Surgical neurology international最新文献

{"title":"Glial fibrillary acidic protein immunopositive neuroglial tissues with or without ependyma-lined canal in spinal lipoma of filar type: Relationship with retained medullary cord.","authors":"Nobuya Murakami, Takato Morioka, Ai Kurogi, Satoshi O Suzuki, Takafumi Shimogawa, Nobutaka Mukae, Koji Yoshimoto","doi":"10.25259/SNI_458_2024","DOIUrl":"10.25259/SNI_458_2024","url":null,"abstract":"<p><strong>Background: </strong>Retained medullary cord (RMC) and filar lipomas are believed to originate from secondary neurulation failure; filar lipomas are reported to histopathologically contain a central canal-like ependyma-lined lumen with surrounding neuroglial tissue with ependyma-lined central canal (NGT w/E-LC) as a remnant of the medullary cord, which is a characteristic histopathology of RMC. With the addition of glial fibrillary acidic protein (GFAP) immunostaining, we reported the presence of GFAP-positive NGT without E-LCs (NGT w/o E-LCs) in RMC and filar lipomas, and we believe that both have the same embryopathological significance.</p><p><strong>Methods: </strong>We examined the frequency of GFAP-positive NGT, with or without E-LC, in 91 patients with filar lipoma.</p><p><strong>Results: </strong>Eight patients (8.8%) had NGT w/E-LC, 25 patients (27.5%) had NGT w/o E-LC, and 18 patients (19.8%) had tiny NGT w/o E-LC that could only be identified by GFAP immunostaining. Combining these subgroups, 56% of the patients (<i>n</i> = 51) with filar lipoma had GFAP immunopositive NGT.</p><p><strong>Conclusion: </strong>The fact that more than half of filar lipomas have NGT provides further evidence that filar lipoma and RMC can be considered consequences of a continuum of regression failure that occurs during late secondary neurulation.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383097","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":"Is trans-sacral endoscopic laser decompression truly effective? Clinical and functional assessment of a single spine center.","authors":"Shreenidhi Kulkarni, Do-Hyoung Kim, Ji Soo Ha, Chang-Wook Kim, Rajendra Sakhrekar, Hee Don Han","doi":"10.25259/SNI_1000_2023","DOIUrl":"10.25259/SNI_1000_2023","url":null,"abstract":"<p><strong>Background: </strong>Herniated nucleus pulposus (HNP), without causing significant neurological deficit, is a more frequently occurring disease of the spine affecting the activities of daily living with chronic back pain and sometimes progressing to produce significant functional deficit. Trans-sacral epiduroscopic laser decompression (SELD) is being increasingly used as a treatment modality for these conditions and has been shown to give effective results. We present the clinical outcomes of the patients undergoing SELD in our institute for HNP.</p><p><strong>Methods: </strong>A retrospective study of 411 patients who underwent SELD for lumbar disc herniation was done, analyzing the clinical outcomes by measuring visual analog scale (VAS) scores for leg pain and back pain, Oswestry Disability Index (ODI) score, and Short form health survey (SF -36) scores and followed up for 6 months.</p><p><strong>Results: </strong>A total of 195 males and 216 females underwent SELD, with a mean age of 33.2 ± 0.9 years and a mean follow-up period of 7 ± 1.6 months. VAS scores for back pain and leg pain improved significantly from 6.9 ± 0.5 and 6.6 ± 0.6 preoperatively to 1.1 ± 0.5 (<i>P</i> > 0.05) and 0.4 ± 0.5 (<i>P</i> > 0.05) at 6 months. ODI score decreased from 28.2 ± 1.7 to 9.4 ± 1.7 at 6 months from the intervention (<i>P</i> < 0.05). SF-36 showed significant improvement in overall categories through 6 months of follow-up. Twenty-four patients had dural punctures, and four patients needed blood patches but recovered without any complications. One patient had aggravation of the disc herniation post-procedure, and was managed by endoscopic discectomy.</p><p><strong>Conclusion: </strong>SELD is a safe, accurate, and effective procedure in treating symptomatic lumbar disc herniation with excellent clinical outcomes and effective pain relief with minimal damage to paraspinal muscles with an easier learning curve, reproducible results, and high safety index.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383100","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":"Reversible sulcal fluid-attenuated inversion recovery hyperintensity after combined bypass surgery for moyamoya disease - A \"crevasse\" sign.","authors":"Daina Kashiwazaki, Shusuke Yamamoto, Emiko Hori, Naoki Akioka, Kyo Noguchi, Satoshi Kuroda","doi":"10.25259/SNI_571_2024","DOIUrl":"10.25259/SNI_571_2024","url":null,"abstract":"<p><strong>Background: </strong>Transient fluid-attenuated inversion recovery (FLAIR) hyperintensity is often observed on the operated brain surface after direct or combined bypass surgery for moyamoya disease, but its pathophysiology and clinical significance are still obscure. This study was aimed to clarify the underlying mechanism and clinical significance.