Neurocirugia最新文献

{"title":"Intradural anatomy and mobilization techniques of oculomotor, trochlear and abducens nerve after microsurgical dissection: a cadaveric study","authors":"","doi":"10.1016/j.neucir.2024.05.004","DOIUrl":"10.1016/j.neucir.2024.05.004","url":null,"abstract":"<div><h3>Background</h3><p>This study investigates the mobilization of cranial nerves in the upper clival region to improve surgical approaches. Cadaveric specimens (n = 20) were dissected to examine the oculomotor, trochlear, and abducens nerves. Dissection techniques focused on the nerves' intradural course and their relationship to surrounding structures.</p></div><div><h3>Methods</h3><p>Pre-dissection revealed the nerves' entry points into the clival dura and their proximity to each other. Measurements were taken to quantify these distances. Following intradural dissection, measurements were again obtained to assess the degree of nerve mobilization.</p></div><div><h3>Results</h3><p>Dissection showed that the abducens nerve takes three folds during its course: at the dural foramen, towards the posterior cavernous sinus, and lastly within the cavernous sinus. The trochlear nerve enters the dura and makes two bends before entering the cavernous sinus. The oculomotor nerve enters the cavernous sinus directly and runs parallel to the trochlear nerve. Importantly, intradural dissection increased the space between the abducens nerves (by 4.21 mm) and between the oculomotor and trochlear nerves (by 3.09 mm on average). This indicates that nerve mobilization can create wider surgical corridors for approaching lesions in the upper clivus region.</p></div><div><h3>Conclusions</h3><p>This study provides a detailed anatomical analysis of the oculomotor, trochlear, and abducens nerves in the upper clivus. The cadaveric dissections and measurements demonstrate the feasibility of mobilizing these nerves to achieve wider surgical corridors. This information can be valuable for surgeons planning endoscopic or microscopic approaches to lesions in the upper clivus region.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122502","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":"Short-term and long-term results of odontoid screw fixation in patients with Type II and rostral Type III dens fractures","authors":"","doi":"10.1016/j.neucir.2024.04.002","DOIUrl":"10.1016/j.neucir.2024.04.002","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate both the short-term and long-term outcomes of odontoid screw fixation (OSF), identifying potential risk factors for implant-related complications in patients with odontoid fractures.</p></div><div><h3>Methods</h3><p>This is a retrospective observational cohort study. Inclusion criteria were as follows: 1) Type II fractures and rostral Type III fractures, according to the Anderson and D’Alonzo classification; 2) patients older than 15 years. Exclusion criteria were: 1) other Type III injuries; 2) osteoporosis confirmed by densitometry or a CT bone density score below 100 Hounsfield units; 3) odontoid fractures related to tumors or aneurysmal bone cysts.</p></div><div><h3>Results</h3><p>In total, 56 patients were considered for the analysis of short-term results, and 26 patients were evaluated for long-term outcomes. No significant differences were observed in the preoperative imaging data and intraoperative features of OSF between patients with Type II and rostral Type III fractures. The mean operative duration was 63.9 ± 20.9 min, and the mean intraoperative blood loss was 22.1 ± 22.9 ml.</p><p>Screw cut-out was identified in four patients with rostral Type III fractures (p = 0.04). The rate of screw cut-out was found to correlate with the degree of dens fragment displacement. The bone fusion rate was 95.7%. CT scans identified stable pseudarthrosis in two cases. We observed C2–C3 ankylosis in all cases following partial disc resection. One third of patients with screws placed through the anterior lip of C2 showed no C2–C3 ankylosis. A strong trend towards lateral joint ankylosis formation in patients with a median lateral mass dislocation of 11.9 mm was observed. Most SF-36 scores either matched or exceeded the corresponding normal median values in the published reference database.</p></div><div><h3>Conclusions</h3><p>OSF is a reliable treatment method of Type II and rostral Type III odontoid fractures with fragment displacement of 4 mm or less. The minimally invasive OSF through the anterior-inferior lip of C2, using monocortical screw placement and cannulated instruments, without rigid intraoperative head immobilization, is sufficient to achieve favorable clinical and fusion results. This technique reduces the risk of ankylosis in the C2–C3 segment. OSF restore the quality of life for patients with odontoid fractures to levels comparable to those of the general population norm.