Journal of neurological surgery. Part A, Central European neurosurgery最新文献

Collision tumors, defined as the simultaneous occurrence of two distinct neoplasms within the same anatomical location, are exceptionally rare in the clivus. The coexistence of chordoma and chronic lymphocytic leukemia (CLL) within the clivus has not been previously reported, making this case particularly noteworthy.We present the case of a 69-year-old woman with a known history of stable CLL who presented with a 3-month history of progressive right-sided horizontal diplopia and hemianopsia. Imaging revealed a large sellar/suprasellar lesion with significant involvement of both cavernous sinuses, prompting surgical intervention. An endoscopic endonasal transsphenoidal and transclival approach was utilized to achieve near-total mass resection, with a small remnant left in the right cavernous sinus due to its proximity to the internal carotid artery. Histopathological examination confirmed the presence of a collision tumor composed of chordoma and CLL.This case represents the first reported instance of a collision tumor involving a chordoma and CLL within the clivus. The patient's postoperative course was uneventful, and she remains stable at 3-month follow-up after receiving adjuvant radiotherapy. The rarity of such a collision tumor underscores the need for heightened clinical suspicion and thorough pathological evaluation in cases presenting with atypical skull base lesions. The involvement of a multidisciplinary team was crucial in the management and favorable outcome of this complex case.

This study aimed to evaluate clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) without additional anterior plate fixation.A retrospective, single-center analysis was conducted. Clinical outcomes were assessed by the Visual Analog Scale (VAS) scores, Neck Disability Index (NDI), and Odom's criteria. Radiological outcomes were evaluated based on changes in segmental disc height (subsidence), and Cobb angle by X-rays. Fusion was defined as a consistent distance between spinous processes.The study population consisted of 98 patients (mean age of 55.8 years) with a follow-up of 22.1 months. Procedures included 55 one-level, 33 two-level, and 10 three-level surgeries. The study results demonstrated good clinical outcomes, with statistically significant reductions in NDI scores with notable improvements in VAS (p < 0.001). Radiologically, we recorded a subsidence and reduction in Cobb angle of 1.6 mm/2.2 degrees in one-level, 3.8 mm/3.0 degrees in two-level, and 2.5 mm/2.4 degrees in three-level surgeries, respectively. Complete postoperative fusion was recorded for 86.7% patients, comprising rates of 87.3% for one-level, 90.9% for two-level, and 70.0% for three-level procedures. No revision surgery had to be performed.ACDF without additional plating appears to be an effective procedure for the surgical treatment of single- and multilevel degenerative cervical disease with good clinical outcome.

Background and Objective Arachnoid cysts are extra-axial cerebrospinal fluid collections within the arachnoid membrane. Ruptured or hemorrhagic arachnoid cysts, though rare, present significant controversies in management. The present study is an attempt to analyze the factors contributing to management decision of ruptured/hemorrhagic arachnoid cysts using patient-level data from the literature. Methods A literature search was conducted on PubMed and EMBASE to identify case reports and series of ruptured arachnoid cysts. Tree-augmented naïve Bayes (TAN) classifiers were implemented to analyze factors influencing surgical decision. The dataset was split into training and testing sets (0.75:0.25) and augmented using data augmentation techniques to address class imbalance. TAN classifiers were evaluated for accuracy and area under the curve (AUC), and a web application was developed to explore the networks. Results The dataset included 254 unique cases after exclusion of missing data. Middle cranial fossa cysts accounted for 95% of cases, with a male predominance (M:F ratio 4.29:1). Management was predominantly surgical (89.8%), with craniotomy being the most common procedure. TAN classifiers for surgery and type of surgery were validated internally with accuracies of 90.48% and 75%, respectively. Cyst location, presence and type of hemorrhage, patient age group, Galassi classification were key influencing variables. The choice of surgical modality was influenced by additional variables like head injury, seizure, and macrocrania. Conclusion TAN models highlighted the interrelated factors influencing management decision, but do not propose definitive strategies. The generalizability of the findings are limited by heterogenous data, imbalance of various management strategies, particularly conservative management and evolution of surgical techniques over time. The complexity of decision-making underscores the need for multicenter registries to improve data quality and to formulate optimal management strategy.

