Journal of neurosurgery. Case lessons最新文献

Simple rigid skull base reconstruction with resorbable unsintered hydroxyapatite/poly-l-lactide plate in endoscopic endonasal skull base tumor surgery: illustrative case. 内镜下鼻内颅底肿瘤手术中采用可吸收的未烧结羟基磷灰石/聚l-丙交酯钢板重建简单刚性颅底：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-10-06 DOI: 10.3171/CASE25544

Kittipit Manthawornsiri, Hiroki Morisako, Atsufumi Nagahama, Masaki Ikegami, Rayford Hazunga, Boon Seng Liew, Takeo Goto

{"title":"Simple rigid skull base reconstruction with resorbable unsintered hydroxyapatite/poly-l-lactide plate in endoscopic endonasal skull base tumor surgery: illustrative case.","authors":"Kittipit Manthawornsiri, Hiroki Morisako, Atsufumi Nagahama, Masaki Ikegami, Rayford Hazunga, Boon Seng Liew, Takeo Goto","doi":"10.3171/CASE25544","DOIUrl":"10.3171/CASE25544","url":null,"abstract":"Background: Skull base reconstruction following an extended endoscopic endonasal approach (EEA) is essential for preventing postoperative CSF leakage. Despite recent advancements in surgical techniques and materials, CSF leakage remains a significant complication. This report presents a rigid reconstruction technique utilizing a resorbable unsintered hydroxyapatite/poly-l-lactide (u-HA/PLLA) plate to reduce postoperative CSF leakage.Observations: Between May 2024 and June 2025, this method was used in 10 cases of extended EEA involving high-flow intraoperative CSF leaks and bone defects more than 25 mm. Notably, no postoperative CSF leakage was observed following the introduction of the u-HA/PLLA plate.Lessons: This material offers a unique combination of flexibility and mechanical strength comparable to cortical bone, along with osteoconductivity and bioresorbability, while producing negligible interference on postoperative imaging. These properties make it a highly promising material for skull base reconstruction. https://thejns.org/doi/10.3171/CASE25544.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240641","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}

引用次数: 0

Malignant cutaneous adnexal neoplasms with distant brain metastasis: an aggressive behavior. Illustrative cases. 恶性皮肤附件肿瘤伴远端脑转移：一种侵袭性行为。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-10-06 DOI: 10.3171/CASE25447

John Vargas-Urbina, Raúl Martinez-Silva, Giuseppe Rojas-Panta, Gabriel Ponce-Manrique, Jerson Flores-Castillo, William Anicama-Lima

{"title":"Malignant cutaneous adnexal neoplasms with distant brain metastasis: an aggressive behavior. Illustrative cases.","authors":"John Vargas-Urbina, Raúl Martinez-Silva, Giuseppe Rojas-Panta, Gabriel Ponce-Manrique, Jerson Flores-Castillo, William Anicama-Lima","doi":"10.3171/CASE25447","DOIUrl":"10.3171/CASE25447","url":null,"abstract":"Background: Primary malignant cutaneous adnexal neoplasms are rare and can spread locally or to lymph nodes, and very infrequently to distant sites, such as the brain. Their management is poorly documented, and there are no established clinical practice guidelines for treatment.Observations: A 57-year-old male underwent surgery 2 years earlier for adenocarcinoma of the cutaneous adnexa of the right arm. He was admitted to the emergency department with a 15-day history of drowsiness, dysarthria, and signs consistent with frontal lobe involvement. Preoperative MRI revealed a heterogeneous left frontal lobe tumor with contrast enhancement of a solid mass. A craniotomy and complete tumor resection were performed. He then received radiosurgery (27 Gy). MRI studies at 1 and 6 months postoperatively showed complete resection. These tumors are rare and originate from hair follicles, sebaceous glands, or sweat glands. They have an overall 5-year survival rate of 78.2%, but the metastasis rate can range from 15% to 30%. The treatment approaches are not well described in the literature; combinations of surgery, chemotherapy, immunotherapy, targeted therapy, and radiotherapy are utilized.Lessons: Malignant cutaneous adnexal neoplasms are rare conditions that need precise diagnosis and prompt multidisciplinary treatment. https://thejns.org/doi/10.3171/CASE25447.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240674","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}