</p><p><strong>Methods: </strong>This prospective study included 106 hemispheres of 61 patients with moyamoya disease and analyzed their radiological findings before and after combined bypass surgery. This study also included 11 patients who underwent superficial temporal artery to middle cerebral artery anastomosis for occlusive carotid artery diseases as the controls. Magnetic resonance imaging examination was serially repeated, and cerebral blood flow was measured before and after surgery. Signal intensity ratio (SIR) in the cortical sulci and cortex to the adjacent white matter on FLAIR images was calculated, and the postoperative SIR changes were semi-quantitatively evaluated to assess the temporal profile of postoperative FLAIR hyperintensity.</p><p><strong>Results: </strong>Postoperative FLAIR hyperintensity occurred within the cortical sulci on the operated hemispheres in all moyamoya patients but not in patients with occlusive carotid artery diseases. SIR values started to increase immediately after surgery, peaked at about 4-fold at 4-13 days post-surgery, then declined, and recovered to baseline values over 28 days or later. The magnitude of this phenomenon was proportional to the severity of cerebral ischemia but not to postoperative hyperperfusion.</p><p><strong>Conclusion: </strong>Reversible sulcal FLAIR hyperintensity specifically occurs in the operated hemispheres after direct bypass surgery for moyamoya disease. This \"<i>crevasse sign</i>\" may represent the mixture of the extensive leakage of oxygen and proteins from the pial arteries into the CSF.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383107","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":"Role of scheduled repeat CT scan in traumatic brain injuries: A prospective observational study.","authors":"Saurabh Beedkar, G Lakshmi Prasad, Girish Menon","doi":"10.25259/SNI_376_2024","DOIUrl":"10.25259/SNI_376_2024","url":null,"abstract":"<p><strong>Background: </strong>Scheduled CT scan is a routine practice at many centers after traumatic brain injury (TBI), but it has been questioned by few authors. The majority of the studies are reported in mild TBI; however, no specific data exist for the same in moderate and severe TBI.</p><p><strong>Methods: </strong>This was a single-center and 1-year prospective study. All cases with TBI who underwent scheduled repeat scans were included in the study. Patients who underwent emergency surgery after first computed tomography (CT) and those who expired before repeat CT were excluded from the study. Data included demographics, Glasgow coma scale (GCS) score, initial head CT findings, findings of repeat CT, and the need for any intervention (medical/surgical).</p><p><strong>Results: </strong>A total of 231 cases were analyzed. The mean time interval for the repeat CT was 7.8 h. One hundred and seventy-one patients underwent scheduled repeat CT (Group 1), 53 patients with GCS >13 were discharged from emergency before the repeat scan (Group 2), and seven cases underwent repeat CT before the scheduled time in view of clinical deterioration (Group 3). The mean age and gender did not vary significantly between the three groups. Mixed lesions predominated in all; however, the proportion significantly differed between groups. In Group 1, two patients required surgery; in Group 3, all patients required a significant change in treatment, whereas none deteriorated or required a repeat scan in Group 2.</p><p><strong>Conclusion: </strong>In our study, the yield of routine repeat CT scans requiring surgery was 3.5%. Based on the results of our study and the observations from previous studies, we have proposed a few general working statements regarding indications for repeat CT scans in TBI.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383108","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":"Optimizing surgical technique in microvascular decompression for hemifacial spasm - Results from a surgical series with contemporary use of neuronavigation and intraoperative neuromonitoring.","authors":"Marco Battistelli, Alessandro Izzo, Manuela D'Ercole, Quintino Giorgio D'Alessandris, Michele Di Domenico, Eleonora Ioannoni, Camilla Gelormini, Renata Martinelli, Federico Valeri, Fulvio Grilli, Nicola Montano","doi":"10.25259/SNI_268_2024","DOIUrl":"10.25259/SNI_268_2024","url":null,"abstract":"<p><strong>Background: </strong>Microvascular decompression (MVD) through a retrosigmoid approach is considered the treatment of choice in cases of hemifacial spasm (HFS) due to neurovascular conflict (NVC). Despite the widespread of neuronavigation and intraoperative neuromonitoring (IONM) techniques in neurosurgery, their contemporary application in MVD for HFS has been only anecdotally reported.