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

The purposes of this study were to identify the primary level at which prevertebral tissue swelling (PSTS) occurs following one-level anterior cervical diskectomy and fusion (ACDF) based on surgical level, and to quantify the degree to which it occurs. Although PSTS peaks at day 2 or 3 after ACDF, with swelling noted to be prominent at the C2-C4 levels, the way in which the features of PSTS vary according to surgical level has not been examined.Thirty-seven patients who underwent one-level ACDF were reviewed and classified into retropharyngeal and retrotracheal groups based on surgical level. PSTS occurring at C2-C6 and the width of the airway (WA) at C2-C4 were assessed using plain radiographs before surgery and at 1, 3, 5, and 7 days postoperatively.The retropharyngeal group comprised 10 patients, while the retrotracheal group comprised 27 patients. The retropharyngeal group had the most severe PSTS on day 3 after surgery. C4 showed PSTS peaked on day 3, with a value of 3.26 times the preoperative prevertebral tissue thickness. The WA at C4 was narrowest on day 1, with a value of 0.74 times and remained narrow until day 3. The retrotracheal group showed the most severe PSTS on day 1 at the C3 level: 2.81 times. The WA at C4 was narrowest on day 1 with a value of 0.78 times and increased thereafter.PSTS following one-level ACDF for both retropharyngeal and retrotracheal lesions was greatest at the C3 and C4 levels, with peaks on the third day after operation for the former and the first day for the latter. The WA at C4 was narrowest from day 1 in both groups. In the retropharyngeal group, narrowing remained until day 3.

Vertebral endplate cavities (VECs) have been reported with the use of titanium (Ti) cages. Only few articles have recently demonstrated unfavorable radiographic changes in the form of cysts or cavities, which may predispose to nonunion.The aim was to assess the prevalence of VEC in posterior lumbar interbody fusion (PLIF) using Ti cages and to estimate their impact on fusion. The term "cavity" was used to describe the endplate changes. Computed tomography (CT) analysis of the VECs and fusion status following PLIFs with Ti cages was conducted by two observers. VECs were assessed according to the size, multiplicity, location, and presence of sclerosis.Forty-two consecutive patients with surgeries conducted on 52 levels were enrolled. There were 20 males and 22 females. The mean age was 43.6 ± 10.89 years. The mean follow-up was 20.85 ± 8.49 months. Definite union was seen in 48 levels (92.3%) by observer 1 and in 40 levels (76.9%) by observer 2. The strength of agreement was moderate. The presence of VEC was observed in 9 levels (17.3%) by observer 1 and in 12 levels (23.1%) by observer 2. The strength of agreement was moderate. The majority of VECs in the endplates were less than 5 mm. The strength of agreement was high. The strength of agreement for location and multiplicity were moderate. The VEC was significantly correlated with the fusion status.Our study confirmed that VECs were observed following Ti cage placement after PLIF procedures. They tend to be small and might be associated with nonunion. Furthermore, it reflected the limited inter-rater reliability of the assessment of both the fusion status and VEC morphology after Ti PLIF cage placement.

The McConnell capsular artery (MCCA) is a vascular component with notable significance in neurosurgery. Discovered by McConnell in 1953, these arteries, categorized as inferior and anterior capsular, contribute significantly to the vascularization of the sellar region. This article explores the anatomical variations of MCCA, aiming to provide a comprehensive overview of its structure and neurosurgical implications.This study was conducted following a literature review of articles related to the MCCA. Electronic databases, including PubMed, ScienceDirect, and Web of Science, were searched up until January 2024. Specific keywords used in the search included "McConnell capsular artery," "intracapsular branches," and "MCCA." An in-depth investigation was undertaken to explore the existence, anatomy, pathology, and clinical implications of the MCCA.We found a mere 13 articles pertaining to this artery. It highlights the MCCA's close proximity to important neuroanatomical components and describes how it has been consistently identified in multiple studies. The review explores anatomical variations and anomalies and provides insights into neurosurgical cases that emphasize the artery's involvement in oncological diseases.The variability in the occurrence of this artery has significant therapeutic ramifications, especially in procedures involving pituitary and suprasellar lesions. The study emphasizes the importance of meticulous identification and management of MCCA during surgical interventions, underscoring their crucial role in neurosurgical procedures.

Extra-Intracranial (EC-IC) bypass surgery is an effective procedure to restore hemodynamic insufficiency and mitigating cerebral ischemia. With increasing life expectancy, the incidence of patients with hemodynamic insufficiency is expected to rise further. Here we aimed to analyze the complications and patency rate of patients ≥70 years that underwent EC-IC bypass and compare it with a younger cohort (<70 years).Patient charts were retrospectively reviewed for diagnosis, patient presentation, type of bypass, postoperative course, and follow-up. A total of 175 patients underwent arterial bypass during the study period. A total of 158 patients were <70 years old compared with 17 patients ≥70 years old.EC-IC bypass was performed with a scalp artery in 88.2% cases in the older group and 88.0% cases in the younger group. The younger group was more likely to undergo bilateral bypass (28.1%) than the older group (0%; p = 0.01). There were no significant differences in overall medical and surgical complication rates between older and younger patients undergoing arterial bypass (p = 0.61). Direct postoperative graft patency was similar between groups. Follow-up patency data were available in 97.7% of patients (average 18.0 ± 25.1 months). Graft patency rate at follow-up was 88.3%, with rates 88.2% in the older group and 88.3% in the younger group.Our data confirm previous data in the literature on the safety and efficacy of EC-IC Bypass in the elderly population. These results suggest that variables other than age may be more important in determining potential benefit from EC-IC bypass treatment.

