Surgical neurology international最新文献

{"title":"Treatment of 23 spinal perimedullary arteriovenous fistulas in a single center: A simple and practical treatment strategy.","authors":"Hon-Man Liu, Chung-Wei Lee, Yen-Heng Lin","doi":"10.25259/SNI_133_2025","DOIUrl":"10.25259/SNI_133_2025","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study is to present our strategy for stratifying patients with spinal perimedullary arteriovenous fistulas (PMAVFs) and apply the appropriate treatment.</p><p><strong>Methods: </strong>This retrospective study included 23 patients with PMAVF. We divided the patients into three groups according to the location of the fistula and size of the predominant feeder: Group 1 (dorsal PMAVF, <i>n</i> = 4), Group 2 (nondorsal PMAVF having a predominant feeder through which the smallest coil-deploying microcatheter could pass, <i>n</i> = 6), and Group 3 (nondorsal PMAVF having no feeder through which the smallest available microcatheter could pass, <i>n</i> = 13). Group 1 underwent surgical treatment. All patients in Groups 2 and 3 underwent endovascular treatment with a liquid embolic agent, except one in Group 3, who opted for surgical treatment. Coil was used as a supplementary tool for treating lesions in Group 2. Patients' basic and clinical characteristics, treatment, and outcome data were recorded.</p><p><strong>Results: </strong>Six patients were aged <15 years. Overall, patient fistulas were located in the thoracic region (<i>n</i> = 11), conus region (<i>n</i> = 7), and cervical spine (<i>n</i> = 5). Of the 18 PMAVFs who underwent endovascular treatment, 100% occlusion was observed in 14, 90% in 3, and 75% in 1. Nineteen patients had complete or partial recovery of neurological deficits. Six patients experienced temporary worsening immediately after treatment but recovered within 3 months. No bleeding or rebleeding was noted after either treatment.</p><p><strong>Conclusion: </strong>Our simple strategy for stratifying PMAVF for treatment is easy to apply in clinical practice and results in favorable outcomes.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"196"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228176","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":"Patient selection criteria and preliminary outcome of the first 20 endoscopic evacuation of intracerebral hematoma in a tertiary hospital center.","authors":"Mohammed Yassaad Oudrhiri, Hajar Bechri, Yao Christian Hugues Dokponou, Yasser Arkha, Abdessamad El Ouahabi","doi":"10.25259/SNI_98_2025","DOIUrl":"10.25259/SNI_98_2025","url":null,"abstract":"<p><strong>Background: </strong>Evacuation of intracerebral hemorrhage (ICH) using endoscopic, minimally invasive surgery is becoming the main technique in the surgical treatment of this devastating disease, given the overall improved outcomes reported. We report our experience with patient selection and preliminary results of the first 20 patients with ICH treated with endoscopic evacuation.</p><p><strong>Methods: </strong>A retrospective analysis of intraparenchymal and/or intraventricular hemorrhage cases, treated from 2018 to 2020 was performed. Patient characteristics, technical details, and surgical outcomes (favorable, modified Rankin scale [mRS] 0-2; unfavorable, mRS 3-5; death, and mRS 6) were analyzed and discussed.</p><p><strong>Results: </strong>Six (30.0%) cases of IVH, 10 (50.0%) of intraparenchymal hematoma (IP), and 4 (20.0%) of IP&IVH were treated using the endoscopic technique. The mean age was 50.8 [17.6] years, with a male predominance of 60.0% (<i>n</i> = 12). Analysis of variance testing of the mean difference confirmed a favorable outcome when the hemorrhage was limited to the IP location (mean mRS score at 6 months was 1.90 (95% confidence interval [CI] [1.37-2.43], <i>P</i> = 0.032). However, there was an unfavorable outcome when blood was inside the ventricles: IVH (mean mRS at 6 months was 4.17 (95% CI [2.02-6.31], <i>P</i> = 0.032) and IP&IVH (mean mRS at 6 months was 5.0 (95% CI [1.81-8.18], <i>P</i> = 0.032).</p><p><strong>Conclusion: </strong>The endoscopic intracranial hematoma evacuation technique can achieve a high evacuation rate with shorter surgical duration and acceptable morbidity, encouraging the transition from classical craniotomy in selected patients. Sufficient knowledge and training in endoscopic techniques can be achieved through a short learning curve.