Surgical Neurology International最新文献

{"title":"Adjuvant proton beam therapy in patients with grade 2 meningiomas","authors":"Taylor Anne Wilson, Joseph I. Kang Jr, Lei Huang, A. Văcaru, Kevin Nogueira Martins, Warren W. Boling","doi":"10.25259/sni_485_2023","DOIUrl":"https://doi.org/10.25259/sni_485_2023","url":null,"abstract":"\u0000\u0000The World Health Organization (WHO) grade 2 meningiomas behave aggressively with a high proclivity toward recurrence despite maximal surgical resection. Our institution, a pioneer of proton therapy, uses exclusively proton beam radiation, and thus, we present a retrospective cohort analysis of patients with WHO grade 2 meningiomas treated with adjuvant proton beam therapy (PBT) at our institution between 2007 and 2019. The effects of adjuvant PBT were evaluated.\u0000\u0000\u0000\u0000Data collected include diagnosis, gender, histological subtype, WHO grade, the extent of surgical resection, adjuvant PBT radiation, details of the PBT radiation, recurrence, any additional PBT radiation, systemic medical therapy, and disease-specific survival.\u0000\u0000\u0000\u0000Among the WHO grade 2 meningiomas (n = 50) recommended PBT, 80% and 78% of patients with gross-total resection (GTR) and subtotal resection (STR), respectively, followed through with PBT. The median radiation dose of PBT was 59.5 Gy and 59.92 Gy for patients with GTR and STR, respectively, with a median of 33 fractions delivered in 1.8 Gy doses for both groups. Combined 3-year progression-free survival (PFS) was 96%, and 5-year PFS was 92%. Combined overall survival was 95% at five years. Minimal radiation side effects were reported with no grade 3 or higher toxicities.\u0000\u0000\u0000\u0000Our results suggest that adjuvant PBT is well tolerated with minimal radiation toxicity. Alternative to photon radiation, PBT may be considered at least as safe and effective for adjuvant treatment of WHO grade 2 meningiomas when it is available.\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":" 891","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140092039","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":"Management of cerebrospinal fluid rhinorrhea as a rare complication of antiphospholipid syndrome","authors":"Elissa Xian, Joel Hardman, Geoffrey Parker, Arjuna Nirmalananda","doi":"10.25259/sni_32_2023","DOIUrl":"https://doi.org/10.25259/sni_32_2023","url":null,"abstract":"\u0000\u0000Antiphospholipid syndrome is a complex autoimmune condition associated with the formation of recurrent thrombosis in any vascular bed throughout the body. Jugular vein thrombosis is very rare with only a 0.9% occurrence and is not typically associated with cerebrospinal rhinorrhea as a result of raised intracranial pressure.\u0000\u0000\u0000\u0000A 54-year-old patient presented with a 9-month history of cerebrospinal fluid (CSF) rhinorrhea and headache on a background of antiphospholipid syndrome. Investigations showed a superior vena cava (SVC) and right internal jugular vein (IJV) obstruction with moderately elevated intracranial venous pressures. Her magnetic resonance imaging (MRI) brain was consistent with a CSF leak. The patient underwent successful endovascular stenting of her obstructed SVC and right IJV followed by surgical repair of a herniating meningocele in the posterior left ethmoid air cells.\u0000\u0000\u0000\u0000CSF rhinorrhea is uncommon and never previously reported associated with SVC thrombosis induced by antiphospholipid syndrome. A combination of endovascular techniques and surgical repair is recommended for this challenging presentation.\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":"52 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140085745","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 computed tomography (CT)-based morphometric study of various skull base parameters and their anatomical relationships relevant to endoscopic endonasal skull base surgery","authors":"V. L. Ganesh, Sundarakrishnan Dharanipathy, V. Pavana, Amandeep Kumar, Leve Joseph Devarajan Sebastian, Ajay Garg","doi":"10.25259/sni_1010_2023","DOIUrl":"https://doi.org/10.25259/sni_1010_2023","url":null,"abstract":"\u0000\u0000Endoscopic skull base surgery requires a thorough understanding of skull base anatomy. Orientation to regional anatomy to avoid complications like internal carotid artery injury can be assisted by knowledge of certain bony landmarks. These landmarks are themselves highly variable structures. This study focuses on the radiological morphometric characterization of these landmarks, which can be of great assistance to surgeons for better planning of endoscopic skull base approaches.\u0000\u0000\u0000\u0000Computed tomography scans of patients without skull base pathologies were analyzed retrospectively for the following parameters – Vidian canal (VC) length, VC and foramen rotundum (FR) distance from midline, the angle between the axis of VC and petrous internal carotid artery (pICA) and between VC and palatovaginal canal, the horizontal, vertical and direct distances between VC and FR and the patterns of sphenoid sinus (SS) pneumatization.