Surgical neurology international最新文献

{"title":"Radiological and pathological findings of spinal intramedullary granular cell tumor.","authors":"Ryo Inagaki, Daisuke Kohno, Seiji Shigekawa, Akihiro Inoue, Riko Kitazawa, Takeharu Kunieda","doi":"10.25259/SNI_993_2024","DOIUrl":"10.25259/SNI_993_2024","url":null,"abstract":"<p><strong>Background: </strong>Granular cell tumors (GCTs) are rare, usually benign, tumors with classic histomorphology. This tumor can occur throughout the body, but the spine is a distinctly rare location. Here, we report a very rare case of intramedullary GCT arising in the thoracic spinal cord.</p><p><strong>Case description: </strong>A 36-year-old woman presented to our hospital with an approximately 1-year history of gradually worsening numbness in the left toe and weakness in both lower limbs. Neuroimaging showed a tumor mass in the upper spine at the level of thoracic vertebrae 7-8, appearing hypointense on T2-weighted imaging (WI) and showing uniform gadolinium enhancement on T1-WI. Complete surgical resection was successfully performed. Histopathological examination revealed round or polygonal cells with abundant granular eosinophilic cytoplasm strongly staining for S-100 and SOX10, and benign intramedullary GCT in the thoracic spinal cord was diagnosed. Postoperative magnetic resonance imaging (MRI) showed no residual tumor, and the patient recovered well from this intervention, showing no sequelae. Follow-up neuroimaging after 2 years showed no signs of recurrence.</p><p><strong>Conclusion: </strong>This report describes an extremely rare case of GCT arising from the intramedullary thoracic spinal cord, which is difficult to diagnose by routine neuroimaging. Therefore, accurate diagnosis requires careful identification of clinical signs, MRI including hypointensity on T2-WI, and analysis of combined morphologic and immunohistochemical studies.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384574","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":"Intracranial epidermoid cysts: Demographics, surgical strategies, and postoperative outcomes in a retrospective cohort study.","authors":"Moneer K Faraj","doi":"10.25259/SNI_1085_2024","DOIUrl":"10.25259/SNI_1085_2024","url":null,"abstract":"<p><strong>Background: </strong>Intracranial epidermoid cysts are infrequent, benign, and slow-growing lesions derived from ectodermal vestiges. Although extremely uncommon, these lesions represent a great challenge from a diagnostic and surgical point of view because they are located close to major neurovascular structures with great potential for complications. Our work aims to analyze demographic, clinical, radiological, and surgical features in patients with intracranial epidermoid cysts and to assess post-surgical outcomes to define better management strategies.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients diagnosed with histologically confirmed intracranial epidermoid cysts and treated surgically at Dr. Said Al-Witry's Neuroscience Hospital from January 2020 to September 2024. Demographic data, clinical presentations, imaging findings, surgical approaches, and postoperative complications were analyzed using descriptive statistics and Chi-square tests. Statistical significance was set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>Out of 40 patients, 75% were male, with headaches being the most common symptom (50%). Magnetic resonance imaging (MRI) findings demonstrated T1 hypo-intensity in 95% and T2 hyper-intensity in all cases. The retrosigmoid approach was the most frequently employed surgical method (60%), followed by frontotemporal (30%) and midline suboccipital (10%) approaches. Postoperative complications occurred in 35% of cases, including facial nerve palsy (15%), aseptic meningitis (10%), cerebrospinal fluid leaks (5%), and hydrocephalus (5%). Chi-square analysis showed significant associations between surgical approaches and postoperative complications (<i>P</i> = 0.048).</p><p><strong>Conclusion: </strong>Intracranial epidermoid cysts show a high incidence in males and present mostly with nonspecific symptoms such as headaches and seizures. MRI remains the key investigation modality. The retrosigmoid approach shows less complication rate when compared to other techniques. Even though surgery has evolved, complications such as meningitis and nerve palsy persist, so much attention to detail is required in preoperative planning and follow-up in the long run for optimum outcomes for the patients.