Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献

Background

The advent of computed tomography (CT) and magnetic resonance imaging (MRI) has revolutionized stereotactic brain interventions, which enabled precise targeting of deep brain structures and enhanced patient safety in modern neurosurgery. This study aims to investigate the risk factors associated with biopsy failure and hemorrhage in CT-guided brain stereotactic surgeries.

Methods

In the current study, we present a retrospective descriptive analysis of cases that showed biopsy failures and hemorrhage after CT-guided stereotactic brain biopsy surgeries at our department from January 2019 to January 2021. Biopsies were obtained using a Sedan-type needle.

Results

Out of the 80 patients who underwent CT-guided stereotactic surgeries, two patients (2.5 %) experienced biopsy failure, necessitating a repeat procedure. There was a notably higher risk of biopsy failure when fewer than four biopsy attempts were made (adjusted odds ratio = 6.4, 95 % CI 1.8 to 16.7). A postprocedural CT scan revealed intracranial hemorrhage in five patients (6.25 %); four of these cases were silent, with no accompanying neurological complications. Four out of the five hemorrhage cases were associated with astrocytoma.

Conclusions

Stereotactic surgery provides a precise and minimally invasive approach to target lesions with a relatively low risk of biopsy failures and hemorrhage.

Acute spontaneous subdural hematoma (SDH) of arterial origin is rare in the field of neurosurgery. We report a 57-year-old male patient developed sudden onset headache and right hemiparesis. He had no history of head trauma.A computed tomography demonstrated an acute left-sided SDH. A computed tomography angiogram (CTA) demonstrated active contrast extravasation from a small cortical middle cerebral artery (MCA) branch into the left-sided SDH. Endoscopic surgery was performed to evacuate the hematoma,we verified the arterial origin of the bleeding and coagulated the bleeding point. Postoperatively the patient’s symptoms clearly improved. He was discharged 7 days after surgery. In a case of acute spontaneous SDH, the possibility of a cortical artery origin should be considered, The initial radiologic investigation in a patient with a spontaneous acute SDH should be a CT and CTA. Endoscopic hematoma evacuation of acute spontaneous SDH may be a safe and effective method in some cases.

Background

Blood blister-like aneurysms (BBAs) are a rare but clinically important cause of subarachnoid hemorrhage. Although regrowth or repeat rupture can occur following reconstructive endovascular treatment of BBAs, there is currently a lack of studies reporting the surgical exploration of BBAs after endovascular management. Herein, we present the first case report of a ruptured BBA treated with reconstructive endovascular treatment followed by surgical exploration.

Case Presentation

A 42-year-old woman with subarachnoid hemorrhage was found to have the following: a saccular aneurysm of the lateral wall of the right supraclinoid internal carotid artery (ICA); and irregular vessel wall of the anterior wall of the right supraclinoid ICA on angiography. Based on intraoperative findings, the patient was diagnosed with a ruptured BBA of the right ICA. She underwent coating of the dissected ICA followed by overlapping stents; however, angiography showed rapid regrowth of the aneurysm. After high-flow bypass, surgical exploration was performed under proximal control of the cervical ICA. The deployed stent was directly observed through a vessel wall defect of the anterior wall which was consistent with angiographical irregular vessel wall. There was a clear positional discrepancy between angiographical base of the aneurysm and intraoperative laceration site.

Conclusions

Surgical exploration indicates there is a potential risk of regrowth and/or repeat rupture of BBAs until the stent is fully endothelialized. Moreover, stent should be deployed to ensure that the irregular vessel wall is included when reconstructive endovascular treatment is employed for ruptured BBAs associated with irregular vessel wall.

Background

Decompressive craniectomy (DC) is performed routinely following traumatic brain injury (TBI), including depressed fracture (DSF), and following other mass-occupying conditions such as large ischemic strokes. DC could be followed by cranioplasty (CP), which is associated with cosmetic and protective benefits. The appropriate choice of implant, ideal timing, complications, and avoiding reoperation are challenges that neurosurgeons face in CP.

