Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-030
Abdurrahman Mousa, Deni Nasution, M. Ari Irsyad, Fahmi Rasyid
Background. The incidence of CM-I is estimated to be 1/1,000 births. In rare cases, CM-I is complicated by associations with other malformations of the craniocervical junction, including mainly Basilar invagination (BI). Chiari malformation (CM) is characterized by a congenital malformation of the posterior cranial fossa with cerebellar tonsils herniation through the foramen magnum, probably due to the underdevelopment of the posterior bony skeleton (exo-occipital and supraoccipital bones). CM may be complicated by a variety of other malformations, including platybasia, basilar invagination and occipitalization, although syringomyelia (SM) is the most commonly observed Case Report. A girl, 14 years old came with a chief complaint of headache, which is exacerbated whenever the patient coughed or sneezed. The patient also complained about neck pain and a tingling sensation in her hand. A history of vomiting or seizure has not been found. A history of muscle weakness was not found. On physical examination, the patient has a GCS score of 15 on admission, with normal muscle tone and normal reflexes. The patient has a sensory deficit, on the level below C4. The patient underwent CT Scan and MRI whole spine, Chiari 1 malformation and platybasia were diagnosed. The patient underwent posterior fossa decompression, and postoperatively symptoms of Chiari and sensory deficit gradually improved. Discussion. As an association with this syndrome, there is also basilar invagination as shown by flat basioccipt (platybasia) and upward odontoid projection. hydrocephalus [3]. Virchow coined the term ‘platybasia’ to describe an abnormal flattening of the skull base, a defect which he attributed to abnormal bone development. In addition to the flattening of the base of the skull, there was upward displacement (impression) of the basilar and condylar portions of the occipital bone, which caused infolding, or impression of the foramen magnum, reduction of the posterior fossa, and consequent protrusion of the upper cervical spine into the anterior brainstem, with neurological signs. The symptomatology presented by CM-1 patients is diverse, and its severity does not correlate with the degree of TH, with some asymptomatic cases presenting with prominent TH. The onset of symptoms generally develops gradually, however, trauma, coughing/sneezing or pregnancy can also precipitate the event. The most common treatment for these patients is surgical PCF decompression (alone or with duraplasty), although cerebellar tonsillectomy, cervical laminectomy, and suboccipital cranioplasty are also applied. The goal of these surgical procedures is to decompress the foramen magnum and increase the subarachnoid space in order to avoid the impaction of the cerebellar tonsils, reestablish the CSF flow and reverse the symptoms Conclusion. This patient was diagnosed with Chiari 1 malformation and platybasia, as suggested in the literature, posterior fossa decompression was done and the patient i
{"title":"Chiari 1 malformation with Platybasia","authors":"Abdurrahman Mousa, Deni Nasution, M. Ari Irsyad, Fahmi Rasyid","doi":"10.33962/roneuro-2023-030","DOIUrl":"https://doi.org/10.33962/roneuro-2023-030","url":null,"abstract":"Background. The incidence of CM-I is estimated to be 1/1,000 births. In rare cases, CM-I is complicated by associations with other malformations of the craniocervical junction, including mainly Basilar invagination (BI). Chiari malformation (CM) is characterized by a congenital malformation of the posterior cranial fossa with cerebellar tonsils herniation through the foramen magnum, probably due to the underdevelopment of the posterior bony skeleton (exo-occipital and supraoccipital bones). CM may be complicated by a variety of other malformations, including platybasia, basilar invagination and occipitalization, although syringomyelia (SM) is the most commonly observed Case Report. A girl, 14 years old came with a chief complaint of headache, which is exacerbated whenever the patient coughed or sneezed. The patient also complained about neck pain and a tingling sensation in her hand. A history of vomiting or seizure has not been found. A history of muscle weakness was not found. On physical examination, the patient has a GCS score of 15 on admission, with normal muscle tone and normal reflexes. The patient has a sensory deficit, on the level below C4. The patient underwent CT Scan and MRI whole spine, Chiari 1 malformation and platybasia were diagnosed. The patient underwent posterior fossa