Neurocirugia (English Edition)最新文献

{"title":"Chylous fistula during anterior cervical microdiscectomy: Case report and literature review","authors":"Pelayo Hevia-Rodríguez,&nbsp;Laura Panés Laglera,&nbsp;Irati de Goñi García,&nbsp;Fernando Iturbe-Sarmiento,&nbsp;Nicolás Samprón","doi":"10.1016/j.neucie.2025.500736","DOIUrl":"10.1016/j.neucie.2025.500736","url":null,"abstract":"<div><div>The anterior approach to the cervical spine is a widely used technique in spinal surgery. Although its most common complications involve vascular, neural, or digestive structures, there is also the potential for injury to lymphatic vessels, which can lead to serious complications if not promptly diagnosed and treated. We present the case of a 70-year-old woman with a history of lumbar arthrodesis and a C5-C6 cervical prosthesis, who underwent an anterior microdiscectomy at C7-T1 via a right-sided approach. During dissection, a dense whitish fluid compatible with chyle was observed, indicating injury to a lymphatic vessel. Ligation with suture was performed and a prevertebral drain was placed. In the postoperative period, the patient developed a mild hematoma in the acromioclavicular region, without cervical collections. The drain was removed after four days of total fasting, followed by the introduction of a low-fat diet. The patient was discharged without complications. After five years of follow-up, no associated complications have been observed. Chyle fistula following anterior cervical discectomy is a rare complication (0.02%) and should be suspected in the presence of milky fluid in the surgical wound, drainage, and/or progressive accumulation. Early diagnosis and appropriate treatment are essential to prevent more severe outcomes. The risk is higher in left-sided approaches near C6 and low right-sided approaches (C7-T1), particularly in the presence of anatomical variants.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 1","pages":"Article 500736"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703057","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":"Global neurosurgery training. Part 1: Skills and challenges for equity","authors":"María J. García-Rubio ,&nbsp;Jose Piquer-Martínez ,&nbsp;Jose Piquer-Belloch ,&nbsp;Ruben Rodríguez-Mena","doi":"10.1016/j.neucie.2025.500702","DOIUrl":"10.1016/j.neucie.2025.500702","url":null,"abstract":"<div><div>Neurosurgery requires rigorous training, yet access remains limited in low-resource countries, particularly in Africa, creating a crisis in specialised care.</div><div>This paper, grounded in the principles of global neurosurgery, examines the essential competencies required in neurosurgical training, distinguishing between clinical skills—such as technical proficiency and decision-making—and non-clinical skills, including leadership, emotional management, and communication. Deliberate practice is emphasised as a key methodology for improving skill acquisition through structured repetition, continuous feedback, and expert supervision.</div><div>Additionally, the main challenges of specialisation in East Africa are analysed: inadequate infrastructure, overburdened health systems, limited and heterogeneous residency programmes, and a shortage of qualified mentors. Finally, the development of innovative educational strategies is proposed to enhance training in resource-constrained settings and contribute to the sustainable advancement of the specialty.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 1","pages":"Article 500702"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762617","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":"Giant Intrabdominal Meningocele in a Patient with Marfan Syndrome: Case Description and Surgical Management","authors":"Jorge Cabrera-Montes ,&nbsp;Ricardo Díez-Valle","doi":"10.1016/j.neucie.2025.500713","DOIUrl":"10.1016/j.neucie.2025.500713","url":null,"abstract":"<div><div>Anterior sacral meningocele is a rare complication associated with Marfan syndrome. There is no consensus regarding management and surgical treatment. Here, we describe the case of a 44-year-old women with Marfan syndrome who presented a progressive abdominal mass with gastrointestinal and urinary symptoms. Abdominopelvic MRI revealed a 3<!--> <!-->cm S1 dural ectasia and a 19x17x15<!--> <!-->cm abdominal mass. A posterior sacral transdural approach was performed. Dural friability made ligation unfeasible. Obliteration with a fat flap and fibrin sealant was the treatment alternative. Postoperative MRI imaging performed 4 months after surgery evidenced complete resolution of the intrabdominal collection. The patient remains free of symptoms 2 years later. Here we present one of the largest meningoceles reported to date in the literature, and illustrate the surgical management in a patient with Marfan syndrome, where technical difficulties arose. Solely posterior sacral transdural approach with fat graft may be sufficient for the treatment of these patients even with voluminous pelvic meningoceles.