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384545","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":"Artificial intelligence in corticospinal tract segmentation using constrained spherical deconvolution.","authors":"Erom Lucas Alves Freitas, Bruno Fernandes de Oliveira Santos","doi":"10.25259/SNI_982_2024","DOIUrl":"10.25259/SNI_982_2024","url":null,"abstract":"<p><strong>Background: </strong>Tractography of cerebral white matter tracts is a technique with applications in neurosurgical planning and the diagnosis of neurological diseases. In this context, the approach based on the constrained spherical deconvolution (CSD) algorithm allows for more efficient and plausible segmentations. This study aimed to compare two CSD techniques for corticospinal tract (CST) segmentation.</p><p><strong>Methods: </strong>This study examined 40 diffusion-weighted images (DWIs) acquired at 7T from healthy participants in the human connectome project (HCP) and 12 clinical 1.5T DWIs from patients undergoing neurosurgical procedures. Tractography was performed using two techniques: regions of interest-based approach and an automatic approach using the TractSeg neural network. The volume of the CST segmented by the two methods was compared using the Dice similarity coefficient.</p><p><strong>Results: </strong>There was a low similarity between the CST volumes segmented by the two techniques (Dice index for the HCP: 0.479 ± 0.04; Dice index for the Clinical: 0.404 ± 0.08). However, both techniques achieved high levels of consistency in sequential measurements, with intraclass correlation coefficient values above 0.995 for all comparisons. In addition, all selected metrics showed significant differences when comparing the two techniques (HCP - volume <i>P</i> < 0.0001, fractional anisotropy [FA] <i>P</i> = 0.0061, mean diffusivity [MD] <i>P</i> < 0.0001; Clinical - volume <i>P</i> < 0.0001, FA <i>P</i> = 0.0018, MD <i>P</i> = 0.0018).</p><p><strong>Conclusion: </strong>Both methods demonstrate a high degree of consistency; however, the automatic approach appears to be more consistent overall. When comparing the CST segmentations between the two methods, we observed only a moderate similarity and differences in all considered metrics.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384452","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":"Early use of targeted blood patch in spontaneous intracranial hypotension presenting with bilateral subdural hematomas and acute infarcts.","authors":"Muhammad Shahzad, Mohammad Ashraf, Samiul Muquit","doi":"10.25259/SNI_833_2024","DOIUrl":"10.25259/SNI_833_2024","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intracranial hypotension (SIH) is a rare but important condition characterized by cerebrospinal fluid (CSF) leakage, typically presenting with postural headaches. In severe cases, SIH can result in subdural hematomas (SDHs), brain herniation, and acute infarcts. The 2023 SIH guidelines recommend starting with nontargeted epidural blood patches as the initial treatment, with up to two attempts before considering a targeted patch. Nontargeted patches are effective in most cases by distributing blood widely in the epidural space. However, in rapidly deteriorating patients, targeted blood patches may be necessary, especially when a specific leak site has been identified. This report highlights the importance of timely, targeted interventions in severe SIH cases.</p><p><strong>Case description: </strong>A 34-year-old male presented with a 6-month history of worsening headaches, impaired mobility, and stupor. On admission, his Glasgow Coma Scale was 12, which rapidly deteriorated to 5. Imaging revealed bilateral chronic SDHs, cerebellar tonsillar herniation, and signs of intracranial hypotension despite no history of trauma or anticoagulant use. Initial surgical evacuation of the hematomas failed to improve the patient's neurological status. Subsequent magnetic resonance imaging and computed tomography myelogram identified a CSF leak at the T12 level. Given the patient's critical state and rapid neurological decline, we opted for a targeted epidural blood patch at the L1/2 level. This intervention led to significant clinical improvement, with follow-up imaging demonstrating a reduction in the subdural collections and resolution of the leak. The patient fully recovered and remained asymptomatic at a 6-month follow-up.</p><p><strong>Conclusion: </strong>This case highlights the need for flexibility in SIH management, particularly in severe cases with acute neurological decline. While nontargeted blood patches are typically recommended, early use of a targeted patch when imaging identifies the leak can lead to faster resolution and improved outcomes. Personalized treatment strategies are essential for managing complex SIH presentations and preventing further neurological complications.