Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献_第2页

Integrative analysis of bulk and single-cell transcriptomes uncovers fibroblast-driven modulation of aneurysm stability 整体和单细胞转录组的综合分析揭示了成纤维细胞驱动的动脉瘤稳定性调节

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102179

Wu-zhi Wei , Shu-jie Fu , Jin-zhou Zhu , Xue-zhun Xiong , Si Zhu , Ze-hua Lei

Background

Intracranial aneurysm (IA) is characterized by vascular wall remodeling and extracellular matrix (ECM) dysregulation, leading to aneurysm formation and rupture. Fibroblasts, key regulators of ECM homeostasis, have been implicated in IA pathogenesis, but their functional heterogeneity and molecular mechanisms remain poorly defined.

Methods

In this study, we integrated bulk and single-cell RNA sequencing datasets to investigate fibroblast subpopulations involved in IA progression. Using the GSE122897 dataset, we applied DESeq2 for differential expression analysis and WGCNA to construct gene co-expression networks. Hub genes were screened via MCODE and subjected to functional enrichment analysis. Their expression was subsequently validated in the GSE193533 mouse IA single-cell dataset, which included sham, formed, and ruptured aneurysm samples. Fibroblasts were reclustered to explore subtype heterogeneity and functional dynamics.

Results

Two upregulated gene co-expression modules were identified: an ECM remodeling module and a cilium/cytoskeleton organization module. Hub gene analysis revealed 14 key genes, including COL5A1, FSTL1, PRRX2, and ADAMTS2, which were enriched in pathways related to collagen metabolism, ECM organization, and epithelial apoptosis. Re-clustering of fibroblasts revealed two distinct subtypes: C1 and C2. The C1 subtype, characterized by high expression of FSTL1, likely contributes to a persistent inflammatory state and pathological remodeling, potentially exacerbating vessel wall weakening. In contrast, the C2 subtype, characterized by high expression of ADAMTS2 and PRRX2, appears to orchestrate a protective response. Clinically, our findings highlight the imbalance between these fibroblast states as a potential determinant of aneurysm stability. Strategies aimed at preserving the ADAMTS2-driven reparative capacity or inhibiting FSTL1-mediated remodeling may represent novel therapeutic avenues to prevent IA rupture.

颅内动脉瘤（IA）以血管壁重塑和细胞外基质（ECM）失调为特征，导致动脉瘤形成和破裂。成纤维细胞是ECM稳态的关键调节因子，与IA的发病机制有关，但其功能异质性和分子机制仍不明确。方法在这项研究中，我们整合了大量和单细胞RNA测序数据集来研究参与IA进展的成纤维细胞亚群。使用GSE122897数据集，我们使用DESeq2进行差异表达分析，使用WGCNA构建基因共表达网络。通过MCODE筛选Hub基因，并进行功能富集分析。随后在GSE193533小鼠IA单细胞数据集中验证了它们的表达，该数据集包括假的、形成的和破裂的动脉瘤样本。成纤维细胞重新聚集以探索亚型异质性和功能动力学。结果鉴定出两个基因共表达上调模块：ECM重塑模块和纤毛/细胞骨架组织模块。Hub基因分析发现COL5A1、FSTL1、PRRX2、ADAMTS2等14个关键基因富集于胶原代谢、ECM组织和上皮细胞凋亡相关通路。成纤维细胞的重新聚类显示出两个不同的亚型：C1和C2。C1亚型以FSTL1的高表达为特征，可能导致持续的炎症状态和病理性重塑，潜在地加剧血管壁弱化。相比之下，以ADAMTS2和PRRX2高表达为特征的C2亚型似乎协调了保护性反应。临床上，我们的发现强调了这些成纤维细胞状态之间的不平衡是动脉瘤稳定性的潜在决定因素。旨在保持adamts2驱动的修复能力或抑制fstl1介导的重塑的策略可能是预防内膜破裂的新治疗途径。

{"title":"Integrative analysis of bulk and single-cell transcriptomes uncovers fibroblast-driven modulation of aneurysm stability","authors":"Wu-zhi Wei , Shu-jie Fu , Jin-zhou Zhu , Xue-zhun Xiong , Si Zhu , Ze-hua Lei","doi":"10.1016/j.inat.2025.102179","DOIUrl":"10.1016/j.inat.2025.102179","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial aneurysm (IA) is characterized by vascular wall remodeling and extracellular matrix (ECM) dysregulation, leading to aneurysm formation and rupture. Fibroblasts, key regulators of ECM homeostasis, have been implicated in IA pathogenesis, but their functional heterogeneity and molecular mechanisms remain poorly defined.</div></div><div><h3>Methods</h3><div>In this study, we integrated bulk and single-cell RNA sequencing datasets to investigate fibroblast subpopulations involved in IA progression. Using the GSE122897 dataset, we applied DESeq2 for differential expression analysis and WGCNA to construct gene co-expression networks. Hub genes were screened via MCODE and subjected to functional enrichment analysis. Their expression was subsequently validated in the GSE193533 mouse IA single-cell dataset, which included sham, formed, and ruptured aneurysm samples. Fibroblasts were reclustered to explore subtype heterogeneity and functional dynamics.</div></div><div><h3>Results</h3><div>Two upregulated gene co-expression modules were identified: an ECM remodeling module and a cilium/cytoskeleton organization module. Hub gene analysis revealed 14 key genes, including COL5A1, FSTL1, PRRX2, and ADAMTS2, which were enriched in pathways related to collagen metabolism, ECM organization, and epithelial apoptosis. Re-clustering of fibroblasts revealed two distinct subtypes: C1 and C2. The C1 subtype, characterized by high expression of FSTL1, likely contributes to a persistent inflammatory state and pathological remodeling, potentially exacerbating vessel wall weakening. In contrast, the C2 subtype, characterized by high expression of ADAMTS2 and PRRX2, appears to orchestrate a protective response. Clinically, our findings highlight the imbalance between these fibroblast states as a potential determinant of aneurysm stability. Strategies aimed at preserving the ADAMTS2-driven reparative capacity or inhibiting FSTL1-mediated remodeling may represent novel therapeutic avenues to prevent IA rupture.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102179"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939480","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}

