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

Objective: This bibliometric analysis aims to identify and evaluate the top 200 most influential articles on the treatment of trigeminal neuralgia (TN), encompassing both pharmacological and surgical interventions. The study seeks to provide a comprehensive overview of research trends, international collaborations, and citation metrics to inform future research and clinical practice.

Methods: A systematic search was conducted in November 2024 using the Web of Science (WoS) database, focusing on articles related to TN treatment. Articles were filtered by language (English) and type (original articles and reviews), excluding letters, errata, and conference abstracts. The top 200 most cited articles were selected and analyzed using the Bibliometrix R package and biblioshiny web application. Data on authorship, institutions, countries, journals, keywords, and citations were extracted and analyzed.

Results: The 200 articles, published between 1953 and 2021, were cited a total of 23,059 times, with an average of 115.3 citations per article. The majority (73%) were published in the 21st century, with the most productive year being 2002. Surgical management was the focus of 56.5% of the articles, with microvascular decompression (MVD) being the most studied surgical technique (25.5%). Pharmacological management was addressed in 18% of the articles. The United States contributed the most articles (39%), followed by the United Kingdom (12.5%) and Italy (5.5%). The most prolific journals were the "Journal of Neurosurgery" (21.5%) and "Neurosurgery" (19.5%). Key trends included a shift towards prospective studies and a decline in radiosurgery-focused research in the last decade.

Conclusion: This analysis highlights the dominance of surgical approaches, particularly MVD, in TN research, with a significant underrepresentation of pharmacological and minimally invasive treatments. The findings underscore the need for more international collaborations, particularly with low- and middle-income countries, and a greater focus on comparative effectiveness research, pharmacological studies, and basic science to address existing gaps in TN management.

Background: Determining the true size or extent of the nerve defect after damage and excision of the post-traumatic neuroma is fundamental in the microsurgical treatment of the patient. It is assumed that the length of the scar in the nerve may depend on the nature of the combat wound of the limb, gunshot or mine-explosive. Determining the extent of scarring in the nerve in cases of these two types of injury may provide an opportunity to establish a relationship with the type of injury or to disprove such a relationship. This should help in the tactics of surgical treatment.

Methods: 50 samples of damaged peripheral nerves were studied, including 36 nerves of the upper limb and 14 nerves of the lower limb. Microsurgical operations were performed after the injury in an average of 5.4±0.4 months (min=2 months, max=17 months). The specifics of scarring in the nerve were investigated by histochemical method and the specific density of collagen at different distances was calculated. A map of scarring was created for each nerve sample to determine the length of the scar.

Results: Based on the mapping of nerve samples, the average length of the scar was determined, which reached 40-50 mm in the nerves (Me=35.5 mm, Q1=30.0, Q3=55.2, min=19 mm, max=120 mm), where after a gunshot wound - 37.5±5.5 mm (Me=30.0) and mine-explosive wound - 43.5±8.0 mm (Me=36.0). Morphological features of nerve scarring after these two types of damage did not differ (p=0.29), neither in length nor in scar density. Conclusion When calculating the true defect of the nerve, one should take into account the spread of the scarring process in the nerve, which in a combat wound is about 30-50 mm. The length of the scar in the nerve does not depend on the nature of the striking projectile, which proves the critical importance of the energy of the injury.

Key words: peripheral nerve, combat injury, scarring.

