Surgical neurology international最新文献

{"title":"Immunoexcitoxicity as the possible major pathophysiology behind multiple sclerosis and other autoimmune disorders.","authors":"Russell L Blaylock","doi":"10.25259/SNI_1114_2024","DOIUrl":"10.25259/SNI_1114_2024","url":null,"abstract":"<p><p>Autoimmune disorders are destructive processes considered to be an attack on \"self \" antigens by the immune system CD-+4 T-cells that are directed toward antigens, in the case of multiple sclerosis (MS), particularly myelin antigens. Yet, there is growing evidence that the major destructive events in MS, as well as other non-central nervous system (CNS) autoimmune disorders, are much more than an immune attack on the CNS initiated by a misdirected immune system that attacks a \"self \" antigen or antigens by a process called molecular mimicry. Extensive evidence suggests that inflammation, in turn, initiates excitotoxicity, which is responsible for the majority of pathological findings in all stages of the disease, especially a loss of oligodendroglia (source of myelin) and axon injury in MS. Excitotoxicity also is a better explanation for progressive MS, in which the immune attack has either slowed or is halted; yet, the destructive pathology continues to progress. It also explains the destructive lesions seen in gray matter, which is essentially devoid of inflammation. It has recently been shown that most of the damage to the oligodendrocytes, as well as axonal injury, is secondary to excitotoxicity. While there is a growing appreciation that excitotoxicity plays a major role, there has been little effort to link the immune changes to the excitotoxic process, recently named immunoexcitotoxicity, even though the role of excitotoxicity has been shown to occur in the inflammatory stage in the beginning and throughout the process of the disease, particularly the chronic progressive stage. It is also known that peripheral glutamate receptors exist throughout the body, thus making the process of immunoexcitotoxicity a possible integral part of all or most autoimmune disorders in which the immune system is intimately linked to enhancing the excitotoxic process. This is of special concern now that peripheral glutamate receptors have been isolated in many peripheral tissues and are known to be fully functional.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384539","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":"The epidemiology of motorcycle-related acute traumatic brain injury: The NOMADEN study.","authors":"Aryandhito Widhi Nugroho, Nur Upik En Masrika","doi":"10.25259/SNI_929_2024","DOIUrl":"10.25259/SNI_929_2024","url":null,"abstract":"<p><strong>Background: </strong>Although persisting to be a public health hazard in Indonesia, motorcycle-related traumatic brain injury (TBI) due to road traffic accidents (RTA) lacks comprehensive national data. We aim to study the epidemiological pattern of motorcycle-related TBI and analyze the determinants related to mortality in the only neurosurgical center in the rural province of North Maluku, Indonesia.</p><p><strong>Methods: </strong>Using the North Maluku Database in Neurosurgery register, information regarding age, sex, health insurance, alcohol use, point of referral, degree of severity, brain computed tomography abnormalities, helmet use, surgery, injury-to-admission time (IAT), and relationship to the motorcycle were obtained from patients admitted to Chasan Boesoirie General Hospital, Ternate, in 2021-2022. Multivariable logistic regression analysis was performed to investigate associations with in-hospital mortality.</p><p><strong>Results: </strong>Of all RTA-related TBI patients (<i>n</i> = 353), 91.8% (<i>n</i> = 324) were caused by motorcycle collision (mean age ± standard deviation of 30.5 ± 16.7 years old). The majority were motorcyclists (66.7%), male (64.8%), IAT >4 h (55.9%), financed by non-Jaminan Kesehatan Nasional mechanism (66.4%), not under alcohol influence (78.4%), referred from Ternate (55.2%), and suffered mild TBI (75%). Thirty patients (9.3%) succumbed to death. Moreover, 9.3% and 91.2% were ≤17 years old and helmetless. Glasgow coma scale and IAT were significantly associated with in-hospital mortality (odds ratio [95% confidence interval]: 0.58 [0.49-0.68] and 5.44 [1.00-30.34], respectively).</p><p><strong>Conclusion: </strong>The young and productive males dominated the motorcycle-related TBI patients in North Maluku. Poor compliance with road traffic laws, as demonstrated by a considerable proportion of underage, alcohol-intoxicated, and helmetless patients, necessitated prompt actions from all related elements.