引用次数: 0

Comparative review of stimulated Raman histology applications in pediatric and adult glioma surgery 刺激拉曼组织学在小儿和成人胶质瘤手术中的应用比较

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102188

Hadiqa Aimen , Ceemal Khan , Izaz Riaz , Muhammad Riaz , Muhammad Mehboob Alam , Mohammad Aadil Qamar , Abdul Basit , Saad Khan

Gliomas are one of the most difficult primary brain tumours to treat as their infiltrative growth limits the safe extent of resection and results in high recurrence rates. There are variations among adults and children regarding the incidence, molecular drivers and response to treatment of specific challenges. Standard tools used during surgery—like frozen section analysis and fluorescence-guided surgery (FGS) are helpful. But, they are limited by sampling error, issue of processing time and fluorescence specificity. This is especially true for infiltrative margins. Stimulated Raman histology (SRH) has recently been developed as a non-invasive imaging technique for fresh tissue based on intrinsic vibrational contrast to generate H&E-like images, which can be used in near-real-time in neurosurgery. This analysis provides an overview of existing studies on the safety of adult and paediatric glioma surgery. To begin with, we will summarise the epidemiological and molecular differences between the adult-type and paediatric-type diffuse gliomas and look at how these differences shape our intraoperative diagnostic needs. The reported SRH performance across age groups, including its ability to distinguish tumour from non-neoplastic brain, assess margins and support safe extent of resection when tissue is limited, as is often the case in paediatric procedures. An assessment is made of how helpful SRH frozen section FGS neuronavigation intraoperative MRI confocal endomicroscopy is. In conclusion, we review key technological, biological, workflow and regulatory limitations, including concerns regarding data and AI generalisability, and highlight future directions, including paediatric-specific SRH–AI models and multimodal integration. In summary, comparative evidence suggests SRH is a profound bridge for precision age-adapted intraoperative neuropathology in gliomas.

胶质瘤是最难治疗的原发性脑肿瘤之一，其浸润性生长限制了切除的安全范围，并导致高复发率。成人和儿童在发病率、分子驱动因素和对特定挑战治疗的反应方面存在差异。在手术中使用的标准工具，如冷冻切片分析和荧光引导手术（FGS）是有帮助的。但是，它们受到采样误差、处理时间和荧光特异性问题的限制。对于浸润性边缘尤其如此。受激拉曼组织学（SRH）最近发展成为一种基于内在振动对比的新鲜组织非侵入性成像技术，可产生类似H&；的图像，可用于近实时的神经外科。本分析提供了对成人和儿童胶质瘤手术安全性的现有研究的概述。首先，我们将总结成人型和儿科型弥漫性胶质瘤之间的流行病学和分子差异，并看看这些差异如何影响我们的术中诊断需求。报告的SRH在不同年龄组的表现，包括区分肿瘤和非肿瘤性脑，评估边缘和支持组织有限时切除的安全程度的能力，这在儿科手术中经常出现。评估SRH冷冻切片FGS神经导航术中MRI共聚焦内镜的帮助。最后，我们回顾了关键技术、生物学、工作流程和监管限制，包括对数据和人工智能通用性的关注，并强调了未来的方向，包括儿科特定的SRH-AI模型和多模式集成。总之，比较证据表明SRH是神经胶质瘤术中精确年龄适应神经病理学的重要桥梁。

{"title":"Comparative review of stimulated Raman histology applications in pediatric and adult glioma surgery","authors":"Hadiqa Aimen , Ceemal Khan , Izaz Riaz , Muhammad Riaz , Muhammad Mehboob Alam , Mohammad Aadil Qamar , Abdul Basit , Saad Khan","doi":"10.1016/j.inat.2025.102188","DOIUrl":"10.1016/j.inat.2025.102188","url":null,"abstract":"<div><div>Gliomas are one of the most difficult primary brain tumours to treat as their infiltrative growth limits the safe extent of resection and results in high recurrence rates. There are variations among adults and children regarding the incidence, molecular drivers and response to treatment of specific challenges. Standard tools used during surgery—like frozen section analysis and fluorescence-guided surgery (FGS) are helpful. But, they are limited by sampling error, issue of processing time and fluorescence specificity. This is especially true for infiltrative margins. Stimulated Raman histology (SRH) has recently been developed as a non-invasive imaging technique for fresh tissue based on intrinsic vibrational contrast to generate H&E-like images, which can be used in near-real-time in neurosurgery. This analysis provides an overview of existing studies on the safety of adult and paediatric glioma surgery. To begin with, we will summarise the epidemiological and molecular differences between the adult-type and paediatric-type diffuse gliomas and look at how these differences shape our intraoperative diagnostic needs. The reported SRH performance across age groups, including its ability to distinguish tumour from non-neoplastic brain, assess margins and support safe extent of resection when tissue is limited, as is often the case in paediatric procedures. An assessment is made of how helpful SRH frozen section FGS neuronavigation intraoperative MRI confocal endomicroscopy is. In conclusion, we review key technological, biological, workflow and regulatory limitations, including concerns regarding data and AI generalisability, and highlight future directions, including paediatric-specific SRH–AI models and multimodal integration. In summary, comparative evidence suggests SRH is a profound bridge for precision age-adapted intraoperative neuropathology in gliomas.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102188"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037628","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}

引用次数: 0

Internal jugular vein decompression for refractory pulsatile tinnitus with coexisting tinnitus cerebri: A case report and literature review 颈内静脉减压治疗难治性搏动性耳鸣合并脑鸣1例并文献复习

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102177

Xupeng Peng , Shuaibin Lu , Haiyang Ma , Sheng Xu , Junmeng Xu , Meng Lv , Yuchuan Ding , Xunming Ji , Guangtong Zhu , Zhiqiang Hu , Weicheng Peng

Background

Sigmoid sinus wall anomalies (SSWA) are a recognized cause of pulsatile tinnitus (PT). While sigmoid sinus wall reconstruction (SSWR) is often effective, treatment failure can occur. This report describes a case of refractory PT with coexisting tinnitus cerebri (TC) successfully treated with internal jugular vein (IJV) decompression after unsuccessful SSWR.