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122521","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":"La rizotomía parcial sensitiva en la neuralgia del trigémino recurrente. Nuestra experiencia y revisión de la literatura","authors":"","doi":"10.1016/j.neucir.2024.06.001","DOIUrl":"10.1016/j.neucir.2024.06.001","url":null,"abstract":"<div><h3>Background and objective</h3><p>Trigeminal neuralgia (NT) is a common pathology in neurosurgery. It can be classified as idiopathic or secondary to other pathologies, such as multiple sclerosis (MS). Several surgical treatments have been described, some of them being replaced by more modern techniques. Partial sensory rhizotomy (PSR), described by Dandy, is a technique replaced by other techniques due to its permanent side effects. We present our experience with this technique in patients with recurrent NT.</p></div><div><h3>Methods and materials</h3><p>A retrospective review is carried out on five patients who underwent surgery at our center from 2018 to 2023 using the PSR technique.</p></div><div><h3>Results</h3><p>All the patients intervened showed significant clinical improvement, except one patient who required reintervention due to uncontrolled pain. According to the Barrow Neurological Institute (BNI) scale, 80% (4/5) of patients showed improvement from grade<!--> <!-->V to grades<!--> <!-->I/II except for one of them. This patient suffered from MS. Additionally, one patient presented a corneal ulcer after surgery due to impairment of the corneal reflex.</p></div><div><h3>Conclusion</h3><p>In our experience, PSR is a valid treatment option in selected patients with recurrent TN. It has a low incidence of complications with an adequate surgical technique and anatomical knowledge of the region. To the best of our knowledge, we are one of the few centers in Spain to publish our results with PSR in the last ten years. In our study, we report good results in pain control withdrawing medication in 80% (4/5) of the operated patients.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122501","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":"Terson’s syndrome after endoscopic removal of a colloid cyst","authors":"","doi":"10.1016/j.neucir.2024.03.001","DOIUrl":"10.1016/j.neucir.2024.03.001","url":null,"abstract":"<div><p>An extremely rare complication of endoscopic colloid cyst removal is presented. Terson’s syndrome related to endoscopic resection of a colloid cyst has been reported only twice before in the literature and it could be explained by intracranial hypertension related to rinsing during the procedure. The case is described and the complications in the neuroendoscopic removal of colloid cyst are reviewed from the literature.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122792","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":"Comparación entre el uso de drenaje subdural y subgaleal en tratamiento del hematoma subdural crónico","authors":"","doi":"10.1016/j.neucir.2024.05.003","DOIUrl":"10.1016/j.neucir.2024.05.003","url":null,"abstract":"<div><h3>Background and objetives</h3><p>Chronic subdural hematoma (CSDH) is one of the most common pathologies in our daily practice. The standard treatment is the evacuation making a burr-hole and placement of a subdural drainage, which has shown to decrease its recurrence. However, this procedure can entail risks such as parenchymal damage, infection, or the onset of seizures, prompting the consideration of subgaleal drainage as an alternative.</p><p>Our objective is to compare the use of subdural and subgaleal drainage in a cohort of patients undergoing intervention for CSDH, as well as to analyze the differences in complication rates and recurrence between the two groups.</p></div><div><h3>Methodology</h3><p>A retrospective analytical observational study was conducted, analyzing 152 patients diagnosed with CSDH who underwent intervention at our center from January 2020 to April 2022. Patients in whom drainage was not placed were excluded. In all patients, a burr-hole was performed and the type of drainage was chosen by the neurosurgeon.</p></div><div><h3>Results</h3><p>Out of the 152 patients, subdural drainage was placed in 80 cases (52.63%), while subgaleal drainage was used in 72 cases (47.37%). There were no significant differences in the recurrence rate (30% in the subdural drainage group vs. 20.83% in the subgaleal drainage group; <em>P</em>=.134) or in the complication rate (7.5% in the subdural drainage group vs. 5.5% in the subgaleal drainage group; <em>P</em>=.749).