Acute epidural hematoma (AEDH) is recognized as one of the most urgent neurosurgical conditions. Traditionally, the primary treatment for AEDH has involved craniotomy with surgical evacuation of the hematoma. However, with the widespread adoption of neurointerventional techniques, interest in their application to various forms of traumatic brain injuries has increased. Among these, embolization of the middle meningeal artery (MMA) has emerged as a minimally invasive treatment option for AEDH. This study evaluates the effectiveness of MMA embolization as a primary treatment for AEDH.We conducted a retrospective review of patients treated for AEDH with embolization of the MMA at our institution from January 2019 to July 2024. Patient demographics, clinical presentation, procedural details, and outcomes were analyzed.MMA embolization was successfully performed in 20 patients with AEDH, with only 2 cases requiring subsequent burr-hole evacuation. The thickness of the AEDH was 10 mm or more in 47.8% of cases, and a midline shift was observed in 65.2% of cases. The most common angiographic findings included arteriovenous fistulas (AVFs) and contrast extravasation. N-butyl cyanoacrylate was used as the embolic material in all cases. In one case, Squid 12 was added to enhance penetration at sites of extravasation. No patients experienced recurrent AEDH postintervention.MMA embolization is a promising minimally invasive treatment for AEDH, showing effectiveness as both a primary and adjuvant therapy. Future prospective multicenter studies are needed to validate preliminary findings and optimize treatment protocols for this high-risk patient population.

Intracranial solitary fibrous tumors (SFTs) are rare mesenchymal tumors often presenting with dural-based lesions. These tumors can exhibit aggressive characteristics with high recurrence rates and extracranial metastasis. While SFTs occasionally invade venous sinuses, cases where the tumor arises within the venous sinus are rare. This case explores the surgical strategy for removing SFTs occupying the sigmoid sinus and the jugular bulb while preserving the flow of the vein of Labbé.A 59-year-old woman with progressive left hearing loss and facial nerve palsy was diagnosed with a left temporal bone tumor mainly located in the sigmoid sinus and the jugular bulb. Imaging revealed a vascularized tumor with occlusion of the left sigmoid sinus, and the vein of Labbé was preserved via retrograde perfusion of the transverse sinus. After preoperative embolization, surgery was performed using a trans-sigmoid approach. The tumor was carefully extracted, and the sigmoid sinus was ligated distant from the transverse-sigmoid junction to avoid the occlusion of the vein of Labbé outlet. Subtotal resection was achieved, and the patient experienced full recovery from facial paralysis within 3 weeks. Postoperative radiotherapy was administered, and no recurrence was observed 1 year later.SFTs arising within venous sinuses are rare but require thorough surgical planning, especially near critical venous structures like the vein of Labbé. This case highlights the feasibility of the operative technique of extracting the tumor from venous sinuses and the importance of individualized strategies for maximizing resection while preserving neurological function and venous patency.

Stereotactic procedures usually require burr hole trephination. To date, there is no Conformité Européenne-certified drilling system that can be integrated into a stereotactic apparatus, thus enabling stereotactically guided trephinations (SGTs). Therefore, free-hand burr hole trephination is the standard of care, often requiring time-consuming burr hole widening.We developed a novel drill, which can be picked up through a standard cordless drill and a novel guide sleeve (Instrument guide inner diameter: 10 mm for Riechert-Mundinger [RM] rail holder for microprobe insertion), which can be easily integrated into a stereotactic RM-system. This device enables stereotactic guidance of the drill. Over a period of 8 months, we recorded the trephination in all patients who underwent stereotactic-guided biopsy or catheter insertion in our department. In the first 4 months, a freehand trephination (FHT) using a standard trepan was performed; in the second half of the period, the novel SGT was performed. An unpaired t-test and chi-square test were used to compare SGT with FHT in terms of time for trephination, time from trephination to dura incision, and whether additional surgical measurements (osteoclastic enlargement, hemostasis) were necessary.Overall, 84 trephinations (SGT: n = 27, FHT = 57) for stereotactic biopsies were included. The mean time for completing the burr hole showed no difference between the groups (SGT: 64 s, FHT: 55 s, p = 0.485). The mean time until dura incision was significantly (p = 0.018) reduced when using SGT (FHT: 304 ± 170 s vs. SGT: 136 ± 89 s). Additional osteoclastic expansion was frequently necessary in the FHT group (81% [n = 46] vs. 3.7% [n = 1], p < 0.001). Similar results were observed for hemostasis, which was significantly less necessary in the SGT group (71% [n = 41] vs. 40% [n = 11], p = 0.006). We did not observe any difference between board-certified neurosurgeons and trainees for all these parameters.SGT significantly shortens the time until dura opening compared to FHT. Additionally, time-consuming hemostasis and osteoclastic entlargements are no longer necessary when using SGT. Furthermore, SGT seems to be successfully applied regardless of the surgeon's level of training.

