Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献_第10页

Shorter time to initiation of adjuvant chemoradiation therapy as a risk factor for hydrocephalus following high-grade glioma resection: A case-control study 开始辅助放化疗的时间较短是高级别胶质瘤切除术后脑积水的危险因素：一项病例对照研究

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-24 DOI: 10.1016/j.inat.2025.102156

Nikita Das , Ravi Dhamija , Preethy Sridharan , Joseph Swetz , Elleson G. Harper , Herbert B. Newton , Prashant Vempati , Tiffany R. Hodges

Background

While existing literature has explored how timing of adjuvant therapy affects survival in high-grade glioma (HGG) patients, no studies have specifically addressed the relationship between time to initiation (TTI) of therapy and postoperative complications. This study investigates how TTI of adjuvant chemoradiation therapy may impact risk for developing hydrocephalus following HGG resection.

Methods

A single-center, retrospective study identified 257 adults with HGG undergoing their first tumor resection from 2010 to 2020. Demographic and clinical data were collected, including surgical and adjuvant therapy history. Propensity Score Matching generated comparative cohorts using covariates sex, age at surgery, surgery type, tumor location, extent of resection, tumor-associated seizures, ventricular opening, number of additional surgeries, and pre-surgical Karnofsky Performance Scale score. Odds ratios with 95 % confidence intervals and paired t-tests assessed differences in adjunctive chemoradiation trends between patients who developed hydrocephalus within 3 years postoperatively and those who did not.

Results

23 of 257 patients (8.9 %) who underwent HGG resection developed hydrocephalus, with a median time to onset of 5.1 months (IQR: 1.6–11.9). Of these patients, 15 (65.2 %) developed early-onset hydrocephalus, defined as within 6 months postoperatively, whereas 8 (34.8 %) developed late-onset hydrocephalus after 6 months postoperatively. Patients who developed hydrocephalus were more likely to have a shorter TTI of adjuvant chemoradiotherapy than controls (P = 0.03), with median time interval of 7.9 (5.6, 12.7) in controls and 5.7 weeks (IQR: 4.1–8.5) in cases.

Conclusions

Shortened time to initiation of adjuvant therapy postoperatively may increase patients’ susceptibility for postoperative hydrocephalus following initial HGG resection.

虽然现有文献探讨了辅助治疗的时机如何影响高级别胶质瘤（HGG）患者的生存，但没有研究专门探讨治疗开始时间（TTI）与术后并发症之间的关系。本研究探讨TTI辅助放化疗如何影响HGG切除术后发生脑积水的风险。方法采用单中心回顾性研究方法，选取2010年至2020年257例成人HGG患者进行首次肿瘤切除术。收集了人口统计学和临床资料，包括手术和辅助治疗史。倾向评分匹配使用协变量性别、手术年龄、手术类型、肿瘤位置、切除程度、肿瘤相关癫痫发作、心室开放、额外手术次数和术前Karnofsky表现量表评分生成比较队列。95%置信区间的优势比和配对t检验评估了术后3年内发生脑积水的患者和未发生脑积水的患者之间辅助放化疗趋势的差异。结果257例HGG切除术患者中有23例（8.9%）发生脑积水，中位发病时间为5.1个月（IQR: 1.6-11.9）。在这些患者中，15例（65.2%）发生早发性脑积水，定义为术后6个月内，而8例（34.8%）在术后6个月发生晚发性脑积水。发生脑积水的患者辅助放化疗的TTI较对照组更短（P = 0.03），对照组中位时间间隔为7.9(5.6,12.7)，病例中位时间间隔为5.7周（IQR: 4.1-8.5）。结论术后起始辅助治疗时间的缩短可能增加HGG术后患者对脑积水的易感性。

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引用次数: 0

Rosai-Dorfman disease – Isolated intracranial localization: A case report and literature review Rosai-Dorfman病-孤立颅内定位：1例报告及文献复习

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-22 DOI: 10.1016/j.inat.2025.102170