Objective

Our goal is to delineate validatable guidelines for physicians to make decisions based on the latest data in the literature.

Results

CP is not just a cosmetic procedure but also a therapeutic option for patients with depressed fractures. Patients with decompressive craniectomies secondary to other conditions can also develop decompressive craniectomy syndrome needing CP. The choice of materials used for reconstruction is critical to ensure safety and effectiveness. Different alloplastic grafts, such as polymethyl methacrylate, hydroxyapatite, dynamic titanium mesh, and complex mesh patterns, are used in CP, and the advantages and disadvantages must be considered prior to the surgery. Complications are divided into intra- and post-operative groups, and understanding these complications enables the surgeon to diminish the chances of occurrence and enhance surgical consequences. The proper timing of CP following decompressive craniectomy remains controversial.

Conclusion

CP is a simple and useful neurosurgical intervention in those with skull defects. CP provides protective and cosmetic benefits. The main objective of the surgical intervention is to restore the skull to its original shape, protect the brain from further injury and avoid decompressive craniectomy syndrome.

Brain hydatidosis is a rare disease which may have no symptoms or sign for a long time. In this case report, the woman 46-year-old has had a typical multiple cysts in the right parieto-occipital lobe of brain for years that it seems to be silent for long time because eight cysts formed on brain cavity. The patient with vague headaches and blurred vision and cerebrovascular accident, clogged arteries, and stutter symptoms was referred to the Vali-e-Asr Hospital in Arak, located in Markazi Province, central of Iran. The results of the CT scan and MRI revealed multiple hydatid cyst in brain due to the surgery on of the cyst was ruptured, and the cavity was washed with silver nitrate solution for prevention of secondary hydatid cyst. After the surgery, the patient woke up with full consciousness and general well-being. In patients with hydatid cyst, it should be considered as a differential diagnosis of lesions related to the cystic space of the brain.

Objective

Neurocysticercosis (NCC) is still a frequent cause of neurosurgical consultations in most developing countries. Conventional approaches for the resection of large cysts have been used for many years. We report here our experience in the neurosurgical management of NCC using diverse minimally invasive approaches according to the localization of lesions: minimal craniotomy for lesions in the Sylvian fissure, stereotactic surgery for lesions in the posterior fossa, and endonasal neuroendoscopy for lesions in the basal cisterns.

Methods

We reviewed the charts of 24 consecutive NCC patients who had minimally invasive surgery to resect NCC lesions in a neurological referral center in Lima, Peru. Three approaches were used: microcraneotomies through the anterior Sylvian point (n = 16), stereotactic surgery (n = 6), and endonasal endoscopy (n = 2), between January 1, 2016, and July 31, 2022. Demographic and clinical data as well as post-surgical evolution are presented using descriptive statistics.

Results

Clinical improvement was observed in 23 out of 24 cases, with complete resolution of symptoms in nine and partial in 14. One patient evolved poorly and worsened his symptoms. Twenty-two patients received antiparasitic treatment after surgery. Relapse of NCC lesions was observed in three patients. There were no significant complications in any of the cases.

Conclusions

Minimally invasive surgical approaches provide an excellent alternative for the management of patients with NCC, with good surgical and functional results, also markedly reducing the parasitic mass for further antiparasitic treatment.

Background

Adenomas are common pituitary tumors, accounting for 10–15 % of all intracranial tumors. They are non-metastatic and benign, originating in the pituitary gland. The exact genetic mutations causing adenomas are not fully understood, but they involve tumor suppressor inactivator genes and protooncogene activator mutations. Transsphenoidal surgery is the preferred treatment for patients with neuro-ophthalmological symptoms to relieve pressure on the optic tract, resulting in visual improvement for around 80 % of patients. Surgery is recommended for patients with such symptoms or when the tumor invades the optic nerve. Risks of transsphenoidal surgery include diabetes insipidus, electrolyte imbalances, neurological deficits, and CSF rhinorrhea.

