British Journal of Neurosurgery最新文献

{"title":"Intracerebral and pituitary metastatic eccrine carcinoma: prolonged survival using stereotactic radiosurgery.","authors":"Zhishuo Wei, Shalini Jose, Hussam Abou-Al-Shaar, Hansen Deng, Diego Luy, Douglas Kondziolka, Ajay Niranjan, L Dade Lunsford","doi":"10.1080/02688697.2023.2170327","DOIUrl":"10.1080/02688697.2023.2170327","url":null,"abstract":"<p><strong>Purpose: </strong>Eccrine gland carcinoma (EC) is a rare skin neoplasm that uncommonly spreads to the brain or pituitary gland. We describe the role of multiple stereotactic radiosurgery (SRS) procedures to manage recurrent brain metastases of this rare disease.</p><p><strong>Materials and methods: </strong>Retrospective chart review was completed to obtain details for this report. The study was performed under IRB study on medical record only and was exempt from patient's consent.</p><p><strong>Results and conclusions: </strong>A 59-year-old female underwent surgical excision of a right parietal scalp EC. Over the next 13 years, the patient underwent initial fractionated whole brain radiation therapy after she developed multiple brain metastases followed by systemic chemotherapy for extracranial disease. Because of repeated development of new brain disease, three SRS procedures were performed to treat a total of 50 brain metastases and a pituitary metastasis (PM). The patient expired from progressive systemic cancer spread 13 years after her initial surgical excision. Due to the rarity of metastatic EC to the brain, no standard treatment paradigm has emerged. Using multimodality options that included local excision of the original skin tumor, followed by radiation, systemic chemotherapy, and three SRS procedures, long-term survival was possible in this unusual case.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"240-245"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10624947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic chronic subdural haematoma - does it need neurosurgical intervention?","authors":"Daniel Parry, Ravanth Baskaran, Ashleigh Lima, Richard Dagnan, Hisham Jaber, Susruta Manivannan, Malik Zaben","doi":"10.1080/02688697.2023.2210224","DOIUrl":"10.1080/02688697.2023.2210224","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic subdural haematoma (CSDH) is a well-recognized consequence of head injury with a rising incidence worldwide. Whilst symptomatic CSDH warrants consideration of surgical intervention, the management of asymptomatic CSDH (AsCSDH) remains unclear. In this retrospective study, we investigate the natural history of AsCSDH, the requirement for radiological monitoring, and the role of neurosurgical input.</p><p><strong>Methods: </strong>Head injury referrals to a tertiary neurosurgical unit over two years were screened to identify patients with AsCSDH. Clinical, radiological, and outcome parameters were collected for included patients.</p><p><strong>Results: </strong>Of 2725 referrals, 106 (3.9%) patients were eligible for inclusion. The cohort consisted of predominantly male patients (70.8%) with an average age of 81.9 years and independent at baseline (79.3%). Radiological follow-up was recommended by neurosurgery in 4 patients (3.8%). Medical teams performed follow-up imaging for 57 patients (53.8%) culminating in a total of 116 follow-up scans, predominantly for falls or monitoring purposes. Antithrombotic agents were used by 61 patients (57.5%). Anticoagulants were held in 26/37 patients (70.3%) and antiplatelets in 12/29 patients (41.4%), ranging from 7 to 16 days when specified. Only one patient required neurosurgical intervention at 3 months from the time of initial presentation after the development of symptoms.</p><p><strong>Conclusions: </strong>Patients with AsCSDH do not require neuroradiological follow-up or neurosurgical intervention in the majority of instances. Medical professionals should explain to patients, families, and caregivers that the isolated finding of CSDH is not necessarily a cause for concern but safety netting advice regarding AsCSDH should be provided.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"204-209"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9517267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic arteriovenous fistula from internal maxillary artery following trigeminal balloon compression.","authors":"Luke A D Ottewell, Menaka P Paranathala, Craig H Robson, Alistair J Jenkins","doi":"10.1080/02688697.2023.2207651","DOIUrl":"10.1080/02688697.2023.2207651","url":null,"abstract":"<p><p>We describe the development of a direct traumatic arteriovenous fistula arising from the internal maxillary artery after an uneventful percutaneous trigeminal balloon compression for trigeminal neuralgia, and its management through embolization and radiosurgery.