Surgical neurology international最新文献

{"title":"Endovascular intra-arterial infusion for cerebral glioblastoma.","authors":"Habiba Abdullahi, Mayur Sharma, Ahmed M Shahrabani, Samer S Hoz","doi":"10.25259/SNI_775_2026","DOIUrl":"https://doi.org/10.25259/SNI_775_2026","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"540"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121021","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":"Lumbar microdiscectomy during first trimester of pregnancy: Surgical, anesthetic, and radiation considerations with review of reported cases.","authors":"Zara Ismail, Mehar Masroor, Osama Salar, Saqib Kamran Bakhshi","doi":"10.25259/SNI_872_2026","DOIUrl":"https://doi.org/10.25259/SNI_872_2026","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation requiring surgical intervention during pregnancy is rare, particularly during the first trimester. Here, we highlight the pros and cons of performing a microdiscectomy (MD) during the first trimester for a pregnant 27-year-old female.</p><p><strong>Case description: </strong>A 27-year-old pregnant female in her first trimester presented with a progressive right foot drop secondary to an L5-S1 disc herniation. After failing 6 weeks of conservative management, she underwent right L5-S1 MD under general anesthesia in the prone position. Maternal hemodynamic stability was maintained throughout the procedure, and fluoroscopy was limited to a single image. Postoperatively, motor strength improved with rehabilitation, and she subsequently delivered a healthy full-term infant without obstetric or neonatal complications.</p><p><strong>Conclusion: </strong>Medically and neurosurgically indicated lumbar MD should be appropriately performed in patients in their first trimester of pregnancy.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"546"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121254","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":"Cognitive impairment in idiopathic intracranial hypertension: A conceptual framework and therapeutic implications.","authors":"Brandon J Shin, Vishnu Achyuth Suresh, Nicholas Borg","doi":"10.25259/SNI_795_2026","DOIUrl":"https://doi.org/10.25259/SNI_795_2026","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment is an increasingly recognized but poorly understood manifestation of idiopathic intracranial hypertension (IIH). Although deficits in attention, executive functioning, memory, processing speed, and reaction time have been reported, the characteristics, trajectory, and underlying mechanisms of cognitive dysfunction remain incompletely defined. Interpretation of the literature is limited by heterogeneity in study design, variability in neurocognitive assessment methods, and the absence of standardized cognitive outcome measures. Consequently, cognitive morbidity is overlooked in clinical practice and is not incorporated into treatment decision-making, which remains centered around visual outcomes and papilledema.</p><p><strong>Methods: </strong>In this narrative review, we synthesize evidence from IIH studies and related disease models to examine the putative mechanisms underlying cognitive dysfunction and propose a conceptual framework for its pathogenesis.</p><p><strong>Results: </strong>Cognitive dysfunction in IIH may arise through interactions between elevated intracranial pressure, cerebral venous hypertension, symptom-related amplifiers including chronic headache, sleep disturbance, pulsatile tinnitus, and psychiatric comorbidity, and broader biological and socioeconomic modifiers influencing cognitive vulnerability and recovery. This framework integrates current evidence and identifies potential pathways linking IIH to cognitive impairment.</p><p><strong>Conclusion: </strong>Improved understanding of the cognitive effects of IIH may help improve recognition of cognitive dysfunction in clinical care. Recognition of cognition as a clinically meaningful and potentially treatment-responsive outcome may help inform future studies evaluating whether cognition has a role in treatment selection, particularly in patients without papilledema, in whom disease burden may currently be underestimated.