Case description

A 35-year-old woman presented with an 8-year history of right-sided PT synchronous with heartbeat and persistent tinnitus cerebri (TC). Imaging revealed right SSWA and J3-segment IJV stenosis due to compression by the right transverse process of the atlas (C1). After sigmoid sinus wall reconstruction, there was no significant improvement in PT and TC. Subsequent IJV decompression (C1 transverse process removal and soft tissue release) resulted in complete resolution of PT and significant improvement of TC. Postoperative ultrasound and CTV confirmed increased IJV diameter and flow.

Conclusion

This case highlights IJVS as a potential contributor to refractory PT in patients with SSWA. Comprehensive venous evaluation, including assessment of IJV patency, is crucial when SSWR fails. The differential response of PT and TC to IJV decompression suggests distinct pathophysiological mechanisms, warranting further investigation. IJV decompression represents a viable therapeutic option in such scenarios.

乙状窦壁异常（SSWA）是公认的引起搏动性耳鸣（PT）的原因。虽然乙状结肠窦壁重建（ssfr）通常是有效的，但也可能发生治疗失败。本文报告了一例难治性PT合并合并脑鸣（TC）的病例，颈内静脉（IJV）减压在SSWR失败后成功治疗。病例描述：一名35岁女性，8年右侧PT伴心律不齐和持续性脑鸣（TC）。影像学显示右侧SSWA和j3节段IJV狭窄，原因是寰椎右侧横突（C1）压迫。乙状窦壁重建后，PT和TC无明显改善。随后的IJV减压（C1横突切除和软组织释放）导致PT完全消退，TC显著改善。术后超声及CTV证实IJV直径及血流增加。结论本病例强调IJVS是SSWA患者难治性PT的潜在诱因。当SSWR失败时，综合静脉评估，包括评估IJV通畅，是至关重要的。PT和TC对IJV减压的不同反应提示不同的病理生理机制，值得进一步研究。在这种情况下，jv减压是一种可行的治疗选择。

{"title":"Internal jugular vein decompression for refractory pulsatile tinnitus with coexisting tinnitus cerebri: A case report and literature review","authors":"Xupeng Peng , Shuaibin Lu , Haiyang Ma , Sheng Xu , Junmeng Xu , Meng Lv , Yuchuan Ding , Xunming Ji , Guangtong Zhu , Zhiqiang Hu , Weicheng Peng","doi":"10.1016/j.inat.2025.102177","DOIUrl":"10.1016/j.inat.2025.102177","url":null,"abstract":"<div><h3>Background</h3><div>Sigmoid sinus wall anomalies (SSWA) are a recognized cause of pulsatile tinnitus (PT). While sigmoid sinus wall reconstruction (SSWR) is often effective, treatment failure can occur. This report describes a case of refractory PT with coexisting tinnitus cerebri (TC) successfully treated with internal jugular vein (IJV) decompression after unsuccessful SSWR.</div></div><div><h3>Case description</h3><div>A 35-year-old woman presented with an 8-year history of right-sided PT synchronous with heartbeat and persistent tinnitus cerebri (TC). Imaging revealed right SSWA and J3-segment IJV stenosis due to compression by the right transverse process of the atlas (C1). After sigmoid sinus wall reconstruction, there was no significant improvement in PT and TC. Subsequent IJV decompression (C1 transverse process removal and soft tissue release) resulted in complete resolution of PT and significant improvement of TC. Postoperative ultrasound and CTV confirmed increased IJV diameter and flow.</div></div><div><h3>Conclusion</h3><div>This case highlights IJVS as a potential contributor to refractory PT in patients with SSWA. Comprehensive venous evaluation, including assessment of IJV patency, is crucial when SSWR fails. The differential response of PT and TC to IJV decompression suggests distinct pathophysiological mechanisms, warranting further investigation. IJV decompression represents a viable therapeutic option in such scenarios.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102177"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939540","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}

引用次数: 0

Tophaceous gout masquerading as lumbar disc herniation: Case report 以腰椎间盘突出症为伪装的白垩性痛风1例

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102183

Tshiunza Mpoyi Chérubin , Ntalaja Jeff Mukengeshay , Mirenge Goert , Metre Guelord , Gervith Reyes Soto , Ramiro Lopez Elizalde , Egemen Gok , Kivanc Yangi , Manuel de Jesus Encarnacion Ramirez , Ismail Bozkurt

Background

Spinal gout is a rare condition that frequently mimics common spinal disorders such as lumbar disc herniation, leading to diagnostic challenges and misdiagnosis. We report a case of spinal gout presenting as lumbar radiculopathy, ultimately confirmed through histopathological analysis.

Case

A 66-year-old man with a known history of gout and hypertension came to the hospital with a right L5 radiculopathy and right ankle dorsiflexion weakness graded as 3/5. Magnetic resonance imaging suggested a right paracentral disc herniation with nerve root compression. The patient underwent surgical decompression and spinal stabilization, during which abnormal tissue was excised and submitted for pathological examination.

Results

Histopathological analysis confirmed the diagnosis of gouty tophus. Following surgery, the patient experienced rapid symptomatic relief. His motor strength improved significantly to 5/5 at the two-week follow-up, and he regained full independent mobility without recurrence.

Conclusion

Clinicians should consider spinal gout in the differential diagnosis of lumbar radiculopathy, particularly in patients with a history of gout, as histopathological confirmation is essential for accurate diagnosis and effective management.

