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Management of eight cases of subarachnoid hemorrhage using transpulmonary thermodilution during clazosentan therapy
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2025-02-08 DOI: 10.1016/j.inat.2025.101997
Hiroto Iyota , Yasumasa Kawano , Hironori Fukumoto , Takato Tajiri , Mitsutoshi Iwaasa , Sinichi Morimoto , Yoshito Izutani , Shintaro Yamasaki , Kazuya Yamauchi , Hiroki Hatomoto , Hiroshi Abe , Yoshihiko Nakamura
Clazosentan, an endothelin receptor antagonist, is used to prevent delayed neurological deterioration in patients with subarachnoid hemorrhage due to ruptured cerebral aneurysms. However, fluid management presents challenges. This single-center case series presents the findings from eight patients undergoing fluid management using transpulmonary thermodilution while receiving clazosentan. The median age of the patients was 49 years (interquartile range: 45.5–63.5), and four (50 %) were male. The median World Federation of Neurosurgical Societies classification was 5 (interquartile range: 2–5), and the median Fisher classification was 3 (interquartile range: 3). During clazosentan treatment, the median global end-diastolic volume index based on transpulmonary thermodilution remained at 715.5 ml/m2 (interquartile range: 643–788). No ischemic neurological deficits, bilateral pulmonary edema, and pleural effusion were observed. Strict fluid management using transpulmonary thermodilution might prevent the complications associated with clazosentan.
{"title":"Management of eight cases of subarachnoid hemorrhage using transpulmonary thermodilution during clazosentan therapy","authors":"Hiroto Iyota ,&nbsp;Yasumasa Kawano ,&nbsp;Hironori Fukumoto ,&nbsp;Takato Tajiri ,&nbsp;Mitsutoshi Iwaasa ,&nbsp;Sinichi Morimoto ,&nbsp;Yoshito Izutani ,&nbsp;Shintaro Yamasaki ,&nbsp;Kazuya Yamauchi ,&nbsp;Hiroki Hatomoto ,&nbsp;Hiroshi Abe ,&nbsp;Yoshihiko Nakamura","doi":"10.1016/j.inat.2025.101997","DOIUrl":"10.1016/j.inat.2025.101997","url":null,"abstract":"<div><div>Clazosentan, an endothelin receptor antagonist, is used to prevent delayed neurological deterioration in patients with subarachnoid hemorrhage due to ruptured cerebral aneurysms. However, fluid management presents challenges. This single-center case series presents the findings from eight patients undergoing fluid management using transpulmonary thermodilution while receiving clazosentan. The median age of the patients was 49 years (interquartile range: 45.5–63.5), and four (50 %) were male. The median World Federation of Neurosurgical Societies classification was 5 (interquartile range: 2–5), and the median Fisher classification was 3 (interquartile range: 3). During clazosentan treatment, the median global end-diastolic volume index based on transpulmonary thermodilution remained at 715.5 ml/m<sup>2</sup> (interquartile range: 643–788). No ischemic neurological deficits, bilateral pulmonary edema, and pleural effusion were observed. Strict fluid management using transpulmonary thermodilution might prevent the complications associated with clazosentan.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"39 ","pages":"Article 101997"},"PeriodicalIF":0.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Resolution of tremor associated with brainstem arachnoid cyst following surgical intervention: A case report
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2025-02-07 DOI: 10.1016/j.inat.2025.101994
Andrey Rostislavovich Sitnikov , Rezida Maratovna Galimova , Dmitriy Konstantinovich Krekotin

Introduction

Intracranial arachnoid cysts located in the brainstem are extremely rare. Neurological symptoms usually depend on the location of the cyst and present with varying degrees of motor deficit and cranial nerve palsy. Our case report describes the successful surgical treatment of an intraparenchymal brainstem arachnoid cyst followed by significant improvement of severe disabling contralateral tremor.