Arachnoid cysts by virtue of their volume and intracystic tension, produce local mass effect, and impair the perfusion of surrounding brain parenchyma.The magnetic resonance (MR) perfusion parameters cerebral blood flow (CBF), relative cerebral blood volume (rCBV), and mean transit time (MTT) of brain parenchyma contiguous with the arachnoid cyst were compared with corresponding contralateral hemisphere. Twenty cases of arachnoid cyst were treated using endoscopic techniques. The perfusion changes in parenchyma were assessed 3 months postoperatively. Clinical outcomes were assessed at 6 months' postsurgery.Headache was the predominant symptom (85%), with Sylvian fissure representing the most frequent anatomical location (65%). Endoscopic procedure was successful in 80% of the cases, whereas 20% of the cases required conversion to minicraniotomy and microsurgical cyst excision. Preoperatively, mean CBF (mL/100 g/min), rCBV (mL/100 g), MTT (seconds) in perilesional brain area were 42.58 ± 7.17, 4.48 ± 1.25, 5.56 ± 1.72, respectively, and 3 months postoperatively were 45.83 ± 8.87, 4.48 ± 1.62, 4.37 ± 1.68, respectively. The mean CBF (mL/100 g/min), rCBV (mL/100 g), MTT (seconds) in corresponding contralateral hemisphere was 46.77 ± 10.85, 4.29 ± 1.35, 5.24 ± 1.104, respectively, whereas postoperatively they were 46.29 ± 8.49, 5.03 ± 1.16, 5.49 ± 1.97, respectively. The p-value, however, was not significant. Headache improved in 87.5%, whereas seizure in 60% of the cases.Endoscopic treatment of arachnoid cyst is an optimally invasive procedure. The perfusion study is a valuable tool in evaluation of arachnoid cysts. MR perfusion highlights regions of impaired blood flow and focal brain dysfunction. Additionally, changes in perfusion can help assess the therapeutic impact of surgery on the compressed brain tissue.

Background: Although setting a low initial opening pressure in a programmable valve with a gravitational unit seems to be the gold-standard treatment for idiopathic normal pressure hydrocephalus (iNPH) patients, there are no studies in the literature describing the optimal initial low-pressure setting. Here, we sought to describe the optimal initial opening pressure setting for idiopathic normal pressure hydrocephalus in terms of both efficacy and safety.

Material and methods: Patients with probable iNPH underwent shunt surgery with a programmable valve with a gravitational unit, using either an opening pressure of 3 cm H2O or 6.5 cm H2O, and were prospectively followed for one year. Clinical improvement and complications were recorded.

Results: 19 patients with an opening pressure of 3 cm H2O and 37 patients with an opening pressure of 6.5 cm H2O were analyzed. There was no significant difference between the groups. A significant improvement in the iNPH Japanese scale score was observed one year following shunt placement in both the 3.0 cmH2O (p = 0.001) and 6.5 cmH2O groups (p< 0.001), but there was no statistical difference between groups (p= 0.708). 2 patients (10.5%) had subdural effusions that required surgery in the 3 cmH2O group and none in the 6.5 cm H2O group (p= 0.043).

Conclusion: Patients with iNPH treated with a programmable valve with an initial opening pressure of 6.5 cm H2O showed the same clinical improvement as those treated with an initial opening pressure of 3 cm H2O, but with fewer overdrainage complications.

Introduction: Conventional radiographs and bone mineral density are commonly used to predict cage subsidence, though their accuracy can be limited by factors several factors. MRI-based Vertebral Bone Quality (VBQ) and Endplate Bone Quality (EBQ) offer a more detailed assessment of bone quality and subsidence risk. This study aims to evaluate the accuracy of MRI-based VBQ and EBQ in predicting cage subsidence in anterior cervical spine surgery patients.

Methods: A comprehensive search was conducted across databases including PubMed, Europe PMC, ScienceDirect, and Google Scholar using keywords such as "Magnetic Resonance Imaging", "MRI", "Vertebral Bone Quality", "Endplate Bone Quality", "Cage Subsidence", "Anterior Cervical Spine Surgery", "ACDF", "ACCF", combined with Boolean operators "AND" and "OR" up to November 2024. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), with the primary outcome focusing on VBQ and EBQ values, and secondary outcomes examining the AUC, sensitivity, and specificity of VBQ and EBQ.