decompression, and postoperatively symptoms of Chiari and sensory deficit gradually improved. Discussion. As an association with this syndrome, there is also basilar invagination as shown by flat basioccipt (platybasia) and upward odontoid projection. hydrocephalus [3]. Virchow coined the term ‘platybasia’ to describe an abnormal flattening of the skull base, a defect which he attributed to abnormal bone development. In addition to the flattening of the base of the skull, there was upward displacement (impression) of the basilar and condylar portions of the occipital bone, which caused infolding, or impression of the foramen magnum, reduction of the posterior fossa, and consequent protrusion of the upper cervical spine into the anterior brainstem, with neurological signs. The symptomatology presented by CM-1 patients is diverse, and its severity does not correlate with the degree of TH, with some asymptomatic cases presenting with prominent TH. The onset of symptoms generally develops gradually, however, trauma, coughing/sneezing or pregnancy can also precipitate the event. The most common treatment for these patients is surgical PCF decompression (alone or with duraplasty), although cerebellar tonsillectomy, cervical laminectomy, and suboccipital cranioplasty are also applied. The goal of these surgical procedures is to decompress the foramen magnum and increase the subarachnoid space in order to avoid the impaction of the cerebellar tonsils, reestablish the CSF flow and reverse the symptoms Conclusion. This patient was diagnosed with Chiari 1 malformation and platybasia, as suggested in the literature, posterior fossa decompression was done and the patient i","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-033
Ali Dolachee, Hagar Algburi, Salima Alsaad, Mustafa Ismail, Samer Hoz
Many cases of gravitational bullets are reported in developed and non-developed countries. However, few papers highlighted these cases in the literature. In our study, we present two cases of gravitational bullets that have an unusual coincidence in the injury characteristics through their ages, and gender, the site of the inlet.
{"title":"Similarities and differences between two coincidently gravitational bullet cases","authors":"Ali Dolachee, Hagar Algburi, Salima Alsaad, Mustafa Ismail, Samer Hoz","doi":"10.33962/roneuro-2023-033","DOIUrl":"https://doi.org/10.33962/roneuro-2023-033","url":null,"abstract":"Many cases of gravitational bullets are reported in developed and non-developed countries. However, few papers highlighted these cases in the literature. In our study, we present two cases of gravitational bullets that have an unusual coincidence in the injury characteristics through their ages, and gender, the site of the inlet.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-035
Mustafa Ismail, Bandar Mohammed Al-Hadeethi, Amir Ibrahim Moushib, Hagar A. Algburi, Aktham O. Al-Khafaji, Hosam Al-Jehani, Samer S. Hoz
Introduction. Intraoperative rupture (IOR) of an aneurysm is a frightful complication that causes significant morbidity and mortality worldwide. IOR can be attributed to various parameters, including hypertension, increased intracranial pressure (ICP), fragility of the vessels, and inadequate anaesthesia. IOR due to insufficient anaesthesia is scarcely reported in the literature. Here, we describe a re-ruptured anterior communicating artery (ACoA) after incomplete clipping of the neck during craniotomy closure due to unintended early wake-up from anaesthesia with a discussion about the management. Case description. A 38-year-old male suddenly developed a severe headache, a brief loss of consciousness, and vomiting. Computed tomography (CT) scan showed a subarachnoid haemorrhage in the basal cistern. CT angiography showed a bilobed right ACoA aneurysm with a wide neck and Murphy's teat. The patient was considered for surgery. Clipping of the aneurysm neck was done through two curved clips. During craniotomy closure, the patient started coughing and gagging then a huge IOR was encountered. These events can be mainly attributed to unintended inadequate anaesthesia, particularly muscle relaxants. The bleeding ceased after two suction catheters were inserted, temporary clips were applied, and the readjustment of permanent clips. After surgery, the patient showed a left-sided weakness. His postoperative CT scan showed a right distal anterior cerebral artery (ACA) territory infarction. The weakness improved in the follow-up period. Conclusion. Delayed IOR due to early awaking from anaesthesia should be considered a potential source of complications and bad outcomes in aneurysm surgery.