Case presentation

A 34-year-old man was admitted to our clinic with a two-year history of progressive disabling right-sided tremor and muscle weakness. Neurological examination on admission showed moderate left-sided blepharoptosis, right-sided hemiparesis (MRC grade 4 strength) and severe right-sided kinetic and postural tremor. MRI showed a large multiseptal cystic lesion within the left cerebral peduncle and left part of the midbrain. The patient underwent surgical fenestration of the cyst via a left supracerebellar infratentorial approach in the semi-sitting position. The postoperative course was uneventful with significant reduction of tremor and hemiparesis on the second postoperative day. Follow-up MRI at 3 and 12 months showed reasonable reduction in the size of the cystic lesion and restoration of brainstem anatomy. The patient’s tremor decreased by 70 % according to the Tremor Research Group Essential Tremor Rating Scale (TETRAS scale).

Conclusion

In cases of intraparenchymal cystic lesions presenting with neurological abnormalities, surgical exploration and fenestration of the lesion may be a safe treatment option with a good functional outcome.
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引用次数: 0
A case report of abdominal implantation and metastasis caused by transventricular peritoneal drainage tube after radiotherapy for intracranial pituitary tumor
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2025-02-07 DOI: 10.1016/j.inat.2025.101996
Chao Ma, Yuxin Fan, Tianyong Cai, Zheyong Li

Introduction and importance

This article reports the diagnosis and treatment of a patient with a malignant pituitary tumor who underwent transtumoral ventriculo-abdominal drainage and multiple radiotherapies.

Case presentation

The patient exhibited intraperitoneal metastasis and was admitted due to abnormal menopause. Diagnostic examination revealed pituitary gland space occupation, leading to cranial brain surgery. Cerebrospinal fluid was sampled during the operation for cytological examination to consider germinoma. However, the complete removal of the pituitary tumor was hindered by severe cerebral edema, necessitating the temporary placement of a ventriculo-abdominal drainage tube. Following the operation, the patient received 23 sessions of directed radiotherapy, resulting in tumor disappearance as confirmed by pituitary MRI review. Three years later, the patient returned to the hospital due to abdominal pain and anorexia, revealing a substantial abdominal cavity mass. Active surgical intervention was conducted, and postoperative pathology confirmed a secondary malignant tumor in the abdominal cavity originating from dysgerminoma. Following treatment, the patient’s condition improved, and they were discharged. However, intra-abdominal tumor recurrence ensued due to delayed chemotherapy administration, ultimately resulting in death from extensive cerebral infarction.

Clinical discussion

When encountering such patients in the future, if surgery is necessary, how can we select patients who require postoperative maintenance treatment? Which regimen offers greater benefits compared to radiotherapy or chemotherapy? In cases where patients are unable to tolerate chemotherapy and radiotherapy, how can we provide a more specialized treatment plan for them?

Conclusion

Analysis of this report underscores the potential enhancement of clinical treatment strategies for such cases.
{"title":"A case report of abdominal implantation and metastasis caused by transventricular peritoneal drainage tube after radiotherapy for intracranial pituitary tumor","authors":"Chao Ma,&nbsp;Yuxin Fan,&nbsp;Tianyong Cai,&nbsp;Zheyong Li","doi":"10.1016/j.inat.2025.101996","DOIUrl":"10.1016/j.inat.2025.101996","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>This article reports the diagnosis and treatment of a patient with a malignant pituitary tumor who underwent transtumoral ventriculo-abdominal drainage and multiple radiotherapies.</div></div><div><h3>Case presentation</h3><div>The patient exhibited intraperitoneal metastasis and was admitted due to abnormal menopause. Diagnostic examination revealed pituitary gland space occupation, leading to cranial brain surgery. Cerebrospinal fluid was sampled during the operation for cytological examination to consider germinoma. However, the complete removal of the pituitary tumor was hindered by severe cerebral edema, necessitating the temporary placement of a ventriculo-abdominal drainage tube. Following the operation, the patient received 23 sessions of directed radiotherapy, resulting in tumor disappearance as confirmed by pituitary MRI review. Three years later, the patient returned to the hospital due to abdominal pain and anorexia, revealing a substantial abdominal cavity mass. Active surgical intervention was conducted, and postoperative pathology confirmed a secondary malignant tumor in the abdominal cavity originating from dysgerminoma. Following treatment, the patient’s condition improved, and they were discharged. However, intra-abdominal tumor recurrence ensued due to delayed chemotherapy administration, ultimately resulting in death from extensive cerebral infarction.</div></div><div><h3>Clinical discussion</h3><div>When encountering such patients in the future, if surgery is necessary, how can we select patients who require postoperative maintenance treatment? Which regimen offers greater benefits compared to radiotherapy or chemotherapy? In cases where patients are unable to tolerate chemotherapy and radiotherapy, how can we provide a more specialized treatment plan for them?</div></div><div><h3>Conclusion</h3><div>Analysis of this report underscores the potential enhancement of clinical treatment strategies for such cases.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"39 ","pages":"Article 101996"},"PeriodicalIF":0.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of three-dimensional digital exoscope to standard operating microscope in minimally-invasive lumbar decompression: A cohort study in a community setting
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2025-02-04 DOI: 10.1016/j.inat.2025.101993
Daniel E. Fulkerson , Evan Medich , Dale F. Szpisjak , Daniel H. Fulkerson

