbsp;Le Minh Tien Nguyen ,&nbsp;Trong Hiep Nguyen ,&nbsp;Minh Quang Ngo ,&nbsp;Hung Manh Ngo","doi":"10.1016/j.inat.2025.102190","DOIUrl":"10.1016/j.inat.2025.102190","url":null,"abstract":"<div><h3>Background</h3><div>The Far Lateral Approach (FLA) is a neurosurgical access for lesions at the foramen magnum and lower clival regions, where the brainstem, cranial nerves IX-XII, and vertebral artery converge. This surgical approach allows safe access to lesions in the posterior fossa, both anterior and lateral to the brainstem, while minimizing tissue damage. Although widely reported worldwide, no data have been published in Vietnam.</div></div><div><h3>Objectives</h3><div>To evaluate the feasibility, safety, and surgical outcomes of the FLA in managing posterior fossa lesions from a single-surgeon series in Vietnam.</div></div><div><h3>Materials and methods</h3><div>This prospective cross-sectional study was conducted on seven patients who underwent microsurgery via the FLA for posterior fossa lesions between January 2022 and January 2025.</div></div><div><h3>Results</h3><div>The cohort included five women and two men, aged 30–64 years (mean 51.7 ± 14.5). Diagnoses included four meningiomas (two lower clival, two foramen magnum meningiomas), one neurinoma, one neurenteric cyst, and one vertebral artery aneurysm. All procedures were performed by the same surgical team following a standardized protocol. Gross total resection was achieved in all tumor cases. No major complications such as meningitis, hemiplegia, or perioperative mortality were observed. Minor complications included transient lower cranial nerve deficits (hoarseness, dysphagia) and cerebrospinal fluid (CSF) leakage, which resolved with conservative management.</div></div><div><h3>Conclusion</h3><div>The FLA is safe and effective for managing posterior fossa lesions at the foramen magnum and lower clival regions, and can be successfully applied in Vietnam. It provides wide exposure while preserving critical neurovascular structures, with favorable outcomes and manageable complications.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102190"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939394","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":"Clinical exposure to neurosurgery at medical school: The current medical student experience","authors":"Aled Lester ,&nbsp;Ronak Ved ,&nbsp;Gregor Ramage ,&nbsp;Stephen Greenwood ,&nbsp;Daniel Parry ,&nbsp;Paul Leach ,&nbsp;Phil Smith","doi":"10.1016/j.inat.2025.102185","DOIUrl":"10.1016/j.inat.2025.102185","url":null,"abstract":"<div><h3>Background</h3><div>Medical students may be placed at neurosurgical centres (NCs) or non-neurosurgical centres (non-NCs) during their undergraduate clinical neurosciences placements (CNP). Studies show varied exposure to neurosurgery among medical schools, but comparison of clinical exposure between students at neurosurgical centres and non-neurosurgical centres or its impact on their preparedness, is yet to be fully assessed.</div></div><div><h3>Methods</h3><div>A questionnaire was electronically distributed to medical students from Cardiff University in the United Kingdom, all of whom completed a clinical neurosciences placement. Recruitment was through email, social media, and in-person. Quantitative data were analysed using descriptive statistics and non-parametric tests, while qualitative data underwent thematic analysis.</div></div><div><h3>Results</h3><div>Forty responses were collected from medical students. Thirty-four (85.0 %) had their clinical neurosciences placement at a neurosurgical centre, and of these, twenty-four (70.6 %) had a neurosurgical rotation, half of which lasted ≤ two days. Significantly more participants at neurosurgical centres attended neurosurgical theatre compared to none at non-neurosurgical centres (54.8 % vs 0.0 %, p = 0.022). Significant differences were found in neurosurgical tutorials, small group teaching, case-based discussions, and simulations, with these opportunities being more commonly provided at neurosurgical centres. Three themes from the qualitative data supported the quantitative findings.</div></div><div><h3>Conclusion</h3><div>There is a difference in clinical exposure between students at neurosurgical centres and non- neurosurgical centres. Students at non-neurosurgical centres have fewer neurosurgical opportunities, potentially impacting their learning, examination performance, and clinical practice.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102185"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939390","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":"Analysis of the treatment pathway and causes of delay in a young patient with spinal arteriovenous malformations: A case report","authors":"Guiying Liu ,&nbsp;Lifang Wen ,&nbsp;Yanyan Zhang ,&nbsp;Dan Zhao ,&nbsp;Ling Tang ,&nbsp;Xin Guan","doi":"10.1016/j.inat.2025.102159","DOIUrl":"10.1016/j.inat.2025.102159","url":null,"abstract":"<div><h3>Background</h3><div>Spinal arteriovenous malformations (SAVMs) are rare, Early insidious, non-specific symptoms cause diagnostic delay—higher in adolescents—leading to psychological distress, educational interruption, poor prognosis, and more. Timely intervention improves outcomes, but research on young patients’ pre-admission clinical trajectory is limited.</div></div><div><h3>Case presentation</h3><div>A 20-year-old male with 1-month lower limb weakness/numbness and sphincter disturbance was diagnosed with SAVMs. Initial low back pain was ignored due to his intense training but symptoms progressed to urinary/defecatory dysfunction. Spinal CT was normal, MRI showed T9-L3 abnormal signals and T8-T12 spinal cord edema. Even with worsening symptoms every day the time from the discovery of the symptoms to the acceptance of the correct treatment was 40 days.