Asian journal of neurosurgery最新文献

{"title":"Giant Olfactory Groove Meningiomas: A Case Series Demonstrating the Surgical Management and Functional Outcomes.","authors":"Ashraf Elbadry, Azza Abdelazeez, Mohamed Badran","doi":"10.1055/s-0044-1791840","DOIUrl":"10.1055/s-0044-1791840","url":null,"abstract":"<p><p><b>Objective</b>  Giant olfactory groove meningiomas (OGMs) present technical challenges in their management, especially when their size and location complicate the evaluation and planning process, making complete removal difficult. This study provides a comprehensive analysis of the surgical approaches and outcomes encountered in the management of giant OGMs at a single institution. <b>Materials and Methods</b>  This retrospective study evaluated surgical and functional outcomes in 71 patients diagnosed with giant OGMs larger than 6 cm. Tumors were excised using microsurgical resection via the bifrontal, pterional, or combined pterional and unifrontal approaches. <b>Results</b>  The study comprised 48 females (67.6%) and 23 males (32.4%), with a mean age of 54.1 years. The most common pathological type was meningothelial meningioma (45%). The bifrontal approach was the most frequently used ( <i>n</i>  = 47, 66.2%) and resulted in Simpson grade I or II resection in 41 patients (87.2%). The combined pterional and unifrontal approaches were used in 16 patients (22.5%), achieving Simpson grade I or II resection in 12 (75%). The pterional approach was the least commonly used ( <i>n</i>  = 8), with Simpson grade I or II resection achieved in 50% of these patients. Postoperatively, visual acuity and cognitive function improved during follow-up. Postoperative complications were frequently observed after the bifrontal approach. Three patients (4.2%) died. <b>Conclusion</b>  The bifrontal approach resulted in better resection of giant OGMs than other approaches but was associated with more complications. The combined pterional and unifrontal approach was superior to the pterional approach in terms of OGM resection, with no differences in complication rates. Significant postoperative improvements in functional outcomes, including visual acuity and cognitive function, were observed.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"52-60"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560548","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 Prospective Study of CSF Flow Dynamics Across Foramen Magnum in Adult Chiari Malformation/Syringomyelia Complex and its Clinical Correlation with Outcomes after Surgery.","authors":"Manas Prakash, Adesh Shrivastava, Pradeep Chouksey, Sumit Raj, Rakesh Mishra, Amit Agrawal, Suresh Nair","doi":"10.1055/s-0044-1791710","DOIUrl":"10.1055/s-0044-1791710","url":null,"abstract":"<p><p><b>Introduction</b>  Chiari I malformation refers to cerebellar tonsillar descent below the foramen magnum and is frequently associated with syringomyelia. Prior cerebrospinal fluid (CSF) flow studies correlated the clinical severity of these lesions with general flow velocity or bulk flow at the foramen magnum; however, these techniques have not assessed the effect on surgical outcomes. The study aims to present clinical and radiological factors and CSF flow parameters (pre- and postoperative) that affect the surgical outcome. <b>Materials and Methods</b>  The institutional ethics committee approved the study. We collected the prospective clinical data, including pre- and postoperative symptoms. Functional grades were determined along with the change in clinical improvement based on clinical examination notes, the change in functional grade was calculated, and the radiologic data were analyzed according to the degree of clinical improvement. The surgical procedure included suboccipital bony decompression with duroplasty. Patients were followed up at 1 month, 3 months, and 1 year. <b>Results</b>  There were a total of 25 patients. The mean age of the patients was 45.52 ± 13.37 years, with 40% being males and 60% being females. After the surgery, there was a significant increase in the anterior and posterior CSF flows at the foramen magnum. Most had a resolution in the headache and sensory symptoms, while the lower cranial nerve and motor symptoms had a minor resolution at follow-up. Age, sex, and headache do not correlate with the outcome or syrinx improvement. Motor power in the lower limb (preintervention) and syrinx shape (preintervention) were significantly associated with the variable \"anterior flow at the foramen magnum\" (preintervention; <i>p</i>  < 0.05). Average flow, cervicomedullary angle (postintervention), sensory symptom progression, and CSF flow change anterior to the foramen magnum were significantly associated with the variable \"anterior flow at the foramen magnum\" (postintervention; <i>p</i>  < 0.05). <b>Conclusion</b>  Even after surgery, persistent foramen magnum CSF outflow obstruction has a robust negative correlation with the outcome. The Chiari outcome predictability index has shown a significant correlation with patient outcomes and can be used to inform patients about the expected outcome. The results of the present study will be helpful in stratifying patients according to their desired outcomes.