{"title":"Delayed intraoperative rupture of clipped aneurysm during the awaking from anaesthesia","authors":"Mustafa Ismail, Bandar Mohammed Al-Hadeethi, Amir Ibrahim Moushib, Hagar A. Algburi, Aktham O. Al-Khafaji, Hosam Al-Jehani, Samer S. Hoz","doi":"10.33962/roneuro-2023-035","DOIUrl":"https://doi.org/10.33962/roneuro-2023-035","url":null,"abstract":"Introduction. Intraoperative rupture (IOR) of an aneurysm is a frightful complication that causes significant morbidity and mortality worldwide. IOR can be attributed to various parameters, including hypertension, increased intracranial pressure (ICP), fragility of the vessels, and inadequate anaesthesia. IOR due to insufficient anaesthesia is scarcely reported in the literature. Here, we describe a re-ruptured anterior communicating artery (ACoA) after incomplete clipping of the neck during craniotomy closure due to unintended early wake-up from anaesthesia with a discussion about the management. Case description. A 38-year-old male suddenly developed a severe headache, a brief loss of consciousness, and vomiting. Computed tomography (CT) scan showed a subarachnoid haemorrhage in the basal cistern. CT angiography showed a bilobed right ACoA aneurysm with a wide neck and Murphy's teat. The patient was considered for surgery. Clipping of the aneurysm neck was done through two curved clips. During craniotomy closure, the patient started coughing and gagging then a huge IOR was encountered. These events can be mainly attributed to unintended inadequate anaesthesia, particularly muscle relaxants. The bleeding ceased after two suction catheters were inserted, temporary clips were applied, and the readjustment of permanent clips. After surgery, the patient showed a left-sided weakness. His postoperative CT scan showed a right distal anterior cerebral artery (ACA) territory infarction. The weakness improved in the follow-up period. Conclusion. Delayed IOR due to early awaking from anaesthesia should be considered a potential source of complications and bad outcomes in aneurysm surgery.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-026
Mahmut Sertdemir, Mehmet Fatih Erdi
Endoscopic endonasal transsphenoidal surgery (EETS) is a widely accepted technique for the surgical resection of pituitary tumours. In this report, we present our single-centre experience with EETS for pituitary adenomas, mainly focusing on its efficacy and postoperative complications. Among 100 patients who underwent EETS, 57 (57%) were female and 43 were (43%) male. The mean age of the patients was 51.55 ± 13.51 years. Nonfunctional adenoma was found in 61 (61%) patients, acromegaly was found in 29 (29%) patients, Cushing’s disease in six (6%), and prolactinoma was found in four (4%) patients. On average, a 75.8% decrease in the postoperative tumour volume was observed in nonfunctional adenomas. Surgical cure was achieved in 51.7% of patients with acromegaly, 50% of those with Cushing’s disease, and 25% of those with prolactinoma. The most common postoperative complication was found to be cerebrospinal fluid fistula.