Results: Nine retrospective cohort studies involving 911 patients were included. Pooled analysis showed that high VBQ and EBQ scores were significantly associated with increased subsidence risk (OR 2.63, 95% CI: 1.51-4.60, p = 0.0007). Pooled sensitivity and specificity for VBQ were 78.9% (95% CI: 72.5%-85.3%) and 85.7% (95% CI: 82.2%-93.1%), respectively, with an AUC of 0.865. EBQ demonstrated pooled sensitivity of 81.8% and specificity of 88.7%, with an AUC of 0.890. The cutoff values for VBQ and EBQ ranged from 2.68-3.445 and 1.973-4.7, respectively.

Conclusions: MRI-based VBQ and EBQ scores demonstrate strong diagnostic accuracy for predicting cage subsidence in anterior cervical spine surgery. These scores could aid in preoperative risk assessment, though further research should aim to standardize MRI protocols and validate cutoff values across diverse populations.

Background: Vertebral haemangiomas are typically benign and asymptomatic, but a small subset, known as aggressive vertebral haemangiomas, may present with neurological deficits due to extraosseous extension and spinal cord compression. These cases require timely diagnosis and a multidisciplinary management approach.

Case presentation: A 42-year-old male presented with acute onset severe mid-back pain for two months. Neurological examination revealed exaggerated reflexes without motor or sensory deficits. MRI showed expansile lesions at T7, T9 and T10, with additional angiomatous lesions at T3 and T4. T7 and T10 lesions caused spinal cord compression. Pre-operative embolization of T7 and T10 was performed using polidocanol. The patient subsequently underwent vertebroplasty at T7, T9 and T10 levels, pedicle screw fixation from T4-T11, posterior decompression at T6-T7 and T9-T10. Intra-operative biopsies revealed a cavernous haemangioma at T7 and a capillary haemangioma at T9. No malignancy was found Results: Post-operative recovery was uneventful, with early mobilization and significant functional improvement. At 2-year follow-up, the patient had no pain or neurological symptoms and radiographs showed stable fixation with no recurrence.

Conclusion: Aggressive vertebral haemangiomas, though rare, should be considered in patients with progressive neurological symptoms. Early diagnosis, embolization, surgical decompression and stabilization can yield excellent outcomes.

Background: Anterior communicating artery (ACoA) aneurysms are common and complex. This study investigated the effect of A1 artery variations (hypoplasia/aplasia) on treatment outcomes.

Methods: We retrospectively reviewed 104 patients with ACoA aneurysms treated either microsurgically or endovascularly.

Results: Ruptured aneurysms were present in 58.7% of patients. A1 variations occurred in 45.2% of cases, more frequently in unruptured aneurysms (69.8%, p<0.01). The neck width of ruptured aneurysms was significantly smaller than that of unruptured ones. Variations reduced the risk of rupture (OR = 0.16, 95% CI 0.06-0.41; p=0.001). Microsurgery was the primary treatment (74%), and the rate of A1 variations was significantly lower in these cases (p<0.05). Second interventions were required in 11.5% of patients, with no significant association to variation or treatment type. Vasospasm occurred in 41% of the ruptured aneurysm cases. Functional outcomes (mRS) were better in patients with A1 variations (p<0.05). Mortality was 11.5% and unrelated to A1 variation. A higher bottleneck ratio increased mortality risk, whereas a higher height/width ratio decreased it.

Conclusion: A1 variations were more common in unruptured ACoA aneurysms. They did not significantly influence retreatment or mortality. These findings may guide management strategies as the detection of unruptured aneurysms increases.

