Surgical neurology international最新文献

{"title":"A meta-analysis of modern neuro-stimulation modalities-Advances in neuro-stimulation techniques.","authors":"Abdulsalam Mohammed Aleid, Saud Nayef Aldanyowi, Ayat Aleid, Khaled Albazli, Ghadeer Mohammad Fatani, Sami Almalki","doi":"10.25259/SNI_656_2024","DOIUrl":"https://doi.org/10.25259/SNI_656_2024","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain is a debilitating condition that affects about 3% of the population globally. Conventionally, pharmacologic approaches, psychotherapy, and surgery have been used in the management of chronic refractory pain. However, over the past decades, advances in neurotechnology have enabled modern novel techniques of neurostimulation, such as spinal cord stimulation (SCS) and dorsal root ganglion (DRG), to be used in the management of chronic neuropathic pain that does not respond to conventional management. This review, therefore, aims to establish the efficacy of these two novel technologies in the management of chronic neuropathic pain compared to conventional medical management (CMM) techniques.</p><p><strong>Methods: </strong>A systematic search was conducted on three electronic databases, PubMed, Science Direct, and CENTRAL, for all relevant articles to the study topic. After a detailed review by two independent reviewers, only the articles that met the inclusion criteria were included. The Review Manager 5.4 software was utilized to conduct a meta-analysis of the outcomes of pain reduction.</p><p><strong>Results: </strong>Our online search yielded 345 articles; however, only eight studies were included in the analysis according to our inclusion criteria. The results from our pooled analysis indicated that SCS and dorsal root stimulation both resulted in a significant reduction in the rating of chronic pain mean difference (MD) (-4.73; 95% confidence interval [CI] [-4.76, -4.71] <i>P</i> < 0.00001) and MD (-1.09; 95% CI [-1.29, -0.90] <i>P</i> < 0.00001), respectively. Similarly, for the studies that reported percentage change in pain rating, the pooled analysis showed that SCS resulted in a higher percentage reduction in pain rating compared to CMM MD (69.47; 95% CI [64.31, 74.64] <i>P</i> < 0.00001).</p><p><strong>Conclusion: </strong>Based on the results of our analysis, we conclude that advances in neurostimulation techniques, such as SCS and DRG stimulation, have resulted in better management of chronic neuropathic pain compared to conventional pain management techniques.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"146"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033371","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":"Cavernous malformation in the lumbar nerve rootlet.","authors":"Phi Nguyen, Phu An Huynh, Tra My Ton Nu, Minh Huynh Quang Bui, Nhu Phuc Tran, Van Tri Truong","doi":"10.25259/SNI_227_2025","DOIUrl":"https://doi.org/10.25259/SNI_227_2025","url":null,"abstract":"<p><strong>Background: </strong>Intradural extramedullary (IDEM) cavernomas are rare vascular lesions that sometimes needs surgery. However, there has been little information about the surgical strategy for these lesions.</p><p><strong>Case description: </strong>A 39-year-old male presented with 1 month of left lumbosciatalgia. The magnetic resonance imaging was consistent with either an L4 IDEM neurofibroma or a meningioma. At surgery, we encountered a red-oval encapsulated lesion firmly adhered to the L4 nerve root, which was totally excised along with the root itself. Notably, postoperatively, the patient exhibited no new neurological deficit.</p><p><strong>Conclusion: </strong>IDEM cavernoma is rare but should always be a differential diagnosis for other common IDEM lesions. A total excision of an IDEM cavernoma and sacrification of the involved nerve root seem to be a reasonable option.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"152"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgical resection of a giant exclusively dopamine- secreting jugular foramen paraganglioma: A case report.","authors":"Guilherme H W Ceccato, Júlia S de Oliveira, Pedro H Dos Santos Neto, Nick D Carvalho, Hugo A Hasegawa, Vinícius N Coelho, Vitor P Barreto, Gustavo A R Passos, Paulo A S Kadri, Jean G de Oliveira, Luis A B Borba","doi":"10.25259/SNI_188_2024","DOIUrl":"https://doi.org/10.25259/SNI_188_2024","url":null,"abstract":"<p><strong>Background: </strong>Temporal bone paragangliomas are complex pathologies presenting close relationships with many critical neurovascular structures. Exclusively, dopamine-secreting paragangliomas are rare and may present a major hemodynamic challenge during intraoperative and postoperative periods, with great blood pressure lability due to the dose-dependent properties of dopamine. However, preoperative α or β blockage is usually not advised. Microsurgical resection is the treatment of choice; nevertheless, these tumors commonly present with greater size at diagnosis due to their non-specific clinical manifestations.