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"43-51"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560535","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":"Effect of the Effective Metal Surface Area of Two Different Flow Diverter Stents on the Stagnation Region Formation Inside the Aneurysm Sac.","authors":"Muhammed Talha Gunaydin, Gorkem Guclu, Ali Bahadir Olcay, Atakan Orscelik, Cem Bilgin, Bahattin Hakyemez","doi":"10.1055/s-0044-1791842","DOIUrl":"10.1055/s-0044-1791842","url":null,"abstract":"<p><p><b>Objective</b>  Flow diversion (FD) is a relatively new technique for treating large, wide-necked, or fusiform aneurysms. Although FD is a more preferred option than coiling or clipping techniques in neurosurgery and neuroradiology clinics, the blood flow mechanism inside the aneurysm sac is not fully understood after the treatment. Besides, effective metal surface area (EMSA), a property of an FD related to porosity, shows variation at the patient's aneurysm neck by providing more or less blood flow inside an aneurysm sac than planned, causing nonstagnant or stagnant fluid region formation in the sac, respectively. Thus, the change in FD's EMSA can significantly affect the treatment's effectiveness, making even operation unsuccessful when variation in FD's EMSA at the aneurysm neck is overlooked. <b>Materials and Methods</b>  In this study, a large aneurysm of a 52-year-old female patient was numerically investigated by virtually placing two commercially available FDs with different EMSA values one by one into the aneurysm-carrying artery. <b>Results</b>  While FD stents at the aneurysm site substantially reduced the blood flow into the aneurysm, an FD with a 15.6% EMSA caused blood to flow in the aneurysm sac to have six times more kinetic energy than that of FD with a 29.5% EMSA. <b>Conclusion</b>  Although FD's EMSA value demonstrated nearly up to 20% reduction at the patient's aneurysm neck based on a product catalog value, numerical model results revealed that the stagnated region's formation inside the aneurysm sac could be determined within a 9% difference based on digital subtraction angiography reformat image.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"61-68"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560511","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":"Carotid Endarterectomy with Twisted Internal Jugular Vein Located Anterior to the Common Carotid Artery.","authors":"Arumu Endo, Terushige Toyooka, Kazuya Fujii, Satoru Takeuchi, Toru Yoshiura, Masaya Nakagawa, Yohei Otsuka, Arata Tomiyama, Kojiro Wada","doi":"10.1055/s-0044-1791841","DOIUrl":"10.1055/s-0044-1791841","url":null,"abstract":"<p><p>The knowledge of both normal and abnormal anatomy of the veins of the neck may be important for surgeons performing carotid endarterectomy (CEA), to avoid inadvertent injury to vascular structures. We present three cases of abnormal course of the internal jugular vein (IJV) which run anterior to the common carotid artery, named twisted IJV, that usually run posterolateral to the common carotid artery in patients undergoing CEA. These twisted IJV cases were detected by preoperative multidetector computed tomography angiography evaluation. During the CEA procedure, before identifying the common carotid artery, we dissected the retromandibular space to find the common facial vein. Then, dissection proceeded along the common facial vein caudally to find the IJV. After ligation and cutting of the common facial vein, a carotid sheath with the IJV turned laterally revealed the common carotid artery safely, and CEA was accomplished. Our clinical experience shows that knowledge of the anatomical anomaly of the IJV allows safe dissection of the carotid triangle avoiding inadvertent injury to the vasculature and vagus nerve.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"149-154"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560543","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":"Role of Advanced Magnetic Resonance Imaging in Differentiating among Glioma Subtypes and Predicting Tumor-Proliferative Behavior.","authors":"Gunalan Ganesan, Rajeswaran Rangasami, Anupama Chandrasekharan, Sahithi Marreddy, Rajoo Ramachandran","doi":"10.1055/s-0044-1790508","DOIUrl":"10.1055/s-0044-1790508","url":null,"abstract":"<p><p><b>Objective</b>  Gliomas are a devastating and heterogeneous group of primary brain tumors. Previously, the source of glioma was undetermined. Recent literature indicates that neural stem cells, or progenitors, are proposed to be the source of glioma. The prognosis of different types of gliomas differs due to their various biological tissue types. Besides the histological grade, the two useful immunohistochemistry markers that show the tumor's biological behavior are isocitrate dehydrogenase (IDH) labeling and the K _i -67 labeling index. We sought to determine the magnetic resonance imaging (MRI) characteristics associated with IDH mutational status and ascertain whether MRI combined with IDH mutational status, can better predict the clinical outcomes of gliomas. <b>Materials and Methods</b>  This period study was conducted in the Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India for 5 years (May 2016-May 2021). The study cohort included 30 patients diagnosed with gliomas who underwent preoperative MRI followed by surgical resection and histopathological examination. Preoperative MRI images were done to assess qualitative tumor characteristics such as location, margin of tumor, extent, cortical involvement, cystic component, mineralization or hemorrhage, and contrast enhancement. <b>Discussion</b>  Differences in MRI