Background

Work-related musculoskeletal disorders are common in spine surgeons in the current operative environment. The digital exoscope is a visualization system for minimally-invasive spine surgery (MISS) with potential ergonomic benefits for the surgeon when compared to the standard surgical microscope. The exoscope is gaining popularity in Europe but remains uncommon the United States outside of large academic centers.

Purpose

We report surgical metrics for patients who underwent MISS with use of an exoscope or a standard operating microscope in a community-based neurosurgical practice.

Methods

We evaluated 121 patients who underwent one- and two- level minimally invasive lumbar decompressions from 2019 to 2023. Fifty-nine patients underwent surgery with the microscope, and 62 underwent surgery with the exoscope. Patients were categorized by visualization method and number of surgical levels, for a total of four groups.

Results

Demographics were largely similar across the exoscope and microscope cohorts. All groups had similar durations of hospitalization and complication rates. Estimated blood loss trended lower in the one-level exoscope group compared to the one-level microscope group, which was statistically significant for patients with BMI > 40. Operating room and surgical times were increased in both exoscope groups compared to the same-level microscope groups by 15–17 % and 17–24 %, respectively. Surgical time for exoscope groups showed a non-significant downward trend of 9–14 % in the later cases of the study period compared to the earlier cases, suggesting the presence of a learning curve.

Conclusion

The exoscope is a viable alternative to the surgical microscope for MISS in a community-based neurosurgical practice.
{"title":"Comparison of three-dimensional digital exoscope to standard operating microscope in minimally-invasive lumbar decompression: A cohort study in a community setting","authors":"Daniel E. Fulkerson ,&nbsp;Evan Medich ,&nbsp;Dale F. Szpisjak ,&nbsp;Daniel H. Fulkerson","doi":"10.1016/j.inat.2025.101993","DOIUrl":"10.1016/j.inat.2025.101993","url":null,"abstract":"<div><h3>Background</h3><div>Work-related musculoskeletal disorders are common in spine surgeons in the current operative environment. The digital exoscope is a visualization system for minimally-invasive spine surgery (MISS) with potential ergonomic benefits for the surgeon when compared to the standard surgical microscope. The exoscope is gaining popularity in Europe but remains uncommon the United States outside of large academic centers.</div></div><div><h3>Purpose</h3><div>We report surgical metrics for patients who underwent MISS with use of an exoscope or a standard operating microscope in a community-based neurosurgical practice.</div></div><div><h3>Methods</h3><div>We evaluated 121 patients who underwent one- and two- level minimally invasive lumbar decompressions from 2019 to 2023. Fifty-nine patients underwent surgery with the microscope, and 62 underwent surgery with the exoscope. Patients were categorized by visualization method and number of surgical levels, for a total of four groups.</div></div><div><h3>Results</h3><div>Demographics were largely similar across the exoscope and microscope cohorts. All groups had similar durations of hospitalization and complication rates. Estimated blood loss trended lower in the one-level exoscope group compared to the one-level microscope group, which was statistically significant for patients with BMI &gt; 40. Operating room and surgical times were increased in both exoscope groups compared to the same-level microscope groups by 15–17 % and 17–24 %, respectively. Surgical time for exoscope groups showed a non-significant downward trend of 9–14 % in the later cases of the study period compared to the earlier cases, suggesting the presence of a learning curve.</div></div><div><h3>Conclusion</h3><div>The exoscope is a viable alternative to the surgical microscope for MISS in a community-based neurosurgical practice.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"39 ","pages":"Article 101993"},"PeriodicalIF":0.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143368581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Flow-diverter stents alone and in combination with coiling as treatment options for unruptured, symptomatic true PcomA aneurysms
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2025-01-27 DOI: 10.1016/j.inat.2025.101991
S. Matanov , K. Ninov , K. Minkin , K. Sirakova , G. Vladev , S. Sirakov , A. Sirakov