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384526","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":"Frequency of trigeminal neurovascular contacts identified on 3D-fast imaging employing steady-state acquisition magnetic resonance imaging in asymptomatic adults.","authors":"Ashok Kumar, Shayan Sirat Maheen Anwar, Khawar Bilal, Anwar Ahmed, Saira Samnani, Burhan Zafar","doi":"10.25259/SNI_1021_2024","DOIUrl":"10.25259/SNI_1021_2024","url":null,"abstract":"<p><strong>Background: </strong>Neurovascular conflict is considered one of the main causes of Trigeminal neuralgia, and 3D fast imaging employing steady-state acquisition magnetic resonance imaging (MRI) is the diagnostic imaging of choice. However, no tool is available to confirm imaging findings as the primary cause of trigeminal neuralgia because neurovascular contact is frequently found in asymptomatic individuals, according to some literature, although very little data is available till now. Therefore, we aim to determine the frequency of trigeminal neurovascular contact, involved nerve segment, culprit vessel, and characteristics of contacts in asymptomatic individuals. Knowledge about this is very crucial so that every patient may not be labeled as having neurovascular conflict as the primary cause and can be saved from unnecessary surgeries.</p><p><strong>Methods: </strong>A retrospective observational study was conducted on 105 MRI brain scans of asymptomatic individuals for trigeminal neurovascular relationships by two expert neuro-radiologists. Percentages calculated for categorical variables and for continuous variables Shapiro-Wilk test were used. The Fisher Exact test is used to assess the association between conflict and other variables. Inter-rater reliability was computed for the outcome and other variables and Cohen's kappa to evaluate the strength of agreement. All calculations were performed using STATA version 17.0.</p><p><strong>Results: </strong>Out of 105 cases, neuro-vascular contact was identified in 64 cases. The most common contacting vessel was the superior cerebellar artery. The most common nerve segment involved was the cisternal segment, followed by the Root entry zone and porous trigeminus. In about 54 cases, the vessel was abutting the nerve, while in eight cases, it was compressing and, in two cases, displacing the nerve. The superior surface of the nerve was commonly involved. The inter-rater reliability between both neuroradiologists showed significant agreement.</p><p><strong>Conclusion: </strong>Neurovascular contact is found in asymptomatic individuals, so just the presence of contact in symptomatic individuals on MRI should not be considered as only the cause of trigeminal neuralgia. It is important to identify nerve thinning and distortion, which are more reliable signs.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384536","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":"Staged and combined resection of a posterior fossa ganglioglioma.","authors":"Robert C Rennert, Vance L Fredrickson, Vance R Mortimer, William T Couldwell","doi":"10.25259/SNI_812_2024","DOIUrl":"10.25259/SNI_812_2024","url":null,"abstract":"<p><strong>Background: </strong>Posterior fossa gangliogliomas with extension into the cerebellopontine angle are extremely rare and can be challenging to resect because they are infiltrative and the regional neurovasculature is complex.[1,2] Tumor grade may best predict oncologic outcome.[1] Histologic grading can be used to balance surgical aggression with the risk of cranial neuropathies.</p><p><strong>Case description: </strong>During an evaluation for headaches, a 19-year-old woman was found to have a 5.3 × 4.0 × 3.5-cm left lateral cerebellar and cerebellopontine angle tumor, with an apparent intrinsic origin and significant exophytic extension. The lesion was minimally enhancing and partially cystic and had significant calcifications. On examination, she was neurologically intact, with the exception of mildly decreased left oropharyngeal sensation. She underwent a left retrosigmoid craniotomy for tumor debulking and tissue diagnosis; the tumor was found to be adherent to cranial nerves 7 through 11. Pathological evaluation demonstrated a ganglioglioma (World Health Organization grade I). A safe maximal resection was recommended on multidisciplinary review. A secondary left far lateral craniotomy and C1 hemilaminectomy were performed, allowing for a complete resection of the residual tumor. The patient was discharged on postoperative day 6 at her neurologic baseline, with the exception of new mild left V2-3 paresthesias that were resolved by 6-month follow-up. Postoperative and 6-month magnetic resonance imaging demonstrated a gross total resection with no complications.</p><p><strong>Conclusion: </strong>For rare, low-grade tumors, a staged, histology-guided, safe maximal resection can maximize functional and oncologic outcomes.