{"title":"Endoscopic endonasal transsphenoidal surgery for pituitary adenomas","authors":"Mahmut Sertdemir, Mehmet Fatih Erdi","doi":"10.33962/roneuro-2023-026","DOIUrl":"https://doi.org/10.33962/roneuro-2023-026","url":null,"abstract":"Endoscopic endonasal transsphenoidal surgery (EETS) is a widely accepted technique for the surgical resection of pituitary tumours. In this report, we present our single-centre experience with EETS for pituitary adenomas, mainly focusing on its efficacy and postoperative complications. Among 100 patients who underwent EETS, 57 (57%) were female and 43 were (43%) male. The mean age of the patients was 51.55 ± 13.51 years. Nonfunctional adenoma was found in 61 (61%) patients, acromegaly was found in 29 (29%) patients, Cushing’s disease in six (6%), and prolactinoma was found in four (4%) patients. On average, a 75.8% decrease in the postoperative tumour volume was observed in nonfunctional adenomas. Surgical cure was achieved in 51.7% of patients with acromegaly, 50% of those with Cushing’s disease, and 25% of those with prolactinoma. The most common postoperative complication was found to be cerebrospinal fluid fistula.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135860594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite the well-acknowledged link between autism spectrum disorders (ASDs) and epilepsy, the prevalence and significance of electroencephalogram (EEG) changes in epileptic children in the absence of clinical seizures remains underdetermined. Aim. The primary goal of this study is to report the prevalence of EEG abnormalities in non-epileptic or pre-epileptic autistic children, investigate their association with a set of pre-determined risk factors, speculate on their significance, and direct future research efforts. Methods. A case-based sampling for children diagnosed with autism was done. Only patients without a history of epilepsy and those under the age of 15 were included. All patients underwent an EEG study. Children with abnormal EEG findings (case group) were compared to age-matched controls with normal EEG findings using a set of pre-determined factors. Results. A total of 38 patients were enrolled in our study, of whom 31.6% (n=12) had abnormal EEG readings. Of those, the presence of the following EEG abnormalities were noted – each being present in two patients: frontal sharp waves, frontal slowing, temporal slowing, bitemporal slowing, frontal sharp waves, and generalized sharp waves, Frontal intermittent rhythmic delta activity (FIRDA). Patients with abnormal EEG findings were more likely to have a positive family history of epilepsy and/or autism, with odd ratios of 28.05, and 12.62, accordingly. Conclusion. Aberrant brain connectivity patterns have been observed in non-epileptic ASD patients, and our findings support these findings. Furthermore, we believe that gender, mother's age, mode of delivery, and speech abnormalities could all have an impact on the EEG results. However, more research is needed to expand on these findings.
{"title":"Electroencephalographic findings in autistic non-epileptic children","authors":"Arwa K. Ibrahem, Hula Shareef, Kanar Shaker, Dhay Mohammed, Farqad Bader Hamdan","doi":"10.33962/roneuro-2023-041","DOIUrl":"https://doi.org/10.33962/roneuro-2023-041","url":null,"abstract":"Despite the well-acknowledged link between autism spectrum disorders (ASDs) and epilepsy, the prevalence and significance of electroencephalogram (EEG) changes in epileptic children in the absence of clinical seizures remains underdetermined. Aim. The primary goal of this study is to report the prevalence of EEG abnormalities in non-epileptic or pre-epileptic autistic children, investigate their association with a set of pre-determined risk factors, speculate on their significance, and direct future research efforts. Methods. A case-based sampling for children diagnosed with autism was done. Only patients without a history of epilepsy and those under the age of 15 were included. All patients underwent an EEG study. Children with abnormal EEG findings (case group) were compared to age-matched controls with normal EEG findings using a set of pre-determined factors. Results. A total of 38 patients were enrolled in our study, of whom 31.6% (n=12) had abnormal EEG readings. Of those, the presence of the following EEG abnormalities were noted – each being present in two patients: frontal sharp waves, frontal slowing, temporal slowing, bitemporal slowing, frontal sharp waves, and generalized sharp waves, Frontal intermittent rhythmic delta activity (FIRDA). Patients with abnormal EEG findings were more likely to have a positive family history of epilepsy and/or autism, with odd ratios of 28.05, and 12.62, accordingly. Conclusion. Aberrant brain connectivity patterns have been observed in non-epileptic ASD patients, and our findings support these findings. Furthermore, we believe that gender, mother's age, mode of delivery, and speech abnormalities could all have an impact on the EEG results. However, more research is needed to expand on these findings.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-032
Sanjiv Chamraj, Sharan Srinivasan
Background. Pallidothalamic tractotomy” can be effective in Parkinson’s disease by exhibiting anti-parkinsonian effects. Case presentation. The patient was a 53 years old gentleman, having Parkinson’s disease for the last 14 years. The disease onset was on the left side and slowly moved to the right side. He had tremors, slowness of body movements and stiffness of the movements. The first right Pallidotomy was done in January 2019. There was a noticeable improvement in a few weeks. He continued to have symptoms on the right side. The preoperative Unified Parkinson Disease Rating Scale (UPDRS) part 3 score in 2019 was 53 while the postoperative score was only 26 showing drastic improvement after right Pallidotomy. After 2 years of the first surgery, a new technique called Pallido Thalamic Tractotomy (PTT), an MRI-guided stereotactic surgery was done on the left side. Tremors reduced gradually by 99% in 3 weeks after surgery. This is the first case of PTT performed on a patient with Parkinson’s disease in India. Conclusion. PTT is an effective procedure in PD that acts by disconnecting the pallidothalamic tract. Unilateral pallidothalamic tractotomy done on the left side improved contralateral side rigidity, tremors and bradykinesia.
