Surgical neurology international最新文献

{"title":"Innovation under pressure: Managing a complex carotid-jugular fistula in a war-zone limited-resources area.","authors":"Sara Alnufaili, Badriah Alsabbagh, Marshad Hamad Alyami, Waleed Alqurashi, Bader Alahaideb, Mohammed Bafaquh","doi":"10.25259/SNI_286_2025","DOIUrl":"10.25259/SNI_286_2025","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous fistula (AVF) constitutes a pathological direct connection between an artery and a vein without an intervening capillary bed with a spectrum of high to low-grade malformation. Here, we present an unusual case of congenital neck AFV managed in a resource-limited setting in a war-zone area.</p><p><strong>Case description: </strong>A 43-year-old man presented with neck swelling and tinnitus since childhood with no history of trauma or surgical procedure. He was found to have reduced ejection fraction heart failure and atrial fibrillation and started on medications. Examination and bedside Gray scale and color Doppler ultrasound revealed a pulsatile high-flow vascular lesion around the left mandibular angle with thrill and dilated neck veins. A left external carotid artery catheter angiogram showed a large AVF hole with fast arteriovenous shunting distal to the origin of the facial artery draining into a venous sac and then to multiple superficial draining veins emptying into the anterior and external jugular veins. Multiple closure attempts at the fistula point using detachable coils and vascular plugs were unsuccessful. As a result, we treated the fistula surgically by disconnecting the draining veins and the presumed fistula and then resection of the venous sac guided by an intraoperative ultrasound. The patient tolerated the procedure, the tinnitus disappeared, and the heart failure improved at the 8-week follow-up echocardiogram. He developed local neurogenic pain that improved with 2 weeks of carbamazepine. Immediate postoperative neck computed tomography angiography confirmed fistula obliteration.</p><p><strong>Conclusion: </strong>This case demonstrates the ability to consider patient and setting-tailored treatment options in managing complex carotid-jugular fistula and the utility of adjunctive intraoperative ultrasound in these procedures.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"217"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228119","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":"Pseudoaneurysm development in extracranial-intracranial bypass surgery: Diagnostic challenges and surgical solutions.","authors":"Mohammed Q Alibraheemi, Bandar M Alhadeethi, Sheikh Ozair Nissar, Mohammedbaqer Ali Al-Ghuraibawi, Ahmed Muthana, Samer S Hoz","doi":"10.25259/SNI_183_2025","DOIUrl":"10.25259/SNI_183_2025","url":null,"abstract":"<p><strong>Background: </strong>Pseudoaneurysm formation at the anastomotic site of extracranial-intracranial (EC-IC) bypass surgery is a rare but potentially severe complication. Due to its unpredictable nature and associated risks, early detection and appropriate management are crucial. However, the rarity of this condition makes diagnosis and treatment challenging. This review explores the pathophysiology, risk factors, diagnostic strategies, and management options for pseudoaneurysms in EC-IC bypass procedures.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using the PubMed/MEDLINE database to identify studies related to pseudoaneurysm formation following EC-IC bypass surgery. The search algorithm applied was (((Pseudoaneurysm) AND (Extracranial) AND (Intracranial)) AND ((Bypass) OR (Revascularization) OR (Anastomosis))). Studies were included if they reported on pseudoaneurysm formation at the anastomotic site of EC-IC bypass procedures, including case reports, case series, retrospective studies, and reviews. Exclusion criteria encompassed studies focusing solely on nonanastomotic aneurysms, unrelated cerebrovascular procedures, or insufficient clinical data.</p><p><strong>Results: </strong>After applying the inclusion and exclusion criteria, a total of five studies were selected for detailed analysis. The extracted data included patient demographics, clinical presentation, imaging modalities used for diagnosis, treatment strategies, and postoperative outcomes.</p><p><strong>Conclusion: </strong>Pseudoaneurysms at EC-IC bypass sites pose significant diagnostic and therapeutic challenges. Given the potential for delayed complications, early detection, and individualized treatment strategies are essential. Long-term follow-up with serial imaging is necessary to monitor for recurrence and ensure optimal patient outcomes. Greater awareness and reporting of these cases will contribute to improved understanding and management of this rare complication.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"209"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228142","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":"Brachial plexus exposure in 19 post-traumatic patients: A morphometric anatomic analysis.","authors":"Carlo Mandelli, Cinzia Mura, Luigi Albano, Pietro Mortini","doi":"10.25259/SNI_173_2025","DOIUrl":"10.25259/SNI_173_2025","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brachial plexus injuries result in severe functional impairment, significantly affecting patients' quality of life. This study aims to evaluate the clinical outcomes of surgical interventions in 19 patients with brachial plexus injuries, emphasizing the effectiveness of linear incision techniques. Our surgical objectives included restoring shoulder control, elbow flexion, and elbow extension, alongside optimizing sensory recovery.