Egyptian journal of neurosurgery最新文献

{"title":"Management of spontaneous pyogenic spondylodiscitis: a descriptive cohort study","authors":"Aly Ibrahim, Khaled Elshazly, Mohamed A. R. AbdelFatah, Abdelrahman El-Gayar, Sameh Hefny","doi":"10.1186/s41984-024-00299-0","DOIUrl":"https://doi.org/10.1186/s41984-024-00299-0","url":null,"abstract":"Spontaneous spondylodiscitis (SD) is an inflammation of the vertebral endplate and the intervertebral disc with no prior surgery or intervention. The treatment of spontaneous pyogenic SD mainly consists of systemic antibiotics and rest. Some cases require surgery due to failure of medical treatment or due to neurological compromise. Due to the disease heterogeneity, there are no standardized, widely adopted treatment protocols. We conducted this study to assess the clinical outcome of the different treatment modalities. This is a retrospective analysis of prospectively collected data of patients with spontaneous non-tuberculous spondylodiscitis. Thirty-eight patients were identified, including 14 males and 24 females. The mean age was 49 years. Twenty-three patients underwent surgery from the start while 15 patients received conservative medical treatment. Among the latter, 8 patients showed disease progression and required surgical intervention. The ODI/NDI at 1 year (mean = 8) was significantly better than before treatment (mean = 18). Among 11 patients with motor deficit at presentation, 8 improved and 3 remained stable. There were 14 complications, including 11 minor and 3 major, requiring one revision surgery. Surgical decompression and debridement with or without instrumented fusion for complicated SD cases is a safe and effective treatment modality. Close follow-up is needed in case of conservative treatment for early detection of treatment failure and disease progression. Baseline characteristic variabilities in patients with spontaneous pyogenic SD could predict conservative treatment failure, but this needs to be validated in larger series.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141252237","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":"Letter to the editor: additional considerations for giant pituitary adenoma resection strategy","authors":"Andrew B. Yang, Fraser C. Henderson","doi":"10.1186/s41984-024-00305-5","DOIUrl":"https://doi.org/10.1186/s41984-024-00305-5","url":null,"abstract":"<p>We read with interest the recently published retrospective cohort study “Giant invasive pituitary adenomas: surgical approach selection paradigm and its influence on the outcome—case series” by Dr. Saad, et al. highlighting the persistent role in the treatment algorithm for a transcranial approach for <i>giant</i> pituitary adenomas, as present frequently in our low-resource setting in rural Kenya. In our center, we have been learning firsthand the difficulties surrounding maximum safe resection of giant adenomas. We remain humbled by the reality of the challenges in decompressing the optic apparatus, minimizing tumor burden to prevent recurrence, preserving pituitary and hypothalamic functions, and stewarding patient resources in what can be a very expensive undertaking, even in charitable low- and middle-income country (LMIC) hospitals.</p><p>We are grateful to the authors for illustrating in the African setting the importance of including a transcranial approach in the treatment plan for many of these giant adenomas. Although the endonasal approach has become the widespread method of complete resection in many areas of the world over the past two decades, in sub-Saharan Africa, where pituitary adenomas are the second most common brain tumor, the endoscopic endonasal approach (EEA) was only adopted in our center about two years ago [1, 2]. EEA adoption in LMIC settings remains relatively lower in comparison with high-resource academic centers where the EEA continues to be refined to ever-higher heights of efficacy [2, 3].</p><p>We have come to better understand the reasons for this reticence in applying EEA to every pituitary adenoma. First, the learning curve for surgeons and assistants for the EEA can be steep, and adoption is more likely to occur at any given institution if that institution has staff who have been trained in the approach, to avoid postoperative complications like cerebrospinal fluid leaks and hypopituitarism [2,3,4]. Second, the capital resources required to purchase and maintain necessary endoscopic equipment and to train individuals on its use and handling are high [3]. Third is the fact that pituitary tumors tend to present later in their course in LMIC due to a variety of social and economic factors [5]. This means that tumors tend to be larger, of a firmer consistency, and more densely adherent to critical structures such as the Circle of Willis and the pituitary gland and hypothalamus by the time a neurosurgeon becomes involved. Fourth is the significant expense of MRI facilities and intraoperative navigation leading to a dearth of these capabilities in sub-Saharan Africa [6].