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383648","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":"Bone cement versus bone flap replacement: A comparative meta-analysis of posterior fossa craniotomy complications.","authors":"Ryan Neill, Peter Harris, Lekhaj Chand Daggubati","doi":"10.25259/SNI_789_2024","DOIUrl":"10.25259/SNI_789_2024","url":null,"abstract":"<p><strong>Background: </strong>Posterior fossa surgeries are often performed to treat infratentorial pathologies, such as tumors that increase intracranial pressure. Posterior fossa craniotomy has been shown to decrease the incidence of postoperative complications and morbidity compared to craniectomy. More recently, the use of bone cement in posterior fossa craniotomies has been implemented, but there is limited comparative postoperative data of this technique to more commonly used bone flap replacement. This study aims to address this information gap through a meta-analysis comparing the incidence of postoperative cerebrospinal fluid leakage and other complications when utilizing bone cement versus bone flap replacement in posterior fossa craniotomies.</p><p><strong>Methods: </strong>Following a literature review, search parameters for a systematic review were identified and relevant studies were sorted based on selection criteria to be included in the meta-analysis. Data analysis was performed in R studio and Microsoft Excel software. Targeted complications for analysis include cerebrospinal fluid (CSF) leakage, pseudomeningocele formation, and infection. Pooled estimates and odds ratios for dichotomous outcomes were calculated with corresponding 95% confidence intervals, and findings were translated into illustrative tables and figures.</p><p><strong>Results: </strong>Twenty-one articles were included in a systematic review, nine studies using bone cement and thirteen using bone flap (two studies reported data for both groups). With bone flap replacement, CSF leakage was 8.36% (95% confidence interval [CI] 5.89-10.86%), pseudomeningocele formation was 9.22% (95% CI 4.82-13.62%), and infection was 6.85% (95% CI 4.05-9.65%). With bone cement usage, CSF leakage was 3.47% (95% CI 2.37-4.57%), pseudomeningocele formation was 2.43% (95% CI 1.23-3.63%), and infection was 1.85% (95% CI 0.75-2.95%). The odds ratio of CSF leak, pseudomeningocele formation, and infection was 0.39 (95% CI 0.229-0.559), 0.25 (95% CI 0.137-0.353), and 0.26 (95% CI 0.149-0.363), respectively, with the use of bone cement compared to craniotomy.</p><p><strong>Conclusion: </strong>Outcomes demonstrated in this meta-analysis revealed an overall decreased incidence of postoperative complications rates of CSF leak, pseudomeningocele formation, and infection when using bone cement compared to bone flap in posterior fossa craniotomies. Our study suggests that bone cement use is safe and effective in posterior fossa surgery. Future studies should further assess the comparative outcomes of these techniques.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384465","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 novel technique to avoid cerebrospinal fluid leaks following middle fossa approaches: Identifying a new triangle in the middle fossa.","authors":"Sarah C Nanziri, Peter Harris, Ahmed M Ashour, Yana Al-Inaya, Vincenzo Rondinelli, Saleem Abdulrauf","doi":"10.25259/SNI_845_2024","DOIUrl":"10.25259/SNI_845_2024","url":null,"abstract":"<p><strong>Background: </strong>Skull-based approaches involving the middle fossa (MF) can be complicated by postoperative cerebrospinal fluid (CSF) leaks. Most of these CSF leaks are due to inadvertent entry into the eustachian tube (ET) or incomplete packing of surrounding air cells. Air cells are routinely plugged with bone wax during surgery; however, CSF leaks due to entry into the ET are often not recognized. Our objective was to define a safe zone for drilling that would avoid entry into the ET during MF approaches.</p><p><strong>Methods: </strong>Ten cadaveric specimens were fixed in formalin and injected with latex. Twenty sides were dissected and examined under a microscope. We exposed and identified the petrous internal carotid artery (ICA), ET, and all surrounding anatomical landmarks.