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Drug-resistant BRAF V600E-mutant recurrent pleomorphic xanthoastrocytoma, CNS WHO Grade 3 successfully resolved with incidental discontinuation of combined BRAF and MEK inhibitor therapy. 耐药BRAF v600e突变复发性多形性黄色星形细胞瘤,CNS WHO 3级通过偶然停止BRAF和MEK抑制剂联合治疗成功解决。
Surgical neurology international Pub Date : 2024-11-15 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_734_2024
Hirotaka Inoue, Jun-Ichiro Kuroda, Yutaka Fujioka, Nobuhiro Hata, Masahiro Mizoguchi, Daiki Yoshii, Hiroyuki Sueyoshi, Yuki Takeshima, Kenji Fujimoto, Naoki Shinojima, Kuniko Sunami, Yoshiki Mikami, Hideo Nakamura, Akitake Mukasa
{"title":"Drug-resistant <i>BRA</i>F V600E-mutant recurrent pleomorphic xanthoastrocytoma, CNS WHO Grade 3 successfully resolved with incidental discontinuation of combined BRAF and MEK inhibitor therapy.","authors":"Hirotaka Inoue, Jun-Ichiro Kuroda, Yutaka Fujioka, Nobuhiro Hata, Masahiro Mizoguchi, Daiki Yoshii, Hiroyuki Sueyoshi, Yuki Takeshima, Kenji Fujimoto, Naoki Shinojima, Kuniko Sunami, Yoshiki Mikami, Hideo Nakamura, Akitake Mukasa","doi":"10.25259/SNI_734_2024","DOIUrl":"10.25259/SNI_734_2024","url":null,"abstract":"<p><strong>Background: </strong>Combination therapy with BRAF and MEK inhibitor holds promise for treating gliomas harboring the <i>BRAF</i> V600E mutation; however, the development of acquired resistance remains a challenge.</p><p><strong>Case description: </strong>We describe a case of repeated recurrent <i>BRAF-</i>mutant pleomorphic xanthoastrocytoma (central nervous system World Health Organization grade 3) treated with combination therapy with BRAF and MEK inhibitor. The patient received dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor); however, she developed resistance to the combination therapy. Remarkably, incidental drug discontinuation contributed to the disappearance of the resistant tumor. The same phenomenon was repeatedly observed after that. Genetic analysis demonstrated that the resistant tumor had <i>BRAF</i> V600E amplification; the resistant tumor remained BRAF→MEK→ERK pathway dependent, and drug resistance might be due to elevated <i>BRAF</i> V600E expression. We speculated that ERK1/2 signal extremes caused by the discontinuation of the combination therapy affected the resistant tumor survival.</p><p><strong>Conclusion: </strong>This case study provides important insights into novel treatment strategies and their underlying mechanisms for gliomas with <i>BRAF</i> mutations.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"417"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Penetrating intraorbital wooden foreign bodies involving the right frontal lobe of the brain: A rare case report. 穿透眶内木质异物累及右脑额叶:一例罕见病例报告。
Surgical neurology international Pub Date : 2024-11-15 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_668_2024
Donny Wisnu Wardhana, Farhad Bal'afif, Tommy Alfandy Nazwar, Amrina Rosyada, Wahju Sigit Tjahjono Putro, Anisa Nur Kholipah
{"title":"Penetrating intraorbital wooden foreign bodies involving the right frontal lobe of the brain: A rare case report.","authors":"Donny Wisnu Wardhana, Farhad Bal'afif, Tommy Alfandy Nazwar, Amrina Rosyada, Wahju Sigit Tjahjono Putro, Anisa Nur Kholipah","doi":"10.25259/SNI_668_2024","DOIUrl":"10.25259/SNI_668_2024","url":null,"abstract":"<p><strong>Background: </strong>Penetrating orbital trauma from a wooden foreign object is rare and challenging to identify, as it cannot be detected with a computed tomography (CT) scan. This report highlights the clinical presentation, diagnosis, and management of such a case.</p><p><strong>Case description: </strong>A 19-year-old female experienced penetrating orbital trauma from a wooden object following a traffic accident. She intermittently visited the hospital with eye swelling and headache, without visible penetrating wounds on the palpebra. The swelling persisted for weeks, accompanied by increasing signs of ocular and cerebral infection. The suspicion of a non-metallic foreign body penetrating the brain was confirmed 3 months after the initial visit, delayed by the hidden entry wound between the eyelid and eyeball and orbital edema mimicking non-penetrating trauma. A multidisciplinary team managed the case. Procedures included debridement, retro-orbital exploration, retro-orbital abscess evacuation, and frontal basal trephination exploration, successfully removing the wooden object that had penetrated the medial orbit, frontal bone, and brain, along with cerebral abscess evacuation. Postoperative CT scans showed complete removal of the foreign object and successful abscess evacuation. The patient showed improvement in ocular symptoms, resolution of headaches, and no wound leakage. She was discharged on the 14<sup>th</sup> day after completing antibiotic treatment and having the dressing removed.