Asian journal of neurosurgery最新文献

{"title":"A Comprehensive Case Report of Metastatic Intracranial Melanoma with Brief Review of Literature.","authors":"Prachi Prachi, Hema Malini Aiyer, Gaurav Sharma, Ashish Kumar Shrivastav","doi":"10.1055/s-0045-1809329","DOIUrl":"10.1055/s-0045-1809329","url":null,"abstract":"<p><p>Primary intracranial melanomas are an extremely rare entity and are a diagnosis of exclusion. Malignant melanoma represents the third most common site for cerebral metastasis. We hereby narrate a comprehensive and detailed case of metastatic intracranial melanomas with BRAF mutation, which later on had an extensive systemic spread. The imaging differentials include metastasis, intracranial hemorrhage, or granuloma. The final and definitive diagnosis was attained by detailed clinical, histological, and immunohistochemical evaluation as metastatic malignant pigmented tumor consistent with intracranial melanoma.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"660-663"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984318","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":"Diagnostic Accuracy of the Madras Head Injury Prognostication Scale (MHIPS) in Predicting Mortality among Traumatic Brain Injury Patients.","authors":"Nikhil Reddy Y, Devendra Prasad K J, Krishna Moorthy D G S R, Rajesh K, Aravind S R","doi":"10.1055/s-0045-1808233","DOIUrl":"10.1055/s-0045-1808233","url":null,"abstract":"<p><strong>Background: </strong>Accurate prediction of outcomes in traumatic brain injury (TBI) is crucial for optimizing therapeutic interventions and improving patient survival rates.</p><p><strong>Objectives: </strong>This article determines the diagnostic accuracy of Madras Head Injury Prognostication Scale (MHIPS) in predicting mortality among patients with TBI, and compares the performance of MHIPS scores with that of Corticosteroid Randomisation after Significant Head Injury (CRASH) and International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) scores.</p><p><strong>Materials and methods: </strong>This was a prospective observational study conducted among patients ( <i>n</i>  = 100) with clinical evidence of TBI presenting to the Department of Emergency Medicine, R. L. Jalappa Hospital and Research Centre, Tamaka, Karnataka, India, between August 2023 and July 2024.</p><p><strong>Results: </strong>Of the 100 patients, 92 patients (92.0%) were survivors of which 4 patients (4.0%) had disability and 8 patients died/nonsurvivors (8.0%). Age more than 40 years, higher heart rate, lower Glasgow Coma Scale scores, lower MHIPS scores, higher CRASH scores, and higher IMPACT scores were significantly ( <i>p</i>  < 0.05) associated with mortality among patients with TBI. However, gender, mode of injury, diagnosis, time to presentation, systolic blood pressure (BP), diastolic BP, and respiratory rate did not vary significantly between nonsurvivors and survivors in the present study ( <i>p</i>  > 0.05). The mean (standard deviation) duration of ventilation among nonsurvivors was 3.3 (2.2), and that among survivors was 0.5 (1.1)-the difference was statistically significant ( <i>p</i>  < 0.05). The area under the curve of MHIPS scores was 0.912, in comparison with 0.893 for CRASH scores and 0.927 for IMPACT scores ( <i>p</i>  < 0.05). The MHIPS scores, with a cutoff of 13.5, showed a sensitivity of 87.5%, specificity of 81.5%, positive predictive value (PPV) of 29.2%, and negative predictive value (NPV) of 98.7%. The CRASH scores, with a cutoff of 5.5, demonstrated a sensitivity of 87.5%, specificity of 53.3%, PPV of 14.0%, and NPV of 98.0%. The IMPACT scores, with a cutoff of 8.5, had a sensitivity of 87.5%, specificity of 91.3%, PPV of 46.7%, and NPV of 98.8%. All three scoring systems showed statistically significant predictive accuracy.</p><p><strong>Conclusion: </strong>MHIPS, CRASH, and IMPACT are effective tools for prognosticating mortality in TBI patients. MHIPS score offers simplicity and ease of use, making it valuable in resource-limited environments.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"514-522"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984828","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 Comparative Analysis between Intraoperative Fluorescein Sodium Videoangiography and Postoperative Imaging for Evaluating Clipped Intracranial Aneurysms.","authors":"Marcos Dellaretti, André Guimarães Soares, Allan Douglas Oliveira Lima, Matheus Tavares Melo, Natalia Dilella Acherman, Júlio Cesar Almeida, Vitor Deus Rocha Ribeiro Gonçalves, Bruno Silva Costa","doi":"10.1055/s-0045-1809049","DOIUrl":"10.1055/s-0045-1809049","url":null,"abstract":"<p><strong>Introduction: </strong>The evaluation of clipped intracranial aneurysms postoperatively is crucial for successful surgical treatment and minimizing risks such as residual aneurysms and complications. Fluorescein sodium videoangiography (FL-VA) has been introduced to aid in this assessment, but comparative studies with postoperative imaging remain limited.</p><p><strong>Materials and methods: </strong>A prospective observational study was conducted on 57 patients with 64 intracranial aneurysms who underwent surgery between December 2021 and September 2022. FL-VA was performed, followed by postoperative computed tomography angiography (CTA). Discordance between FL-VA and CTA findings was analyzed statistically.