</p><p><strong>Results: </strong>We identified a triangle bordered by the lateral aspect of the third division of the trigeminal nerve (V3), the lateral aspect of the petrous ICA, and an imaginary line through the middle meningeal artery connecting V3 to the petrous ICA. This triangle was then bisected at the base, creating a medial and lateral sub-triangle. In all 20 cadaveric exposures, the ET was in the lateral sub-triangle and did not extend into the medial sub-triangle.</p><p><strong>Conclusion: </strong>Our findings demonstrate that entry into the ET while exposing the petrous ICA during MF approaches can be safely avoided by drilling in the medial sub-triangle. Drilling in the lateral sub-triangle will lead to entry into the ET, increasing the risk of a postoperative CSF leak.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of brain metastatic malignant melanoma coexisting with black colored dura mater: Management in low-resource setting.","authors":"Irvan Yosua Blegur, Elric Brahm Malelak, Donny Argie, Syebenhezer Epatah Hietingwati","doi":"10.25259/SNI_535_2024","DOIUrl":"10.25259/SNI_535_2024","url":null,"abstract":"<p><strong>Background: </strong>Brain metastases significantly contribute to morbidity and mortality in individuals with cancer, with melanoma exhibiting a high propensity for central nervous system dissemination. Early recognition and diagnosis are crucial, especially in low-resource settings where access to advanced diagnostics and treatment may be limited.</p><p><strong>Case description: </strong>We present the case of a 63-year-old male with a history of metastatic melanoma who presented with progressive neurological deficits. Imaging revealed a solitary brain metastasis in the cerebellopontine angle, further complicated by diffuse melanotic infiltration of the dura mater. The patient underwent surgical resection of the cerebellopontine angle mass, and histopathological examination confirmed metastatic melanoma.</p><p><strong>Conclusion: </strong>This case highlights the importance of considering metastatic disease in the differential diagnosis of cancer patients presenting with neurological symptoms, even in atypical locations. The presence of dural melanosis underscores the aggressive nature of melanoma and the need for comprehensive evaluation. This case emphasizes the need for prompt diagnosis and management to optimize patient outcomes, particularly in resource-constrained environments.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384115","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":"Anterior cervical discectomy and fusion for subaxial cervical spine injuries; management challenges and early outcome in a neurosurgical center.","authors":"Francis Chukwuebuka Campbell, Kelechi Onyenekeya Ndukuba, Chika Anele Ndubuisi, Okwuoma Okwunodulu, Wilfred Mezue, Samuel Ohaegbulam","doi":"10.25259/SNI_667_2024","DOIUrl":"10.25259/SNI_667_2024","url":null,"abstract":"<p><strong>Background: </strong>Anterior cervical discectomy and fusion (ACDF) is an effective technique in managing subaxial cervical spine injury (SCSI). The study highlights the experience and challenges of ACDF for SCSI in a subSaharan neurosurgical center.</p><p><strong>Methods: </strong>The medical records of the patients who had ACDF for SCSI over 6 years in Memfys Hospital, Southeast Nigeria were reviewed. Relevant data collated include patient demographics, clinical presentation, radiologic images, operative management, and complications. All patients had right-sided ACDF after resuscitation. The follow-up period was at least 3 months.</p><p><strong>Results: </strong>Eighty-one patients had ACDF, with male preponderance (8:1) and a mean age of 38.9 ± 12.4 years. Motor vehicular accident was the most common injury mechanism (71.6%), and the majority (59.5%) were ASIA A. C5/6 was the most common level of injury (40.7%), and the mean subaxial cervical spine injury classification system (SLIC) score was 7.8 ± 1.40. Fifty-eight (71.6%) patients presented late (>48 h after injury). ASIA A injuries, high SLIC score, and late presentation were associated with higher complication rates (<i>P</i> = 0.02, 0.000, and 0.0001). Dysphagia was the most common complication and was self-limiting. Improvement in neurological status was 84.75% and 10.4% for incomplete and complete injuries, respectively. Only 5% had access to onsite emergency medical services, three patients had comprehensive insurance, and rehabilitation services were available to 35.8% on discharge. The 30-day mortality was 8.6%.</p><p><strong>Conclusion: </strong>ACDF for SCSI is associated with good outcomes in patients with incomplete spinal cord injury. Challenges in management in our setting were related to poor emergency medical services, late presentation, low insurance coverage, and limited rehabilitation services.