</p><p><strong>Conclusion: </strong>This case is notable for its rarity, high risk of misdiagnosis, and potentially fatal consequences if not promptly managed. We emphasize the importance of patient involvement in routine consultations, careful anamnesis, clinical examination, and a multidisciplinary approach for optimal outcomes.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"418"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rare case of resistant Achromobacter xylosoxidans-associated meningitis due to intrathecal catheter. 鞘内导管引起的耐药木糖氧化无色杆菌相关性脑膜炎罕见病例。
Surgical neurology international Pub Date : 2024-11-15 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_764_2024
Ajay Nair, Vito Lucarelli, Alastair Hoyt
{"title":"Rare case of resistant <i>Achromobacter xylosoxidans-</i>associated meningitis due to intrathecal catheter.","authors":"Ajay Nair, Vito Lucarelli, Alastair Hoyt","doi":"10.25259/SNI_764_2024","DOIUrl":"10.25259/SNI_764_2024","url":null,"abstract":"<p><strong>Background: </strong><i>Achromobacter xylosoxidans</i> (AX) is an aerobic Gram-negative opportunistic bacteria known to inhabit various environments and is most commonly associated with nosocomial infections in immune-compromised patients. Although rare, AX can cause a variety of neurological infections, such as meningitis, ventriculitis, and osteomyelitis. Intravascular catheters, intrathecal pumps, and contaminated surgical instruments are potential vectors for such patients.</p><p><strong>Case description: </strong>Here, we present a unique case of multidrug-resistant AX-positive meningitis secondary to infection of a nonfunctional intrathecal narcotic pump. The patient has a complex past medical history leading up to infection, and care was significantly compromised by homelessness and inflammatory bowel disease (IBD). Treatment included catheter removal and antibiotics.</p><p><strong>Conclusion: </strong>Patients who suffer from homelessness or IBD show a possible increased risk of this infection. This case emphasizes the need for increased care regarding these patients, along with describing the complications and timeline when treating this rare type of meningitis.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"424"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Giant scalp dermatofibrosarcoma protuberans at mid-occipital scalp: A rare case report. 枕中部巨大头皮隆突性皮纤维肉瘤1例。
Surgical neurology international Pub Date : 2024-11-15 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_604_2024
Muhammad Luqman Nul Hakim, Firman Priguna Tjahjono, Ahmad Faried
{"title":"Giant scalp dermatofibrosarcoma protuberans at mid-occipital scalp: A rare case report.","authors":"Muhammad Luqman Nul Hakim, Firman Priguna Tjahjono, Ahmad Faried","doi":"10.25259/SNI_604_2024","DOIUrl":"10.25259/SNI_604_2024","url":null,"abstract":"<p><strong>Background: </strong>Dermatofibrosarcoma protuberans (DFSP) is a rare type of skin cancer that arises in the deeper layers of the skin, most commonly on the trunk and limbs. The presentation of DFSP on the scalp is worth documentation due to its extremely rare occurrence in the literature.</p><p><strong>Case description: </strong>We describe a case of a 41-year-old female presented with a lump on the back of the head with gradual enlargement. It was solitary with a size 19 × 12 × 10 cm with purulent discharge and intermittent pain. A computed tomography-scan showed an isodense mass at mid occipital without intracranial involvement. Tumor extirpation and the free flap were performed collaborated with plastic surgery. The patient was discharged unremarkably on the 7<sup>th</sup> postoperative day without any neurological deficits.</p><p><strong>Conclusion: </strong>Our case is distinct because, after 24 months without any adjuvant therapy and without any recurrence, the patient is still doing well. This is a very rare clinical entity.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"414"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Combined transpetrosal-transtentorial approach with occipital artery - anterior inferior cerebellar artery bypass and aneurysm clipping for a lower basilar artery aneurysm involving anterior inferior cerebellar artery: Two-dimensional operative video. 经门骨-经小脑幕联合入路与枕动脉-小脑前下动脉搭桥及动脉瘤夹闭治疗累及小脑前下动脉的下基底动脉动脉瘤:二维手术影像。