引用次数: 0

Successful management of recurrent multiple intracerebral TFE3-rearranged epithelioid hemangioendothelioma with repeated intervention and active surveillance: illustrative case. 反复干预和积极监测下成功治疗复发性多发性脑内tfe3重排上皮样血管内皮瘤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-10-06 DOI: 10.3171/CASE25416

Yasuzumi Matsui, Shigeki Takada, Yasuhide Takeuchi, Shinya Tokunaga, Etsuko Yamamoto Hattori, Hiroyuki Ikeda, Noritaka Sano, Masahiro Tanji, Yohei Mineharu, Yoshiki Arakawa

{"title":"Successful management of recurrent multiple intracerebral TFE3-rearranged epithelioid hemangioendothelioma with repeated intervention and active surveillance: illustrative case.","authors":"Yasuzumi Matsui, Shigeki Takada, Yasuhide Takeuchi, Shinya Tokunaga, Etsuko Yamamoto Hattori, Hiroyuki Ikeda, Noritaka Sano, Masahiro Tanji, Yohei Mineharu, Yoshiki Arakawa","doi":"10.3171/CASE25416","DOIUrl":"10.3171/CASE25416","url":null,"abstract":"Background: Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor with intermediate malignant potential. TFE3-rearranged intracerebral EHEs (iEHEs) have not been reported to date. Herein, the authors describe a rare case of recurrent multiple TFE3-rearranged iEHEs involving the lung and liver, which exhibited a favorable clinical course after repeated surgeries, radiation therapy, and active surveillance.Observations: A 20-year-old man presented with multiple pulmonary, hepatic, and intracerebral lesions. The patient was diagnosed with EHE via biopsy of pulmonary lesions. During follow-up without treatment, progressive perilesional edema was observed in the left temporal lobe, leading to resection. Histological findings were consistent with EHE, and immunohistochemical analysis revealed overexpression of TFE3 in the tumor cells. Hence, a diagnosis of TFE3-rearranged iEHE was established. Immediately after detecting progressive lesions, the patient received multiple interventions including surgery and radiation therapy. Radiological findings revealed multiple cystic lesions with hemorrhagic components. The tumor has been successfully controlled for 13 years with repeated surgeries, radiation therapy, and active surveillance.Lessons: TFE3-rearranged iEHE is an extremely rare type of tumor and can present with multiple cystic lesions containing hemorrhagic components on imaging. TFE3-rearranged iEHE can be successfully managed with repeated intervention and active surveillance. https://thejns.org/doi/10.3171/CASE25416.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240667","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}

引用次数: 0

Thrombolysis and thrombectomy in a first trimester stroke: expanding the evidence for acute ischemic stroke management in pregnancy. Illustrative case. 早期妊娠期卒中的溶栓和取栓：扩大妊娠期急性缺血性卒中管理的证据。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-10-06 DOI: 10.3171/CASE25126

Esteban R Rivera-Rivera, Alexander I Acevedo-Jetter, Alejandro E Cedeño-Morán, Grecia Negron Torres, Rodolfo E Alcedo-Guardia

{"title":"Thrombolysis and thrombectomy in a first trimester stroke: expanding the evidence for acute ischemic stroke management in pregnancy. Illustrative case.","authors":"Esteban R Rivera-Rivera, Alexander I Acevedo-Jetter, Alejandro E Cedeño-Morán, Grecia Negron Torres, Rodolfo E Alcedo-Guardia","doi":"10.3171/CASE25126","DOIUrl":"10.3171/CASE25126","url":null,"abstract":"Background: Stroke is the leading cause of disability and the fifth leading cause of death nationwide, with large-vessel occlusions (LVOs) contributing significantly to this burden. The risk of LVO increases in hypercoagulable states such as pregnancy; however, LVOs in pregnancy are rare. Management of this condition lacks well-established guidelines due to the exclusion of pregnant women from clinical trials. Case reports of alteplase and mechanical thrombectomy (MT) use during pregnancy suggest therapeutic potential; however, there is less evidence for agents such as tenecteplase (TNK).Observations: The authors present the case of a 27-year-old woman, G5P2A2, at 4 weeks' gestation who presented with seizure-like activity, expressive aphasia, and right-sided hemiparesis, NIH Stroke Scale score of 21. The patient was diagnosed with an ischemic stroke. TNK was administered without symptom resolution, and the patient was transferred to the authors' center. Imaging demonstrated left M2 occlusion, and MT was performed successfully. The patient carried the pregnancy to term and delivered a healthy infant at 37 weeks.Lessons: To the authors' knowledge, this represents the first formally reported case of LVO treated with TNK and MT in the first trimester of pregnancy. More data are needed to determine whether these interventions are safe for patients with LVOs during the first trimester of pregnancy. https://thejns.org/doi/10.3171/CASE25126.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240692","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}