</div></div><div><h3>Intervention</h3><div>The young man had endovascular embolization (DSA + EMB) at a tertiary hospital. Access to the right common femoral artery was gained via the Seldinger method, delivering embolic agents(N-butyl cyanoacrylate NBCA) into this vessel, control angiography confirmed a significant reduction in both blood flow velocity and volume within the malformed vasculature. Post-rehabilitation, 3-month follow-up showed normal walking, recovered defecation, Urinary Functionand improved neurological function (Aminoff &amp; Logue Scale changed from 7to 0.</div></div><div><h3>Conclusion</h3><div>Diagnostic delays stem from atypical symptoms, primary physicians’ limited experience, and poor early screening. Strategies like physician training, optimized diagnostics, and public education are recommended to improve timely SAVM care.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102159"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939474","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":"A new thrombectomy method using proximal balloon-guided aspiration from the common carotid artery for internal carotid artery occlusion","authors":"Takuya Nakamura ,&nbsp;Yoshiki Hanaoka ,&nbsp;Satoshi Kitamura ,&nbsp;Jun-ichi Koyama ,&nbsp;Tetsuyoshi Horiuchi","doi":"10.1016/j.inat.2025.102186","DOIUrl":"10.1016/j.inat.2025.102186","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Internal carotid artery (ICA) occlusion is associated with poor clinical outcomes due to high clot burden and complications. Although several devices such as aspiration catheters and stent retrievers have improved recanalization rates, they carry risks including vessel dissection, carotid-cavernous fistula, vessel perforation, and stent detachment. To address these, we developed a new thrombectomy method using a balloon-guided catheter aspiration from the common carotid artery (CCA) to achieve complete recanalization and minimize device-related complications.</div></div><div><h3>Material and methods</h3><div>We report five consecutive cases of ICA occlusion treated between October 2022 and November 2023 using proximal balloon-guided aspiration from the CCA. An 8F or 9F balloon guide catheter was positioned in the CCA, and proximal manual aspiration was performed following balloon inflation to achieve flow arrest and prevent clot migration. We evaluated puncture to recanalization time, modified TICI grade, and device-related complications.</div></div><div><h3>Results</h3><div>All cases achieved mTICI 2b or 3 recanalization without any device-related complications. Particularly, three of five cases achieved mTICI 3 recanalization in a single pass. One case experienced embolization to a new territory, which was associated with concomitant external carotid artery occlusion. The mean time from puncture to recanalization was 49.2 min.</div></div><div><h3>Conclusion</h3><div>Proximal balloon-guided aspiration from the CCA provides high recanalization rates for ICA occlusion. This method was simpler and faster, more cost-effective, and associated with lower complication risks than conventional mechanical thrombectomy. However, there is a risk of external carotid artery occlusion due to vascular collapse during aspiration. Further investigation is needed to clarify the potential risks and limitations of this method.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102186"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939472","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":"Hydatid cyst of the medulla oblongata: rare presentation and surgical management","authors":"Hanan Ghanem ,&nbsp;George Elian Makhoul ,&nbsp;Mohammad Eyad Takahji ,&nbsp;Rima Alassaad ,&nbsp;Laila Alhaj Hussaen ,&nbsp;Loulitta Nicola Melhem ,&nbsp;Saleem Mazen Aslan ,&nbsp;Mohamad Kadi","doi":"10.1016/j.inat.2026.102208","DOIUrl":"10.1016/j.inat.2026.102208","url":null,"abstract":"<div><h3>Background</h3><div>Hydatid disease is a zoonotic parasitic infection that typically involves the lungs and liver. Primary intracranial cysts, especially in the brainstem, are extremely rare and rarely reported. We present a complex case of a brainstem hydatid cyst in a patient with a history of aqueductal stenosis and ventriculoperitoneal shunt placement, successfully managed with surgical intervention.</div></div><div><h3>Case presentation</h3><div>A 28-year-old woman with a history of aqueductal stenosis and prior ventriculoperitoneal shunt surgeries presented with an 18-month history of headache, dysarthria, dysphagia, ataxia, and dysmetria. Neurological examination confirmed cerebellar signs. A brain MRI revealed a well-defined cystic lesion in the medulla oblongata. Hydatid disease was suspected, even though serology and abdominal imaging were negative. The lesion was surgically treated using a modified PAIR (Puncture, Aspiration, Injection, and Re-aspiration) technique. The diagnosis of hydatid cyst was confirmed by histopathological examination. We have administered postoperative antiparasitic therapy, and the patient showed marked clinical improvement and a stable situation at six-month follow-up.</div></div><div><h3>Conclusion</h3><div>Our case describes the rare occurrence of a hydatid cyst in the brainstem. We emphasize the need to consider hydatid disease in the differential diagnosis of brainstem lesions, particularly in endemic regions, and underscore the diagnostic and therapeutic challenges associated with such unusual presentations.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102208"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419833","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}