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"190"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228134","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 fossa hemorrhagic complication after tuberculum sellae meningioma surgery through transcranial corridor: A proposed hypothesis.","authors":"Guive Sharifi, Esmaeil Mohammadi, Ali Jafari","doi":"10.25259/SNI_177_2025","DOIUrl":"10.25259/SNI_177_2025","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"193"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228135","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":"Road map to enhanced recovery protocol for endonasal endoscopic approach to pituitary adenomas: Surgical short-term outcome and experience of a single ENT/neurosurgery collaboration.","authors":"Mohamed M Arnaout, Mansour A Makia, Ahmed A Bessar, Ismail Elnashar, Magdy O ElSheikh","doi":"10.25259/SNI_726_2024","DOIUrl":"10.25259/SNI_726_2024","url":null,"abstract":"<p><strong>Background: </strong>The endoscopic endonasal transsphenoidal approach has become standard for the management of pituitary adenomas. This approach has been shown to facilitate early recovery and discharge from the hospital. The early recovery protocol has many advantages for both patients and the healthcare system in terms of patient satisfaction and cost-effectiveness.</p><p><strong>Methods: </strong>Forty-seven patients with pituitary adenomas who underwent a trans-nasal endoscopic approach at our institution, operated by one neurosurgeon and one ENT surgeon, were retrospectively studied. Enhanced recovery protocols entailed preoperative, intraoperative, and postoperative protocols. The standard care included 1 day postoperative intensive care unit admission plus 1 or 2 days in the ward. Patient satisfaction was measured in terms of resolution of chief complaint, and a questionnaire survey was conducted at discharge and the 3-month follow-up.</p><p><strong>Results: </strong>There was a significant decrease in the length of hospital stay with a mean of 2.7 days (standard deviation = 0.74). Patient satisfaction was better at the 3-month follow-up than in the early postoperative period. Most of our patients improved in terms of biochemical cure (18 out of 25 functioning adenomas [72%]) and experienced resolution of the chief complaint. The death occurred in only one patient due to pulmonary embolism.</p><p><strong>Conclusion: </strong>Our study supports the benefits of early recovery protocols for endoscopic endonasal surgery for pituitary adenoma resection. The procedure is both safe and efficacious and improves overall patient satisfaction. Cerebrospinal fluid leaks remain a challenge but may improve with the use of fat, fascia lata, or middle turbinate flaps for large defects.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"192"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228159","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":"Cavernoma of the left ventral striatum, anatomical and microsurgical implications of the ipsilateral transcallosal transrostral pathway.","authors":"Alejandro Benjamin Romero Leguina, Luis Ángel Canache Jiménez, Mariano Teyssandier, Álvaro Rodrigo Quiñones Céspedes, Sebastian Juan Mária Giovannini, Mariela Cecilia Salerno, Erica Antunes Effgen, Érico Samuel Gomes Galvão da Trindade, José Maria de Campos Filho, Feres Chaddad-Neto","doi":"10.25259/SNI_285_2025","DOIUrl":"10.25259/SNI_285_2025","url":null,"abstract":"<p><strong>Background: </strong>Cerebral cavernous malformations are vascular abnormalities of the central nervous system with an incidence of 0.4-0.5% and an annual hemorrhage rate ranging from 0.7% to 1%. The most important and consistent risk factor for rebleeding is a prior hemorrhage, and deep lesions (within the thalamus, basal ganglia, and brainstem) characteristically carry a worse prognosis regarding annual hemorrhage rates (10.6% per patient per year vs 0.4% per patient per year for superficial cerebral lesions) and subsequent neurologic deterioration. The ventral striatum is a difficult region to approach. The conservative treatment and also radiosurgery are not compatible with this kind of lesion, in the virtue of the eloquence and high risk of rebleeding, and the worsening of the perilesional edema, respectively, resulting in a motor deficit.</p><p><strong>Case description: </strong>This video presents a case of a 37-year-old male patient with a 6-month history of headaches, with a magnetic resonance imaging (MRI) showing a lesion in the left ventral striatum compatible with cavernoma with signs of recent bleeding. The patient underwent an ipsilateral transcallosal transrostral approach. The procedure was uneventful, and the patient was discharged without neurological deficits. A postoperative MRI confirmed complete resection.</p><p><strong>Conclusion: </strong>The anatomical aspects to consider are analyzed as the dissection progresses toward the lesion, and the other surgical alternatives are studied in this video. The ipsilateral transcallosal transrostral pathway permits an intuitive awareness of the midline at all times, facilitating safer manipulation of the brain tissue when accessing deep-seated lesions. Consequently, the risk of intraoperative and postoperative complications decreases.