</p><p>To illustrate one of our humbling experiences, we reference a recent case of a 50-year-old woman who presented to an eye clinic with 5 years of progressive bilateral visual deficits and was referred to our neurosurgery clinic. She arrived to us 11 months later with complete right eye blindness and the ability to count fingers up to 1 m a","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141168377","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":"Cerebellar liponeurocytoma: clinico-epidemiological, pathological, radiological, genetic, therapeutic and evolutionary characteristics—a review of the literature","authors":"Ahmed Jribi, Fatma Dhouib, Wicem Siala, Nejla Fourati, Jamel Daoud","doi":"10.1186/s41984-024-00304-6","DOIUrl":"https://doi.org/10.1186/s41984-024-00304-6","url":null,"abstract":"Cerebellar liponeurocytoma is a rare benign tumor of the central nervous system affecting adults and mainly the posterior fossa. Its positive diagnosis remains difficult due to its rarity and the presence of several differential diagnoses including medulloblastoma. The oncogenetic mechanism, the therapeutic modalities and results are still currently under study. Very few cases have been published in the literature. The aim of this review is to report, through the available data, all its various clinico-epidemiological, pathological, radiological, genetic, therapeutic and evolutionary features. In fact, this tumor is associated with a slow-growing character, appears in young adulthood with slight female predominance and is often manifested by intracranial hypertension symptoms. It is pathologically characterized by a focal component of lipomatous differentiation and a low proliferation index. It is usually presented in imaging by a well-limited mass with signal attenuation for fatty tissue and heterogeneous contrast. No mutation has been identified yet. The gold standard treatment of this tumor is maximal complete resection. The evolutionary profile is marked by frequent local recurrence. Radiotherapy could be discussed in case of recurrence, incomplete surgery, inoperable cases and cases with high proliferation index, and there is to date no proof of benefit for systemic treatment. Due to the numerous similarities of this entity with medulloblastoma, it should be always evoked face to any suspicion of medulloblastoma in adults in order to avoid a wrong overtreatment.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141168368","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 outcome of isolated benign peripheral nerve sheath tumors without neurofibromatosis","authors":"Mohammud Ahmud Salim, Hossam Elnoamany, Mohammed Adel Dorrah, Zahraa M. Mahdy, Ahmed Said Mansour","doi":"10.1186/s41984-024-00297-2","DOIUrl":"https://doi.org/10.1186/s41984-024-00297-2","url":null,"abstract":"Benign peripheral nerve sheath tumors (BPNSTs) include schwannomas and neurofibromas. About 10% of soft tissue sarcomas are malignant peripheral nerve sheath tumors (MPNSTs), which are invasive and aggressive tumors. These can happen occasionally or after radiation exposure. Up to 90% of schwannomas are made up of differentiated neoplastic Schwann cells. Malignant transformation of schwannomas is rare. We collected the medical records of all patients (including their family histories), performed comprehensive physical and neurological assessments, and checked for the presence of a Tinel-like sign, as well as screening for neurofibromatosis (NF) signs. Magnetic resonance imaging (MRI), nerve conduction studies, and ultrasound were done for all cases. We have operated on 21 patients with age range 29–52 years. The mean age was 39.4 years. 14 of these patients were females and 7 were males. The presenting symptoms were just swelling at nerve site in 14 patients, spontaneous pain at the nerve sites in 7 patients, and sensory deficit at the nerve distribution sites in 9 patients. The other 12 patients were sensory intact and only 7 patients had motor deficit. Postoperatively all patients had improved motor and sensory deficit and none of intact patients were worsened. Preoperatively we did MRI to show important nearby vascular structure anatomical abnormalities and we ordered nerve studies to all patients that showed abnormalities, which was only in 9 patients. Gross total resection was done in 18 patients and other 3 cases had partial resection to avoid sensory and motor deficits. The pathological analysis revealed 11 schwannomas and 10 neurofibromas. With 1 year follow up there was no recurrence in any patients. Benign pheripheral nerve sheath tumours are safely resected without increased sensory and motor deficits after surgery and with improve clinical outcome with no recurrence on follow up.