背景：脊柱痛风是一种罕见的疾病，通常与腰椎间盘突出等常见脊柱疾病相似，导致诊断困难和误诊。我们报告一例脊柱痛风表现为腰椎神经根病，最终通过组织病理学分析证实。病例66岁男性，有痛风、高血压病史，右侧L5神经根病，右踝关节背屈无力，分级3/5。磁共振成像提示右侧中央旁椎间盘突出伴神经根受压。患者接受手术减压和脊柱稳定，期间切除异常组织并提交病理检查。结果病理组织学分析证实了痛风性痛风的诊断。手术后，患者症状迅速缓解。在两周的随访中，他的运动强度明显提高到5/5，并恢复了完全独立的活动能力，没有复发。结论临床医生在鉴别诊断腰椎神经根病时应考虑脊髓痛风，特别是有痛风病史的患者，因为组织病理学证实是准确诊断和有效治疗的必要条件。

{"title":"Tophaceous gout masquerading as lumbar disc herniation: Case report","authors":"Tshiunza Mpoyi Chérubin , Ntalaja Jeff Mukengeshay , Mirenge Goert , Metre Guelord , Gervith Reyes Soto , Ramiro Lopez Elizalde , Egemen Gok , Kivanc Yangi , Manuel de Jesus Encarnacion Ramirez , Ismail Bozkurt","doi":"10.1016/j.inat.2025.102183","DOIUrl":"10.1016/j.inat.2025.102183","url":null,"abstract":"<div><h3>Background</h3><div>Spinal gout is a rare condition that frequently mimics common spinal disorders such as lumbar disc herniation, leading to diagnostic challenges and misdiagnosis. We report a case of spinal gout presenting as lumbar radiculopathy, ultimately confirmed through histopathological analysis.</div></div><div><h3>Case</h3><div>A 66-year-old man with a known history of gout and hypertension came to the hospital with a right L5 radiculopathy and right ankle dorsiflexion weakness graded as 3/5. Magnetic resonance imaging suggested a right paracentral disc herniation with nerve root compression. The patient underwent surgical decompression and spinal stabilization, during which abnormal tissue was excised and submitted for pathological examination.</div></div><div><h3>Results</h3><div>Histopathological analysis confirmed the diagnosis of gouty tophus. Following surgery, the patient experienced rapid symptomatic relief. His motor strength improved significantly to 5/5 at the two-week follow-up, and he regained full independent mobility without recurrence.</div></div><div><h3>Conclusion</h3><div>Clinicians should consider spinal gout in the differential diagnosis of lumbar radiculopathy, particularly in patients with a history of gout, as histopathological confirmation is essential for accurate diagnosis and effective management.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102183"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939544","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}

引用次数: 0

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102192

Yifan Zhou , Qiang Ma , Tianyu Shao, Guanghui Zhang, Guojun Su, Bin Li

Objective

Analyze independent risk factors for cerebral venous sinus thrombosis (CVST) following surgery for tumors in the cerebellopontine angle (CPA) region, construct and validate predictive models, and explore the prognosis of postoperative CVST alongside the application and risks of anticoagulant therapy.

Methods

A retrospective study enrolled 288 patients who underwent regional tumor surgery for CPA tumors and grouped them based on postoperative CVST occurrence. Univariate and multivariate logistic regression analyses identified independent risk factors, and their individual and combined predictive values were assessed using ROC curves. A predictive model was further constructed and validated. Finally, the study analyzed prognostic differences between the anticoagulation therapy group and the conservative treatment group among CVST patients.

Results

Long-term smoking history, sinus compression or infiltration, elevated D-dimer levels, low HALP levels, direct sinus injury during surgery, and postoperative intracranial infection are independent risk factors for postoperative CVST. There was no difference in discharge outcomes between the anticoagulation group and the conservative management group (P > 0.05), and therapeutic anticoagulation was associated with a higher incidence of intracranial hemorrhage.

Conclusion

Factors associated with postoperative CVST in CPA tumors include a history of long-term smoking, tumor-associated sinus compression or infiltration, elevated D-dimer levels, low HALP scores, direct sinus injury during surgery, and postoperative intracranial infection.For patients with clinically diagnosed postoperative CVST, careful consideration is required when initiating anticoagulant therapy due to the potential increased risk of intracranial hemorrhage.

目的分析桥小脑角（CPA）区肿瘤术后脑静脉窦血栓形成（CVST）的独立危险因素，建立并验证预测模型，探讨CVST的预后、抗凝治疗的应用及风险。方法回顾性研究288例CPA肿瘤局部手术患者，根据术后CVST发生情况进行分组。单因素和多因素logistic回归分析确定了独立的危险因素，并使用ROC曲线评估了它们的个体和联合预测值。进一步构建了预测模型并进行了验证。最后，本研究分析了抗凝治疗组与保守治疗组在CVST患者预后的差异。结果长期吸烟史、鼻窦压迫或浸润、d -二聚体升高、低HALP水平、术中鼻窦直接损伤、术后颅内感染是CVST的独立危险因素。抗凝治疗组与保守治疗组出院结局无差异（P > 0.05），治疗性抗凝治疗与颅内出血发生率较高相关。结论长期吸烟史、肿瘤相关性鼻窦压迫或浸润、d -二聚体升高、HALP评分低、术中鼻窦直接损伤、术后颅内感染与CPA肿瘤术后CVST相关。对于临床诊断为术后CVST的患者，由于颅内出血的潜在风险增加，在开始抗凝治疗时需要仔细考虑。

{"title":"Analysis of related risk factors, treatment and prognosis of venous sinus thrombosis after surgery for cerebellopontine angle tumors","authors":"Yifan Zhou , Qiang Ma , Tianyu Shao, Guanghui Zhang, Guojun Su, Bin Li","doi":"10.1016/j.inat.2025.102192","DOIUrl":"10.1016/j.inat.2025.102192","url":null,"abstract":"<div><h3>Objective</h3><div>Analyze independent risk factors for cerebral venous sinus thrombosis (CVST) following surgery for tumors in the cerebellopontine angle (CPA) region, construct and validate predictive models, and explore the prognosis of postoperative CVST alongside the application and risks of anticoagulant therapy.</div></div><div><h3>Methods</h3><div>A retrospective study enrolled 288 patients who underwent regional tumor surgery for CPA tumors and grouped them based on postoperative CVST occurrence. Univariate and multivariate logistic regression analyses identified independent risk factors, and their individual and combined predictive values were assessed using ROC curves. A predictive model was further constructed and validated. Finally, the study analyzed prognostic differences between the anticoagulation therapy group and the conservative treatment group among CVST patients.</div></div><div><h3>Results</h3><div>Long-term smoking history, sinus compression or infiltration, elevated D-dimer levels, low HALP levels, direct sinus injury during surgery, and postoperative intracranial infection are independent risk factors for postoperative CVST. There was no difference in discharge outcomes between the anticoagulation group and the conservative management group (P > 0.05), and therapeutic anticoagulation was associated with a higher incidence of intracranial hemorrhage.</div></div><div><h3>Conclusion</h3><div>Factors associated with postoperative CVST in CPA tumors include a history of long-term smoking, tumor-associated sinus compression or infiltration, elevated D-dimer levels, low HALP scores, direct sinus injury during surgery, and postoperative intracranial infection.For patients with clinically diagnosed postoperative CVST, careful consideration is required when initiating anticoagulant therapy due to the potential increased risk of intracranial hemorrhage.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102192"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939473","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}