features between IDH-mutant (MT) and IDH-wild-type (WT) groups were analyzed using the chi-square test for categorical variables and the Mann-Whitney <i>U</i> test for continuous variables. Statistical analysis was conducted using SPSS software. <b>Results</b>  Among the 30 patients evaluated, 18 had IDH-WT and 12 had IDH-MT type gliomas. Male predominance (73.33%) was noted in our study. Brainstem location, indistinct borders (83.33%), less cortical involvement (72.22%), less cystic changes (88.89%), more area of necrotic component (44.44%), significantly increased choline/creatine (Cho/Cr) ratio, and choline/N-acetyl aspartate (Cho/NAA) ratio favors IDH-WT tumors. Positive T2-fluid-attenuated inversion recovery mismatch sign is more frequently seen in IDH-MT (7/12; 58.33%) tumors than in IDH-WT (4/18; 22.22%) tumors. Whereas well-defined contours (66.67%), more cortical involvement (83.33%), more cystic changes (58.33%), and less area of necrotic component favor IDH-MT type tumors. <b>Conclusion</b>  MRI is a very promising and valuable tool for differentiating among glioma subtypes and predicting tumor-proliferative behavior in glioma cases. The combination of MRI characteristics with IDH mutation status enhances the predictive accuracy for clinical outcomes in glioma patients. This approach could potentially guide treatment planning and improve prognostic assessments.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"34-42"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560563","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":"Neuroendoscopy Training.","authors":"Ketan Hedaoo, Mallika Sinha, Bhanu Pratap Singh Chauhan, Jitin Bajaj, Shailendra Ratre, M N Swamy, Vijay Parihar, Jitendra Shakya, Mukesh Sharma, Jayant Patidar, Yad Ram Yadav","doi":"10.1055/s-0044-1791713","DOIUrl":"10.1055/s-0044-1791713","url":null,"abstract":"<p><p>Neuroendoscopy can be learnt by assisting or doing live human surgery, cadaver dissection with or without augmented pulsatile vessel and cerebrospinal fluid (CSF) perfusion, and practicing on live animal, dead animal model, synthetic models, three-dimensional printing model with or without augmentation with animal, cadaver tissue, pulsatile vessel and reconstructed CSF model, virtual reality (VR) simulator, and hybrid simulators (combined physical model and VR model). Neurosurgery skill laboratory with basic and advanced learning should be there in all teaching hospitals. Skills can be transferred from simulation model or VR to cadaver to live surgery. Staged learning (first with simple model to learn basic endoscopic technique, then animal model, and then augmented cadavers) is the preferred method of learning. Although most surveys favor live surgery and practice on animal models and cadavers as the most preferred training model now, in future VR may also become a favored method of learning. This article is based on our experience in over 10,000 neuroendoscopic surgeries, and feedback from over 950 neuroendoscopic fellows or consultants who attended workshops conducted every 6 monthly since 2010. A literature search was done on PubMed and Google Scholar using (neuroendoscopy) AND (learning), and (neuroendoscopy) AND (training), which resulted in 121 and 213 results, respectively. Out of them, 77 articles were finally selected for this article. Most of the training programs typically focus on microneurosurgical training. There is lack of learning facilities for neuroendoscopy in most centers. Learning of neuroendoscopy differs greatly from microneurosurgery; switching from microneurosurgery to neuroendoscopy can be challenging. Postgraduate training centers should have well-equipped neuroendoscopy skill laboratory and the surgical educational curriculum should include neuroendoscopy training. Learning endoscopy is about taking advantages of the technique and overcoming the limitations of endoscopy by continuous training.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560556","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":"Nonenhancing Prepontine Chordoma with Diffusion Restriction Mimicking an Epidermoid Cyst.","authors":"Bheru Dan Charan, Sushant Agarwal, Ekamjot Singh, Savyasachi Jain, Sumanta Das, Ajay Garg, Leve Joseph Devarajan Sebastian, Manmohan Singh","doi":"10.1055/s-0044-1791581","DOIUrl":"10.1055/s-0044-1791581","url":null,"abstract":"<p><p>Intradural prepontine chordoma is an extremely rare entity and depicts benign features with no recurrence and has a good prognosis as compared with bone endogenous chordoma. Radiologically, it may mimic an epidermoid cyst and present an imaging challenge. Here we present a case of a middle adolescent girl who presented with headache along with limb and facial weakness. A nonenhancing, diffusion-restricting, predominantly intradural cystic-appearing mass lesion was seen in the prepontine cistern. Initially, an epidermoid cyst was suspected, but histopathology revealed it to be a chordoma. Destruction of the clivus is important and chordoma should be included in differential diagnosis.