Cavernomas are vascular malformations that occur commonly in cerebrum, cerebellum, and brainstem, being rare in occurrence within the hypothalamus having only 29 cases known in the literature. They may be clinically asymptomatic or present with symptoms of headache, seizures, hemorrhage, or focal neurologic deficits. The gold standard for diagnosing a cavernoma is magnetic resonance imaging (MRI). The management strategies for hypothalamic cavernoma are expectant, medical, and surgical, along with laser ablation and radiosurgery. Our case is of a 17-years old female who presented with headache and reduced vision secondary to hypothalamic cavernoma on diagnostic imaging. She is on expectant management till date, without worsening of her symptoms. As per the literature, there has been no data on conservatively-managed hypothalamic hamartomas.
Retroclival hematomas and clival fractures are not common, and retroclival hematoma is one of the types of posterior fossa extra-axial hematomas. The exact incidence is not known. They can be categorized into epidural or subdural hematomas based on their relationship to the tectorial membrane. In the literature, most cases occur in the pediatric population, and a few cases have been reported in the adult population as well. The etiology is related to accidental trauma in most cases. Others occur generally spontaneously due to coagulopathy, pituitary apoplexy, and ruptured aneurysms. Still, some remain idiopathic without an identifiable cause.
This is a 28-year-old male patient who presented after sustaining a motor vehicle accident. He was a pedestrian walking by the side of a road when he was suddenly hit by a minibus. He lost consciousness immediately and was non-communicating after the trauma with right ear bleeding. GCS is 9/15, right pupil has cataract, and left pupil is midsized and reactive. A brain CT scan demonstrated retroclival hematoma extending from midclivus to the lower level of C2, right mastoid fracture, multiple post-traumatic subarachnoid hemorrhage, pneumocephalus, and transverse upper third clival fracture. This patient's GCS on the second day improved to 14/15. All cranial nerves are intact. Discharged on the 7th day with GCS 15/15.
Retroclival hematomas and clival fractures are very rare in adults, most often reported in pediatric age groups, and mostly occur due to accidental trauma. Associated cranial nerve palsy is common and the management is non-surgical in most of the cases.
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.
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.
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.
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.
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.
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.
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.
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.
Our goal is to delineate validatable guidelines for physicians to make decisions based on the latest data in the literature.
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.
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.
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.
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.
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.
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.
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.
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.
Various postoperative complications can be seen and be anticipated in transsphenoidal pituitary surgery.
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.
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