Egyptian journal of neurosurgery最新文献

{"title":"Morphometric analysis of posterior cranial fossa and foramen magnum and it’s clinical implications in craniovertebral junction malformations: a computed tomography based institutional study in a tertiary care hospital of northern part of India","authors":"Vikrant Yadav, Ravi Shankar Prasad, Anurag Sahu, Manish Kumar Mishra, Ravi Shekhar Pradhan","doi":"10.1186/s41984-024-00277-6","DOIUrl":"https://doi.org/10.1186/s41984-024-00277-6","url":null,"abstract":"The posterior cranial fossa (PCF) and the foramen magnum (FM) are the critical anatomical components of the craniovertebral junction region, which comprise and transmit numerous vital neurovascular structures. So, a fundamental knowledge of the basic radiological anatomy of PCF and FM is of paramount importance in the evaluation of associated pathologies and approaching these areas surgically. The aim of this study is to describe different linear and angular craniometric parameters of PCF, FM and surrounding territory based on reconstructed computed tomography (CT) images. This study was conducted in our tertiary care hospital in northern India from the period of January 2023 to June 2023 on 120 patients, and CT screening was done for the head and spine region following a history of head injury. In this study, 120 patients were included, of whom 50.83% (n = 61) were females and 49.17% (n = 59) were males. Age ranged from 18 to 70 years with mean age of 43.5 ± 14.08 years. The mean values for linear craniometric parameters of PCF were statistically nonsignificant for different age groups. Statistically significant differences were found for twinning line (TL) (p < 0.0001), McRae’s line (< 0.0001), clivus length (< p < 0.0001), internal occipital protuberence -opisthion line (p = 0.01), Klaus’ index (p < 0.0001), height of posterior fossa (h) (p < 0.0001), h/TL (p = 0.028), when these values were compared for the genders. The measurements of FM transverse diameter, anteroposterior diameter and area were 27.12 ± 1.42 mm (range 23.6–30.1 mm), 30.99 ± 2.23 mm (range 27.6–35.8 mm) and 691.32 ± 30.35 mm2 (range 632.7–777.7 mm2). The values of clivus canal angle (p = 0.038) and clivoodontoid angle (p = 0.012) were statistically significant when compared for different age groups. The values of Boogard’s angle (p = 0.021) and tentorial slope (p = 0.031) were statistically significant when these were compared for the genders. This study described almost all the linear and angular craniometric parameters used in the morphometric analysis of PCF and FM. The findings of this study provide valuable data regarding linear and angular craniometric parameters of PCF and FM which can redefine reference values.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139977760","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":"PICA flow-related aneurysms and posterior fossa AVM: rare association and challenging management: case presentation and review of literature","authors":"Dognon Kossi François de Paule Adjiou, Salma Abbas, Oumaima Benali, Baba Alhaji Bin Alhassan, Othmane El Manouni, Meryem Kajeou, Abdessamad El Ouahabi","doi":"10.1186/s41984-024-00274-9","DOIUrl":"https://doi.org/10.1186/s41984-024-00274-9","url":null,"abstract":"The association of an infratentorial arteriovenous malformations (AVMs) with a PICA aneurysm is very rare and the presence of associated aneurysms was an independent predictive factor of poor outcome at follow-up for posterior fossa AVMs (pfAVMs). We report the case of a 57-year-old female patient admitted to our institution with a challenging management of a pfAVM associated with multiple flow-related aneurysms of the PICA. A 57-year-old patient with no medical past history was admitted to our emergency department with a sudden onset headache and severe neck stiffness. A cerebral CT Scan showed a cerebellar hematoma. Digital subtraction angiography demonstrates a right paramedian supero-posterior infratentorial AVM located at the posterosuperior part of the right cerebellar hemisphere with a small compact nidus supplied by branches of the right PICA and the right superior cerebellar artery. Venous drainage being toward the torcular. The AVM is associated with 3 flow-related aneurysms. We opted for surgical treatment of the 2 high-flow aneurysms on the distal branch of the right PICA. Patient was then sent for radiosurgery for the AVM. We opted for observation of the left small aneurysm. Microsurgery for PICA aneurysms is particularly well suited because exposure through a far-lateral craniotomy is excellent. Endovascular embolization can be used to occlude the aneurysm as well as treat the AVM at the same time in certain circumstances. Clipping or coiling the aneurysm should be discussed in a multidisciplinary meeting.