{"title":"The first and foremost unilateral pallidothalamic tractotomy done in India for Parkinson’s Disease","authors":"Sanjiv Chamraj, Sharan Srinivasan","doi":"10.33962/roneuro-2023-032","DOIUrl":"https://doi.org/10.33962/roneuro-2023-032","url":null,"abstract":"Background. Pallidothalamic tractotomy” can be effective in Parkinson’s disease by exhibiting anti-parkinsonian effects. Case presentation. The patient was a 53 years old gentleman, having Parkinson’s disease for the last 14 years. The disease onset was on the left side and slowly moved to the right side. He had tremors, slowness of body movements and stiffness of the movements. The first right Pallidotomy was done in January 2019. There was a noticeable improvement in a few weeks. He continued to have symptoms on the right side. The preoperative Unified Parkinson Disease Rating Scale (UPDRS) part 3 score in 2019 was 53 while the postoperative score was only 26 showing drastic improvement after right Pallidotomy. After 2 years of the first surgery, a new technique called Pallido Thalamic Tractotomy (PTT), an MRI-guided stereotactic surgery was done on the left side. Tremors reduced gradually by 99% in 3 weeks after surgery. This is the first case of PTT performed on a patient with Parkinson’s disease in India. Conclusion. PTT is an effective procedure in PD that acts by disconnecting the pallidothalamic tract. Unilateral pallidothalamic tractotomy done on the left side improved contralateral side rigidity, tremors and bradykinesia.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135860595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-039
Mustafa Ismail, Ali K. Al-Shalaji, Bahaa S. Abdalnaby, Aktham O. Al-Khafaji, Ali A. Kadhim, Rasha A. Al-Shakarchy, Sarmad A. Zangana, Ahsan A. Al-Rubaye, Samer S. Hoz
Background. Aneurysms of the distal anterior cerebral artery (DACA) are uncommon; they often form near the pericallosal-callosomarginal junction and are typically small. To our knowledge, giant DACA aneurysms developing from the more distant parts of the anterior cerebral artery (ACA), A4-5, have been described only once in the literature. Case description. A 66-year-old gentleman reported with a brief loss of consciousness followed by weakness in his right lower leg. The patient was admitted with a Glasgow Coma Score (GCS) of 15. A computed tomography (CT) scan of the head revealed a left hyperdense mass in the frontal parasagittal supracallosal region. Contrast MRI revealed a heterogeneously enhancing mass measuring 35x30x25 mm. CT angiography (CTA) revealed a small saccular aneurysm on the posteromedial aspect of the mass, perpendicular to the vertical plane of the coronal suture, corresponding to the A4-A5 junction of the left ACA. Through a left paramedian craniotomy, a modified anterior interhemispheric approach that was more posterior than the conventional projection was performed. A giant partially thrombosed was found. The aneurysm was resected, and the neck was reconstructed using four clips placed on top of them to enhance the clipping force over any remaining thrombus. The patient recovered as expected and was neurologically intact three months later. Conclusion. Giant distal anterior cerebral artery (DACA) aneurysms found in the A4-A5 segment represent a pathologically uncommon phenomenon. Due to the rarity of giant aneurysms at this location, their reporting is important to inform meticulous pre-operative planning.
