Surgical neurology international最新文献

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Less invasive bonnet bypass with subcutaneous tunneling method for common carotid artery occlusion - A technical note. 用皮下隧道法进行颈总动脉闭塞的微创帽状旁路手术 - 技术说明。
Surgical neurology international Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_528_2024
Yusuke Sakamoto, Sho Okamoto, Ryuta Saito
{"title":"Less invasive bonnet bypass with subcutaneous tunneling method for common carotid artery occlusion - A technical note.","authors":"Yusuke Sakamoto, Sho Okamoto, Ryuta Saito","doi":"10.25259/SNI_528_2024","DOIUrl":"10.25259/SNI_528_2024","url":null,"abstract":"<p><strong>Background: </strong>Common carotid artery occlusion (CCAO) sometimes requires vascular reconstruction. Ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unsuitable due to insufficient blood flow to the external carotid artery. The bonnet bypass, one treatment option for CCAO, requires a long coronal incision and bone groove to prevent malposition and collapse of an interposition graft. However, this long incision might lead to skin complications and reduced collateral blood flow.</p><p><strong>Methods: </strong>A 60-year-old man who experienced recurrent ischemic stroke presented with the right internal carotid artery occlusion and left CCAO. The left STA was unavailable; however, both branches of his right STA were well-developed. Minimizing skin invasion was a priority because the patient had diabetes mellitus. We performed a right STA parietal branch - right MCA anastomosis, followed by a right STA frontal branch - left radial artery graft (RAG) - left MCA bonnet bypass using small intermittent skin incisions.</p><p><strong>Results: </strong>We drilled a bone groove extending across the entire length of the interposition graft through the small intermittent skin incisions. Furthermore, we applied a right STA-RAG end-to-side anastomosis instead of an endto-end anastomosis to preserve collateral skin anastomosis. Postoperatively, the bypass remained patent, and the patient was discharged without complications.</p><p><strong>Conclusion: </strong>The bonnet bypass is a potential treatment for CCAO, but the procedure is invasive. Our modified bonnet bypass method enables less invasive management, preventing collapse and malposition of the interposition graft and minimizing skin complications.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157135","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}
引用次数: 0
Management of concurrent symptomatic tuberculum sellae meningioma and idiopathic intracranial hypertension: A case report. 并发症状性蝶鞍结节脑膜瘤和特发性颅内高压的治疗:病例报告。
Surgical neurology international Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_294_2024
Jonathan Espinosa, Samon Tavakoli, Philip Chen, Justin Mascitelli, Cristian Gragnaniello
{"title":"Management of concurrent symptomatic tuberculum sellae meningioma and idiopathic intracranial hypertension: A case report.","authors":"Jonathan Espinosa, Samon Tavakoli, Philip Chen, Justin Mascitelli, Cristian Gragnaniello","doi":"10.25259/SNI_294_2024","DOIUrl":"10.25259/SNI_294_2024","url":null,"abstract":"<p><strong>Background: </strong>Coexisting intracranial pathologies of distinct etiology which require intervention are rare. Only a handful of cases have been reported in the literature. The effects of each treatment option on both pathologies need to be considered during management. We describe the first report of the management of a patient with concurrent symptomatic tuberculum sellae meningioma (TSM) and idiopathic intracranial hypertension (IIH).</p><p><strong>Case description: </strong>A 58-year-old male presented with 2 weeks of vision loss and 3 months of headaches. He was found to have an inferior hemi-field deficit in the left eye and bilateral papilledema. Imaging studies revealed bilateral transverse sinus stenosis and a TSM abutting the left optic nerve. The opening pressure was 40 cmH2O. An expanded-endoscopic endonasal approach was performed for mass resection. Intraoperatively, a lumbar drain was placed to aid skull base repair integrity before definitive treatment was obtained. On postoperative day 9, a right transverse-sigmoid sinus stent was placed for IIH treatment. The patient was discharged the following day.</p><p><strong>Conclusion: </strong>Our management of this patient targeted the etiologies of each symptomatic pathology. Stenting provided treatment for the IIH and mass resection for the vision loss. Both the order and approaches to treatment were felt to maximize patient benefit while minimizing harm.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157137","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}
引用次数: 0