引用次数: 0

Sellar atypical teratoid/rhabdoid tumor in an adult mimicking a pituitary macroadenoma: an illustrative case and literature review 成人垂体大腺瘤的鞍不典型畸胎瘤/横纹肌样瘤：一例说明性病例和文献复习

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102171

Julien Adam , Roméo Bujiriri Murhega , Gael Noumi Djoumessi , Vincent Lethongsavarn , Laurent Do

Background: Atypical teratoid/rhabdoid tumors (ATRTs) are rare, aggressive tumors of the central nervous system. In the sellar region, they can clinically and radiologically mimic pituitary macroadenomas, which may delay accurate diagnosis and appropriate treatment. Case Description: A 42-year-old woman presented with visual disturbances and hyperprolactinemia. Brain MRI revealed a sellar mass compressing the optic chiasm, initially suggestive of a pituitary macroadenoma. Within days, she developed cranial nerve palsies and signs of brainstem compression. Repeat imaging showed intratumoral necrosis, hemorrhage, and rapid tumor enlargement. She underwent urgent endonasal transsphenoidal resection. Postoperatively, MRI revealed aggressive tumor regrowth with worsening brainstem compression. Histopathological analysis confirmed an ATRT based on rhabdoid morphology, high mitotic index, and SMARCB1 (INI1) loss. The patient died before any adjuvant therapy could be initiated. Conclusion: Sellar ATRTs should be considered in rapidly progressing or radiologically atypical sellar lesions. Early biopsy and prompt multidisciplinary management are crucial, although the prognosis remains poor in aggressive presentations.

背景：非典型畸胎瘤/横纹肌样瘤是一种罕见的侵袭性中枢神经系统肿瘤。在鞍区，它们可以在临床和放射学上模拟垂体大腺瘤，这可能会延迟准确的诊断和适当的治疗。病例描述：一名42岁女性，表现为视力障碍和高泌乳素血症。脑MRI显示鞍区肿块压迫视交叉，初步提示垂体大腺瘤。几天后，她出现了脑神经麻痹和脑干压迫的症状。重复影像显示肿瘤内坏死、出血及肿瘤迅速增大。她接受了紧急鼻内蝶窦切除术。术后MRI显示肿瘤侵袭性再生，脑干压迫加重。组织病理学分析证实了基于横纹肌形态、高有丝分裂指数和SMARCB1 （INI1）丢失的ATRT。患者在任何辅助治疗开始前死亡。结论：快速进展或放射学上不典型的鞍区病变应考虑鞍区atrt。早期活检和及时的多学科治疗是至关重要的，尽管在侵袭性表现中预后仍然很差。

{"title":"Sellar atypical teratoid/rhabdoid tumor in an adult mimicking a pituitary macroadenoma: an illustrative case and literature review","authors":"Julien Adam , Roméo Bujiriri Murhega , Gael Noumi Djoumessi , Vincent Lethongsavarn , Laurent Do","doi":"10.1016/j.inat.2025.102171","DOIUrl":"10.1016/j.inat.2025.102171","url":null,"abstract":"<div><div><strong>Background:</strong> Atypical teratoid/rhabdoid tumors (ATRTs) are rare, aggressive tumors of the central nervous system. In the sellar region, they can clinically and radiologically mimic pituitary macroadenomas, which may delay accurate diagnosis and appropriate treatment. <strong>Case Description:</strong> A 42-year-old woman presented with visual disturbances and hyperprolactinemia. Brain MRI revealed a sellar mass compressing the optic chiasm, initially suggestive of a pituitary macroadenoma. Within days, she developed cranial nerve palsies and signs of brainstem compression. Repeat imaging showed intratumoral necrosis, hemorrhage, and rapid tumor enlargement. She underwent urgent endonasal transsphenoidal resection. Postoperatively, MRI revealed aggressive tumor regrowth with worsening brainstem compression. Histopathological analysis confirmed an ATRT based on rhabdoid morphology, high mitotic index, and SMARCB1 (INI1) loss. The patient died before any adjuvant therapy could be initiated. <strong>Conclusion:</strong> Sellar ATRTs should be considered in rapidly progressing or radiologically atypical sellar lesions. Early biopsy and prompt multidisciplinary management are crucial, although the prognosis remains poor in aggressive presentations.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102171"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939478","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}

引用次数: 0

Open surgery algorithm for carotid-cavernous fistula 颈动脉-海绵窦瘘的开放手术治疗方法

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102173

Diana Jovett Sanchez, Alaric Emmanuel M. Salonga, Juan Silvestre G. Pascual, Gerardo D. Legaspi, Peter Paul P. Rivera

Background

Traumatic carotid-cavernous fistulas (CCFs) are abnormal arterio-venous communication between the internal carotid artery (ICA) and the cavernous sinus. Standard treatment of CCFs is endovascular embolization with the goal of isolating the fistula and protecting cerebral circulation. The economic burden of this treatment in low-middle income countries such as ours, led our team to devise different open surgical strategies for the management of CCFs.

Case description

Three patients with CCFs were selected to represent the different surgical strategies employed, with their outcomes serving as the basis for the development of a treatment algorithm. Patients who underwent Hunterian ligation alone had persistent fistula, while those who underwent ICA trapping (with or without bypass) had resolution of the CCF. A treatment algorithm was formed after panel discussion by experts. After establishing the diagnosis of CCF, the absence or presence of collateral circulation was evaluated next. Once collateral circulation was determined to be present, the adequacy will be tested via gradual occlusion of the ICA. Appearance of neurologic symptoms during gradual occlusion will qualify the patient for an EC-IC bypass followed by ICA trapping. If no neurologic symptoms arise, ICA trapping will be done. In contrast, if collateral circulation were absent on angiography, bypass followed by ICA trapping was performed.