Kaloyan Ivanov , Ivan Angelov , Ridian Nedelko , Deyan Dzhenkov

Rosai-Dorfman Syndrome – Sinus histiocytosis is a benign disease with idiopathic etiology, primarily presenting with cervical lymphadenopathy and a febrile-intoxication syndrome but it can also affect other organs and systems such a skin, bones, orbit, central nervous system. Isolated intracranial localization is rare. It occurs more frequently in children and young adults but it can affect individuals of any age. In this article, we present a clinical case of a 67-year-old woman with a clinical picture of sudden-onset speech disturbances and a generalized tonic-clonic seizure. Imaging studies revealed an intracranial mass located in the left parietal region, appearing as a meningioma. Cytological and immunohistochemical examinations demonstrated an infiltrate of lymphocytes, plasma cells, and histiocytes expressing protein S-100 and CD68. Also described is the phenomenon of emperipolesis – the presence of intracytoplasmic lymphocytes within histiocytes.

rossai - dorfman综合征-窦性组织细胞增多症是一种具有特发性病因的良性疾病，主要表现为颈部淋巴结病和热中毒综合征，但它也可以影响其他器官和系统，如皮肤、骨骼、眼眶、中枢神经系统。孤立的颅内定位是罕见的。它在儿童和年轻人中更常见，但它可以影响任何年龄的个体。在这篇文章中，我们提出一个临床病例的67岁妇女的临床表现突发性语言障碍和全身性强直阵挛性癫痫发作。影像学检查显示颅内肿块位于左侧顶骨区，表现为脑膜瘤。细胞学和免疫组织化学检查显示淋巴细胞、浆细胞和表达蛋白S-100和CD68的组织细胞浸润。还描述了组织细胞内存在胞浆内淋巴细胞的现象。

引用次数: 0

Surgical biopsy techniques in neurosurgery: A four-year population-based study of frameless and frame-based procedures 神经外科手术活检技术：一项为期四年的基于人群的无框架和基于框架的手术研究

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-18 DOI: 10.1016/j.inat.2025.102158

Hanna Barchéus , Alba Corell , Malin Blomstrand , Thomas Olsson Bontell , Helena Carén , Anneli Ozanne , Asgeir S. Jakola , Anja Smits , Johan Ljungqvist

Background

Suspected malignant lesions in the brain unamenable for resection are most often biopsied to establish the histomolecular diagnosis, guiding further treatment. Herein, we compare the postoperative outcomes in terms of safety and diagnostic yield between traditional and more recent biopsy techniques utilized at our facility.

Methods

Population-based patient data was collected from 2020 to 2023. Patients were subdivided depending on chosen surgical strategy. Data included clinical, radiological and surgical variables, in addition to histopathological diagnosis and post-operative treatment strategy.

Results

We identified 161 adult patients undergoing 163 biopsies; 101 robot-assisted biopsies, 35 frameless skull-mounted trajectory guided biopsies, 15 biopsies obtained via craniotomies, and 12 frame-based stereotactic biopsies. There was no significant difference in diagnostic yield between methods, ranging from 94.3 % in skull-mounted biopsies to 83.3 % in stereotactic biopsies. Glioblastomas were the most common diagnosis (55.2 %), but a plethora of malignancies were identified. The histopathological diagnosis was inconclusive in 19 patients (11.7 % of study population). Robot-assisted and skull-mounted procedures resulted in significantly shorter operating time compared to craniotomies (p < 0.001). There was no statistically significant difference in rate of complications between methods. Small postoperative hemorrhages were detected in 28.2 % of cases (median 6 mm), none required intervention. Subsequent oncologic treatment was administered to 91.7 % of patients with a conclusive histopathological diagnosis, compared to 73.7 % with an inconclusive diagnosis.

Conclusion

Both frameless and frame-based methods demonstrated comparable safety and efficacy. Robot-assisted biopsy was the predominant method. Our findings further illustrate the large variety of histopathological diagnoses in patients presenting with radiologically suspected brain tumor, underscoring the importance of a biopsy to obtain a conclusive tissue diagnosis to guide treatment.