{"title":"A giant A4-A5 distal anterior cerebral artery aneurysm treated with microsurgical clip reconstruction","authors":"Mustafa Ismail, Ali K. Al-Shalaji, Bahaa S. Abdalnaby, Aktham O. Al-Khafaji, Ali A. Kadhim, Rasha A. Al-Shakarchy, Sarmad A. Zangana, Ahsan A. Al-Rubaye, Samer S. Hoz","doi":"10.33962/roneuro-2023-039","DOIUrl":"https://doi.org/10.33962/roneuro-2023-039","url":null,"abstract":"Background. Aneurysms of the distal anterior cerebral artery (DACA) are uncommon; they often form near the pericallosal-callosomarginal junction and are typically small. To our knowledge, giant DACA aneurysms developing from the more distant parts of the anterior cerebral artery (ACA), A4-5, have been described only once in the literature. Case description. A 66-year-old gentleman reported with a brief loss of consciousness followed by weakness in his right lower leg. The patient was admitted with a Glasgow Coma Score (GCS) of 15. A computed tomography (CT) scan of the head revealed a left hyperdense mass in the frontal parasagittal supracallosal region. Contrast MRI revealed a heterogeneously enhancing mass measuring 35x30x25 mm. CT angiography (CTA) revealed a small saccular aneurysm on the posteromedial aspect of the mass, perpendicular to the vertical plane of the coronal suture, corresponding to the A4-A5 junction of the left ACA. Through a left paramedian craniotomy, a modified anterior interhemispheric approach that was more posterior than the conventional projection was performed. A giant partially thrombosed was found. The aneurysm was resected, and the neck was reconstructed using four clips placed on top of them to enhance the clipping force over any remaining thrombus. The patient recovered as expected and was neurologically intact three months later. Conclusion. Giant distal anterior cerebral artery (DACA) aneurysms found in the A4-A5 segment represent a pathologically uncommon phenomenon. Due to the rarity of giant aneurysms at this location, their reporting is important to inform meticulous pre-operative planning.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-031
Hakim Si Ahmed, Megherbi Lilia, Daoudi Smail
Introduction. West syndrome is a rare and severe infantile epileptic encephalopathy, beginning around the age of six months, characterized by a classic electro-clinical triad. This is a pathology totally different from multiple sclerosis (MS) which is a demyelinating disease of the central nervous system caused, affecting young adults, especially females. The association of these two pathologies has never been described. Observation. We report here an exceptional presentation of MS in a 14-year-old girl with a history of West syndrome. She had normal development until the age of six months, when she began to have flexion spasms. The diagnosis of West syndrome was made with a normal MRI. The infantile spasms disappeared after treatment with vigabatrin and adrenocorticotropic hormone (ACTH). It had generally progressed to Lennox Gastaut encephalopathy, with delayed psychomotor development and epileptic sequelae. At 14, she presented with left hemiparesis within a few days. A cerebral MRI showed multiple nodular hyperintensities of the supra and infratentorial white matter, with the presence of an active lesion, fulfilling the diagnostic criteria for multiple sclerosis. CSF analysis was normal. Anti-AQP4, anti-MOG, anti-NMDA and anti-GABA (AB) antibodies were absent in the blood. Antibodies against HIV and viral hepatitis were. Biotinidase activity and autoimmunity tests were correct. The patient received high doses of methylprednisolone IV (1g/day) for three days with remarkable clinical improvement after 15 days. Discussion. MS is a complex and heterogeneous central nervous system (CNS) demyelinating disease. It is not uncommon for epilepsy to be the first symptom of multiple sclerosis. Seizures, on the other hand, are more common after disease progression. Although the disease is characterized by inflammatory lesions of the white matter, various neuropathological and radiological studies have shown that the disease also affects the grey matter. Several studies have shown that seizures are three to six times more common in MS patients than in the general population. Even though MS can start with epilepsy and a seizure may be the only symptom of a relapse of MS, it is still not known whether the two diseases coexist or whether MS predisposes to seizures. Conclusion. The association of these two totally different pathologies can lead us to say that the mechanism of multiple sclerosis may begin in childhood and that the clinical signs appear in adulthood.