Approximately 14% of cavernous malformations (CMs) occur in the medulla oblongata, where their proximity to vital neural structures makes surgical intervention challenging. Anatomical variations, such as an arcuate foramen (AF), a bony canal that encases the vertebral artery (VA), may further complicate surgery by obstructing the surgical view during exposure of the anterolateral surface of the medulla and by restricting VA mobilization, which may be necessary in some cases. We present a case of a medullary CM coexisting with an AF, which required tailored surgical strategies for safe and effective resection. To our knowledge, this is the first report to document this combined pathology, accompanied by a surgical video.A 25-year-old male presented with right-sided hemiparesis. Magnetic resonance imaging (MRI) revealed a large hemorrhagic medullary CM. The patient underwent a left far-lateral transcondylar approach for resection of the CM.The AF was encountered intraoperatively and had to be unroofed to achieve an adequate surgical trajectory. Gross total resection was achieved, and the patient made an excellent recovery without postoperative neurological deficit.The far-lateral approach provides excellent access for resection of anterior medullary CMs. This case highlights the importance of detailed preoperative planning, intraoperative strategy, and real-time navigation, particularly when anatomical variations such as the AF are present. Although the AF may hinder exposure and require tailored adjustments, it does not inherently complicate the entire procedure unless VA mobilization results in vascular injury.

Tuberculum sellae meningiomas (TSMs) tend to compress the optic apparatus and an ideal surgical route, whether transcranial or endonasal, is still debated. Another issue is if the minimally invasive supraorbital (SO) approach offers the same results compared with the more invasive craniotomies. Aiming to guide approach selection, preoperative grading systems have been described.All cases of TSMs treated from 2013 to 2018 by extended endoscopic endonasal approach (EEA) or SO approach have been reviewed and classified according to three preoperative grading systems: McDermott scale, Optic Nerve Laterality Score, and Yaşargil criteria.A total of 15 patients with TSMs were treated with the EEA (n = 6) or the SO (n = 9) approach. Globally, gross total resection was obtained in 87% (n = 13) of cases and was higher with the SO (100%, n = 9) compared with the EEA (67%, n = 4). Visual function improved in all but one patient (n = 14). Compared with the EEA group, patients treated by the SO approach had larger tumors (32.3 mm vs. 24.5 mm), a higher rate of optic canal invasion (4/9 vs. 0/6), and arterial encasement (6/9 vs. 1/5). Patients with McDermott total points of 1 to 2 (7/15) were treated mainly by the EEA; all patients with McDermott total score of ≥3 (8/15) were treated by the SO approach. All patients with optic canal invasion (4/15) and lateral extension of the tumor (ONL score = 1-3) were treated by the SO approach.The SO and EEA are two minimally invasive approaches safe and effective for treating TSMs. For tumors with lateral extension (optic nerve laterality [ONL] score = 1-3), larger diameter (>30-35 mm), vascular encasement, or optic canal involvement (McDermott total point = 2-3), the SO craniotomy is preferred. For small and median tumors with no optic canal invasion or vascular encasement (McDermott total point = 1-2), the EEA represents a valid option.

Idiopathic normal pressure hydrocephalus (iNPH) is a common condition affecting the elderly. Numerous investigations highlight that its period-prevalence could be underestimated, as well as the economic burden of the missed treatments. The objective of the present investigation is to determine if a cohort of radiologically suspected iNPH patients presents the clinical landmarks of this condition, and to estimate the economic burden of these potentially missed diagnoses.We recorded age, sex, reason to access emergency rooms of our community hospitals, values of Evans' Index, callosal Angle, presence of disproportionately enlarged subarachnoid space hydrocephalus and obvious ventricular enlargement. We telephoned the patients who presented at least two radiological signs of iNPH and administered the idiopathic normal-pressure hydrocephalus grading scale (iNPHGS), to assess the severity of signs and symptoms linked to iNPH, to understand if a strong radiological suspect had a clinical correlation.Among the 308 brain computed tomography scans of a week, a total of 21 agreed to be enrolled in the present investigation. When administering iNPHGS questionnaire to radiologically suspected iNPH, 17/21 patients (80.1%) scored ≥1 in at least two of the three iNPHGS subscales. The scores of the three subscales were strongly associated to each other. The estimated monthly and yearly health-related costs may be EUR 4'799'440 and 57.59 million of Euros, respectively.There is an association between the radiological features of iNPH and the scores of iNPHGS. The period-prevalence could be 5.51%, implying high health care costs, with significant societal impact, and reduced quality of life in patients suffering from undiagnosed iNPH.