Surgical neurology international最新文献

{"title":"Efficacy, management of adverse effects and relapse forms after obsessive-compulsive disorder surgery: The first Egyptian and Arab cohort.","authors":"Hussein Hamdi, Hend Aref, Mostafa Kamel","doi":"10.25259/SNI_250_2026","DOIUrl":"https://doi.org/10.25259/SNI_250_2026","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate the outcome of neurosurgery for mental illness in a cohort of Egyptian/Arab patients with treatment-resistant obsessive-compulsive disorder (OCD).</p><p><strong>Methods: </strong>Sixteen patients were recruited from various psychiatric clinics. All participants met DSM-5 criteria for OCD and had failed extensive trials of psychiatric medications and psychotherapies. Eligibility criteria focused on significant distress and functional impairment, as well as a Yale-Brown Obsessive Compulsive Scale (YBOCS) score greater than 30. Patients underwent either cingulotomy or capsulotomy and were followed monthly beginning immediately after surgery. Follow-up assessment evaluated OCD symptom severity, depression, anxiety, functional status, and both immediate and delayed postoperative adverse effects.</p><p><strong>Results: </strong>At the most recent follow-up (median: 19, range: 6 months - 25 months), 56.25% (9/16) of patients achieved at least a partial response, including 8 responders and 1 partial responder. Significant reductions in YBOCS, Beck Depression Inventory (BDI), and Hamilton Anxiety Rating Scale scores were recorded, suggesting that psychosurgery may be associated with improvement in OCD symptoms. However, because this was a noncontrolled study, causality between surgery and clinical improvement cannot be established. Immediate adverse effects were mild, transient, and observed in 37.5% (6/16) of patients. Delayed adverse effects were reported by 68.75% (11/16) of the total cohort and were predominantly characterized by recurrence of the initial OCD symptoms (9/16), often accompanied by depressive symptoms. Notably, two-thirds of patients who experienced symptom relapse were subsequently managed successfully with pharmacotherapy and behavioral therapy.</p><p><strong>Conclusion: </strong>Both cingulotomy and capsulotomy may be associated with significant reductions in OCD symptom severity, as well as improvements in depression and anxiety among patients with treatment-resistant OCD. Although relapse of OCD symptoms during follow-up was common, close monthly monitoring immediately after surgery and ongoing management were effective in restoring clinical improvement in many patients. As the first study of its kind conducted in Egypt and the Arab world, these findings also highlight the unique cultural challenges encountered in introducing psychiatric surgery within this setting.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"517"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121048","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":"Medium and distal vessel occlusion stroke: Redefining the role of thrombectomy through technology, timing, and patient selection.","authors":"Cene Jerele, Senta Frol, René Chapot, Matija Zupan","doi":"10.25259/SNI_929_2026","DOIUrl":"https://doi.org/10.25259/SNI_929_2026","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"516"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121297","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":"Microsurgical clipping for coil-extruded recurrent aneurysms: Case series and technical pearls.","authors":"Jose E Valerio, Jorge Zumaeta, Guillermo de Jesus Aguirre Vera, Arturo Ayala Arcipreste, Pablo Mazon, Fernando Palacios Santos, Andres M Alvarez-Pinzon","doi":"10.25259/SNI_143_2026","DOIUrl":"https://doi.org/10.25259/SNI_143_2026","url":null,"abstract":"<p><strong>Background: </strong>Endovascular coil embolization is widely used for the treatment of intracranial aneurysms, offering minimally invasive access and favorable early outcomes. However, long-term durability remains a concern, with recurrences arising from coil compaction, sac regrowth, or incomplete occlusion. In rare instances, these failures present with coil extrusion, a technically demanding scenario that significantly limits endovascular retreatment options.