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"138-142"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560558","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":"Superior Sagittal Sinus Thrombosis Secondary to Cerebral Aspergillosis with Ventriculitis in an Immunocompetent Patient: A Case Report.","authors":"Chonnawee Chaisawasthomrong","doi":"10.1055/s-0044-1791714","DOIUrl":"10.1055/s-0044-1791714","url":null,"abstract":"<p><p>Cerebral aspergillosis is an opportunistic fungal infection that is exceedingly rare in immunocompetent patients. The primary etiological locations for these infections typically involve the nasal cavity and hematological dissemination. A 62-year-old male, focused on wellness, presented with intermittent, nonprogressive headaches in the occipital region, generalized clonic-tonic seizures, and altered consciousness. A computed tomography scan revealed multiple small rim-enhancing lesions in both occipital lobes, with vasogenic edema in both occipital lobes adjacent to the confluence of the sinuses and the posterior superior sagittal sinus. In this case, superior sagittal sinus thrombosis secondary to cerebral aspergillosis was discovered, a condition not previously diagnosed in this specific location but manageable through surgical intervention. A combination of surgical resection and antifungal therapy resulted in favorable outcomes. The prognosis for patients depends significantly on early diagnosis and prompt, aggressive treatment.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"160-164"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560565","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":"Metastatic Intracranial Choriocarcinoma in the Absence of a Primary Lesion: A Case Report.","authors":"Steven-Andrés Piña-Ballantyne, Eunice-Jazmín Espinosa-Aguilar, Ana-Laura Calderón-Garcidueñas, Rebeca de Jesus Ramos-Sánchez","doi":"10.1055/s-0044-1791712","DOIUrl":"10.1055/s-0044-1791712","url":null,"abstract":"<p><p>Intracranial choriocarcinoma is a rare and aggressive neoplasm characterized by the proliferation of trophoblastic tissue. Although choriocarcinoma most commonly arises in the uterus as a component of gestational trophoblastic neoplasia, instances of intracranial choriocarcinoma are exceptionally uncommon. We report a case of intracranial choriocarcinoma without any evidence of a tumor elsewhere. A 25-year-old woman presented with a history of 1 month of evolution with right frontal hemicranial headache, followed by visual disturbances, otalgia, and diplopia. On neurological examination, she was conscious, cooperative, and well-oriented; a grade 1 bilateral papilledema, left homonymous hemianopsia, and sixth cranial nerve paresis, with diplopia, were detected. Neuroimaging showed a right parieto-occipital lesion with features mimicking an atypical meningioma. After surgical resection, a diagnosis of choriocarcinoma was issued. Primary intracranial choriocarcinomas are typically located in the sellar and pineal regions. The occurrence of this tumor within the occipital lobe suggested metastasis; however, a primary tumor in the thoracic or abdominal organs was not observed and a delayed metastasis was considered. This case highlights the diagnostic challenges associated with intracranial choriocarcinoma.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 1","pages":"155-159"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560554","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":"Traumatic Middle Meningeal Artery Aneurysm: A Rare Cause of Recurrent Acute Epidural Hematoma. A Case Report.","authors":"Toshihide Takahashi, Kiyoyuki Yanaka, Hitoshi Aiyama, Minami Saura, Michihide Kajita, Nobuyuki Takahashi, Eiichi Ishikawa","doi":"10.1055/s-0044-1791580","DOIUrl":"10.1055/s-0044-1791580","url":null,"abstract":"<p><p>Traumatic middle meningeal artery aneurysm (TMMA) is a rare condition and a known cause of several different bleeding patterns after head injury. Once detected, they need to be treated as an emergency due to their potential for morbidity and mortality. Generally, recurrence does not occur in surgery for acute epidural hematoma if adequate hemostasis is achieved. Here, we report a case of atypical postoperative recurrence of an acute epidural hematoma, possibly due to the development and rupture of a TMMA. A 41-year-old man with left acute epidural hematoma after a head injury was referred to our hospital. Emergency craniotomy was performed immediately, and the hematoma was removed. The source of the bleeding was near the fracture site in the middle cranial fossa, and sufficient hemostasis was confirmed. However, a head computed tomography (CT) scan the next day revealed a recurrence of the acute epidural hematoma. Magnetic resonance (MR) angiogram showed an aneurysm with a diameter of approximately 4 mm in the left middle meningeal artery. The recurrence of the acute epidural hematoma appeared to be related to the formation and a rupture of a middle meningeal artery aneurysm, and to prevent subsequent rebleeding, the patient underwent reoperation, and the hematoma and aneurysm were removed. In surgery for acute epidural hematoma, recurrence can be prevented by removing the hematoma and ensuring hemostasis. Although conventional surgery was performed in this case, a repeat of epidural hematoma occurred. A postoperative middle meningeal artery aneurysm had been thought to have developed, ruptured, and caused a repeat epidural hematoma. In treating acute epidural hematoma, a TMMA development should be considered when an atypical clinical course occurs, such as a recurrence of postoperative bleeding.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"825-828"},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741904","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}