Asian Journal of Neurosurgery最新文献

{"title":"Mature Teratoma with Somatic-Type Malignancy: An Entity of Unacquaintance-A Case Report.","authors":"Batuk Diyora,&nbsp;Kavin Devani,&nbsp;Sridhar Epari,&nbsp;Gauri Deshpande,&nbsp;Anup Purandare,&nbsp;Ravi Wankhade","doi":"10.1055/s-0043-1768603","DOIUrl":"https://doi.org/10.1055/s-0043-1768603","url":null,"abstract":"<p><p>Primary intracranial teratomas are nongerminomatous germ cell tumors. They are infrequent lesions along the craniospinal axis, with their malignant transformation extremely uncommon. A 50-year-old-male patient presented with one episode of generalized tonic-clonic seizure (GTCS), without any neurological deficit. Radiological imaging revealed a large lesion in the pineal region. He underwent gross total excision of the lesion. Histopathological examination was representative of teratoma with adenocarcinomatous malignant transformation. He underwent adjuvant radiation therapy and had an excellent clinical outcome. The present case highlights the rarity of malignant transformation of the primary intracranial mature teratoma.</p>","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/86/10-1055-s-0043-1768603.PMC10313429.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10121810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hundred Pediatric Cases Treated for Chiari Type II Malformation with Hydrocephalus and Myelomeningocele.","authors":"Daniel Encarnacion,&nbsp;Gennady Chmutin,&nbsp;Bipin Chaurasia,&nbsp;Ismail Bozkurt","doi":"10.1055/s-0043-1768572","DOIUrl":"https://doi.org/10.1055/s-0043-1768572","url":null,"abstract":"<p><p><b>Background</b> Chiari malformation type II (CM-II) may not always present as an asymptomatic disorder but prove to be difficult in managing. This is especially true for neonates who show the worst prognosis. There is confounding data over whether shunting or craniocervical junction (CVJ) decompression should be employed. This retrospective analysis summarizes the results of 100 patients diagnosed and treated for CM-II along with hydrocephalus and myelomeningocele. <b>Methods</b>  We reviewed all the children who were diagnosed and surgically treated for CM-II at the Moscow Regional Hospital. Surgical timing was decided on the clinical conditions of each patient. Urgent surgery in the more compromised patients (usually infants) and elective surgery for patients with less severe conditions was performed. All patients first underwent CVJ decompression. <b>Results</b>  The retrospective review yielded 100 patients operated on for CM-II with concomitant hydrocephalus and myelomeningocele. The average herniation was 11.2 ± 5.1 mm. However, herniation level did not correlate with clinical findings. Concomitant syringomyelia was observed in 60% of patients. More severe spinal deformity was observed in patients with widespread syringomyelia ( <i>p</i>  = 0.04). In children of the younger age group, cerebellar symptoms and bulbar disorders were more frequently observed ( <i>p</i>  = 0.03), and cephalic syndrome was noted much less frequently ( <i>p</i>  = 0.005). The severity of scoliotic deformity correlated with the prevalence of syringomyelia ( <i>p</i>  = 0.03). Satisfactory results were significantly more often observed in patients of the older age group ( <i>p</i>  = 0.02). Patients with unsatisfactory results at the time of treatment were significantly younger ( <i>p</i>  = 0.02). <b>Conclusion</b>  If CM-II is asymptomatic, then no specific treatment is prescribed. If the patient develops pain in the occiput and neck, then pain relievers are prescribed. If a patient has neurological disorders or concomitant syringomyelia, hydrocephalus or myelomeningocele, surgical intervention is indicated. The operation is also performed if the pain syndrome cannot be overcome within the framework of conservative therapy.</p>","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/03/10-1055-s-0043-1768572.PMC10310441.