Background

True posterior communicating artery (PcomA) aneurysms are rare compared to those at the junction of the internal carotid artery (ICA) and PcomA. They account for a small subset of unruptured intracranial aneurysms, yet approximately 20 % present with ophthalmoplegia, significantly impairing quality of life. While direct third nerve compression was considered the primary cause of symptoms, evidence suggests that restricted blood flow can alleviate symptoms. Flow-diverter (FD) stents, while effective for complex aneurysms, are scarcely reported for symptomatic, unruptured true PcomA aneurysms.

Methods

A retrospective study (March 2015–December 2023) included patients with unruptured, saccular true PcomA aneurysms presenting with ophthalmoplegia. Data on demographics, aneurysm characteristics, interventions, clinical outcomes, and occlusion were analyzed.

Results

Endovascular treatment involved loose coiling with an FD in 9 patients (60 %) and FD alone in 6 patients (40 %). All procedures were successful, with no complications. Angiographic follow-up showed total occlusion in 13 out of 15 aneurysms (87 %). At six months, 60 % of patients had complete resolution of ophthalmoparesis, and 40 % showed partial improvement. By 12 months, 73.3 % had complete symptom resolution, and 26.7 % exhibited partial improvement.

Conclusion

FD stents, used alone or with coiling, are promising for treating symptomatic, unruptured true PcomA aneurysms, showing high occlusion rates, safety, and symptom relief. Despite the study’s retrospective design and small cohort, findings highlight the potential of this approach, warranting larger multicenter studies.
{"title":"Flow-diverter stents alone and in combination with coiling as treatment options for unruptured, symptomatic true PcomA aneurysms","authors":"S. Matanov ,&nbsp;K. Ninov ,&nbsp;K. Minkin ,&nbsp;K. Sirakova ,&nbsp;G. Vladev ,&nbsp;S. Sirakov ,&nbsp;A. Sirakov","doi":"10.1016/j.inat.2025.101991","DOIUrl":"10.1016/j.inat.2025.101991","url":null,"abstract":"<div><h3>Background</h3><div>True posterior communicating artery (PcomA) aneurysms are rare compared to those at the junction of the internal carotid artery (ICA) and PcomA. They account for a small subset of unruptured intracranial aneurysms, yet approximately 20 % present with ophthalmoplegia, significantly impairing quality of life. While direct third nerve compression was considered the primary cause of symptoms, evidence suggests that restricted blood flow can alleviate symptoms. Flow-diverter (FD) stents, while effective for complex aneurysms, are scarcely reported for symptomatic, unruptured true PcomA aneurysms.</div></div><div><h3>Methods</h3><div>A retrospective study (March 2015–December 2023) included patients with unruptured, saccular true PcomA aneurysms presenting with ophthalmoplegia. Data on demographics, aneurysm characteristics, interventions, clinical outcomes, and occlusion were analyzed.</div></div><div><h3>Results</h3><div>Endovascular treatment involved loose coiling with an FD in 9 patients (60 %) and FD alone in 6 patients (40 %). All procedures were successful, with no complications. Angiographic follow-up showed total occlusion in 13 out of 15 aneurysms (87 %). At six months, 60 % of patients had complete resolution of ophthalmoparesis, and 40 % showed partial improvement. By 12 months, 73.3 % had complete symptom resolution, and 26.7 % exhibited partial improvement.</div></div><div><h3>Conclusion</h3><div>FD stents, used alone or with coiling, are promising for treating symptomatic, unruptured true PcomA aneurysms, showing high occlusion rates, safety, and symptom relief. Despite the study’s retrospective design and small cohort, findings highlight the potential of this approach, warranting larger multicenter studies.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"39 ","pages":"Article 101991"},"PeriodicalIF":0.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2025-01-27 DOI: 10.1016/j.inat.2025.101992
Adrian Liebert , Thomas Eibl , Thomas Bertsch , Hans-Herbert Steiner , Karl-Michael Schebesch , Leonard Ritter

Objective

Chronic subdural hematoma (CSDH) patients usually present with mild symptoms; however, a subset of patients presents with disturbance of consciousness (DOC). We analyzed clinical and radiographic factors, which could influence the level of consciousness in CSDH patients before surgery.