Conclusion

The primary goals in treatment of CCF are isolation of the fistula and preservation of cerebral circulation. To achieve these objectives, our findings indicate that ICA trapping was the most effective method to isolate the fistula, while cerebral protection may be ensured by assessing the adequacy of collateral circulation via progressive gradual occlusion of the ICA. Endovascular treatment still remains the gold standard in management of CCFs, however, open surgery can be a safe and cost-effective treatment option in circumstances where the standard treatment is unavailable.

外伤性颈内动脉-海绵窦瘘（CCFs）是颈内动脉（ICA）和海绵窦之间异常的动静脉交通。CCFs的标准治疗是血管内栓塞，目的是隔离瘘管和保护脑循环。在我们这样的中低收入国家，这种治疗的经济负担促使我们的团队设计了不同的开放手术策略来治疗CCFs。病例描述选择三例CCFs患者来代表所采用的不同手术策略，其结果作为治疗算法发展的基础。单纯行Hunterian结扎的患者存在持续性瘘管，而行ICA夹住（有或没有搭桥）的患者CCF得到解决。专家小组讨论后形成了治疗算法。在确定CCF的诊断后，接下来评估有无侧支循环。一旦确定存在侧支循环，将通过逐渐闭塞ICA来测试其充分性。在逐渐闭塞期间出现的神经系统症状将使患者有资格进行EC-IC搭桥，然后进行ICA捕获。如果没有出现神经症状，将进行ICA捕获。相反，如果在血管造影中没有侧支循环，则行旁路手术，然后进行ICA捕获。结论CCF治疗的首要目标是隔离瘘管和保持脑循环。为了实现这些目标，我们的研究结果表明，ICA捕获是隔离瘘管的最有效方法，而通过逐渐闭塞ICA来评估侧支循环的充分性可以确保脑保护。血管内治疗仍然是治疗CCFs的金标准，然而，在无法获得标准治疗的情况下，开放手术可以是一种安全且经济有效的治疗选择。

{"title":"Open surgery algorithm for carotid-cavernous fistula","authors":"Diana Jovett Sanchez, Alaric Emmanuel M. Salonga, Juan Silvestre G. Pascual, Gerardo D. Legaspi, Peter Paul P. Rivera","doi":"10.1016/j.inat.2025.102173","DOIUrl":"10.1016/j.inat.2025.102173","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic carotid-cavernous fistulas (CCFs) are abnormal arterio-venous communication between the internal carotid artery (ICA) and the cavernous sinus. Standard treatment of CCFs is endovascular embolization with the goal of isolating the fistula and protecting cerebral circulation. The economic burden of this treatment in low-middle income countries such as ours, led our team to devise different open surgical strategies for the management of CCFs.</div></div><div><h3>Case description</h3><div>Three patients with CCFs were selected to represent the different surgical strategies employed, with their outcomes serving as the basis for the development of a treatment algorithm. Patients who underwent Hunterian ligation alone had persistent fistula, while those who underwent ICA trapping (with or without bypass) had resolution of the CCF. A treatment algorithm was formed after panel discussion by experts. After establishing the diagnosis of CCF, the absence or presence of collateral circulation was evaluated next. Once collateral circulation was determined to be present, the adequacy will be tested via gradual occlusion of the ICA. Appearance of neurologic symptoms during gradual occlusion will qualify the patient for an EC-IC bypass followed by ICA trapping. If no neurologic symptoms arise, ICA trapping will be done. In contrast, if collateral circulation were absent on angiography, bypass followed by ICA trapping was performed.</div></div><div><h3>Conclusion</h3><div>The primary goals in treatment of CCF are isolation of the fistula and preservation of cerebral circulation. To achieve these objectives, our findings indicate that ICA trapping was the most effective method to isolate the fistula, while cerebral protection may be ensured by assessing the adequacy of collateral circulation via progressive gradual occlusion of the ICA. Endovascular treatment still remains the gold standard in management of CCFs, however, open surgery can be a safe and cost-effective treatment option in circumstances where the standard treatment is unavailable.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102173"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939470","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}

引用次数: 0

Idiopathic intradural extramedullary epidermoid cyst at the conus medullaris 特发性髓圆锥硬膜内髓外表皮样囊肿

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102184

Berkay Bozkurt , Halit Alioglu , Mahmoud Osama , Mert Yavuz , Zuhal Kuş Silav , Baris Ozoner

Background

Spinal epidermoid cysts are uncommon, comprising < 1 % of all spinal tumors. Involvement of the conus medullaris and cauda equina is particularly rare, often presenting with nonspecific symptoms and posing diagnostic and surgical challenges.

Case Presentation

A 32-year-old woman presented with chronic low back pain and distal limb numbness without weakness or sphincter dysfunction. MRI showed an intradural extramedullary lesion at L1 compressing the conus and displacing cauda equina roots. Gross total excision via hemilaminectomy with neuromonitoring confirmed an epidermoid cyst. Symptoms resolved completely, with no recurrence at 9 months.

Clinical Discussion

Spinal epidermoid cysts may mimic other intradural lesions and are best identified with MRI, where DWI improves diagnostic confidence. Reported cases most often present with back pain or sensory disturbance, while delayed diagnosis may result in motor or sphincter involvement. Surgical excision remains the treatment of choice, though capsule adherence can limit removal. Our case illustrates these observations, with complete recovery following timely microsurgical excision.

Conclusion

Epidermoid cysts of the conus medullaris region are rare intradural lesions. This case highlights the importance of recognizing their subtle clinical presentation and demonstrates that timely microsurgical excision can achieve symptom resolution with a favourable short-term outcome.