</p><p><strong>Methods: </strong>We performed morphometric analyses to standardize surgical approaches, utilizing topographic linear incisions for enhanced exposure and precision. This technique ensures critical advantages: short incisions with excellent nerve visualization, identification of consistent anatomical landmarks for safe dissection even amidst scar tissue, and facilitation of multiple neurotizations through single incisions. This approach is inspired by and builds on the principles outlined by Bertelli and Ghizoni, whose work highlighted the importance of precise anatomical dissection and efficient nerve exposure.</p><p><strong>Results: </strong>We collected all morphometric measurements to standardize surgical approaches. Key findings demonstrated that linear incisions improved surgical efficiency and facilitated tension-free nerve anastomoses without the need for grafts in most cases.</p><p><strong>Conclusion: </strong>Linear incision techniques, supported by the foundational principles established by Bertelli and Ghizoni, provide significant clinical benefits in brachial plexus surgery. This approach enhances both surgical precision and patient recovery while supporting the achievement of critical neurofunctional objectives.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"203"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228170","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":"Prevalence of anatomical variants in preoperative computed tomography imaging for surgical planning of the endonasal transsphenoidal corridor.","authors":"Marcelo Rafael Vera Larrea, Rocío Santibáñez Vásquez, David Martínez Neira","doi":"10.25259/SNI_294_2025","DOIUrl":"10.25259/SNI_294_2025","url":null,"abstract":"<p><strong>Background: </strong>The endonasal transsphenoidal approach is a fundamental technique for the resection of pituitary tumors. Anatomical variability of the sphenoid sinus and its relationship with neurovascular structures can influence surgical planning and outcomes.</p><p><strong>Methods: </strong>A retrospective observational prevalence study was conducted using data from 102 patients from the INVIMEDIC database. Preoperative tomographic images in DICOM format were analyzed using RadiAnt Viewer^®. Data were collected in Microsoft Excel and analyzed with the Statistical Package for the Social Sciences 28 for Windows, including cross tables, Pearson's Chi-square test, and logistic regression analysis.</p><p><strong>Results: </strong>Significant sex-based differences were identified in sphenoid sinus morphology. The mean anteroposterior length in the overall population was 24.55 mm, with males showing greater depth (26.01 mm vs. 22.98 mm in females) and width (33.26 mm vs. 29.94 mm in females).</p><p><strong>Conclusion: </strong>Significant morphological differences in the sphenoid sinus were observed between sexes, highlighting dimensions that contrast with previous studies. These findings emphasize the importance of assessing anatomical variations to optimize transsphenoidal approach planning and minimize surgical risks.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"208"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228139","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":"Thoracic outlet syndrome associated with cervicothoracic scoliosis.","authors":"Kelsey Marie Bowman, Darius S Ansari, Amgad S Hanna","doi":"10.25259/SNI_330_2024","DOIUrl":"10.25259/SNI_330_2024","url":null,"abstract":"<p><strong>Background: </strong>Thoracic outlet syndrome (TOS) is a debilitating neurologic condition that is commonly encountered in routine neurosurgical practice. It causes severe pain, paresthesias, and weakness in the affected limb and can negatively impact patients' quality of life. Classically, TOS is caused by compression of the neurovascular bundle in the thoracic outlet region, often by soft tissue or bony anomalies. A relationship to cervicothoracic scoliosis has not been previously reported. The purpose of this case series is to report on the clinical and radiographic findings, surgical interventions, and clinical outcomes in patients with TOS and concurrent cervicothoracic scoliosis. We hypothesize that the abnormal cervicothoracic curvature may contribute to compression within the thoracic outlet.</p><p><strong>Methods: </strong>Patients who presented to the senior author's clinic and had both cervicothoracic scoliosis and TOS were identified, and a retrospective chart review was performed. A review of the electronic medical records was used to collect clinical information and outcomes data. The study is a retrospective case series of patients who presented to the senior author's clinic and underwent surgical intervention by the senior author at a university hospital. Ten patients were identified as having symptoms consistent with TOS and were also found to have coexisting cervicothoracic scoliosis. We report on the preoperative physiology measures, such as imaging and electrodiagnostic findings, and postoperative self-reported symptoms and functional measures.</p><p><strong>Results: </strong>Ten patients who presented to the clinic for evaluation of symptoms consistent with TOS were also noted to have mild-to-moderate cervicothoracic scoliosis. Eight of these patients underwent surgical intervention for their TOS, including anterior scalenectomy, pectoralis minor release, first rib resection, or a combination of the three procedures. Four patients underwent bilateral procedures. At 3 months, all patients (100%) had improvement in their numeric rating scale, and at 1 year, this dropped to 83%.