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 1","pages":"Article 500713"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755296","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":"Impact of arteriovenous malformations in the precentral and postcentral gyri on intracranial volumes","authors":"Abdulkerim Goköğlu ,&nbsp;Hüseyin Yiğit ,&nbsp;Tolga Turan Dündar ,&nbsp;Erdoğan Unur ,&nbsp;Ahmet Selçuklu","doi":"10.1016/j.neucie.2025.500705","DOIUrl":"10.1016/j.neucie.2025.500705","url":null,"abstract":"<div><h3>Objective</h3><div>Arteriovenous malformations are known as arterial-venous shunts that connect nidus, the nourishing arteries, to draining veins. Although they are not very common in the brain, they are responsible for approximately 2% of all strokes. The volumetric changes in the surrounding brain tissues caused by cerebral arteriovenous malformations have not yet been reported.</div></div><div><h3>Methods</h3><div>To detect these volumetric changes, MR data were acquired from 38 controls and 25 unoperated patients with arteriovenous malformations in the precentral and postcentral gyrus. MR data were analyzed with vol2Brain, Ceres and HIPS pipelines. The niduses of these patients were resected by transsulcal microsurgical dissection.</div></div><div><h3>Results</h3><div>A comprehensive volumetric analysis encompassing 135 distinct brain, cerebellar, and hippocampal structures was conducted using the Vol2brain software. Comparison between the patient group and the control group revealed significant volumetric differences. Specifically, the patient group exhibited significantly larger volumes in the nucleus accumbens, fusiform gyrus, middle occipital gyrus, anterior insula, inferior lateral ventricle, and the gray matter of cerebellar lobules VIIIA and VIIIB compared with the control group. Conversely, relative to the control group, the patient group demonstrated significantly smaller volumes in the gray matter of cerebellar lobules IV, I-II, and III, as well as in the hippocampal subfields of CA2-CA3, SR-SL-SM, and the subiculum.</div></div><div><h3>Conclusion</h3><div>Arteriovenous malformations occurring in the precentral and postcentral gyrus lead to volumetric changes in structures distant from the site of the malformation, including the brain, hippocampus, and even the cerebellum. Therefore, AVMs may influence the volumes of structures located not only within their immediate brain region but also in other parts of the cerebrum and cerebellum. Understanding these volumetric changes can aid in explaining patient symptoms. However, further research is required regarding whether these volumetric changes result from the mass effect of the nidus or stem from another underlying cause.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 1","pages":"Article 500705"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303897","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":"Transcranial Microsurgery as a Salvage Strategy in Giant Pituitary Adenomas: A Single-Center Experience and Long-Term Follow-up Results","authors":"Oguz Altunyuva,&nbsp;Ali Imran Ozmarasali,&nbsp;Nur Balcin,&nbsp;Hanside Setenay Unal,&nbsp;Selcuk Yilmazlar","doi":"10.1016/j.neucie.2025.500699","DOIUrl":"10.1016/j.neucie.2025.500699","url":null,"abstract":"<div><h3>Introduction</h3><div>Endoscopic transsphenoidal surgery<span> (ETSS) is the preferred approach for most pituitary adenomas<span>. However, transcranial microsurgery<span> remains relevant for giant adenomas<span> with complex features. This study presents long-term outcomes and complications in a single-surgeon series of patients with giant pituitary adenomas who underwent transcranial resection.</span></span></span></span></div></div><div><h3>Material and methods</h3><div>This retrospective study analyzed 29 patients with giant pituitary adenomas (≥4 cm) who underwent transcranial surgery between 2009 and 2018 at Bursa Uludağ University Faculty of Medicine. Inclusion criteria were: a minimum tumor diameter of 4 cm, histologically confirmed pituitary adenoma, tumor resection via a transcranial approach, regular postoperative follow-up, and a minimum follow-up of 60 months. Data collected included patient demographics, clinical presentation, tumor characteristics, surgical details, extent of resection, and long-term outcomes (minimum 60 months follow-up).</div></div><div><h3>Results</h3><div>The mean patient age was 48.17 ± 12.92 years. Vision loss<span> was the most common presenting symptom (n = 20). Gross total resection (GTR) was achieved in 51.7% (n = 15) and subtotal resection (STR) in 48.3% (n = 14). Postoperative improvement in visual function was observed in 48.3% (n = 14), while 20.7% (n = 6) experienced deterioration. Endocrinological remission occurred in 20.7% (n = 6). Complications included diabetes insipidus (24.13%, n = 7), cerebrovascular events (10.34%, n = 3), and mortality (17.24%, n = 5).</span></div></div><div><h3>Conclusions</h3><div>Transcranial surgery for giant pituitary adenomas can achieve favorable outcomes in terms of tumor control and visual function improvement. However, it is associated with a risk of complications, including endocrinological and cerebrovascular events. Careful patient selection, meticulous surgical technique, and close postoperative monitoring are essential for optimizing outcomes. Transcranial microsurgery remains an important tool in the armamentarium of neurosurgeons managing complex giant pituitary adenomas.