Surgical neurology international Pub Date : 2024-11-15 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_884_2024
Gahn Duangprasert, Nakao Ota, Kosumo Noda, Rokuya Tanikawa
{"title":"Combined transpetrosal-transtentorial approach with occipital artery - anterior inferior cerebellar artery bypass and aneurysm clipping for a lower basilar artery aneurysm involving anterior inferior cerebellar artery: Two-dimensional operative video.","authors":"Gahn Duangprasert, Nakao Ota, Kosumo Noda, Rokuya Tanikawa","doi":"10.25259/SNI_884_2024","DOIUrl":"10.25259/SNI_884_2024","url":null,"abstract":"<p><strong>Background: </strong>Aneurysms of the lower basilar artery (BA) are rare, accounting for <1% of all intracranial aneurysms. This location has been described as \"No man's land\" since it poses a potential challenge for microsurgery. Recently, endovascular treatment has become an alternative option; however, there are some disadvantages regarding the obliteration rate, patency of the parent, and perforating arteries.</p><p><strong>Case description: </strong>We present the case of a 69-year-old female with an incidentally found lower BA aneurysm. The imaging examinations revealed a wide-neck aneurysm size of 8.5 mm arising just distal to the vertebrobasilar junction, with involvement of the left anterior inferior cerebellar artery (AICA). After a discussion with the patient, she opted to undergo the surgical treatment. We described the detailed steps of our surgical techniques in performing a combined transpetrosal-transtentorial approach. First, the occipital artery (OA) was harvested. Then, the posterior transpetrosal (retrolabyrinthine) and a far-lateral suboccipital approach were conducted with tentorial sectioning to expose the aneurysm. After AICA was confirmed to arise from the aneurysm sac, the OAAICA bypass was established to ensure AICA patency, followed by complete aneurysm clipping. The approach provided both the presigmoid and retrosigmoid corridors for bypass and clipping procedures, respectively. The patient tolerated the procedure well. Postoperative imaging examinations showed complete aneurysm obliteration and bypass patency without complications. She was discharged without neurological deficits (modified Rankin Scale 0).</p><p><strong>Conclusion: </strong>The combined transpetrosal approach is safe and effective for revascularization and clipping procedure for a lower BA aneurysm.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"425"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A rare case of spinal myeloid sarcoma. 脊髓样肉瘤1例。
Surgical neurology international Pub Date : 2024-11-15 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_640_2024
Wouter Deconinck, Sven Bamps, Thomas Steelandt, Maarten Wissels, Mark Plazier, Eric Put, Salah-Eddine Achahbar, Steven Vanvolsem, Sacha Meeuws, Sam Klein, Gert Roosen
{"title":"A rare case of spinal myeloid sarcoma.","authors":"Wouter Deconinck, Sven Bamps, Thomas Steelandt, Maarten Wissels, Mark Plazier, Eric Put, Salah-Eddine Achahbar, Steven Vanvolsem, Sacha Meeuws, Sam Klein, Gert Roosen","doi":"10.25259/SNI_640_2024","DOIUrl":"10.25259/SNI_640_2024","url":null,"abstract":"<p><strong>Background: </strong>Myeloid sarcoma (MS), a rare extramedullary tumor composed of myeloid blast cells, is classified by the World Health Organization as a subtype of acute myeloid leukemia (AML). Isolated, primary, or nonleukemic MS has an incidence of 2/1,000,000 adults and constitutes only 0.7% of all AML cases. MS presentations vary widely, with spinal involvement being rare.