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384563","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":"Immunoexcitoxicity as the possible major pathophysiology behind multiple sclerosis and other autoimmune disorders.","authors":"Russell L Blaylock","doi":"10.25259/SNI_1114_2024","DOIUrl":"10.25259/SNI_1114_2024","url":null,"abstract":"<p><p>Autoimmune disorders are destructive processes considered to be an attack on \"self \" antigens by the immune system CD-+4 T-cells that are directed toward antigens, in the case of multiple sclerosis (MS), particularly myelin antigens. Yet, there is growing evidence that the major destructive events in MS, as well as other non-central nervous system (CNS) autoimmune disorders, are much more than an immune attack on the CNS initiated by a misdirected immune system that attacks a \"self \" antigen or antigens by a process called molecular mimicry. Extensive evidence suggests that inflammation, in turn, initiates excitotoxicity, which is responsible for the majority of pathological findings in all stages of the disease, especially a loss of oligodendroglia (source of myelin) and axon injury in MS. Excitotoxicity also is a better explanation for progressive MS, in which the immune attack has either slowed or is halted; yet, the destructive pathology continues to progress. It also explains the destructive lesions seen in gray matter, which is essentially devoid of inflammation. It has recently been shown that most of the damage to the oligodendrocytes, as well as axonal injury, is secondary to excitotoxicity. While there is a growing appreciation that excitotoxicity plays a major role, there has been little effort to link the immune changes to the excitotoxic process, recently named immunoexcitotoxicity, even though the role of excitotoxicity has been shown to occur in the inflammatory stage in the beginning and throughout the process of the disease, particularly the chronic progressive stage. It is also known that peripheral glutamate receptors exist throughout the body, thus making the process of immunoexcitotoxicity a possible integral part of all or most autoimmune disorders in which the immune system is intimately linked to enhancing the excitotoxic process. This is of special concern now that peripheral glutamate receptors have been isolated in many peripheral tissues and are known to be fully functional.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384539","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 epidemiology of motorcycle-related acute traumatic brain injury: The NOMADEN study.","authors":"Aryandhito Widhi Nugroho, Nur Upik En Masrika","doi":"10.25259/SNI_929_2024","DOIUrl":"10.25259/SNI_929_2024","url":null,"abstract":"<p><strong>Background: </strong>Although persisting to be a public health hazard in Indonesia, motorcycle-related traumatic brain injury (TBI) due to road traffic accidents (RTA) lacks comprehensive national data. We aim to study the epidemiological pattern of motorcycle-related TBI and analyze the determinants related to mortality in the only neurosurgical center in the rural province of North Maluku, Indonesia.</p><p><strong>Methods: </strong>Using the North Maluku Database in Neurosurgery register, information regarding age, sex, health insurance, alcohol use, point of referral, degree of severity, brain computed tomography abnormalities, helmet use, surgery, injury-to-admission time (IAT), and relationship to the motorcycle were obtained from patients admitted to Chasan Boesoirie General Hospital, Ternate, in 2021-2022. Multivariable logistic regression analysis was performed to investigate associations with in-hospital mortality.</p><p><strong>Results: </strong>Of all RTA-related TBI patients (<i>n</i> = 353), 91.8% (<i>n</i> = 324) were caused by motorcycle collision (mean age ± standard deviation of 30.5 ± 16.7 years old). The majority were motorcyclists (66.7%), male (64.8%), IAT >4 h (55.9%), financed by non-Jaminan Kesehatan Nasional mechanism (66.4%), not under alcohol influence (78.4%), referred from Ternate (55.2%), and suffered mild TBI (75%). Thirty patients (9.3%) succumbed to death. Moreover, 9.3% and 91.2% were ≤17 years old and helmetless. Glasgow coma scale and IAT were significantly associated with in-hospital mortality (odds ratio [95% confidence interval]: 0.58 [0.49-0.68] and 5.44 [1.00-30.34], respectively).</p><p><strong>Conclusion: </strong>The young and productive males dominated the motorcycle-related TBI patients in North Maluku. Poor compliance with road traffic laws, as demonstrated by a considerable proportion of underage, alcohol-intoxicated, and helmetless patients, necessitated prompt actions from all related elements.