Surgical neurology international最新文献

{"title":"Tethered cervical cord syndrome: A rare entity - a case report and literature review.","authors":"Manahil Irfan, Saira Samnani, Fatima Mubarak","doi":"10.25259/SNI_335_2025","DOIUrl":"10.25259/SNI_335_2025","url":null,"abstract":"<p><strong>Background: </strong>Tethered cord syndrome typically occurs in the lumbosacral spine, with rare instances of cervical cord tethering. This case presents the first documented adult female with cervical cord tethering and a dermal sinus tract in Pakistan, an uncommon congenital anomaly typically identified in infancy.</p><p><strong>Case description: </strong>A 32-year-old female with a history of spina bifida cystica presented with upper back pain, neck pain, and hand paresthesia. Magnetic resonance imaging (MRI) revealed tethering at the cervical spine, with a dermal sinus tract and dorsal meningocele. The patient underwent surgical detethering and excision of the dermal sinus tract under general anesthesia, and postoperative follow-up was conducted to assess neurological recovery. MRI confirmed cervical cord tethering, with associated abnormalities including a dermal sinus tract extending from C1 to D7, and focal syrinx formation. The patient's symptoms improved postsurgery, with no new neurological deficits observed.</p><p><strong>Conclusion: </strong>Cervical tethered cord with a dermal sinus tract is an exceedingly rare condition, particularly in adults. Early diagnosis and surgical intervention can lead to significant improvement, even in the absence of motor deficits. This case highlights the importance of timely management, even in asymptomatic or mildly symptomatic presentations, to prevent long-term neurological damage. Given the prevalence of spinal dysraphisms in South Asia, including Pakistan, raising awareness about congenital spinal anomalies is essential for early detection and intervention.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"331"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202625","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 resection of large subependymal giant cell astrocytoma using presurgical mammalian target of rapamycin inhibitor.","authors":"Mika Kawabe, Haruhisa Ichikawa, Kozo Nagai, Yasushi Ishida, Eiichi Yamamoto, Shiro Ohue","doi":"10.25259/SNI_159_2025","DOIUrl":"10.25259/SNI_159_2025","url":null,"abstract":"<p><strong>Background: </strong>A subependymal giant cell astrocytoma (SEGA) grows slowly near the foramen of Monro and develops in tuberous sclerosis complex patients. Large SEGA resection has a high risk of hemorrhage, resulting in irreversible sequelae. Mammalian target of rapamycin (mTOR) inhibitor has been approved for the treatment of SEGA which cannot be curatively treated surgically.</p><p><strong>Case description: </strong>An 8-year-old boy was found to have two nodules beside bilateral ventricles. After the interruption of regular examination, he was transported to the hospital with seizure, headache, and visual impairment caused by hydrocephalus. Computed tomography (CT) scan revealed two masses: one at each the left (60 × 50 × 60 mm) and right (20 × 10 × 10 mm) ventricles. An emergency ventricular outside shunt was placed, but reduction surgery could not be performed. Everolimus at 3 mg/m² was orally administered as preoperative therapy. A reduction in tumor size was observed 2 months after everolimus initiation. Reduction surgery for the right-sided tumor was performed after discontinuation of the drug. The tumor at the left septum lucidum and caudate nucleus remained. Everolimus was administered again for residual tumor growth. After a series of surgeries, complete resection of both tumors was performed eventually.</p><p><strong>Conclusion: </strong>This report shows preoperative treatment using mTOR inhibitor to be an effective strategy for unresectable large SEGA.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"332"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202646","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":"Evolution of neurosurgery in Kurdistan-Iraq: Milestones in development and international collaboration.","authors":"Injam Ibrahim Sulaiman Rowandizy","doi":"10.25259/SNI_491_2024","DOIUrl":"10.25259/SNI_491_2024","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"326"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202690","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":"Impact of teaching hospital status on postoperative outcomes following posterior cervical fusion/instrumentation.","authors":"Janesh Karnati, Aydin Kaghazchi, Gabriel Jelkin, Ahmed Ashraf, Xu Tao, Andrew Wu, Sruthi Ranganathan, Shameel Abid, Leina Lunasco, Sachin Shankar, Mir Ashraf, Mikayla Wallace, Joseph Cheng, Owoicho Adogwa","doi":"10.25259/SNI_681_2025","DOIUrl":"10.25259/SNI_681_2025","url":null,"abstract":"<p><strong>Background: </strong>Despite the high volume of posterior cervical fusions performed annually, the impact of academic versus non-academic hospital status on postoperative complications and readmissions requires clarification.