Neurosurgical Review最新文献

Treating complex posterior cerebral artery (PCA) aneurysms, such as fusiform, giant, and dissecting aneurysms, poses significant challenges. Parent artery occlusion carries a risk of ischemic stroke and fails to alleviate mass effects. This study aims to analyze the technical nuances and patient outcomes of treating complex PCA aneurysms, ranging from the P1 to P2P segments, using a Zygomatic Anterolateral Temporal Approach(ZATA) combined with flow reconstruction. This study was a retrospective study. Surgical treatment was performed on twelve patients with complex PCA aneurysms located in the P1 to P2P segments. Ten patients underwent flow reconstruction including Superficial Temporal Artery(STA)-Middle Cerebral Artery(MCA),Internal Maxillary Artery(IMA)-Radial Artery(RA)-MCA,STA-PCA(P2), and IMA-RA-PCA(P2). The aneurysm occlusion rate, surgical complications, and patient prognosis, including stroke occurrence/ modified Rankin Scale(mRS), were recorded and analyzed. Using the ZATA, all twelve complex PCA aneurysms were successfully clipped/resected/trapped. This included two high-position aneurysms (> 3 mm above the posterior clinoid process) at the P1/P2 junction and three P2P aneurysms. The mass effects of six large or giant aneurysms were resolved or alleviated. Postoperative and follow-up CTA/DSA confirmed the patency of the bypass vessels. Four patients experienced strokes in the perioperative period, with three ischemic and one hemorrhagic. The median follow-up period was 28.5 months. At the last follow-up, the good prognosis rate (mRS ≤ 2) was 83.3%, and one patient had died. Clipping/resection/trapping of aneurysms via the ZATA, combined with flow reconstruction, is a feasible option for treating complex PCA aneurysms from the P1 to P2P segments. This approach helps maintain or improve cerebral perfusion in the affected vascular territory.

Endoscopic transorbital approaches (ETOAs) are finding wide application for skull base lesions, particularly for spheno-orbital meningiomas (SOMs). These tumors have high recurrence rates, and second surgery can often represent a challenge. In this study we analyze our experience of management of recurrent SOMs through a slightly modified eyelid crease approach. Between May 2016 and September 2023, in the Department of Neurosurgery of Fondazione IRCCS Policlinico San Matteo (Pavia, Italy), five consecutive recurrent SOMs have been treated using an endoscopic transorbital approach. Demographic data, preoperatory deficits, lesions characteristics, histology, grade of resection, eventual adjuvant treatments, complications, outcome in terms of symptoms improvement and cosmesis, and hospitalization are described. One patient maintained a right lateral rectus muscle palsy that was already present in the preoperatory, no cerebrospinal fluid (CSF) leaks were reported. All patients had postoperative periorbital edema, but no other systemic complication was found. All patients had proptosis improvement, two had visual acuity improvement, and best cosmetic outcome was obtained in all cases. Hospitalization varied between 4 and 6 days. ETOAs in the management of recurrent SOMs are safe and have good outcome. Right selection of patients is mandatory, but when feasible, endoscopic surgery can allow a virgin route to a previously operated tumor, guaranteeing a good strategic option.