引用次数: 0

Aspiration prevention surgeries for adult patients with brainstem malignant gliomas: illustrative cases. 成人脑干恶性胶质瘤的误吸预防手术：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-10-06 DOI: 10.3171/CASE25284

Kensuke Ikeda, Kuniaki Saito, Nobuyoshi Sasaki, Keiichi Kobayashi, Motoo Nagane

{"title":"Aspiration prevention surgeries for adult patients with brainstem malignant gliomas: illustrative cases.","authors":"Kensuke Ikeda, Kuniaki Saito, Nobuyoshi Sasaki, Keiichi Kobayashi, Motoo Nagane","doi":"10.3171/CASE25284","DOIUrl":"10.3171/CASE25284","url":null,"abstract":"Background: Adult patients with brainstem gliomas have a poor prognosis, with a median survival of approximately 1 year. Although patients often remain conscious until the end of life, lesions affecting the medulla oblongata can cause severe dysphagia and increase the risk of aspiration and suffocation. These symptoms significantly reduce quality of life (QOL) during advanced stages. While aspiration prevention surgery is often performed for severe dysphagia in other conditions, its efficacy in adult patients with brainstem gliomas remains unclear.Observations: This report presents 2 cases of adult patients with malignant brainstem gliomas who develoved progressive dysphagia. In case 1, glottic closure was performed as an aspiration prevention surgery; however, postoperative complications delayed the resumption of oral feeding, and the patient died due to tumor progression. In case 2, total laryngectomy was performed as an aspiration prevention surgery, which facilitated long-term oral intake and resulted in a good functional outcome, despite subsequent disease progression.Lessons: Aspiration prevention surgery may benefit selected adult patients with malignant brainstem gliomas. However, potential complications must be carefully considered. Further studies with larger sample sizes are needed to assess the impact of this intervention on QOL and clinical outcomes. https://thejns.org/doi/10.3171/CASE25284.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240619","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}

引用次数: 0

Acquired Chiari malformation type I after atlanto-occipital dislocation: illustrative case. 寰枕脱位后获得性Chiari畸形I型：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-10-06 DOI: 10.3171/CASE25473

Luis A Robles, Ibrahim Alhalal, R John Hurlbert

{"title":"Acquired Chiari malformation type I after atlanto-occipital dislocation: illustrative case.","authors":"Luis A Robles, Ibrahim Alhalal, R John Hurlbert","doi":"10.3171/CASE25473","DOIUrl":"10.3171/CASE25473","url":null,"abstract":"Background: Chiari malformation type I (CM-I) is characterized by the descent of the cerebellar tonsils through the foramen magnum. In some patients, this condition can be acquired secondarily due to another condition that alters the dynamics of CSF in the foramen magnum, leading to tonsillar herniation. In this report, the authors describe a case of an acquired CM-I occurring 3 years after a traumatic atlanto-occipital dislocation (AOD).Observations: The authors report the case of a 31-year-old male who initially presented with traumatic AOD associated with a craniocervical hematoma and subsequently developed CM-I. MRI revealed herniation of the cerebellar tonsils through the foramen magnum and extensive cervical spinal cord hyperintensity indicative of a presyrinx state. The patient underwent a suboccipital craniectomy, partial laminectomies of C1 and C2, and duraplasty. After surgery, he exhibited progressive improvement, achieving complete neurological recovery. Postoperative MRI demonstrated complete resolution of the cerebellar descent and the signal changes in the cord.Lessons: The authors describe the case of a patient presenting with CM-I after experiencing an AOD and a circumferential hematoma in the cervicomedullary junction. Although rare, clinicians should consider CM-I in the differential diagnosis of patients who present with delayed neurological symptoms after sustaining traumatic injury to the craniovertebral region. https://thejns.org/doi/10.3171/CASE25473.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240676","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}

