British Journal of Neurosurgery最新文献

{"title":"Acute quadriplegia and death following a routine MRI for undiagnosed degenerative cervical myelopathy.","authors":"Cylene Yang, Oliver D Mowforth, Amir Rafati Fard, Benjamin M Davies, Rodney J C Laing","doi":"10.1080/02688697.2023.2216284","DOIUrl":"10.1080/02688697.2023.2216284","url":null,"abstract":"<p><p>Bilateral upper limb paraesthesia and pain are common symptoms of degenerative cervical myelopathy (DCM). Such symptoms instigate investigation by cervical spine magnetic resonance imaging (MRI). This was the case for our patient, who was 72-years-in age and otherwise fit and well. During the scan he unfortunately developed sudden onset quadriplegia secondary to an intervertebral disc prolapse. This necessitated intubation due to respiratory failure and urgent transfer to the neurosciences critical care unit at a tertiary neurosciences centre. Despite prompt surgical decompression, he did not regain function. Extubation was unsuccessful on three occasions. Following discussion between the patient and his family, ventilation was withdrawn, and he died the following day. This case highlights the potentially devastating consequences of DCM and poses questions about the aetiology of DCM.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"259-261"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947772","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}

{"title":"Global neurosurgery: Colombia.","authors":"Alvaro Rojas-Villabona, Nitin Mukerji","doi":"10.1080/02688697.2025.2469455","DOIUrl":"10.1080/02688697.2025.2469455","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"161-162"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482175","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":"Spontaneous Shrinkage of isocitrate dehydrogenase (IDH)-mutant astrocytoma caused by intra-tumoural cyst rupture: a case report.","authors":"Ryutaro Suzuki, Masayuki Kanamori, Ryuta Saito, Yoshiteru Shimoda, Mika Watanabe, Teiji Tominaga","doi":"10.1080/02688697.2023.2170328","DOIUrl":"10.1080/02688697.2023.2170328","url":null,"abstract":"<p><strong>Background: </strong>T2-fluid-attenuated inversion recovery (FLAIR) mismatch sign is a specific imaging finding of isocitrate dehydrogenase (IDH)-mutant astrocytomas. Histologically, a hypointense area on FLAIR images indicates the presence of microcysts. Here we report a case of IDH-mutant astrocytoma that shrunk spontaneously.</p><p><strong>Case description: </strong>A 26-year-old woman presented with a complaint of headache. Her magnetic resonance (MR) images revealed a lesion mass with a T2-FLAIR mismatch sign in the left frontal lobe. Subsequently, after 1 month, she was referred to our department, and we found that the lesion had unexpectedly shrunk; however, no further shrinkage was observed in the next 3 months. Furthermore, a biopsy was performed, and the results indicated a diagnosis of astrocytoma, IDH-mutant CNS WHO grade 3. Thus, she underwent subtotal resection. We found no neurological deficits in the patient, and she received 60 Gy of radiotherapy at the local site and chemotherapy with nimustine hydrochloride (ACNU), followed by the administration of ACNU every 8 weeks for 2 years. Overall, after 36 months of tumour resection, she was in good health and exhibited no recurrence. Notably, her histological and MR image findings suggested that the macroscopic cyst was formed by the fusion of microcysts, which is a characteristic feature of IDH-mutant astrocytoma with a T2-FLAIR mismatch sign, and that the tumour shrunk because of the rupture of the cyst in the Sylvian cistern.</p><p><strong>Conclusion: </strong>The present case report suggests that IDH-mutant astrocytoma cannot be ruled out even when the lesion shrinks spontaneously.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"246-250"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10599955","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":"Stabbed to the back! A C-clamp technique used to stabilize a C7 sagittal split fracture.","authors":"Carlo Brembilla, Giorgio Cracchiolo, Andrea Fanti, Claudio Bernucci","doi":"10.1080/02688697.2022.2162851","DOIUrl":"10.1080/02688697.2022.2162851","url":null,"abstract":"<p><p>The management of stab wounds to the back is controversial. This case report entails a 17-year-old female that was assaulted from behind and stabbed to the lower cervical region with a knife. The patient reported mild lower limb hypoesthesia. Neuroradiological exams showed a sagittal split fracture of C7, with a contextual split lesion of the spinal cord. The patient underwent surgical intervention for the stabilization of the sagittal split fracture via the C-clamp technique and dura mater plastic. In the current literature, the use of the C-clamp technique for the stabilization of a lower cervical fracture has never been reported.