</p><p><strong>Results: </strong>FL-VA showed complete occlusion in 57 out of 61 aneurysms (93.4%), with 10 cases of discordance identified in postoperative CTA. One patient showed a neck remnant in FL-VA, but CTA revealed a residual aneurysm. Another patient displayed neck remnant and stenosis in branching vessels on CTA, not identified by FL-VA. Additionally, five aneurysms had neck remnants, and three had stenosis in branching vessels, detected in CTA but missed in FL-VA. Statistical analysis did not reveal significant associations between discordance and studied factors.</p><p><strong>Conclusion: </strong>FL-VA shows potential as an effective intraoperative assessment tool for clipped intracranial aneurysms, although further research is needed to establish its definitive efficacy and reliability compared with other modalities.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"556-563"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985010","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 Low-Grade Angiomyxofibromatous Tumor of the Falx Cerebelli: A Mimic of Fourth Ventricular Tumors.","authors":"Parth P Modi, Vinay Rohra, Parth Anand Kumar Patel, Udayan Kachchhi","doi":"10.1055/s-0045-1807746","DOIUrl":"10.1055/s-0045-1807746","url":null,"abstract":"<p><p>Low-grade fibromyxoid tumors are very uncommon in children. A tumor of this type has never been reported in the posterior fossa to date. Such lesions may mimic more common lesions of the posterior fossa. Awareness of this entity and its subsequent behavior may guide better management and outcomes. We describe the case of a previously unreported low-grade angiomyxofibromatous tumor of the falx cerebelli in a 10-year-old female, whose presentation mimicked cystic lesions of the posterior fossa causing obstructive hydrocephalus. Microscopic examination revealed stellate cells set in myxoid and edematous stroma, along with a plexiform vasculature pattern. The tumor cells were diffusely immunopositive for vimentin and focally positive for S-100 protein, but negative for epithelial membrane antigen, CD34, MIC2, Bcl-2, glial fibrillary acidic protein, cytokeratin, CAM 5.2, desmin, and smooth muscle actin. This lesion could not be categorized according to the current World Health Organization classification of tumors of the nervous system. Therefore, there is a need for a better understanding of the central nervous system (CNS) myxoid neoplasms and a reassessment of the classification of CNS tumors.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"615-620"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984288","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":"Calvarial Biopsy Using Augmented Reality Technology: A Case Report and Technical Note.","authors":"Nikhil Sharma, Regan M Shanahan, Shovan Bhatia, Michael R Kann, Anthony Tang, Samuel Adida, Nicolas M Kass, Lucille Cheng, Fritz Steuer, Jeffrey R Head, Michael Raver, Stephen P Canton, Arka N Mallela, Jacob Biehl, Constantinos G Hadjipanayis, Edward G Andrews","doi":"10.1055/s-0045-1809048","DOIUrl":"10.1055/s-0045-1809048","url":null,"abstract":"<p><p>Calvarial lesions are uncommonly encountered and are often a slow and progressive process. Biopsies of calvarial lesions can be uniquely challenging due to its proximity to critical structures. Augmented reality (AR) offers a potential alternative to computed tomography guidance that reduces radiation exposure and provides hands-free intraoperative guidance through complex and challenging surgical approaches. The patient is an 86-year-old female with significant past medical history of coronary heart disease. The patient underwent imaging which demonstrated a left parietal lytic skull lesion with extracranial extension. Using Surgical AR (Medivis, New York, New York, United States), a trajectory was planned centered on the lesion. Surgical AR was registered using point-to-point registration reliant on four anatomic fiducials. We used a ground truth, which is a bi-faced adhesive tag that measures 2 cm × 1 cm, with a QR code on each side that the Surgical AR system recognizes. This ground truth was placed on the patient's forehead, which linked to the registered holographic overlay. A small incision was made and after removal of a small portion of the overlying skull, multiple pieces of the lytic skull lesion were sampled. A specimen was obtained for frozen sectioning. Intra-operative pathology was consistent with metastatic carcinoma. Total surgical time was 35 minutes from incision to closure. The frameless AR navigation system successfully allowed accurate location, visualization, and biopsy of a calvarial lesion that had minimal surface landmarks. More so, this was completed without obscuring the surgical field or requiring time-consuming setup or registration.