背景：对于无法切除的疑似脑恶性病变，最常进行活检以确定组织分子诊断，指导进一步治疗。在此，我们从安全性和诊断率方面比较了传统活检技术和我们医院采用的最新活检技术的术后结果。方法收集2020 - 2023年基于人群的患者数据。根据选择的手术策略对患者进行细分。数据包括临床、放射学和外科变量，以及组织病理学诊断和术后治疗策略。结果161例成年患者接受了163例活组织检查；101例机器人辅助活检，35例无框颅骨弹道引导活检，15例开颅活检，12例基于框架的立体定向活检。两种方法的诊断率无显著差异，从颅骨活检的94.3%到立体定向活检的83.3%。胶质母细胞瘤是最常见的诊断（55.2%），但也发现了过多的恶性肿瘤。19例患者（占研究人群的11.7%）组织病理学诊断不确定。与开颅手术相比，机器人辅助和颅骨安装手术显著缩短了手术时间（p < 0.001）。两种方法的并发症发生率比较，差异无统计学意义。28.2%的病例术后发现小出血（中位6毫米），无需干预。91.7%的结论性组织病理学诊断的患者接受了后续的肿瘤治疗，而73.7%的诊断不确定的患者接受了后续的肿瘤治疗。结论无框架和基于框架的方法均具有相当的安全性和有效性。机器人辅助活检是主要的方法。我们的研究结果进一步说明了在放射学上疑似脑肿瘤的患者中有多种组织病理学诊断，强调了活检对获得结论性组织诊断以指导治疗的重要性。

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引用次数: 0

Development of a low-cost chicken wing model for STA–MCA bypass simulation in neurosurgical training: a technical note 开发用于神经外科训练STA-MCA旁路模拟的低成本鸡翅模型：技术说明

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-16 DOI: 10.1016/j.inat.2025.102169

Bob Irfan Syahputra , Achmad Adam , Bilzardy Ferry Zulkifli , Hasan Baraqbah , Helza Efriani , Dhany Febriantara

Background

Microsurgical bypass procedures such as the superficial temporal artery to middle cerebral artery (STA–MCA) bypass are complex and require refined microsurgical skills. However, hands-on training opportunities are often limited, particularly in low-resource settings.

Objective

This technical note describes the development and validation of a low-cost, anatomically realistic chicken wing model designed to simulate STA–MCA bypass for neurosurgical training.

Methods

Chicken wings were dissected to expose arterial segments mimicking donor and recipient vessels. The model was mounted on a stable platform and used under an operating microscope to practice end-to-side anastomosis using 10-0 nylon sutures. Six neurosurgical residents of different training levels (junior to senior) performed the simulation, and quantitative parameters including completion time, perceived difficulty, and anastomosis patency were evaluated.

Results

The model allowed realistic simulation of vessel dissection, preparation, and microvascular suturing. The average cost was less than USD 2 per unit, and each specimen could be reused multiple times. Completion time decreased with higher training levels, and the overall patency rate was 83%, confirming the model’s educational value and reproducibility. The model provided superior tactile feedback and anatomical realism compared to conventional silastic tube simulators.

Conclusion

The chicken wing model is a practical, ethical, and cost-effective alternative for microsurgical bypass training. It provides a realistic and accessible platform for developing microvascular skills, especially in centers without access to cadaveric or live models. Ethical approval was not required as the chicken wings were obtained from commercially available food sources without animal sacrifice.

显微外科旁路手术如颞浅动脉到大脑中动脉（STA-MCA）旁路手术是复杂的，需要精细的显微外科技术。然而，实践培训的机会往往是有限的，特别是在资源匮乏的环境中。目的：本技术说明描述了一种低成本、解剖学逼真的鸡翅模型的开发和验证，该模型设计用于模拟神经外科训练中的STA-MCA搭桥。方法解剖鸡翅，暴露模拟供体和受体血管的动脉段。将模型安装在稳定的平台上，在手术显微镜下采用10-0尼龙线进行端侧吻合。6名不同训练水平（初级到高级）的神经外科住院医师进行了模拟，并对完成时间、感知难度、吻合口通畅等定量参数进行了评估。结果该模型能够真实地模拟血管剥离、制备和微血管缝合。平均成本低于2美元/个，且每个标本可重复使用多次。训练水平越高，完成时间越短，总体通畅率为83%，证实了模型的教育价值和可重复性。与传统的硅胶管模拟器相比，该模型提供了优越的触觉反馈和解剖真实感。结论鸡翅模型是一种实用、道德、经济的显微外科搭桥训练方法。它为发展微血管技能提供了一个现实和可访问的平台，特别是在没有尸体或活体模型的中心。由于鸡翅是从商业上可获得的食物来源获得的，没有动物牺牲，因此不需要伦理批准。