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500699"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227792","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":"Contralateral subdural effusion following decompressive hinged craniotomy: A case report and narrative review","authors":"Artem Kuptsov ,&nbsp;Alessandra Rocca ,&nbsp;Cristina Gómez-Revuelta ,&nbsp;Ana Flores-Justa ,&nbsp;J. Fernández-Villa ,&nbsp;J.A. Nieto-Navarro","doi":"10.1016/j.neucie.2025.500660","DOIUrl":"10.1016/j.neucie.2025.500660","url":null,"abstract":"<div><div><span>Hinged craniotomy (HC) is an alternative surgical technique that can be used in place of </span>decompressive craniectomy<span><span><span> (DC) to treat refractory intracranial hypertension. This procedure has the advantage of avoiding the need for a second surgery to replace the bone, while giving a good control of </span>intracranial pressure<span>. However, there is no consistent literature about complications of HC. In particular, there are no reported cases of contralateral </span></span>subdural effusion<span> (CSE) after HC. In this article we present a case of a 55-years-old man who developed CSE after a hinged craniotomy (HC) for intracranial hypertension, and how we handled it. Therefore, we explored literature to better understand the pathogenesis of CSE, treatments and possible prevention strategies.</span></span></div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500660"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639931","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":"Is there such a thing as black disc disease?","authors":"Giancarlo Mattos Piaggio,&nbsp;Esteban Quevedo Orrego,&nbsp;Emilio González Martínez,&nbsp;Javier Ibañez Plágaro,&nbsp;José García-Cosamalón","doi":"10.1016/j.neucie.2025.500673","DOIUrl":"10.1016/j.neucie.2025.500673","url":null,"abstract":"<div><div>The study of degenerative pathology of the intervertebral disc (IVD) with magnetic resonance imaging (MRI) has generated such an extensive and ambiguous terminology that it causes confusion. The loss of the nucleus pulposus signal intensity (ISNP) in the T2 sequence of MRI, secondary to the early decrease in water content, is generally described as “black disc”, a term spread as a synonym for degenerative disc disease. On the other hand, to designate a supposedly symptomatic dehydrated disc, the following names have been introduced: “painful black disc”, “black disc syndrome” and “black disc disease”. In this way, the physiological dehydration of the NP present in the entire population from the third decade on, is arbitrarily considered a presumed radiological marker of discogenic back pain, with the consequent risk of being the target of unnecessary interventions. Dehydrated discs suspected of being a source of pain present, in addition to the decrease in ISNP, other radiological signs such as a high intensity zone (HIZ) in the posterior part of the annulus fibrosus (AF), protrusion, loss of height or Modic changes.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500673"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562217","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":"Image control after aneurysm clipping: Is 3D computed tomogram angiography enough?","authors":"Sebastián Menéndez-Girón,&nbsp;Antonio González-Crespo,&nbsp;Alberto Blanco Ibáñez de Opacua,&nbsp;Roser García-Armengol,&nbsp;Carlos J. Dominguez,&nbsp;Ana Rodríguez-Hernández","doi":"10.1016/j.neucie.2025.500677","DOIUrl":"10.1016/j.neucie.2025.500677","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral digital subtraction angiography<span> (DSA) remains the gold standard for the control of aneurysmal remnants after surgical clipping. Despite being associated with minimal risks, it is an invasive procedure far from being iatrogenia free. Furthermore, it has limited availability which may prolong patient’s postoperative stay. On the other hand, the image quality of computed tomography angiography (CTA) has improved significantly over the past decades providing a valuable alternative to DSA. The objective of this study was to compare the capacity of CTA and DSA to detect clinically significant aneurysmal remnants.</span></div></div><div><h3>Methods</h3><div>From a prospective series of surgically treated aneurysms, those with postoperative CTA and DSA were retrospectively included in the study. A three-dimensional reconstruction of the CTA was performed using the Brainlab Elements software and the results were compared with those of the DSA. In addition, variables that could affect the three-dimensional reconstruction were collected, such as the number of clips per aneurysm and previous clipping or embolization. In case of an aneurysm remnant, its size was also recorded.