Methods

We retrospectively analyzed consecutive unilateral CSDH patients, who were surgically treated in our department from 2018 to 2023. We compared a group of patients with moderate DOC (group 1), defined as a Glasgow Coma Scale (GCS) 9–13, with a control group of awake but symptomatic patients (GCS > 13, group 2). Clinical and radiographic parameters were analyzed in bivariate and multivariate analyses.

Results

41 (12.9 %) patients presented with GCS 9–13 and 276 patients with GCS > 13. In bivariate analysis, radiographic parameters, like greater mean midline shift (p < 0.001), homogenous hypodense type (p = 0.017), additional temporal (p < 0.001) and occipital (p < 0.001) location, “acute-to-chronic” (p = 0.002) and “acute-on-chronic” (p = 0.049) forms were more frequent in group 1. The trabecular hematoma subtype was less common in group 1 (p = 0.002). INR (p = 0.004) and CRP values (p = 0.003) in the preoperative blood sample were significantly higher in group 1. History of ischemic stroke and intake of statins were more common in group 1 (p = 0.033, p = 0.04; resp.). In the multivariate analysis, midline shift (p = 0.033), occipital location (p = 0.005) and history of ischemic stroke (p = 0.046) remained significant.

Conclusion

We could identify factors which contribute to DOC in CSDH patients. Among those are greater midline shift, occipital location and history of ischemic stroke as independent risk factors.
{"title":"Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma","authors":"Adrian Liebert ,&nbsp;Thomas Eibl ,&nbsp;Thomas Bertsch ,&nbsp;Hans-Herbert Steiner ,&nbsp;Karl-Michael Schebesch ,&nbsp;Leonard Ritter","doi":"10.1016/j.inat.2025.101992","DOIUrl":"10.1016/j.inat.2025.101992","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic subdural hematoma (CSDH) patients usually present with mild symptoms; however, a subset of patients presents with disturbance of consciousness (DOC). We analyzed clinical and radiographic factors, which could influence the level of consciousness in CSDH patients before surgery.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed consecutive unilateral CSDH patients, who were surgically treated in our department from 2018 to 2023. We compared a group of patients with moderate DOC (group 1), defined as a Glasgow Coma Scale (GCS) 9–13, with a control group of awake but symptomatic patients (GCS &gt; 13, group 2). Clinical and radiographic parameters were analyzed in bivariate and multivariate analyses.</div></div><div><h3>Results</h3><div>41 (12.9 %) patients presented with GCS 9–13 and 276 patients with GCS &gt; 13. In bivariate analysis, radiographic parameters, like greater mean midline shift (p &lt; 0.001), homogenous hypodense type (p = 0.017), additional temporal (p &lt; 0.001) and occipital (p &lt; 0.001) location, “acute-to-chronic” (p = 0.002) and “acute-on-chronic” (p = 0.049) forms were more frequent in group 1. The trabecular hematoma subtype was less common in group 1 (p = 0.002). INR (p = 0.004) and CRP values (p = 0.003) in the preoperative blood sample were significantly higher in group 1. History of ischemic stroke and intake of statins were more common in group 1 (p = 0.033, p = 0.04; resp.). In the multivariate analysis, midline shift (p = 0.033), occipital location (p = 0.005) and history of ischemic stroke (p = 0.046) remained significant.</div></div><div><h3>Conclusion</h3><div>We could identify factors which contribute to DOC in CSDH patients. Among those are greater midline shift, occipital location and history of ischemic stroke as independent risk factors.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"39 ","pages":"Article 101992"},"PeriodicalIF":0.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Seizure in a child with cerebellopontine angle tumour
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2025-01-27 DOI: 10.1016/j.inat.2025.101990
Emmanuel Garba Sunday , Eno-Abasi Garba Sunday , Piel Panther Kuol , Ignatius N. Esene , Abdulbasit Opeyemi Muili , Nwafuluaku Emmanuel Chukwudi , Mubarak Jolayemi Mustapha , Yao Christian Hugues Dokponou , Nourou Dine Adeniran Bankole , Alvan-Emeka K. Ukachukwu