</p><p><strong>Case description: </strong>A-year-old male presented with interscapular pain radiating to the right upper arm/neck but was neurologically intact. Once diagnosed with isolated spinal MS, he underwent a surgical decompression followed by local irradiation, systemic chemotherapy, and bone marrow transplantation. Eight months postoperatively, however, he experienced a graft-versus-host rejection and required additional therapies.</p><p><strong>Conclusion: </strong>Establishing the diagnosis of MS is challenging and typically requires histological confirmation (i.e., the presence of myeloblasts and granulocytic cells). However, optimal treatment strategies remain elusive; despite radiation, chemotherapy, bone marrow transplant/other local therapies, the overall long-term prognosis for MS remains poor.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"415"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pathological laughter as an unusual first-presenting symptom of petroclival meningioma. 病理性笑声是岩斜坡脑膜瘤的一种不寻常的首发症状。
Surgical neurology international Pub Date : 2024-11-15 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_673_2024
Pavan Tulshiram Lanjewar, Mayank Tripathi, Simran Kaur Syal, Binoy Kumar Singh, Shailendra Anjankar, Charandeep Singh Gandhoke
{"title":"Pathological laughter as an unusual first-presenting symptom of petroclival meningioma.","authors":"Pavan Tulshiram Lanjewar, Mayank Tripathi, Simran Kaur Syal, Binoy Kumar Singh, Shailendra Anjankar, Charandeep Singh Gandhoke","doi":"10.25259/SNI_673_2024","DOIUrl":"10.25259/SNI_673_2024","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"420"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biological and hardware-related spinal cord stimulation complications and their management: A single-center retrospective analysis of the implantation of nonrechargeable implantable pulse generators in different pain conditions. 生物和硬件相关的脊髓刺激并发症及其处理:不同疼痛条件下植入非充电式植入式脉冲发生器的单中心回顾性分析。
Surgical neurology international Pub Date : 2024-11-08 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_821_2023
Marek Prokopienko, Michał Sobstyl
{"title":"Biological and hardware-related spinal cord stimulation complications and their management: A single-center retrospective analysis of the implantation of nonrechargeable implantable pulse generators in different pain conditions.","authors":"Marek Prokopienko, Michał Sobstyl","doi":"10.25259/SNI_821_2023","DOIUrl":"10.25259/SNI_821_2023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;We present our experience with spinal cord stimulation (SCS) for patients suffering from different pain conditions who subsequently developed hardware-related complications after SCS surgery. The SCS hardware-related complications may compromise the continuous SCS therapy due to partial or total hardware removal. Such situations should be avoided, and possible predisposing factors for their development should be minimized. The present study aimed to evaluate the frequency of hardware-related complications and their proper neurosurgical management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study is designed as a retrospective analysis of all hardware-related complications of SCS procedures for pain patients who underwent the implantation of the nonrechargeable PrimeAdvanced&lt;sup&gt;™&lt;/sup&gt; SureScan&lt;sup&gt;™&lt;/sup&gt; magnetic resonance imaging (MRI) neurostimulator (Medtronic, Minneapolis, United States). This neurostimulator allows patients safe access to MRI scans anywhere on the body. The PrimeAdvanced&lt;sup&gt;™&lt;/sup&gt; SureScan&lt;sup&gt;™&lt;/sup&gt; MRI neurostimulator can deliver stimulation through one or more leads in the epidural space. From December 2017 to December 2021, 20 patients with SCS implantations and a minimum postoperative follow-up of 3 months were included. All patients were operated on using identical surgical and intraprocedural techniques. The same SCS hardware was implanted (nonrechargeable PrimeAdvanced&lt;sup&gt;™&lt;/sup&gt; SureScan&lt;sup&gt;™&lt;/sup&gt; MRI neurostimulator) in all patients. We examined numerous preoperative variables (i.e., sex, age at surgery, diabetes, body mass index, and type of pain syndrome) to detect any correlation between them and the incidence of postoperative hardware-related complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 20 patients, 8 (40%) patients were affected by hardware-related complications. The most common