</p><p><strong>Methods: </strong>A retrospective analysis was conducted to identify patients who underwent posterior cervical instrumentation from 2010 to 2022. Patients were grouped by academic or non-academic treatment setting. Propensity score matching controlled for age, gender, race, and comorbidities. Outcomes assessed included surgical and medical complications at 30 and 90 days, pseudoarthrosis or mechanical failure at 1-2 years, and readmission rates.</p><p><strong>Results: </strong>After matching, 4,344 patients per cohort demonstrated no significant differences in surgical complications or medical complications at 30 days and 90 days. Similarly, no significant difference was found in pseudoarthrosis or mechanical failure rates at 1-2 years postoperatively. However, non-academic centers had significantly higher readmission odds at 30 (Odds ratio [OR] = 2.325) and 90 days (OR = 2.232).</p><p><strong>Conclusion: </strong>Patients undergoing posterior cervical instrumentation at non-academic centers experience similar surgical, medical, and mechanical complication rates compared to academic centers. However, significantly higher readmission rates for non-academic centers may indicate significant variations in postoperative care.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"329"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202726","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":"Safety of argatroban to address heparin hypersensitivity in open and interventional carotid procedures.","authors":"Tyler S Cole, Stefan W Koester, Dimitri Benner, Joshua S Catapano, Felipe C Albuquerque, Michael T Lawton, Andrew F Ducruet","doi":"10.25259/SNI_560_2025","DOIUrl":"10.25259/SNI_560_2025","url":null,"abstract":"<p><strong>Background: </strong>Heparin-induced thrombocytopenia or heparin-induced hypersensitivity reactions pose a challenge for periprocedural anticoagulation. Direct thrombin inhibitors are an alternative anticoagulant; however, limited literature is available regarding argatroban use in neurovascular procedures.</p><p><strong>Case description: </strong>We describe a patient with symptomatic carotid stenosis undergoing angiography and stent placement with an attempted argatroban loading bolus. Stenting was aborted because of plaque morphology, and therapeutic anticoagulation was not reached. The patient underwent carotid endarterectomy with a higher-dose argatroban administration protocol given the previous subtherapeutic anticoagulation during angiography. Argatroban bolus (150 µg/kg) and maintenance infusion (5 µg/kg/min) with argatroban irrigation (0.5 mg/mL, 250 mL total prepared) were used without complication.</p><p><strong>Conclusion: </strong>We reviewed the safety of argatroban in reports from eight institutions, including intraoperative use for eight patients and periprocedural use for 178 patients. Reports demonstrated no argatroban-related complications.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"320"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202657","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":"Accessory left vertebral artery with the inferior thyroid branch: A report of anatomical variant.","authors":"Samer S Hoz, Christopher Cutler, Ahmed Muthana, Matthew Stedman Smith, Peyman Shirani, Charles J Prestigiacomo, Aaron W Grossman","doi":"10.25259/SNI_513_2025","DOIUrl":"10.25259/SNI_513_2025","url":null,"abstract":"<p><strong>Background: </strong>Awareness of the anatomical variations of the vertebral arteries is critical in the diagnosis and management of the related neurovascular pathologies. This study describes a rare anatomical variant of an accessory left vertebral artery (ALVA).</p><p><strong>Case description: </strong>An 88-year-old female with a chronic subdural hematoma was admitted to our hospital for embolization of the left middle meningeal artery. Pre-procedural imaging revealed an ALVA (medial branch) arising directly from the aortic arch between the origins of the left common carotid artery and the left subclavian artery. The ALVA runs directly from its origin toward the vertebral foramina and gives off the left inferior thyroid branch at the mid-point of its course, then unites with the left vertebral artery (LVA) (lateral branch) at C4 level and courses through the C6 foramina transversaria. The left thyrocervical trunk has no inferior thyroid branch. Digital subtraction angiography was obtained and confirmed the above-described findings. There was no evidence of stenosis or flow restriction at the anastomotic site between the ALVA and LVA. The patient has no symptoms related to the LVA anatomical variant. The right vertebral artery was larger than both LVAs. The ALVA was smaller in size as compared to the LVA.