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139977913","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":"Patterns and management outcomes of intracranial extra-axial hematomas in low-resource setup: a 6-month prospective observational study at Jimma University Medical Center, Ethiopia","authors":"Nebiyou Simegnew Bayleyegn, Mohammed Abafita, Addis Temie Worku, Minale Fekadie Baye","doi":"10.1186/s41984-024-00272-x","DOIUrl":"https://doi.org/10.1186/s41984-024-00272-x","url":null,"abstract":"Intracranial hematoma is the collection of blood in various intracranial spaces. Knowledge of patterns, origins, causes and outcomes of ICH conditions is important for decision-making for urgent surgical interventions such as craniotomy and hematoma evacuations. No prior study was conducted in our setup. Hence, this study aimed to assess the patterns and management outcomes of intracranial hematomas in low-resource setting and tailored our management approach at Jimma University Medical center. An institution-based prospective observational study was conducted at Jimma University Medical Center, Ethiopia, for six consecutive months from June to December 2020. Different data sources and interview methods were used and analyzed using SPSS version 24. A bivariate and multivariate logistic regression was conducted to determine the association between the variables. A total of 91 eligible patients were recruited during the study period, with a mean age of 34 years. The majority of patients were males [73 (80.2%)] and more common in reproductive age groups (62.6%), from rural areas (50.5%). About 93.4% of patients reported a history of trauma, and road traffic accidents & fighting account for 63.8% of the trauma cases. Sixty-five percent of patients arrive in the hospital within 24 h. Upon presentation, there were loss of consciousness (48.4%), convulsion (11%), aspiration (9.9%) and increased ICP (12%). The majority (49.5%) of the patients had a mild head injury. The focal neurologic deficits were hemiparesis (29.7%) and hemiplegia (5.5%). Acute epidural hematoma (68.1%) was a common finding, followed by sub-acute subdural hematoma. Of the total study participants, 11% had died. All the surviving patients were accessed at 30 days after discharge and re-assessed, 66 patients had good neurologic recovery (62 upper and 4 lower good recovery), 11 patients had moderate disability (7 lower and 4 upper-moderate disabilities), two patients had a severe disability, and two patients (among those with severe disability) had died. Trauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139951434","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 treatment of cavernous sinus meningioma with petrous bone invasion causing internal auditory canal stenosis and hearing impairment 7 years after gamma-knife radiosurgery","authors":"Yasuhiro Mukai, Takashi Sugawara, Yukika Arai, Taketoshi Maehara","doi":"10.1186/s41984-024-00275-8","DOIUrl":"https://doi.org/10.1186/s41984-024-00275-8","url":null,"abstract":"Surgical intervention for cavernous sinus meningiomas remains challenging because of their anatomically complicated location. We report a case of a cavernous sinus meningioma that enlarged and caused hearing impairment due to internal auditory canal stenosis 7 years after gamma-knife radiosurgery. A 38-year-old man with abducent nerve paralysis and dysesthesia on the left side of the face was diagnosed with a cavernous sinus meningioma with thickened petrous bone. After a year, the patient had mild left-sided hearing impairment, and gamma-knife radiosurgery was performed. At the age of 46, the left hearing impairment worsened, the tumor was slightly enlarged, and petrous bone thickening in the internal auditory meatus had progressed. We partially resected the tumor, which seemed to be viable, and removed the thickened petrosal bone and opened the internal auditory meatus. The tumor was pathologically diagnosed as meningothelial meningioma. The patient’s hearing impairment did not progress, and the residual tumor had not grown for four years. Removal of the viable tumor that progressed after gamma-knife radiosurgery and opening of the internal auditory meatus were effective in stopping the worsening of hearing impairment and controlling the tumor.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139951439","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":"Benign extradural haemorrhage: scope of conservative trial","authors":"Sajad Hussain Arif, Kaiser Kareim, Mohsin Fayaz, Sarabjit Singh Chibber","doi":"10.1186/s41984-024-00267-8","DOIUrl":"https://doi.org/10.1186/s41984-024-00267-8","url":null,"abstract":"Epidural hematomas have been treated with urgent surgical evacuation to prevent catastrophic neurological sequelae and death. Brain Trauma Foundation recommends EDH volume greater than 30 cm3 and warrants surgical evacuation irrespective of GCS. However, due to increase in number of patients undergoing brain CTs following head injuries, more patients have been detected with EDH causing minimal symptoms. To study factors influencing patients being treated conservatively for head injury with supratentorial epidural hematomas. Our study is a retrospective analysis of supratentorial epidural hematoma treated conservatively from august 2018 to July 2020 at Sher-i-Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir. A total of 19 patients with EDH were treated conservatively and fulfilled the inclusion criteria.