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141168488","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 management of cervical intramedullary cavernoma: case report and systematic review of the literature","authors":"Yao Christian Hugues Dokponou, Moussa Elmi Saad, Fresnel Lutece Ontsi Obame, Napoleão Imbunhe, Salami Mohcine, Abad Cherif El Asri, Miloud Gazzaz","doi":"10.1186/s41984-024-00300-w","DOIUrl":"https://doi.org/10.1186/s41984-024-00300-w","url":null,"abstract":"Cavernous malformations can occur throughout the cerebral nervous system, most commonly located in the supratentorial compartment. The intramedullary location is rare and accounts for approximately 2.4% to 5% of all spinal vascular tumors. The cervical cord location and its clinical manifestations are underreported. The authors report a case of spinal cord compression at the C5–C6 level by a cervical intramedullary cavernoma with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines. Relevant studies (1980 to 2023) that reported patients with cervical intramedullary cavernoma were identified from PubMed databases. A total of 29 studies reporting 423 patients were included in this study with a mean age of 40.5 ± 6.3 years old. The overall male-to-female ratio was 1:2.5 with a median duration of follow-up of 46 months [18.5–63.9]. The type of resection as well as the patient’s outcome was also reported. Intramedullary cavernous angiomas are rare. Early surgical total resection of the symptomatic lesions in adequate conditions is crucial for good outcomes.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141168487","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":"Frailty concept in Africa neurosurgical practice: a prospective review","authors":"Kehinde Alare, Habiblah Jagunmolu, Esther Adewuyi, Taiwo Oluwafemi, Peter Olaniyi, Precious Amuzat","doi":"10.1186/s41984-024-00284-7","DOIUrl":"https://doi.org/10.1186/s41984-024-00284-7","url":null,"abstract":"Neurosurgical management of older patients is very complex and delicate; efforts are being made in identifying groups of older patients at risk of poor surgical outcomes before the surgery, making frailty an important concept in risk Identification and postoperative outcome assessment of older patients in the ever-changing neurosurgical world. It's of great importance for the concept of frailty to be adopted in Africa's neurosurgical practice in other to optimize the outcomes and improve the efficiency of neurosurgery in the older patients whose population is expanding, forming a great quota of people using neurosurgical services in Africa. This article looks into the importance and challenges of frailty studies in African neurosurgical practice which mainly are the longer length of time in carrying out such studies; reduces manpower, lack of availability of specialized equipment in standardizing the assessment, and others; makes recommendations on ways to ease its adoption such as funding frailty research and creation of population-specific frailty assessment tools among others.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140928266","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":"Ultrasound-assisted resection of insular gliomas","authors":"Patrick Murithi Kaberia, Ahmed Hafez Farhoud, Mahmoud Abbassy, Anwar Hamed Heikal, Ahmed AbdelAziz Fayed","doi":"10.1186/s41984-024-00290-9","DOIUrl":"https://doi.org/10.1186/s41984-024-00290-9","url":null,"abstract":"Insular gliomas’ management challenges are attributed to their complex shape, proximity to critical vasculature, and organization. However, cytoreductive surgery's role in maximal extent of resection (EOR) improves survival. Intraoperative ultrasound (IOUS) aids in defining tumor border, detecting residual, and guiding access. The aim of this study was to assess the impact of using intraoperative ultrasound on the extent of resection of insular gliomas, and the postoperative outcomes in a prospective cohort of 20 patients operated at Alexandria main university hospital and followed up for a period of at least 3 months. The Near total resection rate was 45% with 70% of patients having no neurological morbidity postoperatively. The median EOR was 81% with a range of 44 to 96%. The mean duration of IOUS setup was 19.6 ± 5.04 min, while the additional resection rate following IOUS assessment for residual tumor was 65% (n = 13). In addition, there was a significant increase in Karnofsky Performance Status (KPS) from the preoperative through to the 90-day follow-up period (p = 0.012). Finally, following multivariate linear regression analysis, the EOR was identified as having a statistically significant correlation with the postoperative KPS (p = 0.004). Intraoperative ultrasonography is a valuable modality for strategizing the most efficient route to the tumor, promptly detecting any remaining tumor tissue, and optimizing the extent of resection for insular gliomas, while taking into consideration the phenomenon of brain shift.