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"199"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228171","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":"Cranial-orbital approaches for vascular pathology: A review of surgical approach selection and technical considerations.","authors":"Kara A Parikh, Vincent N Nguyen, Mustafa Motiwala, Taylor J Orr, Kaan Yagmurlu, C Stewart Nichols, Adam S Arthur, Jeffrey M Sorenson, L Madison Michael Ii, Nickalus R Khan","doi":"10.25259/SNI_106_2025","DOIUrl":"10.25259/SNI_106_2025","url":null,"abstract":"<p><strong>Background: </strong>Modified cranial approaches for vascular pathology are sometimes necessary to enhance exposure and can be tailored by the pathology treated and surgical conditions. The authors outline these approaches, comparing the advantages and disadvantages of each.</p><p><strong>Methods: </strong>Surgical footage of the senior author performing cranial-orbital skull base approaches for intracranial aneurysms as part of routine care was reviewed to identify and describe the advantages and disadvantages of these approaches to vascular pathology. The variations of cranial-orbital approaches included supraorbital, lateral supraorbital (LSO), orbito-pterional, cranio-orbital, and transcavernous approaches. Four illustrative cases are included. The literature was also reviewed for a concise compilation and summary of technical considerations and comparisons of cranial-orbital approaches for the microsurgical treatment of vascular pathology.</p><p><strong>Results: </strong>The supraorbital approach provides a trajectory along the orbital roof, allowing access to anterior circulation aneurysms without drilling the anterior clinoid process. While this approach is suited for inferiorly and anteriorly projecting anterior communicating artery (AcomA) aneurysms, orbito-pterional approaches are better suited for superiorly projecting AcomA aneurysms. The LSO approach allows access to anterior circulation and low-lying basilar apex lesions. The orbito-pterional approach is an \"outside-in\" approach to access the intracranial space from the orbit; the cranio-orbital approach is considered an \"inside-out\" approach to access the orbit from the intracranial space.</p><p><strong>Conclusion: </strong>Modifications of the traditional pterional craniotomy are useful for various anterior and posterior circulation vascular pathologies. Extensions of these surgical corridors with transcavernous approaches can also be useful. Understanding the advantages and disadvantages of each is important in optimal approach selection.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"191"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228185","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":"Conjoined nerve root, epidural varicose vein, and extruded lumbar disc: Triad of refractory sciatica.","authors":"Nazmin Ahmed, Mohammad Nazrul Hossain, Shahidul Islam Khan, Raad Kazi","doi":"10.25259/SNI_371_2025","DOIUrl":"10.25259/SNI_371_2025","url":null,"abstract":"<p><strong>Background: </strong>A patient presented with sciatica attributed to a conjoined lumbosacral nerve root, an extruded disc herniation, and epidural varicose veins.</p><p><strong>Case description: </strong>A 60-year-old male presented with 5 months of sciatica (4/5 motor deficit). The lumbosacral magnetic resonance showed a right paracentral disc herniation causing thecal sac/L5-S1 nerve root compression. Intraoperatively, the patient had an L5-S1 conjoined nerve root, an extruded disc herniation, and type C epidural varicose veins. A wide fenestration and foraminotomy were performed to facilitate the removal of the extruded disc and partial coagulation of the epidural varicose veins. Surgery resulted in complete symptom resolution within the 1^st postoperative month.</p><p><strong>Conclusion: </strong>A patient with intractable right-sided sciatic was found at surgery to have an L5-S1 conjoined nerve root, a herniated disc, and marked epidural varicosities. Following a wide fenestration/foraminal decompression, the patient's symptoms fully resolved within the 1^st postoperative month.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"200"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228183","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 rare case of lumbar intraspinal osteolipoma presenting with a sciatic pain.","authors":"Daishiro Abe, Kiyoshi Ito, Tetsuyoshi Horiuchi","doi":"10.25259/SNI_281_2025","DOIUrl":"10.25259/SNI_281_2025","url":null,"abstract":"<p><strong>Background: </strong>Osteolipoma constitutes <1% of all lipomas. They are only rarely located in the spine. Here, we report an extremely rare lumbar intraspinal osteolipoma, along with a review of its clinical and radiological features.