</div></div><div><h3>Results</h3><div>Between January 2020 and January 2022, a total of 42 patients in whom 52 aneurysms were clipped (8 of them ruptured) were included. CTA presented a sensitivity of 50% and a specificity of 97% in the detection of aneurysmal remnants. The cases in which CTA did not detect the aneurysmal remnant were previously embolized aneurysms or complex aneurysms that required neck reconstruction with 3 or more clips. None of the remnants undetected by CTA were significant enough to warrant retreatment of the aneurysm.</div></div><div><h3>Conclusions</h3><div>Excluding complex aneurysms (previously embolized or requiring surgical reconstruction with 3 or more clips), three-dimensional reconstructions of CTA images showed excellent results in detecting clinically significant postoperative aneurysm remnants and may obviate the need for a the more invasive and less available DSA.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500677"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082609","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":"Influence of the magnitude and orientation of forces on the odontoid fracture: A finite element model analyses","authors":"Pedro Miguel González-Vargas ,&nbsp;Jorge Caramés ,&nbsp;Antonio Riveiro ,&nbsp;José Luis Thenier-Villa ,&nbsp;Cesáreo Conde ,&nbsp;Juan Pou","doi":"10.1016/j.neucie.2025.500675","DOIUrl":"10.1016/j.neucie.2025.500675","url":null,"abstract":"<div><h3>Background</h3><div>Fractures of the odontoid, prevalent among the elderly but affecting diverse demographics, pose significant risks ranging from mild discomfort to severe disability or fatality. These fractures, often stemming from trauma<span><span>, are particularly frequent in the cervical spine. While commonly attributed to high-impact events like </span>traffic accidents in adults, even low-energy incidents such as falls can precipitate these fractures in the elderly.</span></div><div>Previous studies have explored loading conditions and treatment effects; however, a comprehensive investigation into the influence of the magnitude and direction of the force involved in the trauma, and the influence of the sex and age of the patient remains scarce so we want to delve deeper into this topic.</div></div><div><h3>Methods</h3><div><span>This study uses a finite element (FE) model to analyze the response of 3D models of the second cervical vertebra (extracted from </span>computed tomography images) exposed to different loads of magnitude and force. 52 patients were analyzed in this study.</div><div>The patients were divided into 4 groups: male &lt;70, female &lt;70, male &gt;70, female &gt;70) under different force conditions.</div><div><span>Von Mises stress values were obtained when loads of 200 N and 1500 N were applied to the anterior surface of the odontoid with different angles of incidence in the sagittal and </span>axial plane.</div></div><div><h3>Results</h3><div>Odontoid fractures in subjects over 70 years of age are more frequent in female, the maximum stresses produced in the odontoid are 181 MPa and are considerably higher compared to male, which is 131 MPa. In young subjects (&lt;70 years), the differences between sex are less marked, 113 MPa for female and 114 MPa for male.</div></div><div><h3>Conclusions</h3><div>Load direction is one of the main factors affecting odontoid fracture, especially in subjects &gt;70 years of age; by understanding this, the mechanisms that cause different types of fractures can be understood and better strategies can be proposed to apply different treatment approaches to them, both from a medical and surgical point of view.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500675"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082611","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":"Langerhans cells histiocytosis with invasion into the brain parenchyma: A rare presentation","authors":"Claudio Sebastián Iglesias Vargas ,&nbsp;Tomas Quinzacara Aravena ,&nbsp;Ingrid Trujillo Ramos ,&nbsp;Sebastián Vigueras Alvares","doi":"10.1016/j.neucie.2025.500676","DOIUrl":"10.1016/j.neucie.2025.500676","url":null,"abstract":"<div><div>This case presents an unusual case of Langerhans cell histiocytosis with invasion into the brain parenchyma, a rare phenomenon documented in few cases worldwide. The relevance of this case lies in the contribution to the knowledge of this pathology in the paediatric neuro-oncologic context.</div><div>An 11-year-old boy presented with increased volume in the left frontal region, without neurological deficit or systemic symptoms. CT and MRI revealed an aggressive osteolytic lesion with perilesional oedema and intracranial extension.</div><div>Complete excision of the lesion was performed, confirming Langerhans cell histiocytosis by immunohistochemistry. Chemotherapy was started with good tolerance and no complications so far.</div><div>This case highlights the need for timely diagnosis and treatment in cases of Langerhans cell histiocytosis with brain involvement, given its potential impact on prognosis and the scarcity of specific guidelines for this type of manifestations.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500676"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786138","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}