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383648","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":"Bone cement versus bone flap replacement: A comparative meta-analysis of posterior fossa craniotomy complications.","authors":"Ryan Neill, Peter Harris, Lekhaj Chand Daggubati","doi":"10.25259/SNI_789_2024","DOIUrl":"10.25259/SNI_789_2024","url":null,"abstract":"<p><strong>Background: </strong>Posterior fossa surgeries are often performed to treat infratentorial pathologies, such as tumors that increase intracranial pressure. Posterior fossa craniotomy has been shown to decrease the incidence of postoperative complications and morbidity compared to craniectomy. More recently, the use of bone cement in posterior fossa craniotomies has been implemented, but there is limited comparative postoperative data of this technique to more commonly used bone flap replacement. This study aims to address this information gap through a meta-analysis comparing the incidence of postoperative cerebrospinal fluid leakage and other complications when utilizing bone cement versus bone flap replacement in posterior fossa craniotomies.</p><p><strong>Methods: </strong>Following a literature review, search parameters for a systematic review were identified and relevant studies were sorted based on selection criteria to be included in the meta-analysis. Data analysis was performed in R studio and Microsoft Excel software. Targeted complications for analysis include cerebrospinal fluid (CSF) leakage, pseudomeningocele formation, and infection. Pooled estimates and odds ratios for dichotomous outcomes were calculated with corresponding 95% confidence intervals, and findings were translated into illustrative tables and figures.</p><p><strong>Results: </strong>Twenty-one articles were included in a systematic review, nine studies using bone cement and thirteen using bone flap (two studies reported data for both groups). With bone flap replacement, CSF leakage was 8.36% (95% confidence interval [CI] 5.89-10.86%), pseudomeningocele formation was 9.22% (95% CI 4.82-13.62%), and infection was 6.85% (95% CI 4.05-9.65%). With bone cement usage, CSF leakage was 3.47% (95% CI 2.37-4.57%), pseudomeningocele formation was 2.43% (95% CI 1.23-3.63%), and infection was 1.85% (95% CI 0.75-2.95%). The odds ratio of CSF leak, pseudomeningocele formation, and infection was 0.39 (95% CI 0.229-0.559), 0.25 (95% CI 0.137-0.353), and 0.26 (95% CI 0.149-0.363), respectively, with the use of bone cement compared to craniotomy.</p><p><strong>Conclusion: </strong>Outcomes demonstrated in this meta-analysis revealed an overall decreased incidence of postoperative complications rates of CSF leak, pseudomeningocele formation, and infection when using bone cement compared to bone flap in posterior fossa craniotomies. Our study suggests that bone cement use is safe and effective in posterior fossa surgery. Future studies should further assess the comparative outcomes of these techniques.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384465","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 novel technique to avoid cerebrospinal fluid leaks following middle fossa approaches: Identifying a new triangle in the middle fossa.","authors":"Sarah C Nanziri, Peter Harris, Ahmed M Ashour, Yana Al-Inaya, Vincenzo Rondinelli, Saleem Abdulrauf","doi":"10.25259/SNI_845_2024","DOIUrl":"10.25259/SNI_845_2024","url":null,"abstract":"<p><strong>Background: </strong>Skull-based approaches involving the middle fossa (MF) can be complicated by postoperative cerebrospinal fluid (CSF) leaks. Most of these CSF leaks are due to inadvertent entry into the eustachian tube (ET) or incomplete packing of surrounding air cells. Air cells are routinely plugged with bone wax during surgery; however, CSF leaks due to entry into the ET are often not recognized. Our objective was to define a safe zone for drilling that would avoid entry into the ET during MF approaches.</p><p><strong>Methods: </strong>Ten cadaveric specimens were fixed in formalin and injected with latex. Twenty sides were dissected and examined under a microscope. We exposed and identified the petrous internal carotid artery (ICA), ET, and all surrounding anatomical landmarks.</p><p><strong>Results: </strong>We identified a triangle bordered by the lateral aspect of the third division of the trigeminal nerve (V3), the lateral aspect of the petrous ICA, and an imaginary line through the middle meningeal artery connecting V3 to the petrous ICA. This triangle was then bisected at the base, creating a medial and lateral sub-triangle. In all 20 cadaveric exposures, the ET was in the lateral sub-triangle and did not extend into the medial sub-triangle.</p><p><strong>Conclusion: </strong>Our findings demonstrate that entry into the ET while exposing the petrous ICA during MF approaches can be safely avoided by drilling in the medial sub-triangle. Drilling in the lateral sub-triangle will lead to entry into the ET, increasing the risk of a postoperative CSF leak.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383712","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}