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Subdural Hematoma following Epidural Anesthesia.","authors":"Rajesh Bhosle,&nbsp;Dimble Raju,&nbsp;Shamshuddin Senior Patel,&nbsp;Grandhi Aditya,&nbsp;Jagriti Shukla,&nbsp;Nabanita Ghosh,&nbsp;Prasad Krishnan","doi":"10.1055/s-0043-1768576","DOIUrl":"https://doi.org/10.1055/s-0043-1768576","url":null,"abstract":"<p><p>The spinal subdural space is an avascular, potential space and is a rare location for intraspinal hematomas. Compared to spinal epidural hematomas, spinal subdural hematomas are uncommonly described complications of lumbar puncture for spinal or epidural anesthesia, particularly in patients who have no pre-existing bleeding disorders or history of antiplatelet or anticoagulant intake. We describe a 19-year-old girl who had a large thoracolumbar spinal subdural hematoma following epidural anesthesia for elective cholecystectomy with no pre-existing bleeding diathesis that caused rapidly developing paraplegia that evolved over the next 2 days following surgery. Nine days after the initial surgery she underwent multilevel laminectomy and surgical evacuation with eventual satisfactory recovery. Even epidural anesthesia without thecal sac violation can result in bleeding in the spinal subdural space. The possible sources of bleed in this space may be from injury to an interdural vein or extravasation of subarachnoid bleed into the subdural space. When neurological deficits occur, prompt imaging is mandatory and early evacuation yields gratifying results.</p>","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/77/10-1055-s-0043-1768576.PMC10313436.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Idiopathic De Novo Arteriovenous Malformation: A Rare Acquired Intracranial Lesion.","authors":"Tritan Plute,&nbsp;Prateek Agarwal,&nbsp;Aneek Patel,&nbsp;Arka N Mallela,&nbsp;L Dade Lunsford,&nbsp;Hussam Abou-Al-Shaar","doi":"10.1055/s-0043-1769893","DOIUrl":"https://doi.org/10.1055/s-0043-1769893","url":null,"abstract":"<p><p>The de novo development of cerebral arteriovenous malformations (AVMs) in adults is an exceedingly rare event that has prompted the theory that a \"second hit\" is required to induce AVM formation. The authors document development of an occipital AVM in an adult a decade and a half after a brain magnetic resonance imaging (MRI) disclosed no abnormality. A 31-year-old male with a family history of AVMs and a 14-year history of migraines with visual auras and seizures presented to our service. Because of the onset of a first seizure and migraine headaches at age 17, the patient underwent high-resolution MRI that showed no intracranial lesion. After 14 years of progressively worsening symptoms, he underwent a repeat MRI that demonstrated a new de novo Spetzler-Martin grade 3 left occipital AVM. The patient received anticonvulsants and underwent Gamma Knife radiosurgery for his AVM. This case suggests that patients with seizures or persistent migraine headaches should have periodic repeat neuroimaging to exclude the development of a vascular cause despite an initial negative MRI.</p>","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/e2/10-1055-s-0043-1769893.PMC10313434.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Trident-Shaped Neurofibroma: A Rare Variant.","authors":"Inamul Haque,&nbsp;Navanil Barua,&nbsp;Nabajyoti Borah,&nbsp;Sneha Gang,&nbsp;Ananya Barman,&nbsp;Shabnam A Ahmed","doi":"10.1055/s-0043-1768579","DOIUrl":"https://doi.org/10.1055/s-0043-1768579","url":null,"abstract":"<p><p>Spinal nerve root tumors can arise throughout the spine and at multiple levels, likely representing plexiform neurofibromas that grow from the nerve root into the intraspinal space either intradurally or epidurally and exit through the neural foramen, producing a dumbbell-shaped appearance. Although many cases of dumbbell-shaped extramedullary neurofibromas in the cervical spine have been reported, to the best of our knowledge, there are no reports of trident-shaped extramedullary neurofibromas. A 26-year-old woman presented with swelling over the right side of her neck. Diagnostic workup included magnetic resonance imaging (MRI) and contrast-enhanced computed tomography (CECT) of the neck, which revealed an intradural, extramedullary tumor mass at the right C2-C6 level with an extraspinal extension. Spinal cord compression or canal compromise is the most reliable indication for surgery. The solitary cervical neurofibroma was treated surgically in a single stage through laminoplasty and excision of the intradural tumor along with that of the neck component. This was performed without any complications. A single-stage double approach was adopted in this case. After total excision, the shape of the tumor was found to be more like a trident than a dumbbell. Hence, here we would like to suggest a new nomenclature for this neurofibroma, the trident neurofibroma.</p>","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/f0/10-1055-s-0043-1768579.PMC10313435.