Background

Cerebellopontine angle (CPA) tumours in paediatric patients are rare. Cerebellar seizures are infrequent and scarcely discussed. Only one case of paediatric cerebellar seizure due to a CPA tumour is available in the literature.

Methods

We present a 4-year-old girl with features of cerebellar seizure and fever, who was initially managed for febrile convulsion for 8 months at various private facilities. We also conduct a comprehensive search of English-language medical literature on PubMed, Google Scholar, and grey literature using free Google search with the appropriate keywords.

Results

Twenty-three English-language medical literature were published, with 25 cases whose age at presentation ranged from 1 day to 122 months and male: female ratio of 1.18:1. Only one child with cerebellar seizure had CPA tumour, while the rest variously originated from the cerebellum, brainstem or within the fourth ventricle. The age at surgery ranged between one month to 122 months.

Conclusion

Cerebellar seizures should prompt consideration of posterior fossa lesions as a possible cause, provided there are no supratentorial lesions.
{"title":"Seizure in a child with cerebellopontine angle tumour","authors":"Emmanuel Garba Sunday ,&nbsp;Eno-Abasi Garba Sunday ,&nbsp;Piel Panther Kuol ,&nbsp;Ignatius N. Esene ,&nbsp;Abdulbasit Opeyemi Muili ,&nbsp;Nwafuluaku Emmanuel Chukwudi ,&nbsp;Mubarak Jolayemi Mustapha ,&nbsp;Yao Christian Hugues Dokponou ,&nbsp;Nourou Dine Adeniran Bankole ,&nbsp;Alvan-Emeka K. Ukachukwu","doi":"10.1016/j.inat.2025.101990","DOIUrl":"10.1016/j.inat.2025.101990","url":null,"abstract":"<div><h3>Background</h3><div>Cerebellopontine angle (CPA) tumours in paediatric patients are rare. Cerebellar seizures are infrequent and scarcely discussed. Only one case of paediatric cerebellar seizure due to a CPA tumour is available in the literature.</div></div><div><h3>Methods</h3><div>We present a 4-year-old girl with features of cerebellar seizure and fever, who was initially managed for febrile convulsion for 8 months at various private facilities. We also conduct a comprehensive search of English-language medical literature on PubMed, Google Scholar, and grey literature using free Google search with the appropriate keywords.</div></div><div><h3>Results</h3><div>Twenty-three English-language medical literature were published, with 25 cases whose age at presentation ranged from 1 day to 122 months and male: female ratio of 1.18:1. Only one child with cerebellar seizure had CPA tumour, while the rest variously originated from the cerebellum, brainstem or within the fourth ventricle. The age at surgery ranged between one month to 122 months.</div></div><div><h3>Conclusion</h3><div>Cerebellar seizures should prompt consideration of posterior fossa lesions as a possible cause, provided there are no supratentorial lesions.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"39 ","pages":"Article 101990"},"PeriodicalIF":0.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Restorative neurostimulation for chronic low back pain using ReActiv8® in a patient with a large lumbar disc herniation 使用 ReActiv8® 恢复性神经刺激治疗大腰椎间盘突出症患者的慢性腰背痛
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-05-13 DOI: 10.1016/j.inat.2024.101988
Dirar Aldabek , Christian Schürer , Michael Luchtmann