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"276-280"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10820096","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":"Non-missile penetrating brain injury-surgical techniques for removing a long penetrating foreign body: a case report.","authors":"Ming-Fai Tse, Shih-Hao Huang, Yi-Hsin Tsai, Chien-Hsun Li","doi":"10.1080/02688697.2022.2159926","DOIUrl":"10.1080/02688697.2022.2159926","url":null,"abstract":"<p><strong>Purpose: </strong>Penetrating brain injury (PBI), a relatively uncommon injury, is associated with remarkable secondary complications such as vascular injury, intracranial haemorrhage, infection, and mortality. Non-missile PBI (NMPBI) due to sharp or blunt objects is usually treated surgically by removing the penetrating object, evacuating the associated haemorrhage, identifying possible bleeders along with haemostasis, and performing debridement. Various approaches are used for different scenarios of non-missile PBI according to the object's characteristics, penetrating site, depth, associated intracerebral haemorrhage (ICH), and presence of vascular injury along the penetrating tract. NMPBI cases are rarely reported among civilians. We herein describe a patient who was successfully treated for NMPBI, as well as frontal ICH, by simultaneously removing the heavy, metallic penetrating foreign body.</p><p><strong>Methods: </strong>We performed corticotomy through a shorter tract instead of a deep penetrating trajectory, which minimizes the extent of damage to the brain and enables immediate management of vascular injury under direct vision while removing the foreign body, and intraoperative sonography, which provides real-time information of the penetrating object and the surrounding brain structure. We did not perform computed tomography angiography and digital subtraction angiography (DSA) because the stab location was at the frontal region, with low risk of vascular injury. Moreover, DSA is time-consuming, which may delay decompressive surgery.</p><p><strong>Results: </strong>The patient was successfully treated through an alternative approach removing the long, heavy, metallic penetrating foreign body and eliminating the accompanying frontal ICH simultaneously. Focal brain abscess developed 8 days after the injury and resolved completely after antibiotics treatment. Dysphasia gradually improved but right distal limbs weakness with spasticity is still present.</p><p><strong>Conclusions: </strong>Our findings suggest prompt diagnosis by preoperative imaging, screening of vascular injury, decompression with debridement, and antibiotics treatment are important. The alternative surgical approach we proposed is exceptional and should be considered while treating patients with deep NMPBI.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"266-269"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10452165","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":"Radiofrequency thalamotomy for tremor outcomes correlate with dentorubrothalamic tract distance.","authors":"Adnan A Shaikh, Agustin Querejetacoma, Beth Petric, Nagaraja Sarangmat, Tipu Z Aziz, James J Fitzgerald, Marko Bogdanovic, Erlick A Pereira, Alexander L Green","doi":"10.1080/02688697.2025.2481874","DOIUrl":"https://doi.org/10.1080/02688697.2025.2481874","url":null,"abstract":"<p><strong>Background: </strong>Thalamotomy was the main surgical treatment for medically refractory tremor before deep brain stimulation (DBS). While DBS is now preferred, it has drawbacks such as hardware failure, infection risk, frequent battery replacements, and multiple programming adjustments. Radiofrequency (RF) thalamotomy avoids these issues, can be performed under local anaesthesia, and suits patients in poor health. This study examines long-term outcomes of RF thalamotomy.