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384427","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":"Risk factors for cerebrospinal fluid shunt infection in pediatrics: A meta-analysis.","authors":"Roidah Taqiyya Zahra Wathoni, Wihasto Suryaningtyas, Budi Utomo, Muhammad Arifin Parenrengi, Agus Turchan, Asra Al Fauzi","doi":"10.25259/SNI_848_2024","DOIUrl":"10.25259/SNI_848_2024","url":null,"abstract":"<p><strong>Background: </strong>Placement of cerebrospinal fluid (CSF) shunt for diversion remains a primary treatment for patients with hydrocephalus despite its surgical complications, including shunt infection, that remain high and become a medical and social problem. The meta-analysis was conducted to investigate risk factors of shunt infection in pediatrics.</p><p><strong>Methods: </strong>Literature was searched on PubMed, Scopus, and the Cochrane Library. The methodology used for this investigation was preferred reporting items for systematic reviews and meta-analysis.</p><p><strong>Results: </strong>This meta-analysis included five publications. The only significant results were found in ages <6 months with relative risk (RR) of 33.06 (95% confidence interval [CI] 9.27-117,99; <i>P</i> < 0.01), Caucasian race with RR of 15.24 (95% CI 6.77-34.34), and African-American race with RR of 2.37 (95% CI 2.07-2.70). The other results provided were not significant, such as intraventricular hemorrhage (IVH) of prematurity as the etiology of hydrocephalus with RR of 4.71 (95% CI 1.07-20.82), presence of gastrostomy during shunt insertion with RR of 3.80 (95% CI 0.91-15.88), and comorbidity of respiratory diseases with RR of 0.22 (95% CI 0.11-0.43).</p><p><strong>Conclusion: </strong>Younger age during the shunt placement procedure, Caucasian race, and African-American race have a significantly higher risk of CSF shunt infection. The previously reported higher risk of shunt infection in cohort studies, such as IVH of prematurity and the presence of gastrostomy, were not significant in this study. Primary studies regarding shunt infection are advocated to be performed in a more extensive population with further risk factors included in the analysis.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384557","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":"Short course of low-dose steroids for management of delayed pericontusional edema after mild traumatic brain injury - A retrospective study.","authors":"G Lakshmi Prasad, Ashwin Pai, Swamy Pt","doi":"10.25259/SNI_948_2024","DOIUrl":"10.25259/SNI_948_2024","url":null,"abstract":"<p><strong>Background: </strong>Secondary insults such as brain edema is commonly observed after traumatic brain injury (TBI) and remains an important cause of neurological deterioration. Based on the corticosteroid randomisation after significant head injury (CRASH) trial findings, Brain Trauma Foundation guidelines recommend against giving steroids in TBI. However, the findings of two recent clinical studies suggest that there may be a subset of patients who may benefit from steroids.</p><p><strong>Methods: </strong>This study was a retrospective, single-center, 4-year study. The study analyzed patients who had received systemic corticosteroids for pericontusional delayed edema after TBI. The time interval to steroid prescription, drug dosage, time to symptomatic improvement, and complications were analyzed.</p><p><strong>Results: </strong>There were 19 males and eight females. Mean age was 42.1 years (range, 21-91 years). Except for one, all were mild TBI categories. All patients had brain contusions on computed tomography. Dexamethasone was used in tapering doses over 5-10 days, starting with 12 mg/day. The mean interval to steroid prescription after the trauma was 5.9 days, and the mean and median duration was 7 days. All, except one, had symptomatic improvement. The mean time to complete improvement in symptoms was 2.8 days. There were no complications pertinent to steroid usage in any of our cases.</p><p><strong>Conclusion: </strong>This is the third clinical study to document the efficacy of systemic corticosteroids for delayed cerebral edema after TBI. As steroids are excellent drugs for vasogenic edema, the timing and dosage of steroids are two important factors that will determine their efficacy in TBI. We strongly feel that there needs to be more robust clinical trials with good patient numbers to confirm these findings.