Materials and methods

This is a clinical trial study with a prospective cohort design to evaluate outcomes of pituitary adenoma patients who were undergone transsphenoid surgery at USU Hospital in 2022–2023. Total of 13 patients were included in the study. Preoperative and postoperative Na⁺, K⁺, and Cl⁻ were measured to assess outcomes of transsphenoid surgery in pituitary adenoma patients.

Result

Various postoperative complications can be seen and be anticipated in transsphenoidal pituitary surgery.

Conclusion

Water and electrolyte imbalance is one of the most common complication found in patient who undergone transsphenoid surgery for pituitary adenoma. It can lead to secondary hospital admission and may be life-threatening if not treated adequately and immediately. Preoperative and postoperative laboratory Na⁺, K⁺, Cl⁻ and urinary output are important parameters to be monitored in pituitary adenoma patient who undergone transsphenoid surgery.

Intracranial Subdural hematoma is a rare but potentially catastrophic complication after Cerebrospinal fluid drainage (CSFD) for thoracoabdominal aortic aneurysm repair. We report a patient with an acute left frontoparietal subdural hematoma following insertion of lumbar drain for prevention of spinal cord ischemia after thoracoabdominal aortic aneurysm repair. He presented with delayed neurological deficits which were completely reversed after surgery. The rationale for systematic use of lumbar drainage of Cerebrospinal fluid (CSF) in Thoracoabdominal Aortic Aneurysm (TAAA) repair is discussed.

Objective

To investigate the efficacy of stereotactic radiotherapy (CyberKnife) in treating primary trigeminal neuralgia and to summarize the treatment experience.

Methods

A retrospective analysis was conducted on the efficacy and efficacy of CyberKnife treatment in 33 patients with primary trigeminal neuralgia from August 2012 to April 2023. Targets are selected in the trigeminal nerve root and half-moon segment. The length of treatment is about 6–8 mm, the prescribed dose is 54–65 Gy. Classified according to the (BNI) scale, trigeminal neuralgia and sensory impairment. Follow-up assessed the time and extent of pain relief and the time and extent of numbness. Wilcoxon Signed Ranks Test was used to analyze pain scores before and after radiotherapy. The KM curve analysis using the R survival package was used to analyze the survival.

Results

Among them, 12 were males (36.4%) and 21 females (63.6%), with an average age of 67.76 ± 10.62 years. Facial numbness scores after treatment averaged 2.61 ± 0.86. Pain relief started on average 28.26 ± 47.27 days. The pain scores of 33 patients before and after radiotherapy were statistically significant (P < 0.001), and the effect was significant after treatment. The average occurrence time of facial numbness was 248.47 ± 182.88 days, and the proportion of drooling was 39.4%. In this study, pain score before and after treatment, and numbness score after treatment were analyzed by Log-rank test survival.

Conclusion

CyberKnife is the advantage of being non-invasive and effective in reducing pain for primary trigeminal neuralgia.

Background

A hyperplastic anterior choroidal artery (AChA) resulting from incomplete distal annexation between the primitive AChoA and the posterior cerebral artery, increases the risk of cerebral aneurysms at the branching site of the AChA and other distant locations. It has also been reported that infundibular dilatation (IFD) rarely progresses into a saccular aneurysm with a risk of rupture.

Case report

A 59-year-old man presented with sudden onset of headache and vomiting due to the rupture of an aneurysm originating from an IFD of the posterior communicating artery (PcomA) associated with a hyperplastic AChA. The aneurysm was successfully treated using coil embolization.

Conclusion

To the best of our knowledge, this is the first reported case of a ruptured aneurysm originating from an IFD of the PcomA associated with a hyperplastic AChA, accompanied by a review of previous case reports. Neurosurgeons should be aware of this anomaly to prevent critical events.