(GCS of 13–15 with no neurological deficit, mild signs of elevated ICP, EDH thickness < 1.5 cm on CT, EDH volume on CT < 30 ml, midline shift on CT less than or equal to 5 mm with no significant intradural pathology)Age ranged from 2 months to 70 years (average 27.15 yrs)males (89.47%) predominated females (10.53%). Motor vehicular accidents were the most common mode of injury (42.1%). EDH was localised 13 times on right side, 5 times on left side and bilateral in one, supratentorially. A midline shift of 5 mm was found in 3 of 19 patients; GCS was > 13 on admission. 8 patients were hospitalised for a week, whilst 2 patients stayed in the hospital for 20 and 25 days, respectively, due to problems not related to EDH. One patient in whom conservative treatment had to be changed to surgical evacuation after 6 days of observation because of worsening headache, impaired alertness repeated imaging showed slight increase in EDH. EDH can be managed conservatively in carefully selected patients of minor head injury with radiological surveillance and close neurological monitoring. Patients with GCS on admission more than 13, midline shift of less than 5 mm, location and volume of EDH less than 30 ml. Thus, leading to optimal utilisation of hospital resources. So, we conclude that even a dreaded entity like extradural haemorrhage can be managed conservatively in selected cases with strict clinical and radiological surveillance. We have called them ‘’Benign extradural haemorrhages’’.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139769667","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":"The effect of early rehabilitation after lumbar spine surgery: a systematic review and meta-analysis","authors":"Fatih Özden, Güldane Zehra Koçyiğit","doi":"10.1186/s41984-024-00270-z","DOIUrl":"https://doi.org/10.1186/s41984-024-00270-z","url":null,"abstract":"Evidence-based data are required to provide insightful information on the timing of rehabilitation after lumbar spine surgery (LSS). The aim of this study is to systematically review the outcomes of early rehabilitation interventions and conduct its meta-analysis in patients after LSS. A total of 1183 articles were retrieved through PubMed (n = 793), Web of Science (n = 721), Scopus (n = 335), and ScienceDirect (n = 83) databases. Fourteen studies were included in the systematic review. The quality analysis and risk of bias assessment of the trials included in the systematic review were performed using the Physiotherapy Evidence Database (PEDro) scoring and classification system. Narrative synthesis and standardized mean difference based pooling results were given for the systematic review and meta-analysis, respectively. The additional benefit of early rehabilitation on physical function was moderately effective (ES: − 0.62, 95% CI − 1.00; − 0.25) at the 1-month follow-up. In terms of pain, early rehabilitation provided additional improvement at 1 month (ES: 0.34, 95% CI − 0.03; 0.71), 3 months (ES: − 0.14, 95% CI − 0.37; 0.10), 6 months (ES: 0.35, 95% CI 0.04; 0.65) and 1 year (ES: 0.21, 95% CI − 0.09; 0.52) follow-up at a low level of evidence. This systematic review demonstrated that early rehabilitation mainly improved disability in the early period (1-month follow-up). Regarding pain, short-term (1 month) and mid-term (6 months) follow-ups showed the most significant additional benefit. The positive effects of starting rehabilitation early after surgery on pain may have positively affected disability, specifically in the early period (1 month).","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139769743","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":"Challenges facing level I evidence in treatment of low-grade gliomas and subsequent uncertainties","authors":"Peter Fawzy, Tiffany Karpin","doi":"10.1186/s41984-024-00271-y","DOIUrl":"https://doi.org/10.1186/s41984-024-00271-y","url":null,"abstract":"The current era of molecular characterisation has contributed greatly to our understanding and management of low-grade gliomas (LGGs); however, this has also contributed to a paucity in level 1 evidence. Diagnostic breakthroughs in LGGs are moving quicker than our experimental capacity can react. The design, analysis, and clinical application of first-level evidence are struggling to compete with the considerable variability in the natural course of LGGs and the rapidly evolving utility of molecular characterisation of tumours. This poses several uncertainties to researchers, clinicians, and more importantly, patients. Individualised case-by-case decisions based on best available evidence, albeit lacking level 1 evidence, must be made by considering the tumour behaviour, clinical course, and specific patient needs and goals.