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引用次数: 0

Determinants of outcomes following decompressive craniectomy for traumatic brain injury: a multicenter prospective cohort study in Addis Ababa, Ethiopia 创伤性脑损伤减压颅骨切除术后预后的决定因素：埃塞俄比亚亚的斯亚贝巴的一项多中心前瞻性队列研究

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-15 DOI: 10.1016/j.inat.2025.102167

Kedir D. Guduru , Mikiyas G. Teferi , Helina K. Teklehaimanot , Mersha A. Woldemariam , Abat Baleh , Surafel M. Mendere

Background

Traumatic brain injury is a leading cause of trauma deaths worldwide. In low- and middle-income countries, neuromonitoring is limited. Decompressive craniectomy is used as a last-resort intervention. This study assessed outcomes and key predictors in Ethiopia.

Objectives

To measure 3-month outcomes after decompressive craniectomy for traumatic brain injury and identify clinical and radiologic predictors.

Methods

A multicenter prospective cohort was conducted in Addis Ababa from January 2023 to September 2024. Ninety-four patients underwent surgery and were followed for 90 days. Outcomes were measured with the Extended Glasgow Outcome Score, grouped as favorable (≥5) or unfavorable (<5). Variables with initial associations were tested in multivariable models.

Results

Of 94 patients, 80 were male and the mean age was 38.9 years. At 3 months, 55.3 percent had favorable outcomes, 13.8 percent had unfavorable outcomes, and 30.9 percent died. Severe presentation, non-reactive pupils, unstable vital signs, poor response to osmotic diuretics, intraoperative hypotension, vasopressor need, and low postoperative Glasgow Coma Scale scores were linked to worse outcomes.

Conclusion

Certain clinical and intraoperative factors predict poor outcomes after decompressive craniectomy for traumatic brain injury in Ethiopia. Early identification of these factors may guide treatment and resource allocation.

背景：创伤性脑损伤是世界范围内创伤性死亡的主要原因。在低收入和中等收入国家，神经监测是有限的。减压颅骨切除术被用作最后的干预手段。本研究评估了埃塞俄比亚的结果和关键预测因素。目的观察颅脑损伤减压手术后3个月的预后，并确定临床和放射学预测因素。方法于2023年1月至2024年9月在亚的斯亚贝巴进行多中心前瞻性队列研究。94名患者接受了手术，随访90天。结果采用扩展格拉斯哥结局评分（Extended Glasgow Outcome Score）进行测量，分为有利（≥5）和不利（<5）两组。具有初始关联的变量在多变量模型中进行检验。结果94例患者中，男性80例，平均年龄38.9岁。3个月时，55.3%的患者预后良好，13.8%的患者预后不良，30.9%的患者死亡。严重的表现，无反应性瞳孔，不稳定的生命体征，渗透性利尿剂反应差，术中低血压，血管加压剂需求，术后低格拉斯哥昏迷评分与较差的结果相关。结论在埃塞俄比亚，某些临床和术中因素可预测颅脑损伤减压术后不良预后。这些因素的早期识别可以指导治疗和资源分配。

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引用次数: 0

Infantile dermoid cyst on top of anterior fontanelle mimicking encephalocele, a case report and literature review 婴儿前囟门顶皮样囊肿形似脑膨出1例并文献复习

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-15 DOI: 10.1016/j.inat.2025.102168

Mohammed Alra’e, Ahmad J. Abdallah, Maaweya Jabareen, Wasef Alhroub, Ibrahim Kattoush

Background

Dermoid cyst is defined as a benign congenital tumor caused by sequestration of germ cells in the embryonic fusion lines during development. Dermoid cysts are lined with simple squamous epithelium and filled with keratin and other skin appendages. They can be present at birth or later on. They are among the most common pediatric tumors, particularly in the head and neck regions. When present in the head, they should be differentiated from other lesions, such as encephalocele. Imaging studies and surgical consultation are important before managing such cases.