背景：脊髓表皮样囊肿并不常见，约占所有脊柱肿瘤的1%。累及髓圆锥和马尾是特别罕见的，通常表现为非特异性症状，给诊断和手术带来挑战。病例介绍一名32岁女性，以慢性腰痛和远端肢体麻木为主诉，无无力或括约肌功能障碍。MRI显示L1处硬膜内髓外病变压迫圆锥并移位马尾根。经半椎板切除术及神经监测证实为表皮样囊肿。症状完全缓解，9个月无复发。脊髓表皮样囊肿可能与其他硬膜内病变相似，最好通过MRI诊断，其中DWI提高了诊断的可信度。报告的病例通常表现为背部疼痛或感觉障碍，而延迟诊断可能导致运动或括约肌受累。手术切除仍然是治疗的选择，尽管胶囊的依从性可以限制切除。我们的病例说明了这些观察结果，及时显微手术切除后完全恢复。结论髓圆锥区表皮样囊肿是一种罕见的硬膜内病变。本病例强调了识别其微妙临床表现的重要性，并表明及时显微手术切除可以获得良好的短期结果。

{"title":"Idiopathic intradural extramedullary epidermoid cyst at the conus medullaris","authors":"Berkay Bozkurt , Halit Alioglu , Mahmoud Osama , Mert Yavuz , Zuhal Kuş Silav , Baris Ozoner","doi":"10.1016/j.inat.2025.102184","DOIUrl":"10.1016/j.inat.2025.102184","url":null,"abstract":"<div><h3>Background</h3><div>Spinal epidermoid cysts are uncommon, comprising < 1 % of all spinal tumors. Involvement of the conus medullaris and cauda equina is particularly rare, often presenting with nonspecific symptoms and posing diagnostic and surgical challenges.</div></div><div><h3>Case Presentation</h3><div>A 32-year-old woman presented with chronic low back pain and distal limb numbness without weakness or sphincter dysfunction. MRI showed an intradural extramedullary lesion at L1 compressing the conus and displacing cauda equina roots. Gross total excision via hemilaminectomy with neuromonitoring confirmed an epidermoid cyst. Symptoms resolved completely, with no recurrence at 9 months.</div></div><div><h3>ClinicalDiscussion</h3><div>Spinal epidermoid cysts may mimic other intradural lesions and are best identified with MRI, where DWI improves diagnostic confidence. Reported cases most often present with back pain or sensory disturbance, while delayed diagnosis may result in motor or sphincter involvement. Surgical excision remains the treatment of choice, though capsule adherence can limit removal. Our case illustrates these observations, with complete recovery following timely microsurgical excision.</div></div><div><h3>Conclusion</h3><div>Epidermoid cysts of the conus medullaris region are rare intradural lesions. This case highlights the importance of recognizing their subtle clinical presentation and demonstrates that timely microsurgical excision can achieve symptom resolution with a favourable short-term outcome.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102184"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939475","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}

引用次数: 0

Safety and outcomes of hematoma evacuation surgery for intracerebral hemorrhage during antithrombotic therapy 抗血栓治疗期间脑出血血肿清除手术的安全性和结果

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102193

Shigeo Yamashiro , Ken Uekawa , Toshihiro Amadatsu , Ryuta Ueda , An Murai , Masayoshi Fukuoka , Masatomo Kaji , Akitake Mukasa

Objectives

To evaluate the safety and efficacy of hematoma evacuation surgery for intracerebral hemorrhage in patients receiving antithrombotic therapy.

Methods

We conducted a retrospective observational study at a single institution, including 111 patients who underwent hematoma evacuation for spontaneous intracerebral hemorrhage. Patients were divided into an antithrombotic group and a normal group for comparison. Propensity score matching was performed based on hematoma location and volume to compare matched pairs from both groups. Within the antithrombotic group, patients were categorized into endoscopic surgery and craniotomy groups for further comparison.

Results

The antithrombotic group (n = 37) was older and had a higher prevalence of comorbidities compared to the normal group (n = 74). Hematoma volume was significantly greater in the antithrombotic group (86.7 vs 68.9 ml, p = 0.013). No significant differences were observed in terms of surgery duration, hematoma removal rate, intraoperative bleeding, or adverse events. There were significantly more poor outcomes in the antithrombotic group, with no difference in the proportion of good outcomes between two groups. Propensity score analysis revealed no significant differences in surgical outcomes between matched groups (n = 27, each). The endoscopic surgery (n = 31) had a shorter surgery duration compared to the craniotomy (n = 6), with no differences in hemorrhage volume, removal rate, intraoperative bleeding, adverse events, or outcomes. The antiplatelet group (n = 24) tended to have greater hemorrhage volume and lower removal rates comparatively.

Conclusions

These findings suggest that hematoma evacuation can be safely performed in patients on antithrombotic therapy with appropriate perioperative management. Endoscopic surgery offers a less invasive alternative with similar outcomes.

目的评价血肿引流手术治疗脑出血患者抗栓治疗的安全性和有效性。方法：我们在单一机构进行回顾性观察研究，包括111例自发性脑出血患者行血肿清除术。将患者分为抗栓组和正常组进行比较。根据血肿的位置和体积进行倾向评分匹配，比较两组的匹配配对。在抗血栓组中，将患者分为内镜手术组和开颅组进行进一步比较。结果抗栓组（n = 37）比正常组（n = 74）年龄更大，合并症发生率更高。抗栓组血肿体积显著增大（86.7 ml vs 68.9 ml, p = 0.013）。在手术时间、血肿清除率、术中出血或不良事件方面没有观察到显著差异。抗栓组不良预后明显增多，两组良好预后比例无差异。倾向评分分析显示匹配组间手术结果无显著差异（n = 27）。与开颅手术（n = 6）相比，内镜手术（n = 31）的手术时间更短，在出血量、切除率、术中出血、不良事件或结局方面没有差异。抗血小板组（n = 24）出血量较大，清除率较低。结论在适当的围手术期管理下，接受抗血栓治疗的患者可以安全地进行血肿清除。内窥镜手术提供了一种侵入性较小的替代方法，效果相似。