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9748016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PMMA Cranioplasty Making by Using Open-Source CAD Software, PLA Printers, and Silicone Rubber Molds: Technical Note with Two Illustrative Cases.","authors":"Mohammad Ashraf,&nbsp;Shah Gul Zahra,&nbsp;Minaam Farooq,&nbsp;Nabeel Choudhary,&nbsp;Naveed Ashraf","doi":"10.1055/s-0043-1768604","DOIUrl":"https://doi.org/10.1055/s-0043-1768604","url":null,"abstract":"","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b1/68/10-1055-s-0043-1768604.PMC10313431.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative Chronotropic Cardiovascular Changes in Lumbar Spine Surgery: A Potential Spinal-Cardiac Reflex?","authors":"Kashif Ali Sultan,&nbsp;Mohammad Ashraf,&nbsp;Attika Chaudhary,&nbsp;Laulwa Al Salloum,&nbsp;Naseeruddin Ghulam,&nbsp;Nazir Ahmed,&nbsp;Hassan Ismahel,&nbsp;Minaam Farooq,&nbsp;Javed Iqbal,&nbsp;Naveed Ashraf","doi":"10.1055/s-0043-1769894","DOIUrl":"https://doi.org/10.1055/s-0043-1769894","url":null,"abstract":"Abstract Cardiovascular changes following lumbar spine surgery in a prone position are exceedingly rare. Over the past 20 years, a total of six cases have been published where patients experienced varying degrees of bradycardia, hypotension, and asystole, which could be attributed to intraoperative dural manipulation. As such, there is emerging evidence for a potential neural-mediated spinal-cardiac reflex. The authors report their experience of negative chronotropy during an elective lumbar spine surgery that coincided with dural manipulation and review the available literature. A 34-year-old male presented with a long-standing history of lower back pain recently deteriorating to bilaterally radiating leg pain, with restricted left leg raise, and numbness at the left L5 dermatomal territory. The patient was an athletic police officer with no comorbidities or past medical history. Magnetic resonance imaging lumbosacral spine revealed spinal stenosis most pronounced at L4/L5 and disc bulges at L3/L4 and L5/S1. The patient opted for lumbar decompression surgery. After an unremarkable comprehensive preoperative workup, including cardiac evaluation (electrocardiogram, echocardiogram), the patient was induced general anesthesia in a prone position. A lumbar incision was made from L2 to S1. When the left L4 nerve root was retracted while removing the prolapsed disc at L4/L5, the anesthetist cautioned the surgeon of bradycardia (34 beats per minute [bpm]), and the surgery was immediately stopped. The heart rate improved to 60 bpm within 30 seconds. When the root was later retracted again, a second episode of bradycardia occurred for 4 minutes with heart rate declining to 48 bpm. The surgery was stopped, and after 4 minutes, the anesthetist administered 600 µg of atropine. The heart rate then rose to 73 bpm within 1 minute. Other potential causes for bradycardia were excluded. The total blood loss was estimated to be 100 mL. He remains well at his 6-month follow-up and has returned to work as normal. Akin to previously published cases, each episode of bradycardia coincided with dural manipulation, which may indicate a possible reflex between the spinal dura mater and the cardiovascular system. Such a rare adverse event may occur even in seemingly healthy, young individuals, and anesthetists should caution the operating surgeon of bradycardias to exclude operative manipulation of the dura as the cause. While this phenomenon is only reported in a handful of lumbar spine surgery cases, it provides evidence for a potential spinal-cardiac physiological reflex in the lumbar spine that may be neural mediated and should be investigated further.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/03/5f/10-1055-s-0043-1769894.PMC10313433.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synchronous Posterior and Anterior Pituitary Tumors: A Case Report of a Hypothetic Paracrine Relationship.","authors":"Franco Rubino,&nbsp;Daniel G Eichberg,&nbsp;Ali G Saad,&nbsp;Ricardo J Komotar,&nbsp;Michael E Ivan","doi":"10.1055/s-0043-1768601","DOIUrl":"https://doi.org/10.1055/s-0043-1768601","url":null,"abstract":"<p><p>Tumors of the posterior pituitary are a distinct group of low-grade sellar neoplasms. Furthermore, the coexistence with an anterior pituitary tumor is extremely unlikely and could not be a mere coincidence and could be a paracrine relationship. Here, we present a case of 41-year-old woman with Cushing syndrome and two pituitary masses on magnetic resonance imaging. Histologic examination shows two distinct lesions. The first consisted of a pituitary adenoma with intense adrenocorticotropic hormone immunostaining and the second lesion consisted of a proliferation of pituicytes arranged in vague fascicles or pituicytoma. After a narrative review of the literature, we found that synchronous pituitary adenoma and a thyroid transcription factor 1 (TTF-1) pituitary tumor were only reported eight times in the past. These patients included two granular cell tumors and six pituicytomas and all of them coexisted with pituitary adenomas, seven functioning and one nonfunctioning. We analyze the hypothesis of a possible paracrine relationship for this concomitance, but this exceedingly rare situation is still a matter of debate. To the best of our knowledge, our case represents the ninth case of a TTF-1 pituitary tumor coexisting with a pituitary adenoma.