Case presentation

An 8-month-old female patient presented with swelling over the anterior fontanelle, mimicking encephalocele. The history was significant to duodenal atresia. The swelling started to appear few days after birth. After performing CT scan and MRI, the neurosurgeon attempted to aspirate the cyst for histopathologic examination, but this failed, and surgical excision was planned. Surgical excision of the lesion was performed, and histopathological examination revealed a diagnosis of dermoid cyst. This underscores the importance of ruling out any intracranial communication before performing any procedure in such lesions.

Discussion

Dermoid cyst is essentially a pediatric tumor. It is important to keep in mind dermoid cysts in the differential diagnosis of head and neck swellings, particularly the anterior fontanelle swellings. When lying over the head, it is of paramount importance to rule out intracranial communication by imaging studies before proceeding into the surgical intervention.

Conclusion

Dermoid cysts are common pediatric tumors. Proper diagnosis and surgical intervention are important in this type of tumors before complicating intracranial extension.

皮样囊肿被定义为一种良性先天性肿瘤，是由于胚胎融合系在发育过程中生殖细胞被隔离而引起的。皮样囊肿内衬单层鳞状上皮，充满角蛋白和其他皮肤附属物。它们可以在出生时出现，也可以在出生后出现。它们是最常见的儿科肿瘤之一，特别是在头部和颈部。当出现在头部时，应与其他病变（如脑膨出）鉴别。在处理此类病例之前，影像学检查和外科咨询是重要的。一个8个月大的女性患者表现为前囟门肿胀，模仿脑膨出。该病史对十二指肠闭锁有重要意义。出生后几天开始出现肿胀。在进行CT扫描和MRI后，神经外科医生试图抽吸囊肿进行组织病理学检查，但失败，并计划手术切除。手术切除病变，组织病理学检查显示诊断为皮样囊肿。这强调了在对此类病变进行任何手术前排除颅内交通的重要性。皮样囊肿本质上是一种儿科肿瘤。重要的是要记住皮样囊肿头颈部肿胀的鉴别诊断，特别是前囟门肿胀。当躺在头上时，在进行手术干预之前，通过影像学检查排除颅内交通是至关重要的。结论皮样囊肿是儿科常见的肿瘤。在这种类型的肿瘤并发颅内扩张之前，正确的诊断和手术干预是重要的。

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引用次数: 0

A modified technique for aortic arch and cerebral angiography using one Simmons II catheter 一种使用一根Simmons II型导管进行主动脉弓和脑血管造影的改进技术

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-15 DOI: 10.1016/j.inat.2025.102165

Yi Luo , Shaoliang Zhu , Ziquan Zeng , Shun Liu , Zhansheng Zhu

Background

Radial access is an increasingly popular approach to neuroradiology. Typically, aortic arch and cerebral angiography are performed using a 5F pigtail catheter and a 5F Simmons II catheter. This classical operation increases the operation time, radiation time, and radiation dose, and the catheters pass through the radial artery multiple times, thereby increasing the risk of radial artery spasms and occlusions. In this study, we aimed to demonstrate that using a Simmons II catheter to complete the aortic arch and cerebral angiography is safe and effective.

Methods

This study was a retrospective review of the database on aortic arch and cerebral angiography procedures using two catheters (pigtail catheter and Simmons II catheter) or one catheter (Simmons II catheter) to perform aortic arch and cerebral angiography between August 2024 and January 2025. Patient demographics, clinical data, procedural metrics and radiographic metrics were recorded. Sixty patients underwent aortic arch and cerebral angiographies. Thirty patients underwent aortic arch and cerebral angiographies with two catheters and thirty with one catheter.

Results

Total procedure and fluoroscopy times were shorter in the one catheter group. The contrast volume, dose-area product and total radiation dose were lower in the one-catheter group. Clinical outcomes between the two groups showed no statistically significant differences.

Conclusions

We confirmed for the first time that using a Simmons II catheter to complete the aortic arch and cerebral angiography was effective and safe.