Cerebrospinal fluid protein concentration in patients with lumbar spinal stenosis. 腰椎管狭窄症患者脑脊液中的蛋白质浓度。
Surgical neurology international Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_610_2024
Hitoshi Yamahata, Kosei Ijiri, Fumito Tanabe, Kyoichi Murasumi, Yushi Nagano, Ryutaro Makino, Nayuta Higa, Ryosuke Hanaya
{"title":"Cerebrospinal fluid protein concentration in patients with lumbar spinal stenosis.","authors":"Hitoshi Yamahata, Kosei Ijiri, Fumito Tanabe, Kyoichi Murasumi, Yushi Nagano, Ryutaro Makino, Nayuta Higa, Ryosuke Hanaya","doi":"10.25259/SNI_610_2024","DOIUrl":"10.25259/SNI_610_2024","url":null,"abstract":"<p><strong>Background: </strong>In this study, we examined the impact and degree of lumbar stenosis on cerebrospinal fluid (CSF) protein concentration.</p><p><strong>Methods: </strong>In this retrospective study, we analyzed protein concentrations in CSF samples of 61 patients with lumbar spinal stenosis (LSS) obtained during pre-operative myelography. Patients were divided into two groups: those showing no block to contrast (Group A) versus those showing medium block to contrast below the lumbar puncture level (Group B).</p><p><strong>Results: </strong>The CSF protein concentration in Group B (104.3 ± 59 g/dL) patients with medium block was significantly greater than that in Group A (65.1 ± 33 g/dL) patients without medium block.</p><p><strong>Conclusion: </strong>A higher average CSF protein concentration was seen in Group B patients with significant lumbar stenosis versus Group A patients without significant lumbar stenosis. Theoretically, damage to the cauda equina in patients with LSS may cause these elevated CSF protein levels.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157115","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}
引用次数: 0
Intradural extramedullary cervical cavernoma. 硬膜外颈椎海绵状瘤
Surgical neurology international Pub Date : 2024-08-23 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_542_2024
Ghassen Gader, Wiem Mansour, Mohamed Ali Kharrat, Houssem Hdhili, Ines Chelly, Kamel Bahri, Ihsèn Zammel
{"title":"Intradural extramedullary cervical cavernoma.","authors":"Ghassen Gader, Wiem Mansour, Mohamed Ali Kharrat, Houssem Hdhili, Ines Chelly, Kamel Bahri, Ihsèn Zammel","doi":"10.25259/SNI_542_2024","DOIUrl":"10.25259/SNI_542_2024","url":null,"abstract":"<p><strong>Background: </strong>Spinal cavernomas (SCs) account for about 5% of all spinal vascular malformations. Intradural SCs occur in just 3% of cases and are typically intramedullary.</p><p><strong>Case description: </strong>A 58-year-old female presented with progressive left occipital neuralgia, left cervicobrachial neuralgia, and paresthesia of all four extremities. The magnetic resonance imaging (MRI) revealed an intradural extramedullary C2-C4 lesion causing significant spinal cord compression. Gross total tumor excision was accomplished through a midline laminectomy pathologically; the lesion proved to be a cavernoma. The postoperative follow-up MRI obtained 4 months postoperatively showed complete tumor resection.</p><p><strong>Conclusion: </strong>A 58-year-old female successfully underwent gross total excision of a C2-C4 intradural extramedullary SC.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157134","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}
引用次数: 0
Subgaleal drain versus dissection of subgaleal space and closure without drain after burr-hole drainage of chronic subdural hematoma. 在对慢性硬膜下血肿进行钻孔引流术后,采用气囊下引流管与剥离气囊下间隙并在不使用引流管的情况下进行闭合术的对比。
Surgical neurology international Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_363_2024
Hosam-Eldin Abd-Elazim Habib, Hossam Elnoamany, Ahmed Gabry Elnaggar
{"title":"Subgaleal drain versus dissection of subgaleal space and closure without drain after burr-hole drainage of chronic subdural hematoma.","authors":"Hosam-Eldin Abd-Elazim Habib, Hossam Elnoamany, Ahmed Gabry Elnaggar","doi":"10.25259/SNI_363_2024","DOIUrl":"10.25259/SNI_363_2024","url":null,"abstract":"<p><strong>Background: </strong>Chronic subdural hematoma (CSDH) is a collection of blood, blood degradation products, and fluid that accumulate on the surface of the brain between its arachnoid and dural coverings. This study is to evaluate the efficacy of subgaleal drain (SGD) versus subgaleal dissection without drainage as adjuncts to burr-hole evacuation of CSDH.</p><p><strong>Methods: </strong>A retrospective study was conducted utilizing the data of 60 patients operated for symptomatic CSDH. Patients were divided into two groups, each thirty consecutive patients: Group I, in which a SGD was inserted after CSDH evacuation through a burr-hole; and Group II, the hematoma was evacuated as in the Group I, but with no SGD insertion but instead a subgaleal pocket was created for drainage.