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"255-258"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9425633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>NF2</i> mutation associated with accelerated time to recurrence for older patients with atypical meningiomas.","authors":"Jonathan T Dullea, Danielle Chaluts, Vikram Vasan, John W Rutland, Corey M Gill, Ethan Ellis, Yayoi Kinoshita, Russell B McBride, Joshua Bederson, Michael Donovan, Robert Sebra, Melissa Umphlett, Raj K Shrivastava","doi":"10.1080/02688697.2023.2204927","DOIUrl":"10.1080/02688697.2023.2204927","url":null,"abstract":"<p><strong>Purpose: </strong>Meningiomas occur more frequently in older adults, with the incidence rates increasing from 5.8/100,000 for adults 35-44 years old to 55.2/100,000 for those 85+. Due to the increased risk of surgical management in older adults, there is a need to characterize the risk factors for aggressive disease course to inform management decisions in this population. We therefore sought to determine age-stratified relationships between tumour genomics and recurrence after resection of atypical meningiomas.</p><p><strong>Methods: </strong>We identified 137 primary and recurrent Grade 2 meningiomas from our existing meningioma genomic sequencing database. We examined the differential distribution of genomic alterations in those older than 65 compared to younger. We then performed an age stratified survival analysis to model recurrence for a mutation identified as differentially present.</p><p><strong>Results: </strong>In our cohort of 137 patients with grade 2 meningiomas, alterations in <i>NF2</i> were present at a higher rate in older adults compared to younger (37.8% in < 65 vs. 55.3% in > 65; recurrence adjusted p-value =0.04). There was no association between the presence of <i>NF2</i> and recurrence in the whole cohort. In the age-stratified model for those less than 65 years old, there was again no relationship. For patients in the older age stratum, there is a relationship between <i>NF2</i> and worsened recurrence outcomes (HR = 3.64 (1.125 - 11.811); <i>p</i> = 0.031).</p><p><strong>Conclusions: </strong>We found that mutations in <i>NF2</i> were more common in older adults. Further, the presence of mutant <i>NF2</i> was associated with an increased risk of recurrence in older adults.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"173-179"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10598238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10472424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes of the treatment of unruptured paraophthalmic aneurysms in the era of flow diversion.","authors":"Timothy G White, Morgan Krush, Giyarpuram Prashant, Kevin Shah, Jeffrey M Katz, Thomas Link, Henry H Woo, Amir R Dehdashti","doi":"10.1080/02688697.2023.2210220","DOIUrl":"10.1080/02688697.2023.2210220","url":null,"abstract":"<p><strong>Background: </strong>Paraophthalmic aneurysms present a challenge to surgeons and their ideal management remains up for debate. We studied recent outcomes of these lesions in a single center.</p><p><strong>Methods: </strong>A retrospective chart review of all patients undergoing treatment for paraophthalmic aneurysms from 2017-2019 was performed. Factors including patient demographics, aneurysm characteristics, treatment modality, radiographic treatment outcome, clinical outcome, and length of stay were collected, and bivariate analysis was performed.</p><p><strong>Results: </strong>In total 84.5% (82/97) of aneurysms were treated endovascularly and 15.5% (15/97) surgically. In the surgery cohort, there were three transient perioperative complications (20%) and one minor postoperative complication (6.7%). Complete aneurysm occlusion or near complete (<2mm residual) was achieved in 100% (15/15). All but one patient had mRS ≤1 at the last follow-up. In the endovascular group, 78.1% (64/82) underwent flow diversion alone. Endovascular treatment was associated with a 4.9% (4/82) rate of periprocedural complications: 3 transient events, and 1 death, and a 3.7% (3/82) rate of delayed complications: 2 transient vision changes, and one death. Rate of total occlusion was 87.8% (72/82). 76 patients (92.7%) had mRS ≤1 at the last follow-up. Length of stay was significantly shorter in the endovascular group (3.4 days vs. 7.0 days) [<i>p</i> < 0.001].</p><p><strong>Conclusions: </strong>This series demonstrates similar safety to previously reported series as well as the efficacy of both surgical clipping and endovascular embolization of paraophthalmic aneurysms. Rate of complications and treatment efficacy were similar in both groups although this represents a single institution series not generalizable to all centers.