\u0000\u0000\u0000\u0000The VC-pICA angle was more obtuse and VC and FR were placed farther off the midline on the left as compared to the right side. Similarly, the distances between VC and FR were more on the left side. The VC length and distance of VC and FR from the midline were longer in males than in females. The VC-pICA angle was more obtuse in females. The post-sellar variant was the predominant pneumatization pattern seen (57.9%), and the incidence of lateral recess pneumatization was 15%.\u0000\u0000\u0000\u0000The results of our study can be utilized for a better understanding of the anatomy of the skull base. In skull base pathologies with distorted anatomical landmarks, a basic understanding of their interrelations can be used to have a better anatomical orientation. All these measures can help in avoiding complications and make extended endoscopic approaches safe.\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":"111 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140090779","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":"Single institution series describing external ventricular drain (EVD) placement and short- and long-term complications related to placement accuracy","authors":"Nikhil Sharma, Jeffery R. Head, A. Mallela, Regan M. Shanahan, Stephen P. Canton, Hussam Abou-Al-Shaar, N. M. Kass, Fritz Steuer, Lucille Cheng, Michael Raver, Edward G. Andrews","doi":"10.25259/sni_894_2023","DOIUrl":"https://doi.org/10.25259/sni_894_2023","url":null,"abstract":"\u0000\u0000The placement of an external ventricular drain (EVD) for the treatment of acute hydrocephalus is one of the most common life-saving procedures that neurosurgeons perform worldwide. There are many well-known complications associated with EVD placement, including tract hemorrhages, intra-parenchymal and subdural hemorrhages, infection, and catheter misplacement. Given the variety of complications associated with EVD placement and the inconsistent findings on the relationship of accuracy to complications, the present study reviewed short- and long-term complications related to EVD placement at our institution.\u0000\u0000\u0000\u0000A retrospective review was conducted for all consecutive patients who underwent bedside EVD placement for any indication between December 2020 and December 2021. Collected variables included demographic information, etiology of disease state, pre-and post-operative head computed tomography measurements, and post-procedural metrics (immediate and delayed complications).\u0000\u0000\u0000\u0000A total of 124 patients qualified for inclusion in our study. EVDs that were non-functioning/exchanged were not significantly related to age, accuracy, ventriculomegaly, sex, disposition, laterality, type of EVD used, intraventricular hemorrhage (IVH), etiology, or Kakarla Grade (KG) (all P > 0.17). The need for a second EVD was similarly not related to age, accuracy, ventriculomegaly, sex, disposition, location, laterality, type of EVD used, IVH, etiology, or KG (all P > 0.130). Patients who died, however, were significantly more likely to have a second contralateral EVD placed (18.2% vs. 4.9% P = 0.029). We also found that left-sided EVDs were significantly more likely to fail within seven days of placement (29.4% vs 13.3%, P = 0.037; relative risk (RR) 1.93, 95% confidence interval: 1.09-3.43), unrelated to age, sex, etiology, type of EVD, IVH, location of the procedure, or accuracy (all P > 0.07). This remained significant when using a binary logistic regression to control for ventriculomegaly, accuracy, mortality, age, sex, and etiology (P = 0.021, B = 3.43).\u0000\u0000\u0000\u0000In our cohort, although a clear relationship between inaccuracy and complication rates was not found, our data did demonstrate that left-sided EVDs were more likely to fail within the immediate postoperative time point, and patients who died were more likely to have a second, contralateral EVD placed.\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":"11 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140091164","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":"Fontanellar bone - A rarity in pediatric cranial abnormalities","authors":"Ibrahim Alahmed, A. Almousa, Abdulsalam Aleid","doi":"10.25259/sni_6_2024","DOIUrl":"https://doi.org/10.25259/sni_6_2024","url":null,"abstract":"\u0000\u0000Fontanelles, membranous gaps in the infant skull, are integral for accommodating the expansion of the skull by the growing brain postnatally. The anterior fontanelle, situated at the frontal-parietal bone intersection, typically closes gradually within the first two years. Fontanellar bone, an exceedingly rare ossification anomaly of the anterior fontanelle, clinically mimics craniosynostosis.\u0000\u0000\u0000\u0000We present the case of a 22-day-old male with an almost closed anterior fontanelle who underwent evaluation. Prenatal and postnatal history were unremarkable. Physical examination revealed a well-nourished infant with a nearly closed fontanelle but no other anomalies. The initial diagnosis was craniosynostosis; however, a head computed tomography scan revealed fontanellar bone. Consequently, a conservative management approach with regular follow-ups was adopted.