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

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.

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.

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.

Background and purpose: The goal of the present study was to compare the volumetric three-dimensional growth of traumatic intracerebral hemorrhage (tICH) in patients with and without abnormal coagulation and question the necessity to perform repeated CT scans in all those patients.

Methods: We retrospectively analysed CT-Scans from 50 patients with traumatic ICH. Abnormal coagulation was defined by the results of standard coagulation tests at admission including Factor XIII. The three-dimensional size of the hemorrhage was measured at admission, within 48 hours and 2 weeks.

Results: Growth of the ICH was detected in 56 % of the patients. In the group with normal coagulation out of 30 patients, growth could only be detected in 10 (33.34 %) whereas in the abnormal coagulation group increased ICH volume occurred in 18 of 20 patients (90 %). The mean growth was 3.46 ml [95 % CI: +/- 2.99 ml] and varied from 0,1 ml [95 % CI: +/- 1.57] in the normal coagulation group to 8.52 ml [95 % CI: +/- 6.67 ml] in the coagulation disorder group.

Conclusion: This study demonstrates the need to perform repeated CT scans in patients with coagulation disorders since patients with tICH and coagulation abnormalities are likely to experience substantial growth of the hemorrhage.

A retrospective analysis of prospectively collected data.There have been a few studies comparing surgical outcomes between revision lumbar fusion surgery and the same primary surgery.Using the Zurich Claudication Questionnaire (ZCQ), we compared clinical outcomes of revision posterior lumbar interbody fusion (PLIF) for late deterioration after laminotomy with those of primary PLIF to examine whether surgical outcomes of revision PLIF for late deterioration after laminotomy are inferior to those of primary PLIF.Sixteen consecutive patients undergoing revision single-level PLIF for late deterioration after single-level laminotomy (R group) and 61 consecutive patients undergoing primary single-level PLIF during the same period (P group) were enrolled. Before PLIF surgery and at 2 years postoperatively, clinical outcomes were assessed using the ZCQ. Achievement rates of the minimum clinically important difference (MCID) of each domain (Symptom severity [SS] and Physical function [PF]) on the ZCQ were calculated in each group.In the R group, mean SS and PF before revision PLIF and at 2 years after surgery were 3.429 and 2.8, and 1.946 and 1.6, respectively. In the P group, mean SS and PF before primary PLIF and at postoperative 2 years were 3.438 and 2.5, and 2.194 and 1.6, respectively. Both SS and PF significantly improved at postoperative 2 years in both groups, and SS both before and after PLIF and PF at 2 years postoperatively showed no significant differences between the two groups. Achievement rates of the MCID of SS and PF were 81.3 and 68.8% in the R group, and 59.0 and 59.0% in the P group, respectively. None of the MCID achievement rates of SS and PF showed significant differences between the two groups.Clinical outcomes of revision PLIF for late deterioration after laminotomy were equivalent to those of primary PLIF assessed with the ZCQ at 2 years after PLIF surgery.

Blood blister-like aneurysms (BBA) are rare vascular lesions with challenging treatment. While direct surgery has been the primary technique for treating BBA, there has been a shift toward endovascular methods in recent years. This article presents a retrospective case series of patients treated with direct surgery at our center over a 6-year period.Patients who underwent surgery for BBA from 2014 to 2019 were evaluated. Data on surgical procedures, complications, and clinical outcomes were obtained from patients' medical records. Additionally, patients were contacted to provide updates on their treatment outcomes.A total of 17 patients were treated for BBA during the study period. All cases presented with subarachnoid hemorrhage and were treated using the clipping method. Intraoperative rupture occurred in 11 patients. Additionally, internal carotid artery sacrificing was done in five patients due to avulsion during surgery. Of these 17 patients, 11 (64.7%) had favorable outcomes following surgery, while the mortality rate was 29.4% (5 patients).The rate of favorable outcomes and mortality associated with the direct surgery technique at our center was comparable to results from other centers. Further studies are required to determine the optimal method for treating BBA.

Idiopathic normal-pressure hydrocephalus shows a typical clinical triad consisting of gait disturbance, dementia, and urinary incontinence, often combined with ventriculomegaly. Fortunately, these clinical manifestations are potentially reversible by adequate surgical treatment. Men affected by Klinefelter's syndrome can present cognitive problems. These include impairments in both verbal and nonverbal memory and in executive functions, which could be related to idiopathic normal-pressure hydrocephalus in these patients. In this study, we describe the case of a 62-year-old-man genetically diagnosed with Klinefelter's syndrome with a history of gait ataxia resulting in recurrent falls. Direct associations between idiopathic normal-pressure hydrocephalus and Klinefelter's syndrome and clinical pathophysiologic and potential molecular implications are discussed.