</p><p><strong>Conclusion: </strong>It is well-known that bony abnormalities, such as the presence of a cervical rib or elongated C7 transverse process, can lead to the development of TOS; however, a relationship to scoliosis, which similarly may deform the thoracic outlet region has not been reported. The relationship between these two conditions merits ongoing clinical evaluation.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"210"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228175","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":"Infratentorial cerebral proliferative angiopathy: A rare entity with high risk of hemorrhage.","authors":"Keijiro Shomura, Katsuyoshi Miyashita, Seiya Kudo, Iku Nambu, Yasuo Tohma","doi":"10.25259/SNI_207_2025","DOIUrl":"10.25259/SNI_207_2025","url":null,"abstract":"<p><strong>Background: </strong>Cerebral proliferative angiopathy (CPA) is a rare vascular disease characterized by nonfocal angiogenic activity. Numerous case reports have been published; however, despite there are a few reported cases of infratentorial CPA (or cerebellar proliferative angiopathy), no comprehensive review of this condition has been conducted.</p><p><strong>Case description: </strong>We report two cases of infratentorial CPA, and both of them presented intracranial hemorrhage. The first case was a 48-year-old woman with an incidentally detected vascular abnormality in the cerebellum, which remained stable for 11 years before presenting with subarachnoid hemorrhage. The second case was a 5-year-old girl who presented with a sudden headache and decreased consciousness. Digital subtraction angiography was performed in both cases, but the source of hemorrhage remained unidentified, and conservative management was chosen.</p><p><strong>Conclusion: </strong>A review of previously reported infratentorial CPA cases suggests that infratentorial CPA has a significantly higher risk of hemorrhage than supratentorial CPA. However, the risk of rebleeding appears to be low. Our findings highlight the need for further research to determine the optimal management strategies for this rare entity.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"216"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228118","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":"Delayed-onset spinal subdural hematoma after kyphoplasty.","authors":"Ibrahim Mrad, Mohamad El Houshiemy, Sarah Kawtharani, Wael Ali Shouman, Suhyl Lakkis, Houssein Darwish","doi":"10.25259/SNI_370_2025","DOIUrl":"10.25259/SNI_370_2025","url":null,"abstract":"<p><strong>Background: </strong>Spinal subdural hematoma (SDH) is a very rare complication of percutaneous balloon kyphoplasty. Here, a 66-year-old male developed delayed-onset spinal SDH following kyphoplasty.</p><p><strong>Case description: </strong>A 66-year-old male with a history of atrial fibrillation on Eliquis developed a SDH on day 4 following a T3 single-level kyphoplasty for an osteoporotic compression fracture. The patient presented with progressive lower extremity motor/sensory paralysis that eventually ascended to the cervical region. The magnetic resonance (MR) imaging revealed a large dorsal subdural hematoma extending from T1 to S2. The patient underwent a decompressive laminectomy for hematoma to remove cement fragments and repair a dural tear. Postoperatively, the patient partially recovered sensation but no motor function and expired in the intensive care unit due to major comorbid factors.</p><p><strong>Conclusion: </strong>SDH is a potentially serious risk of performing a kyphoplasty. This is particularly true for patients on anticoagulants who should be stringently monitored with MR if indicated to avoid a major postoperative hemorrhage and paralysis.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"197"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228187","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":"Diagnostic efficacy of radionuclide scintigraphy in detecting lumboperitoneal shunt obstructions in idiopathic hydrocephalus and intracranial hypertension.","authors":"Ahmed Yasin Yavuz, Ece Uysal, Hidayet Safak Cine, Selim Seker, Nazmi Ugur Unlu, Suat Erol Celik","doi":"10.25259/SNI_12_2025","DOIUrl":"10.25259/SNI_12_2025","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the diagnostic effectiveness of radionuclide scintigraphy (RS) in detecting lumboperitoneal shunt (LPS) obstructions in patients with idiopathic normal pressure hydrocephalus (iNPH) and idiopathic intracranial hypertension (IIH).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 44 patients who underwent LPS surgery between 2010 and 2020. Twenty-one patients were diagnosed with iNPH and 23 with IIH. Clinical symptoms, including gait disturbances, cognitive impairment, and urinary dysfunction for iNPH, and headaches and vision loss for IIH, were evaluated. Preoperative computed tomography/magnetic resonance imaging (MRI) scans assessed hydrocephalus indicators, and cerebrospinal fluid (CSF) opening pressure was measured through lumbar puncture. RS was performed using technetium-99m-diethylenetriaminepentaacetic acid, and findings were compared with surgical outcomes. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and concordance (kappa coefficient) were calculated to evaluate the diagnostic accuracy of RS.