</p><p><strong>Methods: </strong>Here, we report the results of MVD performed with a combination of neuronavigation and IONM, including lateral spread response (LSR) in 20 HFS patients. HFS clinical outcome and different surgical-related factors, such as craniotomy size, surgical duration, mastoid air cell (MAC) opening, postoperative cerebral spinal fluid (CSF) leakage, sinus injury, and other complications occurrence, and the length of hospitalization (LOS) were studied.</p><p><strong>Results: </strong>Postoperatively, residual spasm persisted only in two patients, but at the latest follow-up (FU) (mean: 12.5 ± 8.98 months), all patients had resolution of symptoms. The mean surgical duration was 103.35 ± 19.36 min, and the mean LOS was 2.21 ± 1.12 days. Craniotomy resulted in 4.21 ± 1.21 cm² in size. Opening of MAC happened in two cases, whereas no cases of CSF leak were reported as well as no other complications postoperatively and during FU.</p><p><strong>Conclusion: </strong>MVD for HFS is an elective procedure, and for this reason, surgery should integrate all technologies to ensure safety and efficacy. The disappearance of LSR is a crucial factor for identifying the vessel responsible for NVC and for achieving long-term resolution of HFS symptoms. Simultaneously, the benefits of using neuronavigation, including the ability to customize the craniotomy, contribute to reduce the possibility of complications.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383105","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":"Worsening orbital roof \"blow-in\" fractures following traumatic brain injury: A report of two cases.","authors":"Varun Rao, Clayton H Gerndt, Vera Ong, Edward Bradley Strong, Kiarash Shahlaie","doi":"10.25259/SNI_461_2024","DOIUrl":"10.25259/SNI_461_2024","url":null,"abstract":"<p><strong>Background: </strong>Orbital roof fractures are often the result of high-velocity collisions and are seen in 1-9% of patients with craniofacial trauma. Although the majority of orbital roof fractures are displaced superiorly, a subset results in inferior displacement of fracture fragments, posing a risk for muscle/nerve entrapment and possible blindness. Many of these patients have severe traumatic brain injury (TBI) and, in addition to orbital fractures, also have elevated intracranial pressure (ICP). Management of depressed orbital roof fractures in the setting of severe TBI with elevated ICP represents a management dilemma.</p><p><strong>Case description: </strong>Two cases of severe TBI with associated downward displacement of orbital roof fractures were reviewed. Both cases exhibited elevated ICP correlated with the degree of orbital roof fracture depression. Surgical intervention involving elevation and repair of the fractures was undertaken when there was a significant risk of injury to the extraocular muscles and/or the optic nerve due to the extent of the fracture depression.</p><p><strong>Conclusion: </strong>Depressed orbital roof fractures may migrate in response to changes in ICP. Serial computed tomography scans and eye examinations may aid with determining the need for and timing of surgical intervention.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383130","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":"Spontaneous spinal epidural hematoma in infants: A case report and review of the literature.","authors":"Marouane Hammoud, Hmamouche Oualid Mohammed, Khalid Chakour, Mohammed El Faiz Chaoui","doi":"10.25259/SNI_290_2024","DOIUrl":"10.25259/SNI_290_2024","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous spinal epidural hematomas (SSEHs) are exceedingly uncommon, especially in infants, with only two reported cases. Diagnosis can be delayed due to the nonspecificity of presenting symptoms.</p><p><strong>Case report: </strong>We present a case of SSEH in a 10-month-old boy admitted to the pediatric emergency department with a 5-day history of progressive lower extremity motor weakness. There was no history of prior trauma. Magnetic resonance imaging of the spine revealed a posterior epidural hematoma extending from C7 to L4. After hematoma evacuation, the patient's neurological status gradually improved, and no sensorimotor deficit was present 3 weeks postoperatively.</p><p><strong>Conclusion: </strong>Our case suggests that surgical intervention can lead to an excellent prognosis for SSEH in infants, even if the diagnosis is delayed.