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"545"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121402","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":"Surgical treatment of large vestibular schwannomas with hydrocephalus in octogenarians: Two cases with favorable functional outcomes.","authors":"Masahiro Nonaka, Katsuya Ueno, Mayuko Miyata, Haruna Isozaki, Yi Li, Junichi Takeda, Takehiro Suyama, Ryosuke Matsuda","doi":"10.25259/SNI_806_2026","DOIUrl":"https://doi.org/10.25259/SNI_806_2026","url":null,"abstract":"<p><strong>Background: </strong>The optimal management of vestibular schwannoma (VS) associated with hydrocephalus in octogenarians remains controversial. We report two patients aged 80 years or older with Koos grade IV VS who underwent surgical treatment.</p><p><strong>Case description: </strong>Case 1 involved an 86-year-old woman who presented with progressive gait disturbance caused by a 3.5-cm cystic right VS associated with hydrocephalus. Case 2 involved an 81-year-old woman who presented with cognitive impairment and gait disturbance due to a 3.0-cm cystic left VS with hydrocephalus. In both patients, magnetic resonance imaging demonstrated narrowing of the high-convexity sulci, enlarged Sylvian fissures, and an acute callosal angle. Tumor resection was performed via a retrosigmoid approach with intraoperative facial motor evoked potential (FMEP) monitoring. Tumor dissection was terminated when FMEP amplitudes decreased to <50% of baseline values, resulting in subtotal or near-total tumor resection. Neither patient developed clinically significant postoperative facial nerve dysfunction. Both patients regained independent ambulation. Postoperative imaging demonstrated reduction of ventricular enlargement and improvement of hydrocephalus-related radiological findings. Cognitive function improved substantially in Case 2, with the Mini-Mental State Examination score increasing from 11 to 24. At the latest follow-up, the first patient remained independent without tumor progression or recurrent hydrocephalus 5.9 years after surgery, whereas the second patient maintained independent daily functioning without evidence of tumor progression at 8 months postoperatively.</p><p><strong>Conclusion: </strong>Surgical resection with intraoperative facial nerve monitoring may provide favorable functional and radiological outcomes in carefully selected octogenarians with large VSs associated with hydrocephalus.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"534"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121204","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":"Intraoperative motor-evoked potential monitoring during coil embolization of internal carotid-anterior choroidal artery aneurysms: A comparative case series and lessons on monitoring pitfalls.","authors":"Yuki Go, Tetsuya Yokouchi, Yoshinori Teshima, Masanori Nakagawa, Makoto Hiramoto","doi":"10.25259/SNI_882_2026","DOIUrl":"https://doi.org/10.25259/SNI_882_2026","url":null,"abstract":"<p><strong>Background: </strong>Ischemic injury to the anterior choroidal artery (AChA) territory during coil embolization of internal carotid artery-AChA (ICA-AChA) aneurysms can be functionally devastating and is not always detected by angiography. We examined the utility and the interpretive pitfalls of intraoperative motor-evoked potential (MEP) monitoring in this specific aneurysm subgroup.</p><p><strong>Methods: </strong>We retrospectively reviewed 16 consecutive patients who underwent coil embolization for ICA-AChA aneurysms at a single institution. Seven patients (2013-2025) were monitored with intraoperative MEP (MEP group); 9 patients (2005-2015) treated before monitoring was introduced served as a historical comparison group (non-MEP group). Angiographic AChA changes, MEP waveform changes, intraoperative interventions, and postoperative diffusion-weighted magnetic resonance imaging were analyzed.</p><p><strong>Results: </strong>Significant MEP amplitude reduction (≥50%) occurred in two monitored patients, prompting coil retrieval, microcatheter repositioning, or a procedural pause; amplitudes recovered in all. One patient showed transient MEP reduction without angiographic change (possible false-positive). No patient in the MEP group developed postoperative infarction (0%), whereas two of nine non-MEP patients did (22%).</p><p><strong>Conclusion: </strong>In this small comparative series, MEP monitoring provided functional information complementary to angiography, with no infarctions in the monitored group. MEP changes must be interpreted alongside angiographic and clinical findings, as both false-positive and false-negative results occur. These hypothesis-generating findings warrant prospective validation.