This case report presents the therapeutic effect of restorative neurostimulation (ReActiv8®) on chronic low back pain (CLBP) in a 44-year-old male, where the primary etiology was not lumbar disc herniation (LDH). Despite presenting with LDH at L4-L5, clinical evaluations suggested lumbar microinstability and multifidus muscle dysfunction as the main contributors to his pain, without radicular symptoms. The patient had a 12-year history of CLBP, resistant to conventional treatments like physiotherapy, medications, and epidural injections. Opting for a minimally invasive approach, he underwent implantation of ReActiv8®, focusing on rehabilitating the impaired multifidus muscle. Over a 12-month therapy period, significant improvements were noted in pain levels, functionality, and quality of life, leading to a full return to work. Interestingly, follow-up imaging showed not only a substantial reduction in pain but also an unexpected resolution of the LDH at L4-L5, enhanced lumbar lordosis, and improved disc hydration, despite minor progressing Modic changes. This case underlines the potential of restorative neurostimulation in CLBP management, especially when the pain origin is non-discogenic. It emphasizes the importance of accurate pain source identification in CLBP treatment and suggests further research into the efficacy and applicability of neurostimulation in similar clinical scenarios.

本病例报告介绍了恢复性神经刺激(ReActiv8®)对一名 44 岁男性慢性腰背痛(CLBP)的治疗效果,其主要病因并非腰椎间盘突出症(LDH)。尽管患者表现为 L4-L5 处的腰椎间盘突出症,但临床评估表明,腰椎微稳定性和多裂肌功能障碍是导致其疼痛的主要原因,而没有根性症状。患者有12年的CLBP病史,对理疗、药物和硬膜外注射等传统治疗方法有抵抗力。他选择了一种微创方法,接受了 ReActiv8® 植入手术,重点康复受损的多裂肌。在 12 个月的治疗期间,他的疼痛程度、功能和生活质量都有了明显改善,最终完全恢复了工作。有趣的是,随访影像学结果显示,尽管莫迪氏病变有轻微进展,但患者不仅疼痛明显减轻,而且 L4-L5 处的低密度脂蛋白血症也出乎意料地得到缓解,腰椎前凸得到加强,椎间盘水合作用得到改善。该病例凸显了恢复性神经刺激在慢性椎间盘突出症治疗中的潜力,尤其是当疼痛源不是椎间盘时。它强调了在 CLBP 治疗中准确识别疼痛源的重要性,并建议进一步研究神经刺激在类似临床场景中的疗效和适用性。
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引用次数: 0
Topical dexamethason effectiveness combined with surgical intervention in patients suffering from chronic subdural hematoma 慢性硬膜下血肿患者局部使用地塞米松联合手术治疗的效果
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-05-04 DOI: 10.1016/j.inat.2024.101984
Hosein Safari , Masoud Zeinali , Pooyan Alizadeh , Davood Mahmoudi

Background

A chronic subdural hematoma (CSDH) is one of the most common neurosurgery operations. This study aimed to evaluate the effect of topical corticosteroids combined with surgery in patients with CSDH.

Materials and Methods

The present study is a clinical trial study on patients referred to hospitals associated with Ahvaz University of Medical Sciences with chronic subdural hematoma in 2019. Patients requiring surgical drainage of chronic subdural hematoma who met the inclusion criteria underwent open craniotomy surgery on the side of the hematoma. A drain was placed in the open craniotomy site. On the third day after the operation, before removing the drain, 40 mg of methylprednisolone sodium succinate was injected through the drain into the subdural space, after which the drain was pulled entirely. Patients were evaluated with the Markwalder Grading Scale (MGS) on the third day, third month, and sixth month after surgery for improved or worsened neurological symptoms. Also, in the third and sixth months after surgery, the patients underwent Computerized Tomography Scan imaging and were checked for recurrence.

Results

32 patients with CSDH entered the study, including 28 men and four women, with a mean age of 71.62 ± 9.85 years. Moreover, 87.5 % had a unilateral chronic subdural hematoma (uCSDH), and 12.5 % had a bilateral chronic subdural hematoma (bCSDH). Left and right uCSDHs had the same frequency (43. 8 %). After surgery, 26 patients had no postoperative complications, and six patients experienced pneumocephalus.

Conclusion

Topical dexamethasone injection through the potential CSDH cavity can result in desirable outcomes.