</p></div><div><h3>Conclusions</h3><p>Subgaleal drainage shows similar clinical outcomes with a recurrence and complication rate comparable to subdural drainage, suggesting it as a safe and effective alternative to subdural drainage in the treatment of CSDH.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122520","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":"Gamma Knife radiosurgery for the treatment of trigeminal neuralgia: A single center-experience","authors":"","doi":"10.1016/j.neucir.2024.03.003","DOIUrl":"10.1016/j.neucir.2024.03.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>We aimed to assess the outcomes of patients with trigeminal neuralgia (TGN) who underwent Gamma Knife radiosurgery (GKRS).</p></div><div><h3>Materials and methods</h3><p>Fifty-three patients with typical TGN underwent GKRS from May 2012 until December 2022. Among these patients, 45 patients who were follow-up for at least 12 months were included in the study. A mean dose of 87.5 Gy (range, 80–90) was administered to the trigeminal nerve. Postoperatively, outcome was considered excellent if the patient was pain- and medication-free.</p></div><div><h3>Results</h3><p>The mean symtpom duration was 9.53 years, and the mean patient age was 59.8 years (range, 34–85). The mean follow-up period was 46.8 months (range, 12–127 months). 46.7% of patients had a history of previous surgical interventions. A single nerve division was affected in 14 patients (31.1%), and multiple divisions were affected in 31 patients (68.9%). The rate of initial pain relief was 80%. Hypoesthesia in the area of trigeminal nerve developed in 30 (66.7%). Twenty patients (44.4%) exhibited excellent results within 72.4 months. Recurrence occurred in 11 patients (24.4%) with 27.6 months.</p></div><div><h3>Conclusions</h3><p>Our results suggest that GKRS is a safe and effective procedure. Thus, it is an attractive first- and second-line treatment choice for TGN.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122519","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":"Hipertensión intracraneal secundaria a malformación arteriovenosa pial no rota. Idoneidad del tratamiento endovascular aislado con etilen vinil alcohol / dimetilsulfóxido (Onyx®). Presentación de un caso y revisión de la literatura","authors":"","doi":"10.1016/j.neucir.2024.05.002","DOIUrl":"10.1016/j.neucir.2024.05.002","url":null,"abstract":"<div><p>A 36-year-old male presented to the Emergency Department with clinical symptoms of blurred vision of progressive onset of two years of evolution. The ophthalmological examination revealed the existence of bilateral papilledema. Using cranial computed tomography and magnetic resonance imaging, the presence of a right occipital pial arteriovenous malformation was certified. Arteriographically, pial arterial contributions dependent on the right middle cerebral artery and the right posterior cerebral artery were identified. Venous drainage was located at the level of the superior sagittal sinus. An associated right transverse sinus stenosis was also identified. The existence of secondary intracranial hypertension was corroborated by monitoring with an intracranial pressure sensor. An interventional procedure was carried out consisting of embolization of the arterial supplies of the lesion using Onyx®. The clinical-radiological findings after the procedure were favorable: the papilledema disappeared and complete exclusion of the malformation was achieved. A new intracranial pressure measurement showed resolution of intracranial hypertension. Subsequent regulated radiological controls showed complete exclusion of the malformation up to 5 years later.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141411738","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":"Combined thalamic and pallidal deep brain stimulation in diabetic hemiballism/hemichorea","authors":"","doi":"10.1016/j.neucir.2024.03.002","DOIUrl":"10.1016/j.neucir.2024.03.002","url":null,"abstract":"<div><p>Hemiballism/hemichorea (HH) is a hyperkinetic movement disorder observed mostly in older adults with cerebrovascular diseases. Although the symptoms improve without any treatment, lesioning or DBS (deep brain stimulation) may be rarely required to provide symptomatic relief for patients with severe involuntary movements. HH is a rare complication of uncontrolled diabetes. There are only a few reported cases of diabetic HH that have been surgically treated. Thus, herein, we have reported the case of a 75-year-old female with type-II diabetes mellitus that presented with disabling involuntary limb movements of the left side, despite being treated conservatively for six months. DBS targeting the globus pallidus internus (GPi) and ventral intermediate (Vim) thalamic nucleus was performed. Complete resolution of symptoms was achieved with a combined stimulation of the thalamic Vim nucleus (at 1.7 mA) and GPi (at 2.4 mA). The combined stimulation of the Vim nucleus and GPi effectively resolved the diabetes-induced HH symptoms in our patient. Thus, although certain conclusions cannot be drawn due to the rarity of the surgically treated patients with HH, the combined stimulation is a novel treatment option for resistant HH.