</p><p><strong>Results: </strong>The neurological improvement at 24 h, discharge, 2 weeks, and 6 months after surgery was comparable in both groups. The overall recurrence was 4 cases (4/60, 6.7%). The rate of recurrence and surgical infection rate were comparable in both groups. Both groups showed similar incidences of postoperative seizures, bleeding, rates of medical complications, and neurological deficits. The overall postoperative mortality was five cases (5/60, 8.3%) with no significant difference between groups.</p><p><strong>Conclusion: </strong>Blunt dissection to open the subgaleal space and closure without a drain is a safe and efficient alternative to the insertion of a drain after the burr-hole evacuation of CSDH.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157148","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}
引用次数: 0
Use of intracranial compliance to assist arterial blood pressure adjustment in critical patients: Short report and review of the literature. 利用颅内顺应性帮助危重病人调整动脉血压:简短报告和文献综述。
Surgical neurology international Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_92_2024
Salomon Soriano Ordinola Rojas, Mateus Gonçalves de Sena Barbosa, Amanda Ayako Minemura Ordinola, Vinícius Otávio da Silva, Rafaela Luiza Vilela de Souza, Gustavo Frigieri, Nícollas Nunes Rabelo
{"title":"Use of intracranial compliance to assist arterial blood pressure adjustment in critical patients: Short report and review of the literature.","authors":"Salomon Soriano Ordinola Rojas, Mateus Gonçalves de Sena Barbosa, Amanda Ayako Minemura Ordinola, Vinícius Otávio da Silva, Rafaela Luiza Vilela de Souza, Gustavo Frigieri, Nícollas Nunes Rabelo","doi":"10.25259/SNI_92_2024","DOIUrl":"10.25259/SNI_92_2024","url":null,"abstract":"<p><strong>Background: </strong>Blood pressure management is extremely important to prevent cerebral hypoxia and influence the outcome of critically ill patients. In medicine, precise instruments are essential to increase patient safety in the intensive care unit (ICU), including intracranial compliance (ICC) monitoring. A new technology developed by Brain4care, makes it possible to analyze the waveform of intracranial pressure (ICP) non-invasively associated with ICC, and this instrument was used in the patient for monitoring.</p><p><strong>Case description: </strong>A 40-year-old male underwent aortic endocarditis surgery involving 182-min extracorporeal circulation and 9-min aortic clamping. Post-surgery, he exhibited a seizure bilateral mydriasis, followed by isochoric pupils and rapid foot movements. Neuroprotection measures were applied in the ICU, with noninvasive ICC monitoring initiated to assess intervention effectiveness.</p><p><strong>Conclusion: </strong>The non-invasive measurement of ICP can help clinical decision-making regarding the optimization of adapted protocols for neuroprotection in the ICU.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157153","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}
引用次数: 0
A novel leucine zipper-like transcriptional regulator 1 variant identified in a pair of siblings with familial schwannomatosis. 在一对家族性分裂瘤病兄妹中发现的新型亮氨酸拉链样转录调节因子 1 变体
Surgical neurology international Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_193_2024
Joseph Yunga Tigre, David J Levi, Victor M Lu, Andrew J Kloehn, Willa Thorson, Amr Abulaban, S Shelby Burks, Allan D Levi
{"title":"A novel leucine zipper-like transcriptional regulator 1 variant identified in a pair of siblings with familial schwannomatosis.","authors":"Joseph Yunga Tigre, David J Levi, Victor M Lu, Andrew J Kloehn, Willa Thorson, Amr Abulaban, S Shelby Burks, Allan D Levi","doi":"10.25259/SNI_193_2024","DOIUrl":"10.25259/SNI_193_2024","url":null,"abstract":"<p><strong>Background: </strong>Schwannomatosis is a rare genetic disorder marked by the emergence or predisposition to developing multiple schwannomas. Patients typically present with chronic pain or a mass in the second or third decade of life. Schwannomatosis is characterized by its associated gene, or if the specific gene is not known, then a descriptor is used. Here, we report a new Leucine zipper-like transcriptional regulator 1 (LZTR1) pathogenic variant identified in a pair of siblings with familial LZTR1-related schwannomatosis.