</p><p><strong>Case description: </strong>A 43-year-old male patient presented with headache, tinnitus, hearing loss, hypoglossal and facial nerve compromise, as well as vocal cord palsy. Magnetic resonance imaging depicted a giant posterior fossa mass centered in the left jugular foramen extending to the cervical space, associated with important bone erosion. Laboratory investigation depicted elevated serum dopamine concentration of >2.500 pg/mL (reference <30 pg/mL) and increased 24-h urine dosage of 3306 μg (reference <540 μg). Values of epinephrine, norepinephrine, and metanephrines were within normal range. The patient underwent preoperative embolization, and microsurgical resection was performed the next day. Serum and urinary dopamine concentrations were normalized following the procedure. The patient presented a favorable outcome, with no new neurological deficits.</p><p><strong>Conclusion: </strong>Exclusively dopamine-secreting temporal bone paragangliomas may be successfully resected with a favorable outcome. A multidisciplinary, well-trained team is essential to manage intraoperative challenges up to postoperative rehabilitation adequately. Extensive laboratory training is essential to develop the surgical skills to master this skull-based approach.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"147"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061818","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":"Brain sagging syndrome: Occult cerebrospinal fluid leakage as a cause of failed brain expansion after removal of bilateral chronic subdural hematomas.","authors":"Joji Inamasu, Sota Wakahara","doi":"10.25259/SNI_269_2025","DOIUrl":"https://doi.org/10.25259/SNI_269_2025","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic subdural hematoma (CSDH), particularly bilateral hematomas, do not infrequently present with cognitive impairments. While those impairments are usually caused by brain compression by CSDH, other underlying causes may also be responsible for the impairments.</p><p><strong>Case descriptions: </strong>A healthy 74-year-old man visited a local hospital with cognitive impairments of subacute onset. He denied the presence of a headache. A brain computed tomography (CT) revealed bilateral CSDH compressing the cerebral hemispheres. After an emergency bilateral burr hole drainage, his symptoms improved only partially, and recurrence of the CSDH occurred within 14 days of the first surgery. A search for the underlying cause of the cognitive impairments was implemented. A CT myelography revealed cerebrospinal fluid (CSF) leakage at the lumbar spine, and after an epidural autologous blood patch therapy, his cognitive impairments resolved quickly and fully.</p><p><strong>Conclusion: </strong>In the case of bilateral CSDH with early postoperative recurrence, a search for the presence of occult CSF leakage may be warranted. The term \"brain sagging syndrome\" or \"brain sagging dementia\" has been proposed to describe cognitive impairments due both to the brain compression by the CSDH and to the brain sagging by the CSF leakage. The absence of orthostatic headache may not necessarily exclude the presence of CSF leakage.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"142"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059225","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":"Well-developed cutaneous feeder compression using a circular plastic disc and a rubber band for embolization of non-sinus type parasagittal dural arteriovenous fistula.","authors":"Atsushi Hirota, Yoshinobu Horio, Jota Tega, Koichiro Suzuki, Rina Shibayama, Yuta Oka, Hiromasa Kobayashi, Koichiro Takemoto, Hiroshi Abe","doi":"10.25259/SNI_143_2025","DOIUrl":"https://doi.org/10.25259/SNI_143_2025","url":null,"abstract":"<p><strong>Background: </strong>Non-sinus type parasagittal dural arteriovenous fistula (DAVF) is associated with a high incidence of cortical venous reflux and is susceptible to the development of progressive symptoms, including venous infarction and cerebral hemorrhage. Well-developed superficial temporal arteries (STAs) and/or occipital arteries (OAs) are frequently involved, which present a challenge in controlling liquid embolic material when injecting liquid embolic material from the middle meningeal artery (MMA). We developed a method to control the feeding from cutaneous vessels using a circular plastic disc and a rubber band.