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140883084","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":"Pathobiology of traumatic spinal cord injury: an overview","authors":"William A. Florez-Perdomo, Andrés Cardona-Cruz Guillermo, Ezequiel García-Ballestas, Abigail Castilla-Martínez, Yancarlos Ramos-Villegas, Loraine Quintana-Pájaro, Tariq Janjua, Amit Agrawal, Luis Rafael Moscote-Salazar","doi":"10.1186/s41984-024-00282-9","DOIUrl":"https://doi.org/10.1186/s41984-024-00282-9","url":null,"abstract":"Traumatic spinal cord injury (SCI) or traumatic myelopathy is a devastating neurological condition and a heavy burden on the health system. There are inflammatory and structural biomarkers with well-defined profiles, and useful for determining the management and prognosis of this pathology. Laboratory studies have shown some utility in confirming the existence of a spinal cord injury. Little knowledge about the molecular processes that occur after a SCI is evident, and it is well known that its understanding is dispensable to establish therapeutic targets that improve the outcomes for this type of patient. Many studies have explored the role of structural and inflammatory markers and some structural and inflammatory biomarkers. In the present article, we review the ongoing research in the field of spinal injury and possible role of biomarkers in the management of these patients.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837881","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":"Chiari type 1.5 malformation as a cause of secondary trigeminal neuralgia: case report and literature discussion","authors":"Ahmet Cemil Ergün, Bilal Ertuğrul, Gökhan Yildirim, Metin Kaplan","doi":"10.1186/s41984-024-00264-x","DOIUrl":"https://doi.org/10.1186/s41984-024-00264-x","url":null,"abstract":"Chiari syndrome is a very rare cause of secondary trigeminal neuralgia (TN). There are a few cases of TN associated with Chiari syndrome in the literature, and all of these cases were reported as Chiari type 1. In this report, we present a case of secondary trigeminal neuralgia caused by Chiari type 1.5 for the first time unlike the literature. A 38-year-old male patient, who had frequent and severe attacks of pain under the orbit, at the chin and rim of the mouth, was evaluated with craniocervical Magnetic Resonance Imaging (MRI) and revealed Chiari type 1.5 malformation and syringomyelia. The mechanism of TN associated with Chiari malformation is unclear. However, the main concepts emphasized in cases presented in the literature are compression and stretching. The rapid relief of pain after decompression surgery in these cases also supports this situation. It can be predicted that compression and tension forces will become more pronounced in Chiari type 1.5 malformation, in which the brainstem elongation and ventral pressure are more prominent. Decompression of the foramen magnum provides rapid and effective pain control in the treatment of TN accompanying Chiari 1.5 syndrome that does not respond to medical treatment.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837770","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":"Frontal ghost tumour: a case report","authors":"Mesi Mathew, Isaac Gundu, Afeez Ajibade Aruna, Samuel Isa Gana, Muhammad Raji Mahmud, Abdullahi Onimisi Jimoh","doi":"10.1186/s41984-024-00285-6","DOIUrl":"https://doi.org/10.1186/s41984-024-00285-6","url":null,"abstract":"Ghost tumors spontaneously disappear or decrease to less than 70% before definitive diagnosis and treatment (other than steroid treatment). We report our experience with a patient who had not received steroids, and the challenges of managing a ghost tumor from a developing country. A 71 year old female with frontal mass, right proptosis, and frontal headache. Mass was confirmed by cranial CT scan but entirely resolved while the patient was awaiting surgery. Further follow-up at 6 months revealed clinical and MRI evidence of recurrence. Ghost tumors are no myths and can recur! It is imperative to closely follow up with patients who have complete resolution of brain tumors prior to definitive treatment.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140615197","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}