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"197-203"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9791985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A history of the surgery of the cranial sutures.","authors":"Jeremy C Ganz","doi":"10.1080/02688697.2023.2204928","DOIUrl":"10.1080/02688697.2023.2204928","url":null,"abstract":"<p><strong>Introduction: </strong>While the calvarial sutures have a limited importance for the modern neurosurgeon, they were of considerable interest to cranial surgeons from the time of Hippocrates onwards. The reasons for this interest together with the evolution of ideas are the subjects of this paper.</p><p><strong>Materials and methods: </strong>The texts of surgeons from the time of Hippocrates to the eighteenth century have been studied and analysed.</p><p><strong>Results: </strong>Hippocrates advised against trepanation through a suture without specifying why. Galen taught that the dura was only attached to the interior of the calvarium at the sutures. The first author to state that the attachment was diffuse was Berengario da Carpi, at the beginning of the sixteenth century. This teaching was subsequently ignored until the eighteenth century, from which time it has been universally accepted. It was also first emphasized in the eighteenth century that it was not dangerous to trepan at the sutures.</p><p><strong>Conclusions: </strong>This study documents the persistence of incorrect ideas from classical times to the middle of the eighteenth century. These notions would have limited the regions available for surgical access to the skull and thereby limited the benefits to be derived from surgery.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"180-183"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9387646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current landscape of academic neurosurgical training in the United Kingdom: analysis by the Society of British Neurological Surgeons.","authors":"Keng Siang Lee, Conor S Gillespie, Aswin Chari, Sheikh Momin, Carole Turner, Michael D Jenkinson, Robert Brownstone","doi":"10.1080/02688697.2023.2213329","DOIUrl":"10.1080/02688697.2023.2213329","url":null,"abstract":"<p><strong>Objective: </strong>Little is known about the impact of academic training on Neurosurgery in the United Kingdom (UK). The aim was to understand the early career clinical and research training journeys of potential future clinical academics, with a view to informing future policy and strategy to improve career development for academic neurosurgical trainees and consultants in the UK.</p><p><strong>Methods: </strong>An online survey from the Society of British Neurological Surgeons (SBNS) academic committee was distributed to both the SBNS and British Neurosurgical Trainee Association (BNTA) mailing lists in early 2022. Neurosurgical trainees for any period between 2007 and 2022 or who had done any dedicated academic or clinical academic placement were encouraged to complete the survey.</p><p><strong>Results: </strong>Sixty responses were received. Six (10%) were females and fifty-four (90%) were males. At the time of response, nine (15.0%) were clinical trainees, four (6.7%) were Academic Clinical Fellows (ACF), six (10.0%) were Academic Clinical Lecturers (ACL), four (6.7%) were post-CCT fellows, eight (13.3%) were NHS consultants, eight (13.3%) were academic consultants, eighteen (30.0%) were out of the programme (OOP) pursuing a PhD potentially returning to training, whilst three (5.0%) had left neurosurgery training entirely and no longer performing clinical neurosurgery. The mentorship was sought in most programmes, which tended to be informal. Self-reported success on a scale of 0 to 10 with 10 being the most successful, was greatest in the MD and the \"Other research degree/fellowship group\" which does not include a PhD. There was a significant positive association between completing a PhD and having an academic consultant appointment (Pearson Chi-Square = 5.33, p = 0.021).</p><p><strong>Conclusions: </strong>This study provides a snapshot to better understand the opinions of academic training in neurosurgery within the UK. Establishing clear, modifiable, and achievable goals, as well as providing tools for research success, may contribute to the success of this nationwide academic training.