{"title":"West syndrome and multiple sclerosis association","authors":"Hakim Si Ahmed, Megherbi Lilia, Daoudi Smail","doi":"10.33962/roneuro-2023-031","DOIUrl":"https://doi.org/10.33962/roneuro-2023-031","url":null,"abstract":"Introduction. West syndrome is a rare and severe infantile epileptic encephalopathy, beginning around the age of six months, characterized by a classic electro-clinical triad. This is a pathology totally different from multiple sclerosis (MS) which is a demyelinating disease of the central nervous system caused, affecting young adults, especially females. The association of these two pathologies has never been described. Observation. We report here an exceptional presentation of MS in a 14-year-old girl with a history of West syndrome. She had normal development until the age of six months, when she began to have flexion spasms. The diagnosis of West syndrome was made with a normal MRI. The infantile spasms disappeared after treatment with vigabatrin and adrenocorticotropic hormone (ACTH). It had generally progressed to Lennox Gastaut encephalopathy, with delayed psychomotor development and epileptic sequelae. At 14, she presented with left hemiparesis within a few days. A cerebral MRI showed multiple nodular hyperintensities of the supra and infratentorial white matter, with the presence of an active lesion, fulfilling the diagnostic criteria for multiple sclerosis. CSF analysis was normal. Anti-AQP4, anti-MOG, anti-NMDA and anti-GABA (AB) antibodies were absent in the blood. Antibodies against HIV and viral hepatitis were. Biotinidase activity and autoimmunity tests were correct. The patient received high doses of methylprednisolone IV (1g/day) for three days with remarkable clinical improvement after 15 days. Discussion. MS is a complex and heterogeneous central nervous system (CNS) demyelinating disease. It is not uncommon for epilepsy to be the first symptom of multiple sclerosis. Seizures, on the other hand, are more common after disease progression. Although the disease is characterized by inflammatory lesions of the white matter, various neuropathological and radiological studies have shown that the disease also affects the grey matter. Several studies have shown that seizures are three to six times more common in MS patients than in the general population. Even though MS can start with epilepsy and a seizure may be the only symptom of a relapse of MS, it is still not known whether the two diseases coexist or whether MS predisposes to seizures. Conclusion. The association of these two totally different pathologies can lead us to say that the mechanism of multiple sclerosis may begin in childhood and that the clinical signs appear in adulthood.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-029
Teeba A. Al-Ageely, Mustafa Ismail, Salima B. Alsaadi, Fatima F. Salim, Zahraa M. Kareem, Sura H. Talib, Huda Jaafer, Samer S. Hoz
Background. Intra-operative rupture (IOR) of intracranial aneurysms is a critical event affecting the operation course and the patient’s outcome. However, A rupture induced by an avulsion in the aneurysmal neck is exceedingly challenging, as sealing the neck tear by clip application might result in ischemic injury due to parent vessel occlusion. Here we reviewed the literature regarding the intraoperative avulsion of the aneurysmal neck with an illustrative case to provide explanations of its surgical management intricacies. Methods. A Midline PubMed literature review was performed using the following keywords; (Aneurysm) AND (neck) AND (surgery or clipping) AND (tear OR avulsion). Fifty-three results were found initially. After excluding non-human subject studies, and non-English studies, two independent researchers examined the title and the abstract for the cases of neck tear or avulsion with its management. Results. Fourteen articles were found to be included in this study. The average age of the cases is around 57 years. The percentages of females in the review were 62% (8/13), and among the males, 38% (5/13). Regarding the locations, PcomA and AcomA were both 23% (3/13) of the cases; other locations include ACA, 15%, and MCA, 15%. The surgical techniques that opted from the literature include the cotton clip method, clip wrapping, parallel clipping and micro-suturing Conclusion. IOR due to aneurysmal neck avulsion is a devastating surgical complication, and its management may differ according to the extent of the rupture. Choosing the most convenient technique depends on the surgeon’s knowledge and experience.