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"538"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121138","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":"Decision-making for emergency craniotomy in traumatic intracranial hemorrhage with severe thrombocytopenia and coagulopathy in a patient with suspected acute leukemia: A case-based review.","authors":"Kosei Goto, Nobuo Kutsuna, Kotaro Makita, Takuto Nishihara","doi":"10.25259/SNI_336_2026","DOIUrl":"https://doi.org/10.25259/SNI_336_2026","url":null,"abstract":"<p><strong>Background: </strong>Emergency craniotomy for traumatic intracranial hemorrhage is time-dependent, yet surgery may be futile when profound thrombocytopenia and coagulopathy prevent hemostasis and severe brain swelling is already present.</p><p><strong>Case description: </strong>A young adult man with traumatic intracranial hemorrhage rapidly deteriorated to coma (Glasgow coma scale-3). Admission laboratories showed white blood cell count 72,300/µL, platelet count 12,000/µL, and prothrombin time-international normalized ratio 1.59, raising concern for an underlying hematologic disorder, including acute leukemia, with coagulopathy. Head computed tomography demonstrated a large frontal intraparenchymal hemorrhage with traumatic subarachnoid hemorrhage, intraventricular extension, and imaging features consistent with severe diffuse brain swelling. After intubation, emergency craniotomy was undertaken with perioperative transfusion of red blood cells, fresh frozen plasma, and platelets. Diffuse bleeding and marked brain swelling prevented durable hemostasis, and the patient died.</p><p><strong>Conclusion: </strong>When neurotrauma meets hematologic catastrophe, the decision to operate should incorporate both neurologic salvageability and the realistic probability of achieving usable hemostasis within the available time. Early estimation of attainable platelet correction, together with rapid coagulation assessment including fibrinogen when available, parallel hematology support, and a damage-control operative plan with pre-specified stopping rules may help frame surgery as a time-limited trial rather than a binary choice.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"536"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121412","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":"Jugulotympanic paraganglioma, preoperative embolization, and transmastoid retrolabyrinthine approach: Two-dimensional operative video.","authors":"Elizabeth Escamilla Chávez, Rodolfo Zavaleta Antunez, Ricardo Servin Torres, Rodrigo Uribe-Pacheco, Odette Karime Arceo Pool, Alejandro Miranda-González","doi":"10.25259/SNI_500_2026","DOIUrl":"https://doi.org/10.25259/SNI_500_2026","url":null,"abstract":"<p><strong>Background: </strong>Jugulotympanic paraganglioma (JTP), also known as glomus jugulare tumor, is a neuroendocrine neoplasm. Although it represents <0.5% of head-and-neck tumors, it demonstrates significant local aggressiveness due to its tendency to infiltrate bone, vascular structures, and cranial nerves. Due to the hypervascular nature of these tumors, preoperative embolization has become an important surgical adjunct. The retrolabyrinthine approach provides adequate exposure of the jugular foramen while preserving the facial nerve without mandatory transposition.</p><p><strong>Case description: </strong>We present a 52-year-old woman with hearing loss, tinnitus, and dizziness. Evaluation revealed left-sided anacusis secondary to prior cochlear dysfunction and severe conductive hearing loss. Computed tomography showed extensive erosion of the jugular foramen without carotid canal, labyrinth, or internal auditory canal involvement. Magnetic resonance imaging (MRI) demonstrated a Fisch D1 lesion with cisternal and extracranial extension, measured 30 × 18 × 22 mm along its craniocaudal, anteroposterior, and laterolateral axes, respectively, with an estimated volume of 5.94 cm³. After multidisciplinary discussion, preoperative embolization of external carotid branches achieved >50%, followed by a transmastoid retrolabyrinthine approach for resection. Estimated blood loss was 2500 mL. In the postoperative course, the patient had House-Brackmann grade I facial function, moderate dysphagia, and mild dysphonia. A 3-month postoperative MRI shows expected postoperative changes and no evidence of residual tumor.</p><p><strong>Conclusion: </strong>Preoperative embolization facilitates surgical resection in advanced JTP. Combined with meticulous technique and neuromonitoring, it enables favorable functional outcomes and cranial nerve preservation.