</p><p><strong>Case descriptions: </strong>A 35-year-old male presented for evaluation of the left lower extremity pain. Magnetic resonance imaging (MRI) demonstrated multiple lesions throughout his body, highly likely for schwannomatosis. He underwent surgical resection of two of these lesions, located in the left femoral nerve and distal shin. Pathology confirmed that the resected lesions were schwannomas. Six months later, his 34-year-old sister was referred and evaluated for a right ankle mass, previously diagnosed as a ganglion cyst. MRI of her right ankle demonstrated a one-centimeter subcutaneous tumor. She underwent surgical resection, and pathology confirmed that the tumor was a schwannoma. Both siblings elected to undergo genetic analysis for pathogenic variants associated with schwannomatosis. Both results were positive for the c.263del pathogenic variant of the LZTR1 gene associated with LZTR1-related schwannomatosis. Additionally, genetic analysis also determined the mother of the siblings also carried the same c.263del pathogenic variant.</p><p><strong>Conclusion: </strong>There are still schwannomatosis cases with novel switch/sucrose non-fermentable-related matrix-associated actin-dependent regulators of chromatin subfamily B member 1 or LZTR1 mutations to be reported. We report the first three cases of the c.263+1del LZTR1 pathogenic variant causing LZTR1-related schwannomatosis initially found in the two siblings. Identifying further LZTR1 pathogenic variants can give more insight into the pathogenicity of each variant.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157100","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}
引用次数: 0
Computed tomography-guided frame-based stereotactic brain biopsy of non-enhancing lesions using indirect evidence of target selection, technical consideration, and early clinical experience. 利用目标选择的间接证据、技术考虑因素和早期临床经验,对非增强病变进行计算机断层扫描引导的框架式立体定向脑活检。
Surgical neurology international Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_187_2024
T S Lingaraju, A R Prabhuraj, B N Nandeesh, Jitender Saini, Nupur Pruthi
{"title":"Computed tomography-guided frame-based stereotactic brain biopsy of non-enhancing lesions using indirect evidence of target selection, technical consideration, and early clinical experience.","authors":"T S Lingaraju, A R Prabhuraj, B N Nandeesh, Jitender Saini, Nupur Pruthi","doi":"10.25259/SNI_187_2024","DOIUrl":"10.25259/SNI_187_2024","url":null,"abstract":"<p><strong>Background: </strong>The objective was to study the effectiveness and diagnostic outcome of frame-based stereotactic brain biopsy (STB) done for contrast non-enhancing lesions using indirect evidence of target selection observed in a plain computed tomography (CT) scan of the head.</p><p><strong>Methods: </strong>Data of patients with contrast non-enhancing brain lesions who underwent STB are collected retrospectively from NIMHANS Bangalore, hospital neurosurgery database from January 2021 to March 2023. Those cases subjected to plain CT scans after fixing the stereotactic frame to the head were included in the study. A final histopathological report analysis of these cases was done to assess the diagnostic accuracy.</p><p><strong>Results: </strong>A total of 27 such cases were biopsied. The mean age of subjects was 44.04 ± 17.812 years. Most subjects were in the age group 31-40 years (29.6%). About 55.6% were male and 44.4% were female. The most common site of biopsy was the frontal lobe. The most common indirect evidence on CT was perilesional edema at 33.3% and periventricular location at 33.3%, followed by intralesional calcification at 11.1%. Our diagnostic accuracy was 92.59%. The asymptomatic hemorrhage rate was 2%, and an increase in perilesional edema was seen in 2% of cases.</p><p><strong>Conclusion: </strong>Indirect targeting is a safe and intuitive method for biopsy of contrast non-enhancing lesions. Due consideration is to be given to various findings visible in non-contrast CT scans of the head as indirect evidence of target selection while performing frame-based STB of contrast non-enhancing lesions. This method will also be helpful in resource-limited centers, especially in low-income countries.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157119","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}
引用次数: 0
Symptomatic central nervous system tuberculosis and human herpesvirus-6 coinfection with associated hydrocephalus managed with endoscopic third ventriculostomy: A case report and review of human herpesvirus-6 neuropathology. 有症状的中枢神经系统结核和人类疱疹病毒-6合并感染,并伴有脑积水,经内窥镜第三脑室造口术治疗:病例报告和人类疱疹病毒-6神经病理学回顾。
Surgical neurology international Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_355_2024
Nicholas Edward Bui, Paras Savla, Alvaro E Galvis, Brian William Hanak