</p><p><strong>Case description: </strong>We present a case of a 48-year-old male with upper and lower extremity paralysis and diminished sensation in the left lower extremity. Imaging studies revealed a non-sinus type parasagittal DAVF (Borden type III, Cognard type IV) with bilateral MMAs and transosseous feeders from the STA and OA. To control blood flow from cutaneous feeders during Onyx embolization, we used a circular plastic disc and a rubber band to compress the feeders. The DAVF was successfully occluded without any complications. Cutaneous vessels were preserved after embolization.</p><p><strong>Conclusion: </strong>Our technique, which employs a circular plastic disc and rubber band to physically compress the cutaneous feeders and regulate blood flow during transarterial embolization for non-sinus type parasagittal DAVF, represents a valuable approach to preserving the cutaneous vessels and promptly assessing complete occlusion following the procedure. At the same time, it avoids the potential risks of radiation exposure to the surgical assistant.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"145"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061226","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 efficacy of neurostimulation techniques for the management of chronic pain associated with bone disorders: A systematic review and meta-analysis.","authors":"Hassan A Al-Ghanim, Zainab M Aleid, Saud N Aldanyowi, Abdulsalam M Aleid","doi":"10.25259/SNI_521_2024","DOIUrl":"https://doi.org/10.25259/SNI_521_2024","url":null,"abstract":"<p><strong>Background: </strong>The management of chronic pain associated with bone problems has been accomplished by the use of neurostimulation methods, such as spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS). It is still unknown, however, how successful they are in comparison. The effectiveness of SCS and PNS in reducing chronic pain and enhancing functional results in patients with chronic pain related to bone abnormalities was assessed in this comprehensive review and meta-analysis.</p><p><strong>Methods: </strong>To find randomized controlled trials (RCTs) comparing SCS or PNS to standard medical management or placebo/sham treatment in adults with chronic pain related to bone disorders, a comprehensive search of PubMed, MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was carried out from the start of the database until February 2024. The main result was the absence of discomfort. Opioid usage, functional status, and quality of life were secondary outcomes. The Cochrane technique was used to evaluate bias risk. The risk ratios (RRs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were computed using random effects meta-analysis.</p><p><strong>Results: </strong>We included 20 RCTs with a total of 2576 participants. In short-term (≤6 months) follow-up, SCS and PNS were both associated with substantially higher pain alleviation than conventional medical care or placebo/sham: SCS SMD -0.87 (95% CI -1.19--0.55), PNS SMD -0.56 (95% CI -0.91-0.21). SCS SMD -0.71 (95% CI -1.05--0.37) and PNS SMD -0.60 (95% CI -1.03--0.17) benefits were maintained at long-term (>6 months) follow-up. The physical and emotional functioning, as well as quality of life, were also markedly enhanced by SCS and PNS. It was shown that SCS (RR 0.57, 95% CI 0.44-0.74) and PNS (RR 0.58, 95% CI 0.43-0.77) reduced the risk of opioid usage.</p><p><strong>Conclusion: </strong>When it comes to improving functionality and quality of life, SCS and PNS both reduce chronic pain linked to bone problems, both temporarily and permanently. In some individuals, SCS and PNS may assist in lowering opioid consumption. Neurostimulation treatments may be useful in the treatment of persistent pain associated with bone diseases.