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"543"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121195","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":"Case of idiopathic cervical spinal subarachnoid hematoma mimicking an epidural hematoma: A case report.","authors":"Shunki Iemura, Terumasa Ikeda, Yoshihiro Ishihama, Kensuke Toriumi, Koji Goto","doi":"10.25259/SNI_1006_2026","DOIUrl":"https://doi.org/10.25259/SNI_1006_2026","url":null,"abstract":"<p><strong>Background: </strong>Cervical spinal subarachnoid hematoma (SSAH) is rare and may mimic epidural or subdural hematoma on magnetic resonance imaging (MRI). This makes it difficult to correctly localize the hematoma on the preoperative magnetic resonance, thus typically warranting surgery.</p><p><strong>Case description: </strong>A 78-year-old female presented with the sudden onset of neck pain and progressive left hemiparesis. The cervical MRI showed a left dorsolateral C3-C5 compressive hematoma, thought initially to represent an epidural clot. The accompanying computed tomography angiogram (i.e., without preoperative digital subtraction angiography) showed no vascular abnormality. Due to rapid neurological deterioration, the patient underwent an emergency decompression. At surgery, no epidural hematoma was found; rather, following a durotomy, arachnoid dissection revealed an organized SSAH without abnormal vessels that were removed <i>en bloc</i>. The patient improved immediately after surgery, and the postoperative MRI confirmed adequate decompression.</p><p><strong>Conclusion: </strong>Idiopathic cervical SSAH should be included in the differential diagnosis of acute cervical compressive hematomas. As MRI may not reliably define the location of the hematoma, those demonstrating progressive neurological deterioration typically warrant surgery, even without a full vascular work-up.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"537"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121338","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":"Could the right to try act of 2017 be of benefit for surgical investigators?","authors":"Harry Sawyer Goldsmith","doi":"10.25259/SNI_773_2026","DOIUrl":"https://doi.org/10.25259/SNI_773_2026","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"541"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121342","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":"Surgical decision-making in traumatic acute subdural hematoma: A scoping review of current evidence, knowledge gaps, and future directions.","authors":"Fahri Eryilmaz","doi":"10.25259/SNI_865_2026","DOIUrl":"https://doi.org/10.25259/SNI_865_2026","url":null,"abstract":"<p><strong>Background: </strong>Traumatic acute subdural hematoma (ASDH) is a major neurosurgical emergency associated with high morbidity and mortality. Despite numerous studies, uncertainty remains regarding optimal surgical decision-making. This scoping review aimed to map current evidence, identify knowledge gaps, and summarize factors influencing the surgical management of traumatic ASDH.</p><p><strong>Methods: </strong>A Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews-guided scoping review was conducted using PubMed and Scopus to identify studies published between January 2001 and July 2026. Studies involving adult patients with traumatic ASDH that evaluated surgical management or factors influencing surgical decision-making were included in the study. Data were extracted using a standardized framework and qualitatively synthesized.</p><p><strong>Results: </strong>Seventy-seven studies met the inclusion criteria. The current evidence showed no clear superiority of craniotomy over decompressive craniectomy in terms of mortality or functional outcomes. Admission Glasgow Coma Scale score, pupillary response, age, and frailty consistently influenced surgical decision-making and prognosis. Evidence supporting minimally invasive and endoscopic techniques remained limited. Important knowledge gaps included the lack of prospective comparative studies, inconsistent outcome reporting, and insufficient evidence to guide patient selection.</p><p><strong>Conclusion: </strong>No single surgical strategy is universally superior for traumatic ASDH. Surgical management should be individualized, with clinical, radiological, and patient-specific factors considered together. This review identifies important knowledge gaps and highlights priorities for future research to strengthen evidence-based surgical decision-making and improve patient outcomes.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"547"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121151","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}