Giant intracranial aneurysms require complex treatment strategies including clipping, coiling, stenting, parent artery occlusion, bypass, or combined procedures. Neurovascular hybrid operating rooms (h-OR) combine a conventional operating theatre with high-resolution digital subtraction angiography (DSA). We describe a one-step combined surgical and endovascular treatment in a h-OR for a pediatric internal carotid artery (ICA) giant aneurysm that can be an optimal solution to manage such challenging cases.An 11-year-old boy presented with rapid onset right hemiparesis and left eyelid ptosis. A 3-month history of headache associated with sporadic vomit was reported. A giant, unruptured, left ICA aneurysm was detected on imaging. The patient underwent surgical trapping of the aneurysm. Intraoperative DSA showed residual backflow from the posterior communicating artery and coils were placed to completely exclude the aneurysm. At 18-month follow-up, the patient showed a complete recovery and magnetic resonance imaging showed a progressive reduction of the sac aneurysm.Due to their morphological variability, intracranial giant aneurysms may require a different procedural strategy instead of direct clipping or coiling. The introduction of h-OR allows combined treatments to be performed simultaneously in the same room setting. The present case shows that combined treatment in a neurovascular h-OR can be an optimal solution to manage challenging cases, such as giant aneurysms, reducing operative time with the added benefit of selecting an appropriate strategy adjustment in a multidisciplinary effort.

This study investigates the decision-making process among neurosurgeons regarding the surgical management of acute subdural hematomas (aSDH), focusing on the role of non-classical Brain Trauma Foundation (BTF) factors such as brainstem reflexes, hypocoagulation, and patient comorbidity, alongside traditional guidelines.We conducted an international survey that presented neurosurgeons with real-case scenarios, designed to assess the impact of both traditional and non-traditional prognostic indicators on their surgical decisions. The survey also collected demographic data to examine potential correlations with decision-making preferences.The survey garnered 67 responses from neurosurgeons across 22 countries, revealing a reliance on non-classical BTF factors in decision-making for aSDH cases with a potentially poor prognosis. No significant correlations were found between these decision-making practices and the surgeons' demographic characteristics.The findings highlight the complexity and nuanced nature of surgical decision-making in aSDH management, underlining the importance of non-traditional prognostic factors. The results advocate for further research to refine clinical guidelines, ensuring they encapsulate the breadth of factors considered in practice, thereby enhancing patient-centered care.

Neurosurgery in Africa has quite different realities compared to the developed countries, with emphasis on clinical procedures rather than research. The aim of this study was to conduct a bibliometric analysis of neurosurgical research to understand the trends across Africa. We examined the scientific production, collaboration, and publication impact of African institutions from 2010 to 2024. This bibliometric analysis provides information on the statistical tendencies, challenges, and recommendations to improve engagement in neurosurgical research in Africa.Following the Preferred Reporting Items for Bibliometric Analysis (PRIBA) guidelines, a PubMed search was conducted starting on October 9, 2024, where 1,431 publications affiliated with neurosurgical institutions were found. The bibliometric analysis was done using the bibliometrix package from RStudio 4.4.1 version, which involved analyzing the annual scientific production (evaluated in 5-year increments), the countries' scientific production and collaborations, and the most productive affiliations and journals in the context of neurosurgical research in Africa.Egypt, Nigeria, and South Africa are the major contributors to neurosurgical research in Africa, with an upward trend in publications predominantly seen in 2023. These countries' most prevalent collaborators are the United States, India, and Burundi, respectively. Regarding the journals, World Neurosurgery, Child's Nervous System, and Neurosurgical Review were the ones that mostly published Africa-affiliated neurosurgical papers.Amid the challenges, research endeavors in the field of neurosurgery in Africa have yielded some progress, as seen by the upward trend in publication output and the international collaborations among researchers. Recommendations include the need to further strengthen collaborations internationally, infrastructural improvements, and quality enhancement of local research outputs to meet global standards.

Preliminary studies on the new modified surface flow diverters (FD) have shown promising results in the treatment of distal aneurysms. However, there is a lack of data in the literature regarding the use of these devices in very small-caliber arteries. The aim of this study was to analyze the safety and efficacy of the p48 MW HPC device (Wallaby-phenox, Bochum, Germany) device in the treatment of intracranial aneurysms associated with parent arteries with a diameter of <2.0 mm.Sixteen patients were prospectively evaluated from November 2019 to July 2023. All patients underwent follow-ups at 1, 6, and 12 months. Safety was assessed using the modified Rankin Scale and the National Institutes of Health Stroke Scale. Efficacy was defined as complete (grade D) or partial (grade C) aneurysm occlusion, as assessed by the O'Kelly-Marotta scale (OKM).The mean proximal and distal artery diameters were 1.61 mm (1.3-1.9) and 1.5 mm (1.0-1.8), respectively. All procedures were performed with technical success, and no severe adverse events occurred. At the 12-month follow-up, no patients experienced serious adverse events, new neurological symptoms, or deficits. At this stage, seven aneurysms were completely occluded (OKM grade D: 43.7%), and four aneurysms showed entry remnant contrast (OKM grade C: 25%).The treatment of distal unruptured aneurysms with the p48 MW HPC device device appears to be safe in vessels with a diameter of <2 mm. Larger studies with long-term follow-ups are necessary to better clarify the outcomes reported.