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"137"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004367","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":"Adult tentorial medulloblastoma mimicking meningioma: A case report and systematic review.","authors":"Sadeen Sameer Eid, Arshad Ali, Noman Shah, Amal I Alawadat, Muna AbuHejleh, Issam Al-Bozom, Ghanem Al-Sulaiti","doi":"10.25259/SNI_10_2025","DOIUrl":"https://doi.org/10.25259/SNI_10_2025","url":null,"abstract":"<p><strong>Background: </strong>Tentorial medulloblastomas in adults are exceedingly rare and may clinically and radiologically mimic meningiomas. This case report, with a systematic review, aims to outline the clinical, radiological, pathological, and management strategies for adult tentorial medulloblastoma.</p><p><strong>Case description: </strong>A 37-year-old male patient presented with headaches, vertigo, and vomiting. Imaging investigations revealed a tentorial extra-axial mass, initially considered a meningioma. The patient subsequently underwent surgical resection followed by chemoradiation. Histopathological examination ultimately identified the mass as an eccentrically located adult medulloblastoma. We conducted a systematic review of the literature, analyzing four studies that reported similar cases. This analysis included clinical and demographic information, diagnosis through imaging and histopathology, treatment methods, and outcomes for seven cases, including our own.</p><p><strong>Conclusion: </strong>Adult tentorial medulloblastomas are extremely rare tumors that may mimic meningiomas, posing significant clinical challenges. Accurate diagnosis necessitates advanced imaging techniques and histopathological confirmation. The primary treatment strategy involves maximal surgical resection, supplemented by chemoradiotherapy.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"143"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035319","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":"Poor diagnostic value of isocitrate dehydrogenase 1 R132H immunohistochemistry for determination of isocitrate dehydrogenase 1 status in patients with glioblastoma.","authors":"Ahmad Faried, Edward Jaya Hadi, Hasrayati Agustina","doi":"10.25259/SNI_881_2024","DOIUrl":"https://doi.org/10.25259/SNI_881_2024","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization (WHO) classification of central nervous system (CNS) tumors is a major advance toward improving the diagnosis of adult brain tumors. Despite the promise of isocitrate dehydrogenase (IDH) mutations as an important biomarker for glioblastoma, not all institutions have ready access to mutation detection polymerase chain reaction (PCR) methods, and deoxyribonucleic acid (DNA) sequencing may be problematic in very small biopsies. However, a simultaneous evaluation of IDH1 status by DNA sequencing and immunohistochemistry (IHC) to determine the sensitivity and specificity of both methods, along with their predictive value, was unavailable.</p><p><strong>Methods: </strong>This retrospective study included 33 patients who underwent surgical resection or biopsy, January 2016-December 2019. The diagnosis of glioblastoma was established. Surgically resected tumor tissues were fixated in 10%-formaldehyde preserved in paraffin-embedded blocks. Glioblastoma was classified according to the 2021 WHO classification of CNS tumors. The enrolled patients were followed up to obtain the overall survival rate (median follow-up time, 30 months).</p><p><strong>Results: </strong>Thirty-three patients (14 male; 19 female), mean age of 44.74 ± 15.49 years. Eight had WHO Grade II, 2 with WHO Grade III, and 23 with WHO Grade IV. The sensitivity and specificity of IDH1 IHC were 81.82% (<i>P</i> = 0.0007), a positive predictive value of 90.00% (69.90-98.22%), and a negative predictive value of 69.23% (42.37-87.32%). The survival rate was significantly higher in IDH1 mutant than wild-type IDH1, whether based on IHC or PCR (<i>P</i> = 0.0014).</p><p><strong>Conclusion: </strong>IDH1 status evaluation is crucial to predicting the survival rate and important for guiding the treatment decision for patients with glioblastoma. Despite the lesser sensitivity and specificity of IHC in comparison to DNA sequencing in this study, larger prospective studies are needed to validate our preliminary finding.