</p><p><strong>Conclusion: </strong>This case highlights a rare anatomical variant involving an ALVA with an inferior thyroid branch. Awareness of such atypical vascular branching patterns may impact the safety and precision while treating-related neurovascular diseases of the head and neck.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"311"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202662","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":"Intraorbital optic nerve coloboma: Neurosurgical considerations from two rare cases.","authors":"Walter Fagundes, Yasmin Picanco Silva, Stefano Aliprandit Sach, Luiz Guilherme Marchesi Mello, Juliano Bertollo Dettoni, Fabio Victor Rocha, Beatriz Westphalen Pomianoski, Fabio Petersen Saraiva","doi":"10.25259/SNI_316_2025","DOIUrl":"10.25259/SNI_316_2025","url":null,"abstract":"<p><strong>Background: </strong>Coloboma or colobomatous cyst of the optic nerve coloboma (ONC) is a rare congenital anomaly commonly associated with microphthalmia or anophthalmia. Neurosurgeons usually treat orbital lesions surgically; however, in some centers, neuro-ophthalmologists and other surgical specialties may also be involved in these procedures. Given this context, neurosurgeons must be familiar with various intraorbital lesions, including ONC. Here, emphasizing the clinical, pathological, and radiological aspects, we report two uncommon pediatric cases of ONC to enhance neurosurgeons' awareness and recognition of this condition.</p><p><strong>Case description: </strong>The first case involved a 2-year and 9-month-old boy who presented with proptosis, palpebral ptosis, visual impairment, and exotropia of the right eye. Magnetic resonance imaging (MRI) showed an intraorbital retrobulbar cystic lesion without microphthalmia. A right front-orbital craniotomy was performed with total removal of the cystic lesion and with improved proptosis, maintaining the visual deficit. The second case involved a 7-year-old and a 9-month-old girl with congenital exotropia and visual impairment in the right eye. MRI revealed a cystic optic nerve associated with microphthalmia. She underwent a cyst puncture and clinical and MRI follow-up. The histology studies confirmed ONC in both cases.</p><p><strong>Conclusion: </strong>Although often unfamiliar to neurosurgeons, these two presentations of ONC (with and without microphthalmia) should be included in the differential diagnosis of retrobulbar lesions, especially in pediatric patients.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"317"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201484","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":"Hugely dilated/partially calcified epidural varicose vein caused intraspinal neural compression/sciatica.","authors":"Nazmin Ahmed, Mohammad Nazrul Hossain, Shahidul Islam Khan, Md Raad Kazi","doi":"10.25259/SNI_571_2025","DOIUrl":"10.25259/SNI_571_2025","url":null,"abstract":"<p><strong>Background: </strong>A patient presented with lumbago/sciatica attributed to a magnetic resonance (MR)-documented hugely dilated, partially calcified, and extrinsically compressive epidural varicose vein (EVV).</p><p><strong>Case description: </strong>A 36-year-old male presented with 2 months of lumbago-sciatica; the only finding was a positive left-sided straight leg sign to 50°. The MR imaging demonstrated a hugely dilated, branching pattern flow void that caused marked displacement/compression of thecal sac and left S1 nerve root. The X-rays and computed tomography (CT) studies additionally showed a linear \"string of beads\" pattern of calcification at the L5/S1 level. Intraoperatively, an encapsulated, hugely dilated, compressive epidural vein was encountered; partial vein coagulation and gross total removal decompressed the neural elements. He recovered normal neurological function within 1 post-operative month.</p><p><strong>Conclusion: </strong>A 36-year-old male presented with left-sided sciatica attributed to an MR and CT documented hugely dilated, partially calcified L5/S1 EVV. Once the EVV was coagulated and removed, the patient's symptoms resolved.