</p><p><strong>Methods: </strong>We reviewed 14 consecutive RF thalamotomies performed in Oxford from 2016 to 2021. Three patients died from unrelated causes, leaving eight for long-term assessment. We recorded Bain and Findlay (BF) tremor scores, Clinical Global Impression of Severity (CGI-S), Clinical Global Impression of Change (CGI-C), Patient's Global Impression of Change (PGI-C), and Efficacy Index (EI). The median follow-up was 39 months (range 12-126). Post-operative tractography was correlated with clinical outcomes.</p><p><strong>Results: </strong>Six patients had essential tremor and eight had Parkinson's disease. Reasons for choosing thalamotomy over DBS included medical comorbidities, patient preference, age, and previous DBS failure. Ten patients (71%) reported significant tremor improvement, with relapse in two after six months. The mean BF tremor score decreased from 16.1 preoperatively to 8.5 postoperatively (<i>p</i> = 0.0043). Adverse events occurred in seven patients (50%), resolving completely in three, partially in three, and persisting in one. Sustained outcomes correlated with a wider distance of residual dentrorubrothalamic tract (DRTT) fibres from the lesion.</p><p><strong>Conclusions: </strong>RF thalamotomy is an effective long-term treatment for medication-refractory tremor and should be considered for select patients needing unilateral tremor control.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708690","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":"Single stage combined approach total en-bloc spondylectomy of L1 and L2 vertebrae for primary spinal and paraspinal synovial sarcoma.","authors":"Gurushankari Balakrishnan, Narayanaswamy Kathiresan, Chandra Kumar Krishnan, Vijay Sundar Ilangovan, Dileep Damodaran, Suresh Bapu Kandallu, Vijay Sankaran, Krishna Suresh, Anand Raja","doi":"10.1080/02688697.2025.2474030","DOIUrl":"https://doi.org/10.1080/02688697.2025.2474030","url":null,"abstract":"<p><strong>Background: </strong>Spinal synovial sarcomas are the rarest of synovial soft tissue sarcomas. Limited data exist about their epidemiology, management, and oncological and functional outcomes. Multi-segment total en-bloc spondylectomy (TES) is challenging and requires appropriate reconstruction to achieve satisfactory oncological and functional outcomes.</p><p><strong>Case presentation: </strong>A 26-year-old lady was evaluated for bilateral knee pain with magnetic resonance imaging-computed tomography (MRI-CT) and CT guided biopsy and was diagnosed to have non-metastatic synovial sarcoma of the left paraspinal tissue involving the L1 and L2 vertebrae extending into the paravertebral space, neural foramen of L1-L2 and L2-L3 with nerve root compression at L2 level. The patient underwent single-stage multi-segment (L1-L2) TES (posterior-anterior approach) with en-bloc excision of the paravertebral component with vertebral reconstruction followed by adjuvant radiation and chemotherapy. Physiotherapy was used for post-operative functional optimisation. During the follow-up period, the patient had graft failure and fracture of the spinal fixation rods, which were managed surgically with replacements and fixation. The patient is on follow-up with a disease-free survival of 120 months without any neurological deficit, normal gait, and spinal mobility.</p><p><strong>Conclusion: </strong>Multi-segment TES is a safe surgical approach for vertebral malignancy with appropriate reconstruction, which offers better oncological and functional outcomes.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584758","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":"Monitoring of microsurgically and endovascularly treated aneurysms (META): protocol for an international multicentre retrospective cohort study.","authors":"Cathal John Hannan, Jack Henry, David Brennan, Daniel Mc Sweeney, Omar Kouli, Aburrahman I Islim, Ashraf Abouharb, Ahilan Kailaya-Vasan, Mario Teo, Ian Anderson, Patrick Grover, James Galea, Ioannis Fouyais, Nitin Mukerji, Benjamin Fisher, Raghu Vindlacheruvu, Mahmoud Kamel, Daniel Walsh, Samir Matloob, Howard Brydon, Rikin Trivedi, Matthew Crockett, Patrick Nicholson, Diederik Bulters, Mohsen Javadpour","doi":"10.1080/02688697.2025.2471931","DOIUrl":"https://doi.org/10.1080/02688697.2025.2471931","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Following endovascular treatment (EVT) or microsurgical treatment (MT) of intracranial aneurysms (IA), radiological follow-up is performed to assess for recurrence and to determine the need for re-treatment. There is a paucity of evidence