</p><p><strong>Methods: </strong>We report three adult female patients with recurrent intracranial aneurysms involving the anterior communicating artery, middle cerebral artery bifurcation, and distal azygos anterior cerebral artery, all with imaging-confirmed coil extrusion following prior endovascular therapy. Recurrence occurred at 6 months, 10 years, and nearly 20 years, illustrating early, late, and very-late treatment failure. All patients underwent microsurgical clipping performed using neuronavigation, continuous neurophysiological monitoring, indocyanine green videoangiography, and intraoperative Doppler ultrasonography. Operative strategy, technical nuances, and intraoperative decision-making are described. A focused literature review was conducted to contextualize management strategies for this rare presentation.</p><p><strong>Results: </strong>Complete microsurgical reconstruction and aneurysm obliteration were achieved in all patients without coil extraction, bypass, procedure-related neurological morbidity, or mortality. Postoperative imaging confirmed stable clip placement and exclusion of the aneurysm sac. Despite the presence of coil extrusion and dense adhesions, meticulous microsurgical dissection combined with modern intraoperative adjuncts enabled safe and effective clip application without the need for coil removal.</p><p><strong>Conclusion: </strong>Coil extrusion is an uncommon but complex manifestation of aneurysm recurrence that may occur even decades after initial endovascular treatment and can affect a range of anterior circulation locations. This case series underscores the importance of lifelong imaging surveillance and demonstrates that, in carefully selected patients, microsurgical clipping remains a safe and definitive salvage strategy when guided by refined technique and contemporary intraoperative technologies.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"518"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121247","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":"Spinal schwannoma with broad pial adhesion: A case report.","authors":"Masaki Yoshimura, Masato Hatanaka, Shin Kawamura","doi":"10.25259/SNI_604_2026","DOIUrl":"https://doi.org/10.25259/SNI_604_2026","url":null,"abstract":"<p><strong>Background: </strong>Typical spinal schwannomas are well-encapsulated intradural extramedullary tumors arising from sensory nerve roots. Schwannomas adherent to the spinal cord are rare and include both intramedullary (subpial) and combined intra- and extramedullary lesions. Here, a 60-year-old male initially presented with a combined intra/extramedullary schwannoma with dense adhesions to the spinal cord; at surgery, this proved to be a peripheral schwannoma with broad pial adhesions.</p><p><strong>Case description: </strong>A 60-year-old male presented with severe paraparesis attributed to a dorsal thoracic T11 tumor. Chronic hemodialysis precluded performing a contrast magnetic resonance. Intraoperative ultrasonography showed a well-defined, multi-cystic, and dorsal lesion without intramedullary extension. After dural opening, the tumor was tightly adherent to the dorsal spinal cord/pia. A staged internal decompression improved tumor mobility, allowing the tumor to be progressively dissected away from its broad-based pial adhesion/vasculature. Finally, a clean cleavage plane between the tumor capsule and spinal cord confirmed that the tumor was an extramedullary, broad-based pial schwannoma that was totally resected without neurological sequelae.</p><p><strong>Conclusion: </strong>Peripheral spinal schwannomas may occasionally exhibit broad-based pial adhesions that mimic intramedullary (subpial) or combined intra/extramedullary lesions. Proceeding with a step-wise resection often reveals an increasingly clean cleavage plane facilitating gross total tumor resection.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"512"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121190","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":"Approach through the intraparietal sulcus to the ventricular atrium: A cadaveric microanatomical and morphometric study.","authors":"Roberto Abreu Delgado, Valentin Vilas, Caroline Teixeira Cruz, Bautista Campero, Mateo A Rodríguez Delgado, Valeria Forlizzi","doi":"10.25259/SNI_866_2026","DOIUrl":"https://doi.org/10.25259/SNI_866_2026","url":null,"abstract":"<p><strong>Background: </strong>The intraparietal sulcus (IPS) provides a natural transsulcal corridor to the lateral ventricular atrium that minimizes disruption of white matter tracts. However, no previous study has quantified the dissection angles from multiple topographic points along the sulcus.</p><p><strong>Methods: </strong>Descriptive study conducted in the 9 adult human cerebral hemispheres available for dissection. IPS macroscopic morphology was classified and its length was measured. From the anterior, midpoint, and posterior points of the sulcus, straight pins were directed toward the ventricular atrium, and their angles relative to the anterior-posterior commissure line were measured. Subsequently, the depth was measured from each point to the atrium. Means, standard deviations (SD), ranges, and coefficients of variation (CV%) were calculated.