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"315"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202729","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":"Late spinal metastasis of glioblastoma multiforme after maximal tumor resection: A case report.","authors":"Made Agus Mahendra Agus Mahendra Inggas, Fandi Hendrawan, Jeremiah Hilkiah Wijaya","doi":"10.25259/SNI_273_2025","DOIUrl":"10.25259/SNI_273_2025","url":null,"abstract":"<p><strong>Background: </strong>Glioblastoma multiforme (GBM) is the most catastrophic primary central nervous system malignancy. Extraneural metastases are rare in clinical practice and are seldom reported in the literature.</p><p><strong>Case description: </strong>A 29-year-old Javanese male was diagnosed with GBM. Following gross total tumor resection, he underwent a full course of adjuvant radiotherapy and chemotherapy. The posttreatment period was initially uneventful, with no apparent adverse effects. However, 4 months after completion of therapy, the patient experienced a sudden onset of progressive quadriparesis, accompanied by urinary and bowel dysfunction. Contrast-enhanced cranial magnetic resonance imaging (MRI) revealed no evidence of tumor recurrence. Subsequently, a contrast-enhanced spinal MRI demonstrated extensive intradural extramedullary metastases spanning from the cervical to the lumbar spinal segments. Histopathological analysis of a biopsy specimen confirmed the spinal lesions as metastatic GBM. Given the extent of disease and associated risks, the patient and his family declined invasive therapeutic interventions. Supportive and palliative measures were provided, and the patient ultimately succumbed to respiratory failure shortly thereafter.</p><p><strong>Conclusion: </strong>Metastasis of GBM is an uncommon clinical occurrence. Given the increased likelihood of drop metastasis following surgical intervention, it is essential for neurosurgeons and neurologists to closely monitor patients pre and postoperatively. Early detection of spinal involvement can guide timely decision-making and improve supportive care strategies.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"316"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202577","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":"Burst-type deep brain stimulation of the subthalamic nucleus in Parkinson's disease: A case series on tolerability and efficacy.","authors":"Stephen Jaffee, Trent Kite, Dorian Kusyk, Donald Whiting, Nestor Tomycz","doi":"10.25259/SNI_266_2025","DOIUrl":"10.25259/SNI_266_2025","url":null,"abstract":"<p><strong>Background: </strong>Deep brain stimulation (DBS) has become an evidence-based treatment for movement disorders such as Parkinson's disease (PD). Recent animal studies of DBS suggest that burst-type DBS may specifically activate neuronal subpopulations and that this type of electrical stimulation programing may improve the efficacy and durability of DBS. Burst type DBS is defined as a novel stimulation protocol in which intermittent bursts of traditional high-frequency rectangular wave stimulation are delivered. Implanted pulse generators can deliver such stimulation by setting specific \"on\" and \"off \" times; however, there is limited published human data on the results of such programming in patients undergoing DBS for movement disorders such as PD. Herein, we discuss our experience using burst-type DBS of the bilateral subthalamic nucleus (STN) in PD in two patients.</p><p><strong>Case description: </strong>We conducted a case series with two patients implanted with bilateral STN DBS, tested the burst intermittent stimulation parameters, and assessed United Parkinson's Disease Rating Scale scores to determine the effect of therapy and patient tolerance. A 72-year-old man with bilateral STN DBS for bradykinesia/rigidity predominant PD tolerated the burst pattern stimulation for a total of 1 year; parameters were changed within this period, and he was ultimately switched back to continuous stimulation after the 1-year mark. The second patient, a 65-year-old man with bilateral STN DBS for tremor predominant PD, started on the Burst protocol but immediately did not tolerate the programming change due to a significant recurrence of tremor and was subsequently switched to a continuous cycle.</p><p><strong>Conclusion: </strong>Burst programming provided variable results in therapeutic effect for the patient's bilateral STN DBS of differing Parkinson's phenotypes. Further investigation is needed to assess the efficacy of various programming modalities for patients with PD.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"318"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202604","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}