complications were skin erosion found in 5 patients (25%) and incorrect functioning of the implantable pulse generator (IPG) affecting 2 patients (10%). There were 1 case of an IPG migration (5%) and 1 hardware infection (5%) due to a staphylococcal wound. A total number of 16 revision surgeries were performed to manage all hardware-related complications in these patients adequately. Most of the patients (5 of them) were troubled by more than one hardware-related complication episode. Three patients had 3 revision surgeries, 2 patients had 2 revision surgeries, and 3 patients had 1 revision surgery. Among 8 patients with complications, 3 patients had no further continuation of SCS therapy due to hardware-related complications. Among these 3 patients who stopped their SCS therapy, 1 patient had 3 hardware-related episodes, and the remaining 2 patients were troubled by two hardware-related episodes before discontinuation of SCS therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our results indicate that patients treated by the SCS technique are at higher risk for the development of skin-related complicat","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"402"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of thalamotomy with Gamma Knife radiosurgery as a multitarget strategy in patients with complex trigeminal neuralgia. 伽玛刀放射多靶点治疗复杂三叉神经痛的效果。
Surgical neurology international Pub Date : 2024-11-08 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_562_2024
Juan Pablo Leal-Isaza, Oscar Iván Molina-Romero, Juan Carlos Diez-Palma, Andrés Fonnegra-Caballero, Andrés Segura Hernández, Laura Daniela Ramirez-Melo, Julio Roberto Fonnegra-Pardo
{"title":"Effectiveness of thalamotomy with Gamma Knife radiosurgery as a multitarget strategy in patients with complex trigeminal neuralgia.","authors":"Juan Pablo Leal-Isaza, Oscar Iván Molina-Romero, Juan Carlos Diez-Palma, Andrés Fonnegra-Caballero, Andrés Segura Hernández, Laura Daniela Ramirez-Melo, Julio Roberto Fonnegra-Pardo","doi":"10.25259/SNI_562_2024","DOIUrl":"10.25259/SNI_562_2024","url":null,"abstract":"<p><strong>Background: </strong>In the setting of refractory neuralgia or other complex facial pains, the intensity of the pain does not decrease despite medical and even surgical interventions. This report aims to describe the experience of an institution in the management of refractory trigeminal neuralgia and other complex facial pains with Gamma Knife radiosurgery (GKR), including thalamotomy as a multitarget strategy.</p><p><strong>Methods: </strong>We conducted a retrospective observational study. Data were obtained from 50 patients with complex trigeminal neuralgia treated with GKR, in whom the thalamus was included as a target. The Visual Analog Scale (VAS) and the Barrow Neurological Institute (BNI) scale were considered before treatment and at the follow-up. The Wilcoxon test was used to compare the VAS scores and the McNemar test for the BNI scale.</p><p><strong>Results: </strong>The mean age was 62.7 years (standard deviation = 16.3). The indications for management with thalamotomy were neuralgia refractory to medical management (68%), recurrent pain after previous rhizolysis with GKR (20%), atypical deafferentation-type pain in patients with radiofrequency background (10%), and anatomical deformation of the trigeminal nerve by a tumor (2%). Before treatment, all patients were classified as BNI V. At follow-up, a satisfactory response to treatment was described in 82.05% of cases (<i>P</i> = 0.001 McNemar). The median preoperative pain evaluated with VAS was 10 (interquartile range [IQR] = 10-10), while at follow-up, it was 6 (IQR = 1-7) (<i>P</i> = 0.001 Wilcoxon).</p><p><strong>Conclusion: </strong>The thalamus is a versatile, effective, and safe therapeutic target for ablative management in patients with complex facial pain.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"403"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Imaging-tracked progression of primary leptomeningeal gliomatosis: A case report. 影像学追踪原发性脑膜胶质瘤病的进展:1例报告。
Surgical neurology international Pub Date : 2024-11-08 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_759_2024
Noriaki Nomura, Shohei Nagasaka, Kohei Suzuki, Junkoh Yamamoto
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