检索是神经放射学日益流行的一种方法。通常，主动脉弓和脑血管造影使用5F细尾导管和5F Simmons II导管。这种经典手术增加了手术时间、放疗时间和放疗剂量，且导管多次穿过桡动脉，增加了桡动脉痉挛和闭塞的风险。在本研究中，我们旨在证明使用Simmons II导管完成主动脉弓和脑血管造影是安全有效的。方法回顾性分析2024年8月至2025年1月期间使用两根导管（pigtail导管和Simmons II导管）或一根导管（Simmons II导管）行主动脉弓和脑血管造影的数据库。记录患者人口统计学、临床数据、程序指标和放射学指标。60例患者行主动脉弓和脑血管造影。30例患者行双导管主动脉弓和脑血管造影，30例患者行单导管主动脉弓和脑血管造影。结果单管组总手术时间短，透视时间短。单管组造影剂体积、剂量面积积、总辐射剂量均较低。两组临床结果无统计学差异。结论首次证实采用Simmons II型导管完成主动脉弓及脑血管造影是安全有效的。

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引用次数: 0

Primary intracerebral Ewing sarcoma featuring curvilinear calcification: a case report 以曲线钙化为特征的原发性脑内尤文氏肉瘤1例

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-14 DOI: 10.1016/j.inat.2025.102166

Xiujiao Wei , Jimei Meng , Qinghong Duan

Ewing sarcoma (EWS) is a highly aggressive malignant tumor that primarily affects bones and soft tissues, with primary intracerebral cases being exceptionally rare. While sporadic cases have been reported, a systematic analysis of their radiological features—particularly calcification patterns—is lacking. We present what we believe to be the first case of a right parieto-occipital EWS exhibiting characteristic curvilinear calcification. A comparative review of 8 intracerebral EWS cases revealed that while cystic changes are common (75 %), curvilinear calcification is unique, and marked enhancement is a consistent finding. Our patient was treated with craniotomy, VDC/IE chemotherapy, and IMRT, and achieved no evidence of disease at 12-month follow-up. This systematic contextualization highlights that curvilinear calcification is a novel diagnostic clue for intracerebral EWS, which generally has a favorable outcome with multimodal therapy.

尤文氏肉瘤（EWS）是一种高度侵袭性的恶性肿瘤，主要影响骨骼和软组织，原发性脑内病例非常罕见。虽然有零星病例的报道，但缺乏对其放射学特征（特别是钙化模式）的系统分析。我们提出我们认为是第一例右侧顶枕EWS表现出特有的曲线钙化。对8例脑内EWS病例的对比分析显示，虽然囊性改变是常见的（75% %），但曲线钙化是独特的，明显的强化是一致的发现。我们的患者接受了开颅手术、VDC/IE化疗和IMRT治疗，在12个月的随访中没有发现疾病的迹象。这一系统的背景分析强调，曲线钙化是脑内EWS的一种新的诊断线索，多模式治疗通常具有良好的结果。

引用次数: 0

Brachial plexus Schwannoma: a case report involving the middle trunk 臂丛神经鞘瘤：累及中干1例

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-14 DOI: 10.1016/j.inat.2025.102161

Masoud Yavari , Amir Bisadi , Fatemeh Abbasi , Mohammad Abbasalizadeh , Negar Emamzadeh , Morteza Gholipour

Background

Schwannomas arising from the middle trunk of the brachial plexus represent an exceptionally rare subset of peripheral nerve sheath tumors. While brachial plexus schwannomas account for approximately 5% of all schwannomas, those originating specifically from the trunks constitute only 4–5% of peripheral nerve sheath tumors. The middle trunk, formed exclusively by the C7 nerve root, is particularly uncommon as a site of origin, making detailed documentation of such cases clinically valuable due to the unique surgical challenges and risk of compromising critical motor function.

Case presentation

A 28-year-old female presented with a 2-year history of a painless, gradually enlarging 5 cm mass in the left supraclavicular region. Core needle biopsy and MRI confirmed a schwannoma. The patient underwent microsurgical excision via an anterolateral approach with intraoperative neurophysiological monitoring. The tumor was completely excised while preserving the middle trunk integrity. Histopathological examination confirmed schwannoma with characteristic biphasic Antoni A and Antoni B patterns. The patient experienced no postoperative neurological deficits, had uneventful wound healing, and returned to normal activities within three weeks.

Conclusion

Complete microsurgical resection of middle trunk schwannomas with preservation of neurological function is achievable through meticulous dissection and intraoperative monitoring. The anterolateral approach provides optimal exposure while protecting surrounding neurovascular structures. Given the rarity of middle trunk involvement and the low recurrence rate following complete excision, early surgical intervention in symptomatic cases is recommended. Continued documentation through detailed case reports remains essential for advancing surgical understanding and optimizing patient outcomes in this challenging anatomical location.