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139769589","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":"Fibrous dysplasia of sphenoid wing with secondary aneurysmal bone cyst: a rare case report","authors":"Krishan Kumar Vashisth, Kaif Mohammad, Prevesh Kumar Sharma, Deepak Kumar Singh, Vineet Kumar Mishra, Praveenkumar Nagendra Sangolli","doi":"10.1186/s41984-024-00265-w","DOIUrl":"https://doi.org/10.1186/s41984-024-00265-w","url":null,"abstract":"An aneurysmal bone cyst is a locally destructive benign lesion affecting mostly the long bones. Aneurysmal bone cyst of the skull bones is a very rare phenomenon and the involvement of the sphenoid bone of the skull with extension into the orbit is even rarer. We present a case of 15-year-old adolescent with fibrous dysplasia of the sphenoid wing with secondary aneurysmal bone cyst. A 15-year-old male presented to us with chief complaints of headache with swelling in the left temporal region of the face and proptosis of the left eye associated with decreased vision for the past 2 months. NCCT showed a large heterogeneous mass in the left temporal region extending into left orbit. Gadolinium-enhanced MRI showed a well-defined multiloculated osteo-expansile lesion in the left middle cranial fossa extending into the anterior cranial fossa consistent with the fibrous dysplasia of the sphenoid bone with associated aneurysmal bone cyst. Digital subtraction angiography brain to look for any feeders to the lesion was done followed by microsurgical gross total excision of the tumor. The histopathology report confirmed it to be fibrous dysplasia secondary to aneurysmal bone cyst. Aneurysmal bone cyst is a rare entity, commonly affecting the long bones of the body. The involvement of sphenoid wing of skull is very rare occurrence. It can be primary or secondary to fibrous dysplasia, chondroblastoma, giant cell tumor, fibromyomas, etc. Fibrous dysplasia with secondary aneurysmal bone cyst should be kept in mind as one of the differential diagnoses while dealing with osteolytic bone lesions of skull.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139769622","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 operable intracranial lesions from mild traumatic brain injury in a National Trauma Centre","authors":"Selekeowei Peter Kespi Kpuduwei, Ayodeji Salman Yusuf","doi":"10.1186/s41984-024-00268-7","DOIUrl":"https://doi.org/10.1186/s41984-024-00268-7","url":null,"abstract":"Mild traumatic brain injury (TBI) occupies majority of head traumas in most emergency units. Although patients with mild TBI can be reviewed and discharged on head injury advice, a sizeable number require admission for observation or intervention due to operable intracranial lesions. The aim of the study was to establish the prevalence of operable lesions in patients with mild TBI. This was a prospective study of consecutive adult patients with mild TBI who had cranial computerized tomography (CT) done at the National Trauma Centre, Abuja. All participants gave informed consent and the study had ethical clearance in the Hospital. One hundred and three mild TBI patients with cranial CTs were recruited aged 16–76 years with mean age of 32.25 $$pm$$ 12.35 years. With intention to treat, twenty (20.4%) of them were diagnosed with operable intracranial lesions on CT scans, 19 males and 2 females. Majority of them (14; 66.7%) were young adults within 20–40 years of age. The lesions were 16 extradural haematomas (76.2%), 3 subdural haematomas (14.3%) and 2 depressed skull fractures (9.5%) of the operable cohort. Significant number of patients with mild TBI had operable intracranial lesions. Therefore, there is need to screen patients with mild TBI appropriately in order to avoid missed operable lesions.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139663142","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":"Subependymal giant cell astrocytoma as presentation of tuberous sclerosis: a case report","authors":"P. S. Jayalakshmy, Aswathy Mohanachandran Pillai, Reshmi Rajan","doi":"10.1186/s41984-024-00263-y","DOIUrl":"https://doi.org/10.1186/s41984-024-00263-y","url":null,"abstract":"A case of tuberous sclerosis patient on long-term follow-up is reported here. A 22-year-old female patient with epilepsy was diagnosed with tuberous sclerosis at the age of 12 years. At that time, a small subependymal giant cell astrocytoma has been detected along with the other signs of the disease. But the patient was not symptomatic of the intracranial lesion at that time. So, she was kept under follow-up with treatment for the epilepsy. Within 10 years, the lesion gradually enlarged and caused symptoms and the tumour had to be resected at the age of 22 years of age. Subependymal giant cell astrocytoma is very slow-growing low-grade tumour. If small and asymptomatic at the time of the initial diagnosis, resection is not advised. The patient should be kept under close follow-up.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139588031","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}