</p><p><strong>Results: </strong>The IPS exhibited continuous morphology in all hemispheres, with a mean length of 3.96 ± 0.71 cm and a mean of 3.22 ± 0.97 accessory branches. Angular data were obtained in 6 of 9 hemispheres. Mean dissection angles were 4.5 ± 15.9° from the anterior point, 19.33 ± 11.99° from the midpoint, and 29.33 ± 12.14° from the posterior point. Approach depth, determined in 8 of 9 hemispheres, was 4.86 ± 0.74 cm, 5.24 ± 0.79 cm, and 5.4 ± 0.82 cm from the anterior, midpoint, and posterior points, respectively.</p><p><strong>Conclusion: </strong>IPS surface morphology and approach depth showed moderate interindividual variability, whereas dissection angles showed high variability, supporting the need for individualized presurgical trajectory planning. Based on the limited specimens available, these preliminary findings warrant validation in larger cohorts.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"510"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121404","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":"Functional outcomes and anatomy-based surgical strategy in 57 pineal region tumors.","authors":"Vartika Gupta, Pankaj Gupta","doi":"10.25259/SNI_720_2026","DOIUrl":"https://doi.org/10.25259/SNI_720_2026","url":null,"abstract":"<p><strong>Background: </strong>Pineal region tumors are uncommon lesions that present significant surgical challenges due to their deep location, proximity to critical neurovascular structures, and frequent association with obstructive hydrocephalus. Although several operative corridors are available, factors influencing postoperative functional recovery remain poorly defined. This study evaluated clinical, radiological, and surgical determinants of functional outcomes following surgery for pineal region tumors.</p><p><strong>Methods: </strong>We retrospectively reviewed 57 consecutive patients who underwent surgical treatment for pineal region tumors between March 2016 and August 2025 at a tertiary neurosurgical center. Clinical, radiological, operative, pathological, and follow-up data were analyzed. Functional outcomes were assessed using the Karnofsky Performance Scale (KPS). Primary functional outcome was postoperative change in ΔKPS, with admission KPS analyzed separately to identify baseline determinants of preoperative functional status.</p><p><strong>Results: </strong>The mean age was 36.5 years, and 59.6% of patients were male. Gross total resection was achieved in 42 patients (73.7%), subtotal resection in 7 (12.3%), and biopsy alone in 8 (14.0%). Hydrocephalus was present in 45 patients (78.9%), with 12 (21.1%) ultimately requiring permanent cerebrospinal fluid diversion. The posterior interhemispheric transsplenial approach was the most commonly used surgical corridor (36.8%). Increasing age and larger tumor volume independently predicted lower admission KPS scores, whereas lower preoperative KPS was associated with greater postoperative functional improvement. Surgical approach, extent of resection, pathology, and hydrocephalus treatment strategy were not significantly associated with functional recovery. The complication rate was 10.5%, with one perioperative mortality.</p><p><strong>Conclusion: </strong>Favorable functional outcomes and high resection rates can be achieved using multiple microsurgical and endoscopic approaches when operative corridor selection is tailored to individual anatomy. Within the limitations of this retrospective cohort, postoperative functional recovery was more strongly associated with baseline patient- and tumor-related factors than with the operative corridor selected. No statistically significant association between surgical approach and postoperative functional recovery was identified.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"513"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121025","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 posterior tilting of a giant basilar tip aneurysm following stent-assisted coiling with therapeutic P1 occlusion: A case report.","authors":"Hidemoto Fujiwara, Hitoshi Hasegawa, Tomoaki Suzuki, Makoto Oishi","doi":"10.25259/SNI_689_2026","DOIUrl":"https://doi.org/10.25259/SNI_689_2026","url":null,"abstract":"<p><strong>Background: </strong>Giant basilar tip aneurysms remain difficult to treat due to their location, bifurcation anatomy, adjacent perforators, and potential for mass effect. Endovascular treatment, including stent-assisted coiling, is a valuable option. Despite angiographic occlusion, mass effect may still be clinically significant.