\u0000\u0000\u0000\u0000This case provides valuable insights into fontanellar bone, emphasizing its consideration in differential diagnoses for almost closed anterior fontanelles. The report aims to enhance awareness and understanding of this rare condition, promoting accurate diagnosis and optimal patient outcomes.\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":" 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140091267","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":"Hump on head: Rare case of bi-frontal fibrous dysplasia","authors":"Kunal Singla, Nishant Goyal, Pulkit Mittal, Zahed Ali Qamer, Jitender Chaturvedi, Arvind Kumar","doi":"10.25259/sni_201_2023","DOIUrl":"https://doi.org/10.25259/sni_201_2023","url":null,"abstract":"\u0000\u0000FD is relatively rare in the craniofacial region, accounting for only 20% of all cases. Currently, two general subtypes of FD are recognized: monostotic and polyostotic. The monostotic form is more frequent, accounting for 75% to 80% of fibrous dysplasia cases.\u0000\u0000\u0000\u0000An 18-year-old male presented with the complaint of bony-hard swelling over the forehead for 8 years. Radiology showed an expansile osseous lesion involving frontal bones. The patient underwent bi-frontal craniectomy with gross total resection of tumour mass with titanium mesh cranioplasty. His postoperative period was uneventful and was discharged on the seventh postoperative day.\u0000\u0000\u0000\u0000The cases of monostotic skull fibrous dysplasia should be treated by resection of the affected bone and cranioplasty. However, a more conservative re-contouring may be carried out in cases with multifocal involvement or when the excision is considered risky due to proximity to the major venous sinuses.\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":"48 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139382122","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":"Surgical strategy for intracranial hemorrhage with accidental hypothermia in elderly individuals","authors":"Yoshimi Shinohara, Ryo Miyaoka, Junkoh Yamamoto","doi":"10.25259/sni_707_2023","DOIUrl":"https://doi.org/10.25259/sni_707_2023","url":null,"abstract":"\u0000\u0000Accidental hypothermia poses a significant threat to the elderly, and its prevalence might increase due to aging and increasing isolation of individuals in Japan. Here, a series of four consecutive cases of accidental hypothermia in elderly patients with intracranial hemorrhage who underwent surgical treatment at our institution is presented.\u0000\u0000\u0000\u0000All patients were admitted to the emergency department with a diagnosis of intracranial hemorrhage. Among them, two patients experienced acute circulatory failure during emergency surgery, necessitating immediate cardiopulmonary resuscitation. Two other patients required intensive care before surgery; however, one of them exhibited signs of impending cerebral herniation, requiring emergency surgery.\u0000\u0000\u0000\u0000Accidental hypothermia poses a significant threat to elderly individuals, carrying a substantial mortality risk and demanding intensive general care. During rewarming, careful considerations must be devoted to potential complications, such as ventricular fibrillation, rewarming shock, bleeding diathesis, and hyperkalemia. Despite these risks, many life-threatening cases necessitate emergency surgery and rewarming procedures in parallel. The formulation of a surgical strategy aimed at mitigating rewarming-related complications should be entrusted to anesthesiologists. Strict follow-up is required to increase intracranial pressure when prioritizing intensive care over surgery.\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139383616","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":"Pseudogout mimicking cervical spine osteomyelitis and ventral epidural abscess: A case report and literature review","authors":"B. M. Wilkinson, Dan Y. Draytsel, Fakhri Awawdeh, Ali Hazama","doi":"10.25259/sni_975_2023","DOIUrl":"https://doi.org/10.25259/sni_975_2023","url":null,"abstract":"\u0000\u0000Calcium pyrophosphate deposition disease (CPPD), also known as “pseudogout,” is a crystal deposition arthropathy involving the synovial and periarticular tissues. Pseudogout rarely presents in the axial spine. Here, we present the case of an 80-year-old female patient admitted after a mechanical fall, initially misdiagnosed on computed tomography (CT)/magnetic resonance studies with cervical osteodiscitis/ventral epidural abscess that proved to be pseudogout.