引用次数: 0

Symptomatic subcutaneous emphysema following lumboperitoneal shunt placement: illustrative case. 腰腹腔分流术后出现症状性皮下肺气肿：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-10-06 DOI: 10.3171/CASE25584

Tomoya Sofue, Megumi Chatani, Norio Miyoshi, Kenkichi Takahashi, Shinji Yamamoto, Yoshihiro Kuga, Hiroyuki Ohnishi

{"title":"Symptomatic subcutaneous emphysema following lumboperitoneal shunt placement: illustrative case.","authors":"Tomoya Sofue, Megumi Chatani, Norio Miyoshi, Kenkichi Takahashi, Shinji Yamamoto, Yoshihiro Kuga, Hiroyuki Ohnishi","doi":"10.3171/CASE25584","DOIUrl":"10.3171/CASE25584","url":null,"abstract":"Background: Secondary normal pressure hydrocephalus is a common complication in the chronic phase after subarachnoid hemorrhage or intracerebral hemorrhage, with an incidence of approximately 30%. Lumboperitoneal (LP) shunts are often selected for older patients due to their less invasive nature. However, postoperative complications such as infection, catheter malfunction, and subdural hematoma are known.Observations: The authors present the first known case of symptomatic subcutaneous emphysema following LP shunt surgery, necessitating reoperation. The patient was a markedly thin woman (BMI 13.3), and the cause of the complication was determined to be a combination of shallow subcutaneous catheter placement and failure to evacuate retained air prior to closure.Lessons: In thin patients, LP shunt catheters should be placed in deeper layers to minimize dead space and prevent air retention. In addition, care must be taken to release subcutaneous air before wound closure, especially in procedures performed in the lateral decubitus position. https://thejns.org/doi/10.3171/CASE25584.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240701","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}

引用次数: 0

Intracranial granuloma: a rare long-term complication of retained shunt catheter. Illustrative case. 颅内肉芽肿：保留分流导管的一种罕见的长期并发症。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-10-06 DOI: 10.3171/CASE25557

Rothaina Saeedi, Khaled Alfaramawy, Ibtihal Zabermawi, Salwa Bakhsh, Maher Kurdi, Saleh Baeesa

{"title":"Intracranial granuloma: a rare long-term complication of retained shunt catheter. Illustrative case.","authors":"Rothaina Saeedi, Khaled Alfaramawy, Ibtihal Zabermawi, Salwa Bakhsh, Maher Kurdi, Saleh Baeesa","doi":"10.3171/CASE25557","DOIUrl":"10.3171/CASE25557","url":null,"abstract":"Background: Ventriculoperitoneal shunt placement is the most commonly used treatment for hydrocephalus. However, its malfunction frequently presents a challenge in clinical practice, necessitating shunt revision. In certain instances, intracranial catheter revision may pose difficulties due to severe intraluminal adhesions, necessitating the surgeon to leave the catheter in situ. However, retained catheters can lead to severe complications.Observations: A 17-year-old male presented with headache and unsteady gait for several weeks. He had a cystoperitoneal shunt for hydrocephalus associated with Dandy-Walker malformation during infancy. However, at the age of 12 years, the shunt was found to be nonfunctioning and was removed, except for the intradural catheter, due to severe adhesions. Brain MRI revealed a large mass encasing the catheter. Craniotomy and gross-total resection of the mass, including the catheter, revealed a granuloma, but no organisms were isolated from the specimen. The postoperative recovery was uneventful, and there was no recurrence for 10 years.Lessons: This case highlights a potential complication associated with retained intracranial catheters and their neurosurgical management. Our literature review identified a limited number of comparable cases of retained catheter-related granuloma, and the pathophysiology and treatment were elucidated within the review. https://thejns.org/doi/10.3171/CASE25557.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240715","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}