</p><p><strong>Results: </strong>Of the 44 patients, 18 (40.9%) demonstrated total obstruction, 17 (38.6%) showed partial obstruction, and 9 (20.5%) had no obstruction on RS. All patients with total obstruction confirmed by RS had corresponding findings during surgery (PPV 100%). However, 10 of the 19 patients with partial or no obstruction on RS were found to have obstruction during surgery (NPV 47%). The kappa coefficient for total obstruction was 0.467 (<i>P</i> = 0.001), indicating good concordance between RS and surgical outcomes. Patients with lower CSF pressure, particularly those with iNPH, were more likely to experience false-negative RS results.</p><p><strong>Conclusion: </strong>RS is a reliable tool for detecting total LPS obstructions, but its sensitivity for partial obstructions is limited. Extending imaging periods or integrating additional diagnostic tools such as MRI may improve detection accuracy, particularly in cases with low CSF pressure. Combining RS with clinical evaluations can reduce unnecessary shunt revisions and improve patient outcomes.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"194"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228190","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":"Diffuse bone-marrow metastasis of grade 4 isocitrate dehydrogenase-mutant astrocytoma associated with hematological abnormalities: Gliomatosis of the bone marrow.","authors":"Futa Ninomiya, Naoki Nitta, Mai Noujima, Suzuko Moritani, Tadateru Fukami, Kazushi Higuchi, Kazumichi Yoshida","doi":"10.25259/SNI_49_2025","DOIUrl":"10.25259/SNI_49_2025","url":null,"abstract":"<p><strong>Background: </strong>Diffuse bone-marrow metastasis of high-grade glioma associated with hematological abnormalities is extremely rare.</p><p><strong>Case description: </strong>A 32-year-old man was referred and admitted to our hospital for treatment of three remote recurrent brain lesions. He had been treated at the referring hospital for a primary brain tumor in the right frontal lobe. One of the recurrent lesions was resected and diagnosed as a grade 4 isocitrate dehydrogenase (<i>IDH</i>)-mutant astrocytoma. Stereotactic radiation therapy (SRT) was performed on all three lesions. During this hospitalization, a lumbar spine magnetic resonance imaging (MRI) showed signal changes in the first and fourth vertebral bodies, suggesting lumbar metastasis. In addition, blood tests showed a gradual increase in the lactate dehydrogenase (LDH) level. Three months later, the patient was referred to our hospital again for palliative SRT of metastatic lumbar vertebral lesions invading the psoas major muscles. Laboratory data showed pancytopenia and a marked increase in the LDH level. A lumbar spine MRI showed signal changes in all lumbar and sacral vertebrae. To rule out hematological malignancy, biopsies of the psoas major and iliac bone marrow were performed. They showed invasion of grade 4 astrocytoma cells in both areas, leading to a diagnosis of diffuse bone-marrow metastasis. The patient died 12 days after the second admission.</p><p><strong>Conclusion: </strong>We present a rare case of diffuse bone-marrow metastasis of grade 4 <i>IDH</i>-mutant astrocytoma associated with hematological abnormalities. Progressive LDH elevation might predict diffuse bone-marrow metastasis in patients with high-grade glioma.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"201"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228191","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":"Erdheim-Chester with central nervous system involvement: Complex histopathological diagnosis and neurosurgical challenges in a rare histiocytic disorder.","authors":"Kevin S Toache, Santiago Puentes-Rosero, Massiel Zenteno-Zenteno, Luis Guillermo Castellanos-Pallares, Marco A Rodriguez-Florido, Pedro Adrian Gonzalez-Zavala","doi":"10.25259/SNI_199_2025","DOIUrl":"10.25259/SNI_199_2025","url":null,"abstract":"<p><strong>Background: </strong>Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis classified as a neoplastic hematopoietic disorder. It typically affects adults aged 40-56 years, with a male predominance (2.3-3:1). ECD presents with a wide clinical spectrum, ranging from asymptomatic bone lesions (90% of cases) to severe multisystem involvement, including cardiovascular, pulmonary, and central nervous systems (CNSs). CNS involvement occurs in approximately 50% of cases and is associated with increased morbidity and mortality. The BRAF V600E mutation is found in a significant subset of patients and plays a critical role in diagnosis and targeted therapy.</p><p><strong>Case description: </strong>We present the case of a 39-year-old male with central hypothyroidism, progressive visual impairment, and headaches. Magnetic resonance imaging revealed two extra-axial supratentorial lesions. Surgical resection was performed using a \"one-and-a-half \" frontotemporal craniotomy, providing optimal multi-angled access. Histopathological examination confirmed ECD with a BRAF V600E mutation. The patient had an uneventful postoperative recovery.</p><p><strong>Conclusion: </strong>This case highlights the strategic utility of the \"one-and-a-half \" frontotemporal craniotomy in the resection of complex supratentorial lesions. It also underscores the critical importance of molecular diagnostics, particularly the identification of the BRAF V600E mutation, in guiding treatment decisions in ECD.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"202"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228115","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}