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"140"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056315","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":"Erroneous intramedullary placement of spinal cord stimulator: A case report and review of the literature.","authors":"Stephen Jaffee, Trent Kite, Dallas E Kramer, Nestor Tomycz","doi":"10.25259/SNI_1035_2024","DOIUrl":"https://doi.org/10.25259/SNI_1035_2024","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord stimulation is a common treatment for patients with medically refractory chronic neuropathic pain. Before permanent implantation of spinal cord stimulation, patients will undergo a percutaneous trial to ensure the efficacy of the treatment modality and determine the optimal location of placement. While complications from this procedure are rare, there are reports in the literature of infection, epidural hematoma, and even paralysis. There are few reports of percutaneous leads tracking through the spinal cord itself, and subsequently, few reports of management should such a complication take place. Herein, we provide an example of such a phenomenon with no significant postoperative complications, morbidity, or mortality.</p><p><strong>Case description: </strong>A retrospective chart review was completed utilizing the electronic medical record. Data gathered included patient demographics, oncological history, medications, imaging, and operative reports. This is a 64-year-old male with a history of with a history of a traumatic brachial plexus avulsion and right upper extremity amputation at the shoulder after a motorcycle accident approximately 20 years prior presented to our institution with left upper extremity paresthesias, gain imbalance, and urinary incontinence after a permanent percutaneous spinal cord stimulation lead was placed from an outside institution. The patient was found to have the lead tracking through the intramedullary space of his spinal cord. The patient was taken to the operating room for removal of the lead and had no significant complications during his postoperative course.</p><p><strong>Conclusion: </strong>There is a paucity of literature regarding the removal of an intramedullary percutaneous spinal cord stimulator lead; herein, we present such a case.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"144"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039506","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":"Pineal parenchymal tumor of intermediate differentiation: Case series and literature review: Is it time for a consensus?","authors":"Siddharth Srinivasan, Ajay Hegde, Rajesh Nair, Ravi Teja Jampani, Mohammad Ashraf, Dhanwanth Chigurupati, Bharat Kumar Raju, Susanth Subramanian, Udgam Baxi, Yasaswi Kanneganti, Sarah Johnson, Bhavna Nayal, Geeta Vasudevan, Deepak Nayak, Girish Menon","doi":"10.25259/SNI_1068_2024","DOIUrl":"https://doi.org/10.25259/SNI_1068_2024","url":null,"abstract":"<p><strong>Background: </strong>Pineal parenchymal tumor of intermediate differentiation (PPTID) is a rare tumor. This study aims to evaluate patient outcomes and propose a treatment algorithm based on existing literature and our case series.</p><p><strong>Methods: </strong>This prospective observational study includes seven patients diagnosed with PPTID through histopathology. We analyzed their clinical presentation, magnetic resonance imaging findings, surgical approaches, histopathological and immunohistochemical analysis, adjuvant treatments, and outcomes. We conducted univariate and multivariate statistical analyses.</p><p><strong>Results: </strong>The mean patient age was 40 years, with a male predominance. All patients presented with hydrocephalus, four of which required cerebrospinal fluid diversion procedures. The average tumor size was 3.13cm, with 85.7% showing brain invasion. Surgical outcomes included one gross total resection, two near total resections, and four subtotal resections. The supracerebellar infratentorial (Krause) approach was used in 71.4% of cases. About 85.7% were diagnosed with grade 3 PPTID. Five patients received adjuvant radiotherapy. The analysis showed each additional mitosis unit decreased survival by 0.17 units, equating to roughly 2 months (<i>P</i> < 0.016). Follow-up ranged from 6 to 120 months, with a 5-year survival rate of 57.1%. Factors influencing survival included the extent of tumor resection, brain invasion, tumor grade, and adjuvant treatment, although it was not statistically significant due to the small sample size.</p><p><strong>Conclusion: </strong>We propose a treatment algorithm for PPTID and highlight the importance of further research to understand its biological characteristics. Safe maximal resection appears beneficial for higher-grade PPTID, but the role of adjuvant treatment after complete resection of lower-grade tumors remains uncertain.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"16 ","pages":"138"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061555","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}