</p>","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4e/58/10-1055-s-0043-1768601.PMC10313437.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Step Ladder Expansive Cranioplasty: A Novel Perspective in Cranial Volume Augmentation Surgery.","authors":"Sudip Kumar Sengupta,&nbsp;Shashivadhanan Sundervadhanan,&nbsp;Tony J Rappai,&nbsp;S M Sudumbrekar,&nbsp;Sankar Prasad Gorthi,&nbsp;Saurabh K Verma","doi":"10.1055/s-0043-1768571","DOIUrl":"https://doi.org/10.1055/s-0043-1768571","url":null,"abstract":"<p><p><b>Background</b>  In face of a refractory raised intracranial pressure (ICP), surgeons most commonly resort to decompressive craniectomy (DC). Procedure leaves an unprotected brain underlying the craniectomy defect and Monro-Kellie doctrine: disrupted. Different variants of hinge craniotomies (HC) have been used with clinical outcomes comparable to DC as single stage alternatives. However, both DC and every variant of HC have a limit to the achievable volume augmentation and all invariably cause a compression of the cerebral cortex and its vasculature at the craniotomy site. We believe both these limitations adversely affect the outcome. <b>Methods</b>  A team of neuroscientists in Indian Armed Forces Medical Services has been working for the last 9 years toward developing a novel surgical technique that can mitigate both these drawbacks. Desired procedure should take the centripetal pressure exerted by the combination of the tensile strength of the scalp (with or, without an underlying bone flap) and atmospheric pressure off the brain surface while achieving an assured augmentation of intracranial volume that can be optimized on a case-to-case basis. We call it a \"step ladder expansive cranioplasty.\" <b>Results</b>  The distance of the parietal eminence was found to have increased by 10.2 mm on the operated side after expansive cranioplasty. <b>Conclusion</b>  From drawing board to bedside, we have made some progress toward our goal, but it is still far away from completion. More studies are required to fill in the gaps in our knowledge necessary to optimize the various parameters of the surgery. Procedure has promise to be of special role in in war and disaster scenarios.</p>","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/f1/10-1055-s-0043-1768571.PMC10313430.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Myiasis Secondary to Burr Hole Evacuation: A Rare Illustrative Case Report.","authors":"Rama Chandra Deo,&nbsp;Abhijit Acharya,&nbsp;Souvagya Panigrahi,&nbsp;Satya Bhusan Senapati,&nbsp;A K Mahapatra,&nbsp;Sumirini Puppala","doi":"10.1055/s-0043-1769895","DOIUrl":"https://doi.org/10.1055/s-0043-1769895","url":null,"abstract":"<p><p>Myiasis (maggot infestation) is a condition in which fly maggots feed off and develop in the tissues of living organisms. Most common in tropical and subtropical regions, human myiasis, is prevalent among individuals in close association of domestic animals and those inhabiting the unhygienic conditions. We, hereby, describe a rare case of cerebral myiasis (17th in the world, 3rd in India) that presented to our institution in Eastern India secondary in the operated site of craniotomy and burr hole few years back. Cerebral myiases are exceedingly rare conditions, especially in high-income countries with only 17 previously published cases with the reported mortality as high as 6 out of 7 cases dying of the disease. We additionally also present a compiled review of previous case literatures to highlight the comparative clinical, epidemiological features and outcome of such cases. Although rare, brain myiasis should be a differential diagnosis of surgical wound dehiscence in developing countries where conditions do exist in this country that permit myiasis. This differential diagnosis should be remembered, particularly when the classic signs of inflammation are not present.</p>","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/82/10-1055-s-0043-1769895.PMC10313439.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}