</p><p><strong>Case description: </strong>A 57-year-old male presented with a 1-year history of progressively worsening of his sciatica. The magnetic resonance imaging (MRI) revealed a right-sided extradural lesion compressing the cauda equina at the L3/L4 level. The lesion was hyperintense with a hypointense rim on both T1- and T2-weighted images, while the computed tomography (CT) showed that it was hyperdense (i.e., osseous). Following operative resection, the patient's symptoms resolved. Pathologically, it proved to be a benign osteolipoma.</p><p><strong>Conclusion: </strong>MRI and CT studies documented a L3/4 extradural, osseous lesion causing cauda equina compression. Following surgical removal, the patient's symptoms fully resolved.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"195"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228155","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 type II proatlantal artery arising from the external carotid artery: A review of neurovascular anatomy.","authors":"Archit Bharathwaj Baskaran, Aditya Jhaveri, Olivia A Kozel, Chibueze Ikechukwu Agwu, Sachin Kothari, Therese Dunne, Michael Charles Hurley, James E Siegler","doi":"10.25259/SNI_1093_2024","DOIUrl":"10.25259/SNI_1093_2024","url":null,"abstract":"<p><strong>Background: </strong>A type II proatlantal artery is a rare congenital vascular anomaly comprised of a persistent embryologic connection between the carotid and vertebrobasilar circulations. Although generally asymptomatic and detected incidentally, its identification is of clinical importance in neurovascular assessments and interventions.</p><p><strong>Case description: </strong>A 70-year-old male presented with acute-onset left lower extremity weakness and numbness, out of the window for thrombolytics; computed tomography angiography of the head and neck incidentally identifying a persistent left type II proatlantal artery originating from the external carotid artery and supplying the vertebrobasilar circulation. Magnetic resonance imaging of the brain the following day was unremarkable for acute infarction or other cerebrovascular pathology.</p><p><strong>Conclusion: </strong>This case underscores the significance of recognizing congenital vascular anomalies such as the type II proatlantal artery, particularly in the context of cerebrovascular assessment. Although these variants are often incidental and not associated with increased stroke risk, their presence has implications for neuroendovascular procedures and stroke evaluations. Understanding the anatomic and embryologic origins of these vascular anomalies facilitates accurate interpretation of cerebrovascular imaging and enhances clinical decision-making in patients with these anomalies.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"198"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228165","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":"Endoscopic resection of a giant colloid cyst in the cavum septum pellucidum: Illustrative case.","authors":"Nurali Ashirov, Murat Arlanbekov, Daniyar Teltayev, Berik Zhetpisbaev, Serik Akshulakov","doi":"10.25259/SNI_1082_2024","DOIUrl":"10.25259/SNI_1082_2024","url":null,"abstract":"<p><strong>Background: </strong>Colloid cysts (CCs) are a rare type of benign tumor, and the ones >30 mm in diameter are determined as giant CCs. The giant CCs of the cavum septum pellucidum (CSP) are located in the hard-to-reach areas of the brain, and they can be removed microsurgically and endoscopically. At present, the transition from the microsurgical resection to the endoscopic is observed, and researchers demonstrate several benefits of the endoscopic resection over the microsurgical. We noticed the absence of research illustrating the endoscopic resection of the giant CC of the CSP. Therefore, we decided to demonstrate a rare case performed in our hospital.</p><p><strong>Case description: </strong>Our patient was a 57-year-old male who had suffered from dizziness, headache, nausea, urinary incontinence, short-term forgetfulness, gait ataxia, cognitive decline, and vision blurring. The eventual diagnosis of the giant CC in the CSP was established, and it was complicated by occlusive hydrocephalus and headache syndrome. The endoscopic resection of the giant CC in the septum pellucidum was performed using the endoscopic transseptal approach.</p><p><strong>Conclusion: </strong>No complications were observed in the postoperative period. The tumor was removed completely, no recurrence was noted, and only a capsule of the tumor was observed in the control magnetic resonance imaging image taken 3 months after the operation. Considering these results, we conclude that endoscopic removal may have positive and safe outcomes as the surgical treatment method for the giant CCs located in the septum pellucidum.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"186"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228097","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}