引用次数: 0

Successful presurgical gyral functional mapping by combining super-selective Wada test and super-selective cone-beam CT angiography for language preservation in a case of recurrent glioblastoma of the language-dominant inferior frontal gyrus: illustrative case. 结合超选择性Wada测试和超选择性锥束CT血管造影对语言保存的下额回复发性胶质母细胞瘤的成功手术前脑回功能定位：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-10-06 DOI: 10.3171/CASE25384

Ryuga Ogura, Kenji Ibayashi, Rintaro Kuroda, Yoshiyuki Onuki, Katsunari Namba, Naoto Kunii, Kensuke Kawai

{"title":"Successful presurgical gyral functional mapping by combining super-selective Wada test and super-selective cone-beam CT angiography for language preservation in a case of recurrent glioblastoma of the language-dominant inferior frontal gyrus: illustrative case.","authors":"Ryuga Ogura, Kenji Ibayashi, Rintaro Kuroda, Yoshiyuki Onuki, Katsunari Namba, Naoto Kunii, Kensuke Kawai","doi":"10.3171/CASE25384","DOIUrl":"10.3171/CASE25384","url":null,"abstract":"Background: Redo awake surgery is ideal for recurrent malignant gliomas in the language-dominant hemisphere, but it may not always be optimal because of inadequate awake mapping. In this report, the authors describe a case of recurrent language-dominant frontal glioma in which a super-selective Wada (ssWada) test and super-selective cone-beam CT angiography (ssCBCTA) enabled successful tumor removal under general anesthesia after awake surgery.Observations: A woman in her 30s underwent awake surgery for left frontal glioma recurrence 2 years after the initial resection. Three years after another recurrence, the ssWada test and ssCBCTA revealed that the tumor-supplying artery did not perfuse the functional cortex, allowing safe and maximal resection under general anesthesia. Postoperatively, she had mild motor aphasia but recovered quickly with minimal sequelae.Lessons: The combined use of the ssWada test and ssCBCTA enables precise preoperative language mapping and safe tumor resection. Originally developed for epilepsy surgery, the ssWada test is valuable for functional mapping and, when paired with ssCBCTA, provides a 3D understanding of the lesions. This combination serves as a critical preoperative tool for tumors in the language-dominant hemisphere. https://thejns.org/doi/10.3171/CASE25384.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240689","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}

引用次数: 0

Basal cisternostomy for severe traumatic brain injury: illustrative case. 颅底池造瘘术治疗重型颅脑损伤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-09-29 DOI: 10.3171/CASE25170

Afsal Sharafudeen, Kokyou Sakurada, Katsuya Ueno, Omar Jbarah, Kaima Suzuki, Mario Ganau, Iype Cherian, Hiroki Kurita

{"title":"Basal cisternostomy for severe traumatic brain injury: illustrative case.","authors":"Afsal Sharafudeen, Kokyou Sakurada, Katsuya Ueno, Omar Jbarah, Kaima Suzuki, Mario Ganau, Iype Cherian, Hiroki Kurita","doi":"10.3171/CASE25170","DOIUrl":"10.3171/CASE25170","url":null,"abstract":"Background: Basal cisternostomy (BC) is increasingly utilized for intracranial pressure (ICP) management in severe traumatic brain injury (TBI), particularly by neurosurgeons in some high-incidence regions like India and China. It is performed as an adjunct to decompressive craniectomy (DC) or as a stand-alone procedure with bone flap replacement if brain laxity permits after basal cisternal drain placement. Emerging research from regions where this method is used supports its efficacy for ICP control.Observations: A 17-year-old male was involved in a severe road traffic accident. He presented with a Glasgow Coma Scale score of 5 and bilaterally dilated, nonreactive pupils. CT revealed a left acute subdural hematoma (ASDH) with significant midline shift, severe global brain edema, effaced basal cisterns, and brainstem compression signs. Emergency BC was performed, followed by ASDH evacuation. The bone flap was replaced. Postoperatively, the patient showed remarkable recovery, with extubation on day 2 and early mobilization. By day 7, he was walking with assistance, and by discharge on day 13, he exhibited only mild word-finding difficulty, which improved significantly at follow-up.Lessons: This case highlights the potential of BC as an alternative or adjunct to DC in severe TBI, emphasizing the need for larger, multicenter studies to validate its efficacy. https://thejns.org/doi/10.3171/CASE25170.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"10 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194341","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}

引用次数: 0