{"title":"Management of brain aneurysm neck-avulsion during clipping surgery","authors":"Teeba A. Al-Ageely, Mustafa Ismail, Salima B. Alsaadi, Fatima F. Salim, Zahraa M. Kareem, Sura H. Talib, Huda Jaafer, Samer S. Hoz","doi":"10.33962/roneuro-2023-029","DOIUrl":"https://doi.org/10.33962/roneuro-2023-029","url":null,"abstract":"Background. Intra-operative rupture (IOR) of intracranial aneurysms is a critical event affecting the operation course and the patient’s outcome. However, A rupture induced by an avulsion in the aneurysmal neck is exceedingly challenging, as sealing the neck tear by clip application might result in ischemic injury due to parent vessel occlusion. Here we reviewed the literature regarding the intraoperative avulsion of the aneurysmal neck with an illustrative case to provide explanations of its surgical management intricacies. Methods. A Midline PubMed literature review was performed using the following keywords; (Aneurysm) AND (neck) AND (surgery or clipping) AND (tear OR avulsion). Fifty-three results were found initially. After excluding non-human subject studies, and non-English studies, two independent researchers examined the title and the abstract for the cases of neck tear or avulsion with its management. Results. Fourteen articles were found to be included in this study. The average age of the cases is around 57 years. The percentages of females in the review were 62% (8/13), and among the males, 38% (5/13). Regarding the locations, PcomA and AcomA were both 23% (3/13) of the cases; other locations include ACA, 15%, and MCA, 15%. The surgical techniques that opted from the literature include the cotton clip method, clip wrapping, parallel clipping and micro-suturing Conclusion. IOR due to aneurysmal neck avulsion is a devastating surgical complication, and its management may differ according to the extent of the rupture. Choosing the most convenient technique depends on the surgeon’s knowledge and experience.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-15DOI: 10.33962/roneuro-2023-027
Injam Ibrahim S. Rowndzy, Hoshanc Sdeeq Rashid, Mustafa Ismail, Saleh Abdulkareem Saleh, Noor Mohammed Shaker, Ahmed Muthana, Mohammed Mohsen Ahmed, Najat Hassan Rahem, Samer S. Hoz
Background. Penetrating spine injuries can cause catastrophic complications to the patient, and it demands immense medical care to minimize the insult. Mainly, it occurs in the military field; however, it has become more prevalent among civilians due to gun availability. The thoracic spine is the most affected part, followed by the cervical and lumbar spine. Case report. A 15-year-old teenage boy had a penetrating injury to the thoracic (T10) vertebrae due to a missile bullet that resulted in bilateral lower limb weakness and required him to undergo decompressive laminectomy. During surgery, a missed hemothorax was discovered incidentally. Conclusion. To the best of the author's knowledge, this case of penetrating thoracic spine injury due to a missile bullet associated with missed hemothorax has not been previously reported. This paper discusses the importance of early detection and treatment of injuries associated with penetrating spine trauma to improve patient survival and disability.
{"title":"Penetrating thoracic spine injury causing haemothorax","authors":"Injam Ibrahim S. Rowndzy, Hoshanc Sdeeq Rashid, Mustafa Ismail, Saleh Abdulkareem Saleh, Noor Mohammed Shaker, Ahmed Muthana, Mohammed Mohsen Ahmed, Najat Hassan Rahem, Samer S. Hoz","doi":"10.33962/roneuro-2023-027","DOIUrl":"https://doi.org/10.33962/roneuro-2023-027","url":null,"abstract":"Background. Penetrating spine injuries can cause catastrophic complications to the patient, and it demands immense medical care to minimize the insult. Mainly, it occurs in the military field; however, it has become more prevalent among civilians due to gun availability. The thoracic spine is the most affected part, followed by the cervical and lumbar spine. Case report. A 15-year-old teenage boy had a penetrating injury to the thoracic (T10) vertebrae due to a missile bullet that resulted in bilateral lower limb weakness and required him to undergo decompressive laminectomy. During surgery, a missed hemothorax was discovered incidentally. Conclusion. To the best of the author's knowledge, this case of penetrating thoracic spine injury due to a missile bullet associated with missed hemothorax has not been previously reported. This paper discusses the importance of early detection and treatment of injuries associated with penetrating spine trauma to improve patient survival and disability.","PeriodicalId":30188,"journal":{"name":"Romanian Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135859868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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