{"title":"Safety and outcomes of hematoma evacuation surgery for intracerebral hemorrhage during antithrombotic therapy","authors":"Shigeo Yamashiro , Ken Uekawa , Toshihiro Amadatsu , Ryuta Ueda , An Murai , Masayoshi Fukuoka , Masatomo Kaji , Akitake Mukasa","doi":"10.1016/j.inat.2025.102193","DOIUrl":"10.1016/j.inat.2025.102193","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the safety and efficacy of hematoma evacuation surgery for intracerebral hemorrhage in patients receiving antithrombotic therapy.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study at a single institution, including 111 patients who underwent hematoma evacuation for spontaneous intracerebral hemorrhage. Patients were divided into an antithrombotic group and a normal group for comparison. Propensity score matching was performed based on hematoma location and volume to compare matched pairs from both groups. Within the antithrombotic group, patients were categorized into endoscopic surgery and craniotomy groups for further comparison.</div></div><div><h3>Results</h3><div>The antithrombotic group (n = 37) was older and had a higher prevalence of comorbidities compared to the normal group (n = 74). Hematoma volume was significantly greater in the antithrombotic group (86.7 vs 68.9 ml, p = 0.013). No significant differences were observed in terms of surgery duration, hematoma removal rate, intraoperative bleeding, or adverse events. There were significantly more poor outcomes in the antithrombotic group, with no difference in the proportion of good outcomes between two groups. Propensity score analysis revealed no significant differences in surgical outcomes between matched groups (n = 27, each). The endoscopic surgery (n = 31) had a shorter surgery duration compared to the craniotomy (n = 6), with no differences in hemorrhage volume, removal rate, intraoperative bleeding, adverse events, or outcomes. The antiplatelet group (n = 24) tended to have greater hemorrhage volume and lower removal rates comparatively.</div></div><div><h3>Conclusions</h3><div>These findings suggest that hematoma evacuation can be safely performed in patients on antithrombotic therapy with appropriate perioperative management. Endoscopic surgery offers a less invasive alternative with similar outcomes.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102193"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077467","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}

引用次数: 0

Combined transarterial and transvenous Onyx embolization approach for anterior cranial fossa dural arteriovenous fistulas with a pial feeder: Reports of two cases 经动脉、静脉联合Onyx栓塞治疗颅前窝硬膜动静脉瘘2例报告

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2025-12-29 DOI: 10.1016/j.inat.2025.102174

Ryota Sakurai , Tomoaki Terada , Hiroo Yamaga , Takeru Umemura , Toru Kurokawa , Yuko Tanaka

Anterior cranial fossa (ACF) dural arteriovenous fistulas (dAVFs) associated with pial arterial supply are rare, and the appropriate endovascular treatment remains uncertain for this type of dAVFs. Certain patterns of pial arterial supply have been associated with an increased risk of hemorrhage and may complicate endovascular strategies.

We present two cases of ACF dAVFs with pial arterial supply that were successfully treated with Onyx transarterial embolization (TAE) and transvenous embolization (TVE). In both cases, the arterial feeders originated from the ethmoidal arteries and pial arterial supply from branches of the anterior cerebral artery (ACA), with venous drainage via the fronto-orbital vein into the superior sagittal sinus (SSS). The microcatheters were navigated through both transarterial and transvenous routes close to the shunt point. TAE using Onyx from a unilateral posterior ethmoidal artery was first performed to safely reduce arterial inflow and occlude the entire shunt while avoiding excessive reflux, if possible. However, the pial arterial supply remained patent. Subsequent TVE from the fronto-orbital vein led to Onyx retrograde penetration into the pial arterial supply and the draining vein, achieving complete obliteration of the fistulas in both cases. A combined TAE and TVE approach for ACF dAVFs with pial arterial supply seems to be effective in obliterating the draining vein, so-called foot of the vein, as well as the pial arterial supply in a retrograde fashion and in preventing hemorrhagic complications related to the residual pial arterial supply.

颅前窝（ACF）硬脑膜动静脉瘘（davf）伴颅底动脉供应是罕见的，对于这种类型的davf，适当的血管内治疗仍不确定。某些动脉供应模式与出血风险增加有关，并可能使血管内策略复杂化。我们报告两例经Onyx经动脉栓塞（TAE）和经静脉栓塞（TVE）成功治疗心动脉供应的ACF davf。在这两种情况下，动脉供血源均为筛动脉，动脉供血源均为大脑前动脉（ACA）分支，静脉经额眶静脉进入上矢状窦（SSS）。微导管通过靠近分流点的经动脉和经静脉路径进行导航。首先使用Onyx从单侧筛后动脉行TAE，以安全减少动脉流入并封闭整个分流，同时尽可能避免过度回流。然而，动脉供应仍然通畅。随后从额眶静脉进行的TVE导致Onyx逆行渗透到动脉供应和引流静脉，在这两种情况下实现了瘘的完全闭塞。联合TAE和TVE入路治疗有动脉供应的ACF davf似乎可以有效地阻断引流静脉，即所谓的静脉足部，以及以逆行方式阻断动脉供应，并预防与残余动脉供应相关的出血并发症。

{"title":"Combined transarterial and transvenous Onyx embolization approach for anterior cranial fossa dural arteriovenous fistulas with a pial feeder: Reports of two cases","authors":"Ryota Sakurai , Tomoaki Terada , Hiroo Yamaga , Takeru Umemura , Toru Kurokawa , Yuko Tanaka","doi":"10.1016/j.inat.2025.102174","DOIUrl":"10.1016/j.inat.2025.102174","url":null,"abstract":"<div><div>Anterior cranial fossa (ACF) dural arteriovenous fistulas (dAVFs) associated with pial arterial supply are rare, and the appropriate endovascular treatment remains uncertain for this type of dAVFs. Certain patterns of pial arterial supply have been associated with an increased risk of hemorrhage and may complicate endovascular strategies.</div><div>We present two cases of ACF dAVFs with pial arterial supply that were successfully treated with Onyx transarterial embolization (TAE) and transvenous embolization (TVE). In both cases, the arterial feeders originated from the ethmoidal arteries and pial arterial supply from branches of the anterior cerebral artery (ACA), with venous drainage via the fronto-orbital vein into the superior sagittal sinus (SSS). The microcatheters were navigated through both transarterial and transvenous routes close to the shunt point. TAE using Onyx from a unilateral posterior ethmoidal artery was first performed to safely reduce arterial inflow and occlude the entire shunt while avoiding excessive reflux, if possible. However, the pial arterial supply remained patent. Subsequent TVE from the fronto-orbital vein led to Onyx retrograde penetration into the pial arterial supply and the draining vein, achieving complete obliteration of the fistulas in both cases. A combined TAE and TVE approach for ACF dAVFs with pial arterial supply seems to be effective in obliterating the draining vein, so-called foot of the vein, as well as the pial arterial supply in a retrograde fashion and in preventing hemorrhagic complications related to the residual pial arterial supply.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102174"},"PeriodicalIF":0.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978165","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}

引用次数: 0