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"217-223"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9473316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accessory nerve schwannoma extending into the fourth ventricle: case report and review of literature.","authors":"Paul Vincent Naser, Daniel Haux-Nettesheim, Ramin Rahmanzade, Pavlina Lenga, David Reuss, Andreas W Unterberg, Christopher Beynon","doi":"10.1080/02688697.2023.2179598","DOIUrl":"10.1080/02688697.2023.2179598","url":null,"abstract":"<p><p>Accessory nerve schwannoma is a rare entity in patients presenting with cranial nerve (CN) deficits. Most of these tumours arise from the cisternal segment of the eleventh CN and extend caudally. Herein, we report the third case of an accessory schwannoma extending cranially into the fourth ventricle. A 61-year-old female presented with a history of variable headaches. Cerebral magnetic resonance imaging (cMRI) revealed a large inhomogeneous contrast-enhancing lesion at the craniocervical junction extending through the foramen of Magendi and concomitant hydrocephalus due to obstruction of the foramina of Luschkae. Microsurgical tumour resection was performed in the half-sitting position. Intraoperatively, the tumour arose from a vestigial fascicle of the spinal accessory nerve. At three month follow-up, neither radiological tumour recurrence nor neurological deficits were observed.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"251-254"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9289351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural empyema following nBCA embolization of the middle meningeal artery for the treatment of a chronic subdural hematoma.","authors":"Hasitha Milan Samarage, Maya Harary, Jose Morales, Naoki Kaneko, Won Kim","doi":"10.1080/02688697.2022.2159927","DOIUrl":"10.1080/02688697.2022.2159927","url":null,"abstract":"<p><p>Chronic subdural hematomas (CSDHs) are a common neurosurgical disease for which middle meningeal artery (MMA) embolization is emerging as an attractive and efficacious endovascular treatment modality. We present the first known case of a <i>Streptococcus intermedius</i> epidural abscess that resulted following MMA embolization for a left-sided CSDH that required evacuation and washout through a craniotomy. Intracranial infections can be a potentially devastating complication from MMA embolization in this patient population.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"228-231"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10790488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of intraoperative CT navigation for posterior cervical spine foraminotomy.","authors":"Bih Huei Tan, Sutharshan Sockalingam, Dharmendra Ganesan","doi":"10.1080/02688697.2023.2225611","DOIUrl":"10.1080/02688697.2023.2225611","url":null,"abstract":"<p><strong>Objectives: </strong>Posterior cervical foraminotomy is a surgical procedure used to treat unilateral cervical radiculopathy. It provides direct decompression of the nerve root without the necessity of fusion while maintaining cervical mobility. With the advancement in image-guidance technology and minimal access techniques, intra-operative CT has provided a safer, more accurate instrumentation placement with less radiation exposure to operative staff and provides better anatomical visualization quality compared to traditional intra-operative imaging techniques. This case series aims to address the applications of advanced image guidance in posterior cervical foraminotomy and describe the nuances.</p><p><strong>Method: </strong>A technical report on a series of seven cases on intraoperative CT navigation for posterior cervical foraminotomy surgery. Posterior cervical foraminotomy was performed in all patients under CT guided navigation system without an image intensifier. In one case after the foraminotomy, the extruded disc was carefully removed by gentle retraction.</p><p><strong>Result: </strong>From 1 January 2020 to 31 December 2021, a total of seven patients with nine cervical foraminotomy procedures were performed using the aid of CT-guided navigation. The series comprised five women and two men whose mean age was 50.6 years. In all cases, the radiculopathy symptoms were diminished significantly. There were no cases of instability on the dynamic cervical radiograph. There were no complications during the surgical procedure.</p><p><strong>Conclusion: </strong>The navigation also allows the surgeon to localise the index level accurately and appraise the adequacy of the intended decompression in three planes of the CT scan image. The ability to perform accurate spine navigation would be the precursor for robotic spinal surgery.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"262-265"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9673275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}