Asian Journal of Neurosurgery最新文献

{"title":"A Rare Case of Unruptured Small Aneurysm Arising from the Posterior Surface of Proximal A1 Segment, Projecting Posterior-Inferiorly and Entangled with Multiple Perforators from the A1 Segment","authors":"Samir Jagannath Kale, Riki Tanaka, Mai Okubo, Kento Sasaki, Kyosuke Miyatani, Yasuhiro Yamada, Fuminari Komatsu, Yoko Kato","doi":"10.1055/s-0043-1776990","DOIUrl":"https://doi.org/10.1055/s-0043-1776990","url":null,"abstract":"Abstract Aneurysm arising from the A1 segment of the anterior cerebral artery is rare. Aneurysm of the A1 segment even being small tend to rupture early. They tend to develop along the with various vascular anomalies of the vessels arising from the A1 segment. Use of computational fluid dynamics and hemodynamic consideration is of importance in this aneurysm. In this report we describe a 57-year-old woman with a small, unruptured A1 segment aneurysm arising from the proximal segment of the posterior surface of A1, and pointing posterior-inferiorly with multiple perforators entangling around for which microsurgical clipping was done. Intraoperative clipping of the aneurysm and salvaging the multiple perforators were challenging. We report a rare case of an A1 segment aneurysm arising from the posterior surface facing with multiple perforators. It is of significance to understand that a small, unruptured A1 aneurysm can arise from the posterior surface of the A1 segment with projection posterior-inferiorly making it deeper in location with multiple perforators entangling it; hence, it is challenging to treat without causing neurological deficits.","PeriodicalId":505649,"journal":{"name":"Asian Journal of Neurosurgery","volume":" 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141678403","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":"Patient-Reported Outcomes and Complications of Simultaneous versus Staged Surgical Decompression for Tandem Spinal Stenosis","authors":"Mustafa Mushtaq Hussain, Mujtaba Khalil, Fatima Suleman, Iqra Fatima Munawar Ali, Mehar Masroor, M. Shamim","doi":"10.1055/s-0044-1787867","DOIUrl":"https://doi.org/10.1055/s-0044-1787867","url":null,"abstract":"Abstract Introduction  Tandem spinal stenosis (TSS) refers to the narrowing of the spinal canal at two distinct anatomic areas. Symptoms can present due to either cervical myelopathy or lumbar stenosis. Consequently, determining the symptomatic anatomical levels requiring surgery can pose a challenge. We sought to identify the surgical approach associated with better patient-reported outcomes. Materials and Methods  The Information Management System was queried using the International Classification of Diseases Ninth and Tenth Edition codes to identify patients who underwent simultaneous or staged decompression surgery for TSS between 2011 and 2020. Patient records were reviewed to collect data on age, sex, comorbidities, surgical approach, modified Japanese Orthopedic Association (mJOA) score, and complications. The mJOA is a validated composite assessment used to quantify postoperative neurological status. Multivariable regression models were utilized to identify factors associated with better postoperative neurological recovery. Results  Among 42 patients included in the analytical cohort, 33 (78.6%) underwent simultaneous cervical and lumbar decompression, while 9 (21.4%) underwent staged decompression (cervical followed by lumbar). The patient's age, sex, comorbid conditions, and American Society of Anesthesiologists level were similar between the two groups. Furthermore, simultaneous decompression was associated with higher blood loss (676.97 vs. 584.44 mL) and an increased need for transfusion (259.09 vs. 111.11 mL) compared with staged decompression. Moreover, patients who underwent simultaneous decompression experienced a higher number of postoperative complications (10 vs. 1; p  = 0.024). Notably, postoperative mJOA scores improved in both groups; however, the improvement was more pronounced in the staged group (mJOA score: 15.16% [ ± 2.18] vs. 16.56% [ ± 1.59]). On follow-up visits, patients who underwent staged decompression showed better recovery rates (mJOA score: 78.20% [ ± 24.45] vs. 59.75% [ ± 25.05]). Conclusion  The patient's clinical history and examination findings should be the main determinants of surgical decision-making. Our study showed a slightly higher postoperative mJOA score and a recovery rate with fewer complications in staged decompression of TSS.","PeriodicalId":505649,"journal":{"name":"Asian Journal of Neurosurgery","volume":"23 90","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696246","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}