\u0000\u0000\u0000\u0000An 80-year-old female was admitted after a mechanical fall. The initial cervical CT scan showed multilevel degenerative changes with an acute C6 anterior wedge compression fracture, focal kyphosis, C5-6 disc space collapse, and endplate destruction. The magnetic resonance imaging showed marked contrast enhancement of the C5-6 vertebral bodies and disc space. An interventional radiology-guided biopsy of the C5-6 vertebral bodies and disc space was consistent with calcium pyrophosphate deposits, was diagnostic for pseudogout, and was negative for infection. She was managed conservatively with a rigid collar and seven days of oral prednisone.\u0000\u0000\u0000\u0000CPPD involvement in the axial spine is rare. Prompt pathologic diagnosis should be pursued to rule out an infectious process.\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":"81 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139381544","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":"Intraoperative discovery of a radiographically occult subependymoma obstructing the obex in a patient with a Chiari malformation – A rare case","authors":"Sophie F. Peeters, Lauren Uhr, Srinivas Chivukula, Richard Everson, Duc Duong, Duncan McBride, Won Kim, Marcia Cornford, Anton Mlikotic, Isaac Yang","doi":"10.25259/sni_683_2023","DOIUrl":"https://doi.org/10.25259/sni_683_2023","url":null,"abstract":"\u0000\u0000Chiari (type I) malformations are typically congenital. Occasionally, however, tonsillar herniation can arise secondary to cerebrospinal fluid leakage, posterior fossa or intraventricular mass lesions, or other etiologies. We present the first-ever case of an intramedullary subependymoma at the cervicomedullary junction associated with vertebral bone abnormalities and an acquired secondary Chiari malformation.\u0000\u0000\u0000\u0000A 60-year-old woman presented with a 3-year history of occipital, tussive headaches. Preoperative imaging was negative for mass lesions but demonstrated a Chiari malformation. She was recommended posterior fossa decompression with tonsillar shrinkage. During surgery, an intramedullary mass was incidentally observed, obstructing the obex at the cervicomedullary junction. Histopathological analysis of the resected lesion revealed a diagnosis of subependymoma.\u0000\u0000\u0000\u0000Subependymomas can sometimes present a diagnostic challenge due to their subtle appearance in neuroimaging. Only rarely are such masses associated with an acquired Chiari malformation. No such case has previously been reported. We present a literature review on acquired Chiari malformations and discuss their management.\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":"18 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139383229","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":"Anterior cervical surgery for morbidly obese patients should be performed in-hospitals","authors":"N. Epstein, Marc A. Agulnick","doi":"10.25259/sni_957_2023","DOIUrl":"https://doi.org/10.25259/sni_957_2023","url":null,"abstract":"\u0000\u0000Morbid obesity (MO) is defined by the World Health Organization (WHO) as Class II (i.e. Body Mass Index (BMI) >/= 35 kg/M2 + 2 comorbidities) or Class III (i.e. BMI >/= 40 kg/M2). Here, we reviewed the rates for adverse event/s (AE)/morbidity/mortality for MO patients undergoing anterior cervical surgery as inpatients/in-hospitals, and asked whether this should be considered the standard of care?\u0000\u0000\u0000\u0000We reviewed multiple studies to document the AE/morbidity/mortality rates for performing anterior cervical surgery (i.e., largely ACDF) for MO patients as inpatients/in-hospitals.\u0000\u0000\u0000\u0000MO patients undergoing anterior cervical surgery may develop perioperative/postoperative AE, including postoperative epidural hematomas (PEH), that can lead to acute/delayed cardiorespiratory arrests. MO patients in-hospitals have 24/7 availability of anesthesiologists (i.e. to intubate/run codes) and surgeons (i.e. to evacuate anterior acute hematomas) who can best handle typically witnessed cardiorespiratory arrests. Alternatively, after average 4-7.5 hr. postoperative care unit (PACU) observation, Ambulatory Surgical Center (ASC) patients are sent to unmonitored floors for the remainder of their 23-hour stays, while those in Outpatient SurgiCenters (OSC) are discharged home. Either for ASC or OSC patients, cardiorespiratory arrests are usually unwitnessed, and, therefore, are more likely to lead to greater morbidity/mortality.\u0000\u0000\u0000\u0000Anterior cervical surgery for MO patients is best/most safely performed as inpatients/in-hospitals where significant postoperative AE, including cardiorespiratory arrests, are most likely to be witnessed events, and appropriately emergently treated with better outcomes. Alternatively, MO patients undergoing anterior cervical procedures in ASC/OSC will more probably have unwitnessed AE/cardiorespiratory arrests, resulting in poorer outcomes with higher mortality rates. Given these findings, isn't it safest for MO patients to undergo anterior cervical surgery as inpatients/in-hospitals, and shouldn't this be considered the standard of care?\u0000","PeriodicalId":504441,"journal":{"name":"Surgical Neurology International","volume":"50 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139384199","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}