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383112","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":"Successful excision of intradural extramedullary plexiform T1-T4 schwannoma.","authors":"Tommy Alfandy Nazwar, Farhad Bal Afif, Donny Wisnu Wardhana, Christin Panjaitan","doi":"10.25259/SNI_617_2024","DOIUrl":"10.25259/SNI_617_2024","url":null,"abstract":"<p><strong>Background: </strong>Plexiform schwannomas (PSs) are rare. Here, we describe the clinical features, diagnosis, treatment, and outcome of a 17-year-old male presenting with a T1-T4 intradural extramedullary (IDEM).</p><p><strong>Case description: </strong>A 17-year-old male presented with back pain and pain radiating down both legs. The thoracic magnetic resonance revealed a left-sided T1-T4 IDEM mass. The patient underwent a T2-T4 laminectomy for gross total tumor excision, followed by posterior fusion. Immunohistochemical examination revealed S100 positivity, supporting the diagnosis of PS.</p><p><strong>Conclusion: </strong>IDEM PSs are rare, may be readily diagnosed with MR, and can be successfully resected.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383114","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":"Invasive pituitary adenoma presenting with cerebrospinal fluid rhinorrhea and meningitis - A case report.","authors":"Zanib Javed, Zunaira Saeed, Sibgha Khan, Altaf Ali Laghari","doi":"10.25259/SNI_224_2024","DOIUrl":"10.25259/SNI_224_2024","url":null,"abstract":"<p><strong>Background: </strong>Most pituitary neuroendocrine tumors are benign, except some adenomas that show invasiveness and are called invasive pituitary adenomas. These are challenging and rare pathologies.</p><p><strong>Case description: </strong>We present a case of a 40-year-old male who presented to the emergency with seizures, rhinorrhea, headache, and drowsiness. Radiology images showed a sellar mass with supra-sellar extension and pneumocephalus. The pituitary profile was within normal limits. The patient underwent bifrontal craniotomy and maximum safe resection of the lesion with cerebrospinal fluid (CSF) leak repair and lumbar drain insertion. Histological examination and immunohistochemical stain were consistent with pituitary adenoma. Postoperatively, there was no CSF leak, and the patient's Glasgow Coma Scale improved.</p><p><strong>Conclusion: </strong>Rhinorrhea is a unique presentation for pituitary adenoma. According to the current literature, surgery is the only effective treatment as part of the management of invasive pituitary adenomas, along with a multidisciplinary approach.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383099","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 complex case of recurrent intracranial bleeds due to malaria-induced coagulopathy: A case report and literature review.","authors":"Syeda Mahrukh Fatima Zaidi, Ayesha Amjad, Kainat Sohail, Faizan Ur Rehman","doi":"10.25259/SNI_553_2024","DOIUrl":"10.25259/SNI_553_2024","url":null,"abstract":"<p><strong>Background: </strong>Malaria, a prevalent disease in the developing world, is a significant cause of morbidity and mortality. Infection with <i>Plasmodium falciparum</i>, although uncommon, can lead to severe brain injury, including intracranial hemorrhages, resulting in serious neurological deficits. Malaria-induced coagulopathy, while rarely reported, poses a challenge in understanding the exact mechanisms behind the development of intracranial bleeds. Proposed mechanisms include sequestration of parasitized erythrocytes in the brain's microvasculature, leading to capillary occlusion, endothelial damage, cytokine activation, and dysregulation of the coagulation cascade.</p><p><strong>Case description: </strong>We present the case of a 53-year-old male rapidly deteriorating following a history of traumatic brain injury (TBI). Upon admission, a computed tomography scan revealed bilateral acute on chronic hematomas, necessitating a lifesaving craniotomy. Subsequently, the patient experienced three consecutive recurrent intracranial bleeds post-surgery, attributed to <i>Falciparum</i>-induced coagulopathy. Prompt recognition and intervention stabilized the patient's condition, leading to discharge on the 4^th post-operative day.</p><p><strong>Conclusion: </strong>This case underscores the challenges posed by consecutive recurrent intracranial bleeds following TBI exacerbated by <i>P. falciparum</i> infection. It highlights the obstinate nature of malaria-induced coagulopathy and underscores the importance of timely and aggressive interventions in managing such cases.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157098","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}