Surgical neurology international最新文献

{"title":"Liberal use of ketamine is on the rise! A critical warning!!","authors":"Ramsis F Ghaly","doi":"10.25259/SNI_700_2024","DOIUrl":"10.25259/SNI_700_2024","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383101","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":"Value-based healthcare in management of chronic back pain: A multidisciplinary- and lean-based approach.","authors":"Nicola Montemurro, Nunzio Zotti, Jacopo Guercini, Giuliano De Carolis, Chiara Leoni, Roberto Marotta, Renata Tomei, Angelo Baggiani, Adriana Paolicchi, Simone Lazzini, Francesca Di Serafino","doi":"10.25259/SNI_468_2024","DOIUrl":"10.25259/SNI_468_2024","url":null,"abstract":"<p><strong>Background: </strong>Chronic back pain stands as the most common musculoskeletal disorder and a primary cause of disability in people under 45 years old. Multidisciplinary consultation offers an efficient approach to chronic back pain management compared to traditional therapeutic-rehabilitative paths. This paper aims to show the benefit of a diagnostic-therapeutic multidisciplinary program pathway for patients with chronic back pain.</p><p><strong>Methods: </strong>Twenty-six patients who underwent a second-level multidisciplinary consultation with a neurosurgeon and a pain therapist at our University Hospital were retrospectively identified from April 2023 to September 2023. The second-level multidisciplinary consultation is a second step consultation after a first consultation with a single specialist doctor (neurosurgeon, orthopedic, and pain therapist) who did not get the diagnosis and/or did not solve the painful symptom after medical or surgical treatment. Clinical outcomes, patient experience, and cost-effectiveness analysis were assessed using lean healthcare tools.</p><p><strong>Results: </strong>With the introduction of second-level multidisciplinary consultation, patients were assessed by multiple physicians during a single visit, reducing the costs of individual visits, reducing the time to obtain the diagnosis, and facilitating early agreement on a diagnostic-therapeutic plan. The lean value-based healthcare approach showed an average of 45 working days lost per single patient and a total cost per single patient with chronic back pain of € 1069 for the national health system for an average Lead time of 18 months. Questionnaire analysis on service quality and utility, along with overall satisfaction, revealed excellent resolution of back pain in 53.8% of cases and partial resolution of back pain in 11.5% of cases after second-level multidisciplinary consultation.</p><p><strong>Conclusion: </strong>Our multidisciplinary approach to chronic back pain has significantly improved healthcare efficiency. This new proposed clinical model reduces waiting times and costs and improves patient experience by improving clinical outcomes in the management of chronic back pain.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383117","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":"Hybrid open-endovascular onyx embolization of spinal type IVb perimedullary spinal arteriovenous fistula through direct posterior spinal vein access: A case report.","authors":"Romulo Augusto Andrade de Almeida, Francisco Call-Orellana, Christopher C Young, Franco Rubino, Sara L Thrower, Stephen R Chen, Robert Y North","doi":"10.25259/SNI_384_2024","DOIUrl":"10.25259/SNI_384_2024","url":null,"abstract":"<p><strong>Background: </strong>Spinal arteriovenous fistulas (SAVFs) are direct communication between arteries and veins without intervening abnormal vessel nidus, which often results in venous congestion and spinal cord dysfunction. Ventrally located SAVF can be challenging to treat through traditional open or endovascular approaches.</p><p><strong>Case description: </strong>We describe a hybrid (open/endovascular) procedure in a 72-year-old male with a Takai Type IVb SAVF presenting with paraparesis and sphincter dysfunction. Imaging revealed a conus medullaris SAVF in which the main fistulous connection was located ventrally. The conventional endovascular approach was deemed risky, and open surgery failed in the first attempt. The SAVF was resolved using a hybrid approach: under direct visualization, an engorged dorsal vein was punctured with an Angiocath, and a fluoroscopy-guided microcatheter was advanced through it to reach and embolize the ventral perimedullary fistulous connection. After surgery, his progressive neurological decline stabilized, radiographic spinal cord edema improved, and follow-up angiography confirmed obliteration of the fistula. Neurological function remained at the preoperative baseline.</p><p><strong>Conclusion: </strong>This approach may be a treatment for selected cases of type IVb SAVF. Easily accessible feeding vessels are coagulated and cut; the inaccessible ones can be embolized endovascularly during the same procedure.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383098","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":"Occurrence of malignant cerebral infarction following intracranial hematoma evacuation in traumatic brain injury: A case report.","authors":"Vega Pangaribuan, Tedy Apriawan, Agus Turchan","doi":"10.25259/SNI_629_2024","DOIUrl":"10.25259/SNI_629_2024","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury-related cerebral infarctions are well-documented in the literature. We want to report a case of malignant cerebral infarction that occurred at the contralateral location of evacuated epidural hematoma 3 days after surgery. The early-onset cerebral infarction's clinical presentation was already evident during the initial clinical examination, and it resembled \"Kernohan's Notch Syndrome.