背景：起源于臂丛中干的神经鞘瘤是周围神经鞘肿瘤中非常罕见的一类。臂丛神经鞘瘤约占所有神经鞘瘤的5%，而起源于干的神经鞘瘤仅占周围神经鞘瘤的4-5%。中干仅由C7神经根形成，作为发病部位尤其罕见，由于独特的手术挑战和危及关键运动功能的风险，因此对此类病例的详细记录具有临床价值。病例表现：28岁女性，左侧锁骨上区无痛性逐渐增大5厘米肿块，病史2年。核心穿刺活检和MRI证实为神经鞘瘤。患者经前外侧入路行显微手术切除，术中神经生理监测。肿瘤被完全切除，同时保留了中干的完整性。组织病理学检查证实神经鞘瘤具有特征性的双期Antoni A和Antoni B型。患者术后无神经功能缺损，伤口愈合平稳，并在三周内恢复正常活动。结论通过细致的解剖和术中监测，可以实现中干神经鞘瘤的显微手术切除，并保留神经功能。前外侧入路在保护周围神经血管结构的同时提供最佳暴露。鉴于中干受累的罕见性和完全切除后的低复发率，建议对有症状的病例进行早期手术干预。在这个具有挑战性的解剖位置，通过详细的病例报告继续记录对于提高手术理解和优化患者预后至关重要。

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引用次数: 0

Key-hole dual-mirror combined microvascular decompression for the treatment of hemifacial spasm 锁眼双镜联合微血管减压治疗面肌痉挛

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-14 DOI: 10.1016/j.inat.2025.102163

Huanming Wang, Fei Hu, Jun Chen, Yubo Xiong, Chongyang Yang, Shengxu Tu, Yu Li, Pei Duan

Objective

Microvascular decompression is the main operative method to treat hemifascial spasm. In this study we aimed to explore the effect and safety of key-hole dual-mirror combined microvascular decompression for the treatment of hemifacial spasm.

Methods

There were 18 males and 52 females in this group. Their age ranged from 27 to 79 years, and their illness duration from 1 to 10 years. Among them there were 38 cases with hemifacial spasm in the left side, 32 cases in the right side. All the patients underwent MRI 3D-TOF examination. After confirming the possibility of vessel compressing the nerve root, key-hole dual-mirror combined microvascular decompression was performed under general anesthesia.Symptom improvement was followed up for 3–120 months postoperatively.

Results

After the operation the effective rate of hemifacial spasm was 91.43%(64/70). Hearing loss appeared in 3 cases, delayed facial paralysis in 2 cases, transient dizziness and tinnitus in 2 cases, CSF otorrhea in 2 cases and SAH in 1 case. After active treatments all the symptoms improved. The follow-up showed 2 cases(2.86%) recurred.

Conclusion

This study shows that microvascular decompression is the most effective way for the treatment of hemifacial spasm. In order to improve the surgical effect and to reduce symptom recurrence, the key points are skilled microsurgical technique、correct identification of the responsible vessel under the combination of microscope and endoscope 、adequate decompression during the operation.

目的微血管减压是治疗半筋膜痉挛的主要手术方法。本研究旨在探讨锁眼双镜联合微血管减压术治疗面肌痉挛的疗效和安全性。方法本组男性18例，女性52例。年龄27 ~ 79 岁，病程1 ~ 10 年。其中左侧面肌痉挛38例，右侧面肌痉挛32例。所有患者均行MRI 3D-TOF检查。确认血管压迫神经根的可能性后，全麻下行锁眼双镜联合微血管减压术。术后随访3-120 个月症状改善。结果手术后面肌痉挛有效率为91.43%（64/70）。出现听力丧失3例，迟发性面瘫2例，一过性头晕耳鸣2例，脑脊液耳漏2例，SAH 1例。经积极治疗后，所有症状均有所改善。随访2例（2.86%）复发。结论微血管减压术是治疗面肌痉挛最有效的方法。为了提高手术效果，减少症状复发，关键是熟练的显微手术技术，在显微镜和内窥镜结合下正确识别责任血管，术中充分减压。

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