</p><p><strong>Case description: </strong>A 67-year-old man presented with headache and was diagnosed with a 27 × 17-mm giant unruptured basilar tip aneurysm. Preoperative angiography demonstrated perforators arising predominantly from the left P1 segment and a well-developed right posterior communicating artery (PComA), while the left PComA was hypoplastic. Stent-assisted coiling was performed with stent placement from the basilar artery to the left posterior cerebral artery and occlusion of the non-stented right P1 segment. The early postoperative course was uneventful. Posterior tilting of the coiled aneurysm was first noted 1 week after treatment and subsequently progressed. Approximately 3 months after treatment, mass effect resulted in midbrain compression and obstructive hydrocephalus. Skull radiographs in different body positions demonstrated posture-dependent displacement of the coil mass, suggesting a role of gravity. Levodopa administration and ventriculoperitoneal shunting resulted in partial symptomatic improvement. Angiographic follow-up through 3 years demonstrated stable occlusion without recurrence, with no substantial progression of posterior tilting after the first postoperative year.</p><p><strong>Conclusion: </strong>Stent-assisted coiling with therapeutic P1 occlusion may contribute to durable angiographic occlusion in selected giant basilar tip aneurysms. However, delayed posterior tilting of the coiled aneurysm may occur as a postoperative phenomenon. This potential delayed complication, leading to mass effect, should therefore be considered in treatment strategy and postoperative follow-up.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"514"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121027","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":"Reappraising the bifrontal decompressive craniectomy: A systematic literature review of indications, outcomes, and clinical applications.","authors":"Jack T Olson, Kivanc Yangi, Kashif Qureshi, Egemen Gok, Jarett E Prince, Michell Goyal, Kristina M Kupanoff, Mark C Preul","doi":"10.25259/SNI_812_2026","DOIUrl":"https://doi.org/10.25259/SNI_812_2026","url":null,"abstract":"<p><strong>Background: </strong>Bifrontal decompressive craniectomy (BDC) is used to manage elevated intracranial pressure (ICP) from bilateral frontal swelling caused by severe traumatic brain injury (TBI), malignant cerebral edema, or other acute intracranial pathologies, but conflicting outcome data have been reported. This study aimed to evaluate the efficacy of BDC across various etiologies, identify gaps to guide research, and outline a framework for clinical decision-making.</p><p><strong>Methods: </strong>A systematic search of MEDLINE, PubMed, Scopus, Embase, and Cochrane databases was conducted. In addition, 3 formalin-fixed, noninjected cadaveric head specimens were dissected to illustrate BDC and its anatomical correlates.</p><p><strong>Results: </strong>Of 410 articles, 54 met inclusion criteria (742 patients). TBI was the leading etiology (656 of 742 patients; 88.4%), notably from motor vehicle collisions (58.4%) and falls (19.7%). On initial examination, 315 of 519 patients (60.7%) had a Glasgow Coma Scale score ≤8. Mean (standard deviation) time from injury to BDC was 2.5 (1.9) days, intensive care unit stay was 12.9 (5.0) days, hospital stay was 66.7 (38.9) days, and time to cranioplasty was 83.4 (40.7) days. Glasgow Outcome Scale values were reported for 494 patients: 205 patients, 5; 75 patients, 4; 71 patients, 3; 24 patients, 2; and 119 patients, 1.</p><p><strong>Conclusion: </strong>BDC may offer a survival benefit in patients with otherwise-fatal elevations in ICP, but cases require more detailed tracking. Functional outcomes vary, and the risks of developing severe disability are substantial. Implementing BDC in acute neurocritical care requires ethically grounded patient selection and family counseling, incorporating prognosis, patient values, and shared decision-making.