\"</p><p><strong>Case description: </strong>A 57-year-old male Indonesian was taken to our Academic General Hospital's emergency room following a motorcycle accident. His primary complaints were reduced consciousness and left-sided hemiparesis. A head computed tomography (CT) scan revealed an intracerebral hematoma beneath an epidural hematoma (EDH) at the left temporal area. The EDH was surgically removed promptly. The patient's Glasgow coma scale improved, and they were able to follow commands afterwards. The patient had a decreased consciousness 3 days after the surgery. A malignant infarction of the right middle cerebral artery region was identified from the head CT scan evaluation. He immediately had an emergency decompressive craniectomy and had an improvement of consciousness following the surgery.</p><p><strong>Conclusion: </strong>It is imperative to reassess the initial clinical signs of Kernohan's notch phenomenon to determine whether the offending mass was able to generate this clinical phenomenon. Initial cerebral infarction, which occurs concomitantly with traumatic intracranial hematoma, is a possible cause of clinical deterioration following the surgery.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383103","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":"Optimizing shunt integrity during acute subdural hematoma evacuation.","authors":"Tatsuya Tanaka, Hirofumi Goto, Nobuaki Momozaki, Eiichiro Honda, Eiichi Suehiro, Akira Matsuno","doi":"10.25259/SNI_411_2024","DOIUrl":"10.25259/SNI_411_2024","url":null,"abstract":"<p><strong>Background: </strong>Even mild head trauma can cause severe intracranial hemorrhage in patients with cerebrospinal fluid (CSF) shunts for hydrocephalus. CSF shunts are considered a risk factor for subdural hematoma (SDH). The management of acute SDH (ASDH) in shunted patients with normal pressure hydrocephalus can be challenging. Addressing the hematoma and the draining function of the shunt is important. To preserve the shunt, we set the shunt valve pressure to the highest and perform hematoma evacuation for ASDH. In this study, we report the surgical cases of ASDH in patients with shunts.</p><p><strong>Methods: </strong>Between 2013 and 2019, five patients with ASDH and CSF shunts underwent hematoma evacuation at our hospital. We retrospectively analyzed data regarding their clinical and radiological presentation, hospitalization course, the use of antithrombotic medications, and response to different treatment regimens.</p><p><strong>Results: </strong>The patients presented with scores of 5-14 in the Glasgow coma scale and severe neurological signs, consciousness disturbance, and hemiparesis. Most patients were elderly, taking antithrombotic medications (four of five cases), and had experienced falls (4 of 5 cases). All patients underwent hematoma evacuation following resetting their programmable shunt valves to their maximal pressure setting and shunt preservation. ASDH enlargement was observed in only one patient who underwent burr-hole drainage. Glasgow outcome scale scores at discharge were 1 and 3, respectively.</p><p><strong>Conclusion: </strong>In hematoma evacuation, increasing the valve pressure may reduce the bleeding recurrence. To preserve the shunt, setting the shunt valve pressure to the highest level and performing endoscopic hematoma evacuation with a small craniotomy could be useful.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383104","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":"A diagnostically challenging case of brain abscess with associated hemorrhage.","authors":"Kenichiro Eza, Gen Futamura, Yoshihide Katayama, Kyoko Onishi, Masahiko Wanibuchi","doi":"10.25259/SNI_669_2024","DOIUrl":"10.25259/SNI_669_2024","url":null,"abstract":"<p><strong>Background: </strong>Brain abscesses with associated hemorrhage are rare. Herein, we present a case of brain abscess with associated hemorrhage that posed a diagnostic challenge.</p><p><strong>Case description: </strong>A 50-year-old male presented with the left homonymous hemianopia and was admitted to our hospital due to a subcortical hemorrhage in the right occipital lobe, which was revealed during a head magnetic resonance imaging (MRI). Subsequent imaging suggested an intra-tumoral hemorrhage, so surgical treatment was planned. However, on hospital day 6, the patient suddenly showed a decrease in consciousness level. Head MRI showed a high signal within the capsule on diffusion-weighted imaging, which spread to the ventricle and subarachnoid space. Brain abscess was suspected; therefore, an abscess drainage surgery was performed emergency. The postoperative course was relatively smooth.</p><p><strong>Conclusion: </strong>A brain abscess that perforates the ventricle has a poor prognosis, which emphasizes the need for early diagnosis and treatment. Although hemorrhage within a brain abscess is rare, it can complicate diagnosis, which, thus, underscores the importance of awareness.