describing the long-term results of EVT and MT for IA and therefore data to inform the design of follow-up protocols are lacking. The overarching aim of the META study is to determine the clinically relevant long-term outcomes of EVT and MT for IA, and use this data to create evidence based radiological and clinical follow-up protocols for these aneurysms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and analysis: &lt;/strong&gt;The META study will be a multicentre, retrospective cohort study. Data collection will begin in June 2024 and all IA treated with EVT or MT meeting inclusion criteria between 1st January 2013 and 31st of December 2013 will be included, to allow for a maximum of 10 years of radiological and clinical follow-up. Clinical and radiological data will be collected and stored on a secure online database. Following the completion of data collection, factors associated with re-treatment or subarachnoid haemorrhage from an aneurysm treated with EVT or MT will be identified and used to risk stratify IAs, with a view to developing an evidence-based follow-up protocol of IA treated with EVT or MT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ethics and dissemination: &lt;/strong&gt;This project will be registered with the Royal College of Surgeons in Ireland (RCSI) Research Ethics Committee (REC). It will also be registered locally at each participating centre and appropriate local approvals will be obtained. The results of the study will be disseminated through presentation at national and international meetings, and publication in peer reviewed journals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Strengths and limitations: &lt;/strong&gt;This study will be the first contemporary multicentre study examining the long-term outcomes following treatment of ruptured and unruptured intracranial aneurysms.Our study will follow up treated aneurysms over a prolonged period of up to ten years; such prolonged follow-up is essential in the counselling of patients with this pathology, the majority of whom are in the fifth and sixth decades of life.The multicentre study design will increase the external validity and applicability of the results.The study will not assess aneurysm occlusion directly; data on significant aneurysm recurrences requiring re-intervention or leading to aneurysm rupture will be collected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain english summary: &lt;/strong&gt;Intracranial aneurysms (IAs) are abnormal outpouchings or dilations on the main blood vessels supplying the brain. 3% of the general population have IAs and the majority will remain asymptomatic however a proportion will go on to rupture and cause subarachnoid haemorrhage (SAH), which is a condition associated with a significant rate of death and disability. The treatment of both ruptured and unruptured IAs aims to prevent fu","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584739","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":"Electroconvulsive therapy for depression in a patient with a programmable ventriculoperitoneal shunt in situ for congenital hydrocephalus.","authors":"Caed Whittle, Aaida Eghbal, Adam Pilkington, Kehaan Akram, Milo A Hollingworth","doi":"10.1080/02688697.2025.2470836","DOIUrl":"https://doi.org/10.1080/02688697.2025.2470836","url":null,"abstract":"<p><strong>Background: </strong>Shunt surgery remains the gold standard of treatment for hydrocephalus. Ventriculoperitoneal (VP) shunt systems represent the most commonly used technique, and the increasing use of programmable valves allows the neurosurgical team to easily and non-invasively adjust shunt settings where indicated. However, their safety in specific clinical scenarios can be a common source of uncertainty due to potential interactions between parametric shunt components and external electromagnetic fields.</p><p><strong>Case presentation: </strong>We report the case of electroconvulsive therapy being used successfully in a 64-year-old presenting with treatment-resistant depression, on a background of a programmable VP shunt system in situ for congenital hydrocephalus. To our knowledge, this is the first individual report which presents the successful use of ECT in a patient with a programmable shunt valve.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":1.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540252","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}