背景慢性硬膜下血肿(CSDH)是最常见的神经外科手术之一。本研究旨在评估局部皮质类固醇联合手术治疗 CSDH 患者的效果。材料与方法本研究是一项临床试验研究,对象是 2019 年转诊至阿瓦士医科大学附属医院的慢性硬膜下血肿患者。符合纳入标准、需要手术引流慢性硬膜下血肿的患者接受了血肿一侧的开颅手术。在开颅手术部位放置引流管。术后第三天,在拔出引流管之前,通过引流管向硬膜下腔注射 40 毫克琥珀酸甲泼尼龙钠,然后完全拔出引流管。术后第三天、第三个月和第六个月,使用马克瓦尔德分级量表(Markwalder Grading Scale,MGS)对患者的神经症状改善或恶化情况进行评估。此外,在术后第三个月和第六个月,患者还接受了计算机断层扫描成像,检查是否有复发。此外,87.5%的患者为单侧慢性硬膜下血肿(uCSDH),12.5%的患者为双侧慢性硬膜下血肿(bCSDH)。左右硬膜下血肿的发生率相同(43.8%)。结论通过潜在的 CSDH 腔局部注射地塞米松可获得理想的效果。
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引用次数: 0
Cerebellopontine angle epidermoid cyst presenting with only trigeminal neuralgia: A retrospective study at the single-center in Vietnam 仅表现为三叉神经痛的小脑角表皮样囊肿:越南单中心回顾性研究
IF 0.4 Q4 CLINICAL NEUROLOGY Pub Date : 2024-04-26 DOI: 10.1016/j.inat.2024.101987
Phuoc Trong Do , Chung Kim Nguyen , Viet-Thang Le

Objective

To assess the influence of clinical and imaging characteristics on the outcome of microsurgery treatment for cerebellopontine angle (CPA) epidermoid cyst (EC) presenting only with trigeminal neuralgia (TN).

Methods

A retrospective observational study describing 42 cases of CPA epidermoid cyst presenting only with TN n CPA for 10 years from 2011 to 2021 with the mean follow-up period was 37 months (range, 6–60 months). This study is the largest research with a long follow-up period reported so far worldwide for ECs with only TN symptom. We analyzed the clinical-radiological records of all the patients who met the rigorous requirements to find the distinct features of these tumors.

Results

The mean age was 40.1 ± 4.7 years. The time from symptom onset to surgery was 8.6 ± 3.9 months. Symptoms of multiple branches of the 5th nerve appeared in 71.4 %, the most common was V2V3 accounting for 42.9 %. Most of the tumors were located limited in the CPA, accounting for 66.7 %. Total resection reached 90.5 %. The effectiveness of pain relief of microsurgery reached 97.6 %, Barrow Neurological Institute (BNI) score I reached 73.8 % and pain relief was 23.8 %. The postoperative neurologic deficit was 14.3 %.

Conclusion

CPA epidermoid cysts presenting with TN as the sole symptom have favorable characteristics for total removing the tumor compared with other tumors in the remaining group. Total removing the tumor with the support of continuous intraoperative electromyography monitoring and decompressing the 5th nerve was ideal; it will not only increase the symptom improvement but also have a low rate of postoperative complications.

方法一项回顾性观察研究,描述了自2011年至2021年10年间42例仅伴有三叉神经痛(TN)的小脑视角(CPA)表皮样囊肿,平均随访时间为37个月(6-60个月)。该研究是迄今为止世界上针对仅有 TN 症状的表皮样囊肿进行的规模最大、随访时间最长的研究。我们分析了所有符合严格要求的患者的临床和放射学记录,以发现这些肿瘤的显著特征。平均年龄为(40.1±4.7)岁,从症状出现到手术时间为(8.6±3.9)个月。71.4%的患者出现第五神经多支症状,其中最常见的是V2V3,占42.9%。大多数肿瘤局限于CPA,占66.7%。总切除率达到 90.5%。显微手术的止痛效果达到97.6%,巴罗神经研究所(Barrow Neurological Institute,BNI)评分I达到73.8%,疼痛缓解率为23.8%。结论CPA表皮样囊肿以TN为唯一症状,与其余组别中的其他肿瘤相比,完全切除肿瘤具有良好的特征。在术中持续肌电图监测和第 5 神经减压的支持下全切肿瘤是最理想的方法,不仅能增加症状改善率,而且术后并发症发生率低。
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引用次数: 0
期刊
Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
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