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383346","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":"Before blaming glucocorticoids for prolonged postoperative hypotension, alternative explanations must be carefully ruled out.","authors":"Josef Finsterer","doi":"10.25259/SNI_691_2024","DOIUrl":"10.25259/SNI_691_2024","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383090","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":"Vertebral artery stump syndrome associated with a bihemispheric posterior inferior cerebellar artery.","authors":"Takayuki Morimoto, Kenta Fujimoto, Sung-Chul Ko, Toshikazu Nishioka, Hidemori Tokunaga","doi":"10.25259/SNI_488_2024","DOIUrl":"10.25259/SNI_488_2024","url":null,"abstract":"<p><strong>Background: </strong>Vertebral artery (VA) stump syndrome (VASS) is an embolic source for cerebral infarction (CI) in the posterior circulation after VA occlusion.</p><p><strong>Case description: </strong>A 63-year-old patient with a history of hypertension presented to our emergent department with dizziness, vomiting, and gait disturbance. Head magnetic resonance imaging (MRI) showed acute CIs in the bilateral cerebellar hemispheres and the vermis. Magnetic resonance angiography revealed patency of the VA and basilar artery. Left subclavian artery digital subtraction angiography (DSA) revealed severe left VA orifice stenosis and collateral flow from the deep cervical artery into the left V2 segment. Right VA angiography showed retrograde flow to the left V4 segment, branching bihemispheric posterior inferior cerebellar artery (PICA), and to-and-flow appearance in the proximal PICA segment and VA. VASS was diagnosed, and conservative treatment with aspirin was administered. Worsened nausea and gait disturbance had developed during hospitalization. MRI revealed an enlarged posterior circulation CI. Follow-up DSA revealed proximal to-and-flow appearance translocation to the proximal V4 segment and poor PICA flow. We performed proximal V4 segment parent artery occlusion (PAO) by endovascular therapy. No recurrence of symptoms or CI was observed. The patient was discharged on day 32 of hospitalization with 1 on the modified Rankin scale.</p><p><strong>Conclusion: </strong>We reported a rare case of VASS involving bihemispheric PICA. No CI recurrence was observed after performing PAO of the proximal V4 segment. When treating acute cases of bilateral cerebellar CI due to VASS, the contribution of PICA variations should be considered.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383129","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":"The use of ultrasound-guided imaging to localize peripheral nerve injury in pediatric patients: A case report.","authors":"Mareshah N Sowah, Benjamin R Klein, Mark Attiah, Nidia I Perez Pereda, Roseanna A Murray, Danny Lincoln John, Avidesh Panday, Allan D Levi","doi":"10.25259/SNI_580_2024","DOIUrl":"10.25259/SNI_580_2024","url":null,"abstract":"<p><strong>Background: </strong>The use of ultrasonography to diagnose and manage peripheral nerve injury is not routinely performed, but is an advantageous alternative to magnetic resonance imaging (MRI) in the pediatric population.</p><p><strong>Case description: </strong>The authors report a case of a toddler-aged female who sustained a supracondylar fracture and subsequent median and ulnar nerve injuries. All preoperative and postoperative imaging was performed through high-resolution ultrasound as opposed to MRI. Starting at 6 months post-nerve repair and with 18 months of follow-up, the patient exhibited substantial improvement in motor strength and sensory function. This case demonstrated a successful outcome while providing an imaging alternative that is portable, relatively low-cost, lacks ionizing radiation, provides additional information on vascular integrity, and obviates the need for general anesthetic such as MRI.</p><p><strong>Conclusion: </strong>The authors conclude that the use of ultrasonography to diagnose and manage traumatic peripheral nerve injury is advantageous, particularly in the pediatric population.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383115","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":"Posterior location of the facial nerve on vestibular schwannoma: Report of a rare case and a literature review.","authors":"Biji Bahuleyan, Vineetkumar Thakorbhai Patel, Mariette Anto, Sarah E Hessel, Rochan K Ramesh, K M Girish, Santhosh George Thomas","doi":"10.25259/SNI_586_2024","DOIUrl":"10.25259/SNI_586_2024","url":null,"abstract":"<p><strong>Background: </strong>Posterior location of the facial nerve in relation to vestibular schwannoma (VS) is extremely rare.</p><p><strong>Case description: </strong>An elderly man presented with the right cerebellopontine angle (CPA) syndrome. Magnetic resonance imaging showed the partly cystic and partly solid right CPA lesion extending to the internal auditory meatus. Seventh nerve monitoring showed the facial nerve on the posterior surface of the tumor. At surgery, the facial nerve was seen on the posterior surface of the tumor under the microscope. Partial excision of the tumor was done with preservation of the facial nerve both anatomically and electrophysiologically.</p><p><strong>Conclusion: </strong>The posterior location of the facial nerve should be anticipated in all patients with VS. The surgical strategy must be altered appropriately to preserve the facial nerve.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383347","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}