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122503","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":"Evaluación de las últimas 2 décadas en las características de presentación, manejo y pronóstico de las hemorragias cerebrales espontáneas graves en un hospital de tercer nivel","authors":"Francisco Javier Morán Gallego ,&nbsp;Marcelino Sanchez Casado ,&nbsp;Ismael López de Toro Martín Consuegra ,&nbsp;Luis Marina Martinez ,&nbsp;Javier Alvarez Fernandez ,&nbsp;María José Sánchez Carretero","doi":"10.1016/j.neucir.2023.11.001","DOIUrl":"https://doi.org/10.1016/j.neucir.2023.11.001","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the change in the characteristics of presentation, evolution and treatment in the ICU, as well as the functional evolution at 12 months of spontaneous intracranial hemorrhages (ICHs) treated in an ICU reference center.</p></div><div><h3>Patient and methods</h3><p>Descriptive, retrospective study in a Neurocritical Reference Hospital. All admissions of patients with HICE during 3<!--> <!-->periods are studied: 1999-2001 (I), 2015-2016 (II) and 2020-2021 (III). Evolution in the 3<!--> <!-->periods of demographic variables, baseline characteristics of the patients, clinical variables and characteristics of bleeding, evolutionary data in the ICU are studied. At one year we assessed the GOS scale (Glasgow Outcome Score) according to whether they had a poor (GOS 1-3) or good (GOS 4-5) prognosis.</p></div><div><h3>Results</h3><p>300 admitted patients, distributed in periods: I: 28.7%, II: 36.3% and III: 35%. 56.7% were males aged 66 (55.5-74) years; ICH score 2 (1-3). The ICU stay was 5 (2-14) days with a mortality of 36.8%. GOS 1-3 a year in 67.3% and GOS 4-5 in 32.7%. Comparing the 3<!--> <!-->periods, we observed a higher prevalence in women, and the presence of cardiovascular factors; no changes in etiology; in relation to the location, it increases cerebellar hemorrhage and in the brainstem. Although the severity was greater, the stay in the ICU, the use of invasive mechanical ventilation and tracheostomy were lower. Open surgery has decreased its use by 50%. Mortality continues to be high, stagnating in the ICU at 35% and entails a high degree of disability one year after assessment.</p></div><div><h3>Conclusions</h3><p>Severe ICH is a complex pathology that has changed some characteristics in the last 2<!--> <!-->decades, with more severe patients, with more cardiovascular history and a greater predominance of brainstem and cerebellar hemorrhage. Despite the increase in severity, better parameters during the ICU stay, with open surgery used 50% less. Mortality remains stagnant at 35% with high disability per year.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480593","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":"Microorbitotomía lateral como técnica de elección para el seudotumor orbitario en la ER-IgG4. Presentación de un caso y revisión de la literatura","authors":"Gema Bravo Garrido ,&nbsp;José María Narro Donate ,&nbsp;Gabriel María Valdenebro Cuadrado ,&nbsp;José Masegosa González","doi":"10.1016/j.neucir.2024.04.001","DOIUrl":"10.1016/j.neucir.2024.04.001","url":null,"abstract":"<div><p>Immunoglobulin G4-related disease (IgG4-RD) is characterized by a systemic fibroinflammatory infiltrate that often involves the orbit in addition to other tissues. Thus it has to be considered in the differential diagnosis of orbital tumors. We report the clinical case of a 64-year-old woman who presented with right mydriasis, progressive proptosis and paralysis of the third cranial nerve of 1 year of evolution. Cranial MRI identified an intraconal lesion of the right orbit, located between the external and inferior rectus muscles and the optic nerve, and she was scheduled for surgery by transcranial approach with lateral micro-orbitomy. A satisfactory macroscopic excision was achieved with no remarkable complications and a definitive deferred histological result of pseudotumor by IgG4-RD. Follow-up for 24 months showed no tumor recurrence, and the patient clinically improved from ophthalmoplejia. This case highlights the efficacy of lateral orbitotomy in the etiologic diagnosis and successful therapeutic outcome of complex orbital lesions associated with IgG4-RD pseudotumor.</p></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141396878","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}