{"title":"Symptomatic central nervous system tuberculosis and human herpesvirus-6 coinfection with associated hydrocephalus managed with endoscopic third ventriculostomy: A case report and review of human herpesvirus-6 neuropathology.","authors":"Nicholas Edward Bui, Paras Savla, Alvaro E Galvis, Brian William Hanak","doi":"10.25259/SNI_355_2024","DOIUrl":"10.25259/SNI_355_2024","url":null,"abstract":"<p><strong>Background: </strong>Human herpesvirus 6 (HHV-6) is a double-stranded DNA virus well established in the clinical literature to cause the near-universal childhood infection roseola infantum (exanthema subitum/sixth disease). Primary HHV-6 infection has been reported to cause meningoencephalitis in pediatric patients, although generally in the immunocompromised.</p><p><strong>Case description: </strong>The authors treated an immunocompetent 18-month-old female who transferred to our institution for a higher level of care given concerns for meningitis in the setting of decreased level of arousal (Glasgow Coma Scale 12), and bradycardia 9 days after the onset of nasal congestion, fatigue, and repeated bouts of emesis. Outside hospital cerebrospinal fluid (CSF) studies were notable for hypoglycorrhachia, elevated protein, elevated nucleated cells with a mononuclear predominance, and a meningitis polymerase chain reaction panel that was positive only for HHV-6. Brain magnetic resonance imaging with and without contrast revealed a basal cistern predominant leptomeningeal enhancement pattern as well as moderate ventriculomegaly with associated periventricular edema concerning acute communicating hydrocephalus. Considering the CSF studies, neuroimaging, and recent travel history to Mexico, central nervous system (CNS) tuberculosis (TB) was the leading suspicion, and antimicrobial therapy was initiated for this presumptive diagnosis with culture data only proving the TB suspicion correct after nearly 2 months in culture. Anti-viral therapy was initially not felt to be necessary as the HHV-6 was interpreted as incidental and not a cause of symptomatic meningitis in our immunocompetent host. The patient's hydrocephalus was treated with temporary CSF diversion followed by performance of an endoscopic third ventriculostomy. Despite appropriate hydrocephalus management, clinical improvement ultimately seemed to correlate with the initiation of antiviral therapy.</p><p><strong>Conclusion: </strong>The authors present this case and review the literature on HHV-6-associated CNS infections with the goal of informing the neurosurgeon about this often clinically underestimated pathogen.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157150","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}
引用次数: 0
Traumatic arteriovenous fistula of the superficial temporal artery caused by massive subcutaneous hematoma prompting surgical removal and endovascular treatment in a patient with neurofibromatosis type 1. 一名 1 型神经纤维瘤病患者因大量皮下血肿导致颞浅动脉外伤性动静脉瘘,促使其接受手术切除和血管内治疗。
Surgical neurology international Pub Date : 2024-08-16 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_471_2024
Yoshihiro Sato, Tomosato Yamazaki, Sho Hanai, Daisuke Watanabe, Noriyuki Kato, Takehiro Kasai, Alexander Zaboronok, Eiichi Ishikawa
{"title":"Traumatic arteriovenous fistula of the superficial temporal artery caused by massive subcutaneous hematoma prompting surgical removal and endovascular treatment in a patient with neurofibromatosis type 1.","authors":"Yoshihiro Sato, Tomosato Yamazaki, Sho Hanai, Daisuke Watanabe, Noriyuki Kato, Takehiro Kasai, Alexander Zaboronok, Eiichi Ishikawa","doi":"10.25259/SNI_471_2024","DOIUrl":"10.25259/SNI_471_2024","url":null,"abstract":"<p><strong>Background: </strong>Neurofibromatosis type 1 (NF-1) is often characterized by vascular disorders related to vessel vulnerability that can lead to unfavorable outcomes. Here, we describe a case of NF-1 complicated with a massive subcutaneous hematoma posing a risk of visual impairment for which rapid decompression and a subsequent less invasive approach result in a favorable outcome.</p><p><strong>Case description: </strong>A 40-year-old woman with NF-1 presented with a massive left subcutaneous temporal hematoma following a mild head contusion. Four days after hospitalization, the hematoma increased in size and severely compressed the left eye, prompting immediate hematoma removal to preserve visual function. Immediately after the hematoma removal, a superficial temporal arteriovenous fistula was found on the digital subtraction angiography and embolized by the endovascular procedure. Her visual acuity was preserved, and no bleeding recurrence was observed throughout the follow-up.</p><p><strong>Conclusion: </strong>Surgical hematoma removal followed by endovascular treatment was effective in preserving visual function. Since vessel fragility is characteristic of patients with NF-1, it should be kept in mind that vascular complications may lead to serious clinical outcomes. In certain NF-1 cases, less invasive treatments for vascular abnormalities may be preferable.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157151","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}
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