Distal rod migration remains uncommon and has been reported in a variety of anatomical locations, including the retroperitoneal region, knee, and pelvis. It is postulated that spinal fixation without fusion might allow the mechanical system some vulnerability to motion effects of the spine. Bilateral distal rod migration is rarer still. We report the interesting scenario of sequential and delayed bilateral rod migration 17 months after thoracolumbar fracture stabilization.

2019 coronavirus disease (COVID-19) has attracted global attention primarily because of the severe acute respiratory symptoms associated with it. However, nearly one third of the patients also present with neurological symptoms. This report describes a case of a previously healthy woman with acute COVID-19 infection, who developed acute facial nerve palsy and rapid progression to coma due to otogenic brain abscess.A 63-year-old woman with acute COVID-19 infection exhibited acute facial nerve paresis, high fever, and purulent secretion from her left ear within 48 hours after COVID-19 onset. Cranial computed tomography scan confirmed acute mastoiditis, precipitating an urgent mastoidectomy. A postoperative contrast-enhanced magnetic resonance imaging on the same day revealed a subdural empyema, which prompted an urgent craniotomy and decompression. Intraoperative microbiological swabs confirmed a Streptococcus pyogenes infection; however, reverse transcription polymerase chain reaction was negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After immediate intravenous antibiotic treatment, extubation was achieved 4 days after operation, and the patient was discharged without neurological deficits 19 days after postoperatively.This finding adds a layer of insight into the specific nature of the infection, suggesting a potential absence of SARS-CoV-2 involvement in otogenic subdural empyema. However, the impact of SARS-CoV-2 in otogenic brain abscess cannot be excluded to date and should be further prospectively investigated. The complete recovery of neurological status emphasizes the importance of prompt and interdisciplinary interventions in managing rare and severe complications associated with COVID-19.

Subarachnoid-pleural fistula (SAPF) is an abnormal communication between the subarachnoid and pleural spaces that can arise from blunt or penetrating trauma or as a complication of spinal surgery via the transthoracic approach. Uncontrolled cerebrospinal fluid (CSF) leakage after transthoracic spinal surgery could be more problematic than that after spinal surgery via the conventional posterior approach because of the negative pressure in the pleural cavity.The authors reported SAPF management using chest and lumbar drainage in five patients with several troublesome complications, such as intracranial subdural hematoma or severe respiratory dysfunction. Chest drainage was managed for 2 to 3 days by continuous low negative pressure, whereas lumbar spinal drainage was managed for 5 to 7 days, aiming at an output volume of 150 to 200 ml/day and higher than that of chest drainage. Additionally, when changes in the accumulated pleural fluid were seen by standing chest X-ray immediately before the operation and 1 month after the operation, the pleural effusions in four of the five patients were assimilated 1 month postoperatively.Compared with CSF management following standard posterior spinal surgery, management after the anterior transthoracic approach could be more troublesome because of the intrapleural negative pressure. When the chest and lumbar drainage are used, it is important to consider that overdrainage of CSF could potentially cause severe respiratory dysfunction and intracranial subdural hematoma.

The aim of this study is to evaluate the changes in radiologic parameters and clinical outcomes following unilateral biportal endoscopic unilateral laminotomy and bilateral decompression (UBE ULBD) for treatment of central lumbar spinal stenosis.Forty-one central lumbar spinal stenosis patients who underwent UBE ULBD were enrolled from April 2021 to February 2023. Visual analog scale (VAS) for back pain and leg pain, Oswestry Disability Index (ODI) score, and the modified MacNab criteria were assessed preoperatively and postoperatively. The preoperative and postoperative cross-sectional area of the spinal canal (CSAC), anteroposterior diameter, horizontal width, and ipsilateral and contralateral lateral recess height were calculated from axial computed tomography (CT) scans. Percentage of facet joint preservation measured on axial CT scans was obtained preoperation and postoperation.The VAS for back and leg pain improved from 7.24 ± 0.80 and 7.59 ± 0.59 preoperatively to 2.41 ± 0.55 and 2.37 ± 0.62 (p < 0.05) postoperatively and 1.37 ± 0.54 and 1.51 ± 0.55 at the last follow-up (p < 0.05). For ODI, improvement from 60.37 ± 4.44 preoperatively to 18.90 ± 4.66 (p < 0.05) at the last follow-up was observed. CT scans demonstrated that the postoperative CSAC increased significantly from 287.84 ± 87.81 to 232.97 ± 88.42 mm (p < 0.05). The mean postoperative anteroposterior diameter and horizontal width increased significantly from 18.01 ± 3.13 and 19.57 ± 3.80 to 22.19 ± 4.56 and 21.04 ± 3.72 mm, respectively (p < 0.05). The ipsilateral lateral recess height and contralateral lateral recess height were 3.39 ± 1.12 and 3.20 ± 1.14 mm preoperatively and 4.03 ± 1.37 and 3.83 ± 1.32 mm (p < 0.05) postoperatively, with significant differences. The ipsilateral and contralateral facet joint preservations were 88.17 and 93.18%, respectively.The UBE ULBD surgery is a safe and effective treatment for central lumbar spinal stenosis, associated with significant improvement in clinical outcomes and radiologic parameters. Studies with larger samples and longer follow-up periods are needed for further research.