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"631-635"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984886","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":"Vertical Gaze Palsy in Medial Thalamic Infarction Associated with Vein of Galen Malformation: A Case Report.","authors":"Leve Joseph Sebastian, Biswamohan Mishra, Deepti Vibha, Manoj Kumar Nayak","doi":"10.1055/s-0045-1809325","DOIUrl":"10.1055/s-0045-1809325","url":null,"abstract":"<p><p>The thalamus, a gray matter structure, is a crucial relay for various afferent and efferent pathways in the brain. It receives its primary blood supply from the thalamoperforating and thalamogeniculate branches of the posterior cerebral arteries. Damage to the thalamus can lead to classical sensorimotor and amnestic syndromes, as well as neuro-ophthalmological manifestations, including vertical gaze palsy (VGP), pseudo-abducens palsy, skew deviation, cerebral ptosis, and Horner's syndrome. While most cases of VGP are self-limiting, some can persist, significantly affecting daily life. This report describes a case involving a 33-year-old man with a vein of Galen malformation who underwent embolization and subsequently developed VGP in the postoperative period. This complication was attributed to a medial thalamic infarct. Notably, the patient experienced spontaneous resolution of the gaze palsy within 3 months.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"656-659"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984967","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 Course of the Main Trunk and Parietal Branch of the Superficial Temporal Artery for a Pterional Scalp Flap with Superficial Temporal Artery Preservation: Cadaveric and Clinical Study.","authors":"Nattamon Suanchan, Kitiporn Sriamornrattanakul, Thirawass Phumyoo","doi":"10.1055/s-0045-1809324","DOIUrl":"10.1055/s-0045-1809324","url":null,"abstract":"<p><strong>Background: </strong>The pterional incision is usually performed near the course of the superficial temporal artery (STA), which carries a risk of injury to a branch or even the main trunk of the STA (mSTA). In this study, we assessed the usual course of the mSTA and its parietal branch of the STA (pSTA) and evaluated the efficacy of a modified pterional scalp incision for the preservation of all STA branches.</p><p><strong>Materials and methods: </strong>Sixteen sides of cadaveric heads were dissected to study the location and paths of the mSTA and pSTA in the vicinity of the ear cartilage and the oculomeatal (OM) line. We also performed a clinical study of 31 patients who underwent pterional craniotomy using the modified pterional scalp incision. Postoperative STA preservation was retrospectively evaluated.</p><p><strong>Results: </strong>The mean distances between the mSTA and the anterior edge of the ear cartilage were 0.5 and 0.6 mm. The mean angle of the pSTA axis was 88.8 degrees (range 75-95 degrees) from the OM line. Among the patients treated using the modified pterional scalp incision, the mSTA, the pSTA, and the frontal branch of the STA (fSTA) were preserved within the scalp flap in 93.5, 96.7, and 88.9%, respectively.</p><p><strong>Conclusion: </strong>The mSTA was found to pass very close to the ear cartilage, while the axis of pSTA coursed approximately perpendicular to the OM line. To preserve all branches of the STA, the pterional skin incision should begin just anterior to the ear cartilage and then curve slightly to the posterior above the pinna.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"581-589"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984825","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":"Conventional Craniotomy and Neuroendoscopic Surgery for Patients with Hypertensive Intracerebral Hemorrhage: A Meta-analysis and Systematic Review.","authors":"John Emmanuel Y Custodio, Joseph Erroll V Navarro, Oliver Ryan M Malilay","doi":"10.1055/s-0045-1809166","DOIUrl":"10.1055/s-0045-1809166","url":null,"abstract":"<p><p>Primary spontaneous Intracerebral Hemorrhage (PSICH) is a devastating disease occurring in 24.6 cases per 100,000 people per year, more common with chronic arterial hypertension. Emergent hematoma evacuation remains a lifesaving intervention especially in younger patients with large hematoma volume and are clinically deteriorating. Timely and appropriate management is key to improving outcomes. In this study, we compared whether conventional craniotomy or neuroendoscopic surgery would lead to improved mortality and better functional outcomes in patients with PSICH. Specifically, we wanted to determine the extent of hematoma clearance, intraoperative blood loss, intraoperative time, degree of rebleeding, total complications, and length of hospital stay among the surgical approaches utilized. We searched from the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE/PubMed, the U.S. National Institutes of Health Ongoing Trials Register, Embase database, Health Research and Development Information Network (HERDIN), and the World Health Organization International Clinical Trials Registry Platform for studies to be included. Patients with deep hypertensive intracerebral hemorrhage of either sex, aged 18 to 60 years, with a Glasgow Coma Score of 6 to 12, with hematoma volume of 30 to 80 mL, and received treatment within 24 hours with either conventional craniotomy or neuroendoscopic surgery were allowed. Outcomes evaluated were mortality and functional outcome. The risk of bias was assessed using the ROBINS-I tool for nonrandomized studies. The final search yielded four eligible studies. Both conventional craniotomy and neuroendoscopic surgery did not show any statistically significant difference in postoperative mortality (risk ratio [RR]: 1.32, 95% confidence interval [CI]: 0.48-3.62, <i>p</i>  = 0.59, I ² : 42%) and postoperative functional outcome (RR: 3.17, 95% CI: 0.76-13.3, <i>p</i>  = 0.11, I ² : 83%). Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions yielded similar results in amount of volume evacuated, intraoperative blood loss, length of hospital stay, number of rebleeding, and total complications. This meta-analysis and review shows that conventional craniotomy and neuroendoscopic surgery both lead to good postoperative functional outcomes with similar death rates. Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions result in high volume of hematoma evacuated, low number of rebleeding, and total complications, as well as similar amount of intraoperative blood loss and length of hospital stay.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"478-484"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984856","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":"Anatomy of the Fibrofatty Adhesion Related to the Frontozygomatic Process for Suprafascial Dissection of the Pterional Scalp Flap: A Cadaveric and Clinical Study.","authors":"Pakapon Yangsamit, Kitiporn Sriamornrattanakul, Nasaeng Akharathammachote, Thirawass Phumyoo","doi":"10.1055/s-0045-1809326","DOIUrl":"10.1055/s-0045-1809326","url":null,"abstract":"<p><strong>Background: </strong>With the existence of the fibrofatty adhesion (FFA) in the temporal region in relation to the frontotemporal branch of the facial nerve, the suprafascial dissection technique for two-layer pterional scalp flap creation was developed for standard pterional craniotomy. However, the exact anatomy of the FFA has not been well described. We clarified the anatomy of the FFA in cadavers and clinical cases.</p><p><strong>Materials and methods: </strong>Fourteen sides of the cadaveric head were dissected, and the location of the FFA was measured. Twenty patients with cerebral aneurysm who underwent pterional craniotomy using the suprafascial dissection technique between December 2023 and January 2025 were retrospectively reviewed and evaluated for the location of the FFA.</p><p><strong>Results: </strong>In the cadaveric study, the mean distances between the superoposterior border of the FFA and the junction of the frontozygomatic process (FZP) and zygomatic arch were 2.2, 2.1, and 2.5 cm at the posterior, superoposterior, and superior borders of the FFA, respectively. The superior edge of the FFA was located inferior to the junction of the FZP and the temporal line at 2 and 1.8 cm on average for the cadaveric and clinical study, respectively.</p><p><strong>Conclusion: </strong>The FFA was located in a small area posterior to the FZP, superior to the zygomatic arch, and below the junction of the FZP and the temporal line. The existence and anatomy of the FFA confirmed the safety of suprafascial dissection for pterional craniotomy. When exposing the zygomatic arch is necessary, interfascial or subfascial dissection must be performed.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"590-596"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984842","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":"Navigating Limitations and Clinical Challenges in Indonesian Tertiary Trauma Center for Penetrating Brain Injury: A Case Report and Literature Review.","authors":"Tedy Apriawan, Asra Al Fauzi, Nur Setiawan Suroto, Alivery Raihanada Armando, Mohammad Rizky Pratama","doi":"10.1055/s-0045-1809143","DOIUrl":"10.1055/s-0045-1809143","url":null,"abstract":"<p><p>Penetrating brain injury (PBI) accompanied by vascular injury is a severe trauma, often resulting in high mortality, particularly in low- and middle-income countries where many aspects of health care facilities are limited. Effective management of PBI requires efficient prehospital management, followed with advanced neurosurgical equipment, and continuous neurocritical monitoring. Delays in treatment due to inadequate transport infrastructure, scarce facilities, lack of specialized personnel, and inadequate transport infrastructure significantly elevate mortality rates. Neurointensive monitoring with radiological modalities plays significant role in detecting secondary processes in PBI, nevertheless facing significant limitations due to restricted access and resource allocation under national health insurance limit in clinical practice. Furthermore, undetected vascular complications could contribute to the high mortality observed in these environments. This case highlights the dilemmas in the neurocritical care of PBI as well as the need for improved health care policies for better health care.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 3","pages":"636-645"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12370363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984878","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}