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384562","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":"Stereotactic radiosurgery versus whole-brain radiotherapy for intracranial metastases: A systematic review and meta-analysis.","authors":"Abdulrahim Saleh Alrasheed, Abdulsalam Mohammed Aleid, Reema Ahmed Alharbi, Maryam Ali Alamer, Kawthar Abdullah Alomran, Sarah Abdullah Bin Maan, Sami Fadhel Almalki","doi":"10.25259/SNI_913_2024","DOIUrl":"10.25259/SNI_913_2024","url":null,"abstract":"<p><strong>Background: </strong>Brain metastasis has a negative influence on the morbidity and mortality of cancer patients. Conventionally, whole-brain radiotherapy (WBRT) was favored as the standard treatment for brain metastases. However, it has been linked to a significant decline in neuro-cognitive function and poor quality of life. Stereotactic radiosurgery (SRS) has recently gained prominence as an alternative modality, considering that it provides targeted high-dose radiation while minimizing adverse effects. This study evaluates the efficacy and safety of SRS versus WBRT in patients with intracranial metastases.</p><p><strong>Methods: </strong>According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, through July 2024, we searched PubMed, Scopus, and Web of Science for articles comparing WBRT and SRS in patients with intracranial metastases. Outcomes included local and distant recurrence, leptomeningeal disease (LMD), and survival. We also used a random-effect model to perform a meta-analysis.</p><p><strong>Results: </strong>The findings revealed no significant differences in local (risk ratio [RR] = 0.70, 95% confidence interval [CI] [0.46, 1.06]) or distant recurrence rates (RR = 0.83, 95% CI [0.54, 1.28], <i>P</i> = 0.41) between WBRT and SRS. However, SRS was associated with a greater risk of post-radiation LMD (hazard ratio [HR] = 3.09, 95% CI [1.47, 6.49], <i>P</i> = 0.003). Survival rates at 1 year (RR = 1.03, 95% CI [0.83, 1.29], <i>P</i> = 0.76) and 5 years (RR = 0.89, 95% CI [0.39, 2.04], <i>P</i> = 0.78) demonstrated no significant differences.</p><p><strong>Conclusion: </strong>SRS and WBRT exhibited similar recurrence rates and overall survival (OS) at 1 and 5 years, with WBRT being more effective in managing post-radiation LMD. SRS patients, on the other hand, had longer OS when measured in months.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384564","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":"Ventriculoperitoneal shunt-associated giant intraperitoneal cerebrospinal fluid pseudocysts: A case report and literature review.","authors":"Anak Agung Ngurah Agung Harawikrama Adityawarma, Christopher Lauren, Angky Saputra, Joshua Sutikno, Made Gemma Daniswara Maliawan, Tjokorda Gde Bagus Mahadewa","doi":"10.25259/SNI_754_2024","DOIUrl":"10.25259/SNI_754_2024","url":null,"abstract":"<p><strong>Background: </strong>Ventriculoperitoneal (VP) shunt placement, a common treatment for hydrocephalus, can lead to various complications, including the formation of cerebrospinal fluid (CSF) pseudocysts within the peritoneal cavity. Although rare, occurring in 1-4.5% of cases, these pseudocysts pose significant clinical challenges due to their potential recurrence and the complexity of their management. The optimal management strategy depends on individual patient factors and the presence of infection.</p><p><strong>Case description: </strong>A 24-year-old woman presented with decreased consciousness, worsening headaches, and progressive abdominal enlargement. Imaging revealed a giant intraperitoneal cystic lesion, initially suspected to be a malignant ovarian cyst, but later identified as a CSF pseudocyst associated with the distal tip of a VP shunt placed 9 years earlier. The patient underwent urgent shunt revision, converting to a ventriculoatrial shunt. Postoperatively, her neurological status improved, and the abdominal mass resolved completely within 3 weeks. Follow-up over 1 year confirmed the absence of recurrence or neurological deficits.</p><p><strong>Conclusion: </strong>VP shunt-associated intraperitoneal CSF pseudocysts, while rare, can develop long after shunt placement and present significant diagnostic and management challenges. Early recognition and appropriate surgical intervention are crucial to prevent complications. This case underscores the importance of individualized treatment approaches and diligent follow-up to ensure favorable outcomes, even in complex cases.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384050","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}