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"511"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121077","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":"Definitive reconstruction of frontal asymmetry in an adolescent with anterior plagiocephaly due to unilateral coronal craniosynostosis using a hybrid osteo-titanium technology based on an individualized approach: A case report.","authors":"Doniyor Abdullayev, Khumayro Amini, Jakhongirmirzo Yoldoshev, Gayrat Kariev, Uygun Altibayev, Igor Yugay, Nodirbek Tulayev, Jamshid Ashrapov, Bipin Chaurasia, Alvaro Campero, Abhidha Shah","doi":"10.25259/SNI_745_2026","DOIUrl":"https://doi.org/10.25259/SNI_745_2026","url":null,"abstract":"<p><strong>Background: </strong>Unilateral coronal craniosynostosis causes three-dimensional craniofacial asymmetry. Although correction is usually performed during infancy, some patients present in adolescence with an untreated or persistent deformity. We describe an individualized hybrid reconstruction combining a patient-specific titanium implant with autologous bone.</p><p><strong>Case description: </strong>A 15-year-old girl with untreated left unilateral coronal craniosynostosis presented with marked frontal and fronto-orbital asymmetry. Three-dimensional computed tomography demonstrated left frontal retrusion, orbital asymmetry, reduced orbital height, and obliteration of the left coronal suture. Computed tomography-based mirror imaging and computer-aided design were used to create a patient-specific titanium implant containing three compartments for autologous bone. Reconstruction was performed through an asymmetric bicoronal approach. An atypical anterior course of the superior sagittal sinus was identified during bone-flap elevation. Harvested cranial bone was reshaped and incorporated into the titanium framework. Complete filling of all compartments was not possible because the bone required fragmentation to reproduce the intended frontal contour. Postoperative imaging demonstrated improved frontal and fronto-orbital symmetry with stable implant positioning. At 16 months, the reconstructed contour remained preserved, without implant displacement, loosening, fracture, infection, substantial bone resorption, or revision surgery. Progressive mineralized continuity was observed between the autologous bone and adjacent native skull.</p><p><strong>Conclusion: </strong>Patient-specific hybrid osteo-titanium reconstruction was technically feasible and provided stable intermediate-term correction of established frontal asymmetry. Further cases, quantitative assessment, and longer follow-up are required to determine its reproducibility and long-term value.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"521"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121018","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":"Perspective/Short Review: Diagnosis and Treatment of Aggressive Vertebral Hemangiomas and Review of 2 Cases.","authors":"Marc A Agulnick, Roee Ber, Nancy E Epstein","doi":"10.25259/SNI_1025_2026","DOIUrl":"https://doi.org/10.25259/SNI_1025_2026","url":null,"abstract":"<p><strong>Background: </strong>Although vertebral hemangiomas (VH) are relatively common, aggressive symptomatic VH are rarely reported (i.e. in up to 11% of cases). Multiple other benign and malignant primary bone tumors must be considered in the differential diagnosis. Here, we review the clinical diagnosis and surgical management for aggressive hemangiomas, while also presenting 2 patients with thoracic lesions requiring posterior surgical decompression/fusion, with/without vertebroplasty, embolization, and/or CyberKnife radiosurgery.</p><p><strong>Methods: </strong>The classification system for these tumors ranges from Types I-IV; I Occupy < 50% of a vertebral body (VB), II-Occupy > 50% VB (IIb Thoracolumbar - Symptomatic), III-Occupy 100% VB, and IV-Occupy 100% VB involved plus extension into the pedicles, laminae, spinous process, and epidural space.</p><p><strong>Results: </strong>Radiographically (i.e. X-rays, MR, CT) these lesions originate in the vertebral bodies, but aggressive VH extend into the pedicles, laminae, spinous processes, and epidural space causing both spinal cord/root (i.e., myelopathy/radiculopathy)) compression. Surgical options include anterior, posterior, or circumferential decompressions with/without fusions, percutaneous vertebroplasty, embolization, radiation, and/or chemotherapy. Early treatment maximizes neurological recovery and limits/avoids permanent injury.</p><p><strong>Conclusion: </strong>Aggressive VH are rare lesions that most frequently occur in the thoracic spine. Notably, the subset of Type IV lesions that extend into the pedicles, laminae, spinous processes, and epidural space may cause symptomatic myelopathy/radiculopathy warranting early surgical intervention to optimize neurological outcomes.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"519"},"PeriodicalIF":0.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121219","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}