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 , Yasumasa Kawano , Hironori Fukumoto , Takato Tajiri , Mitsutoshi Iwaasa , Sinichi Morimoto , Yoshito Izutani , Shintaro Yamasaki , Kazuya Yamauchi , Hiroki Hatomoto , Hiroshi Abe , 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}
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.
{"title":"Resolution of tremor associated with brainstem arachnoid cyst following surgical intervention: A case report","authors":"Andrey Rostislavovich Sitnikov , Rezida Maratovna Galimova , Dmitriy Konstantinovich Krekotin","doi":"10.1016/j.inat.2025.101994","DOIUrl":"10.1016/j.inat.2025.101994","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Case presentation</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"39 ","pages":"Article 101994"},"PeriodicalIF":0.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143378780","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}
Pub Date : 2025-02-07DOI: 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, Yuxin Fan, Tianyong Cai, 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}
Pub Date : 2025-02-04DOI: 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 , Evan Medich , Dale F. Szpisjak , 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 > 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}
Pub Date : 2025-01-27DOI: 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 , K. Ninov , K. Minkin , K. Sirakova , G. Vladev , S. Sirakov , 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}
Pub Date : 2025-01-27DOI: 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 , Thomas Eibl , Thomas Bertsch , Hans-Herbert Steiner , Karl-Michael Schebesch , 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 > 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 > 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.</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}
Pub Date : 2025-01-27DOI: 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 , 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","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}
Pub Date : 2024-05-13DOI: 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.
{"title":"Restorative neurostimulation for chronic low back pain using ReActiv8® in a patient with a large lumbar disc herniation","authors":"Dirar Aldabek , Christian Schürer , Michael Luchtmann","doi":"10.1016/j.inat.2024.101988","DOIUrl":"https://doi.org/10.1016/j.inat.2024.101988","url":null,"abstract":"<div><p>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.</p></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"37 ","pages":"Article 101988"},"PeriodicalIF":0.4,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214751924000343/pdfft?md5=f3d94bb509aaa6db1f8c7590be315671&pid=1-s2.0-S2214751924000343-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140948783","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}
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.
{"title":"Topical dexamethason effectiveness combined with surgical intervention in patients suffering from chronic subdural hematoma","authors":"Hosein Safari , Masoud Zeinali , Pooyan Alizadeh , Davood Mahmoudi","doi":"10.1016/j.inat.2024.101984","DOIUrl":"https://doi.org/10.1016/j.inat.2024.101984","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Materials and Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>Topical dexamethasone injection through the potential CSDH cavity can result in desirable outcomes.</p></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"37 ","pages":"Article 101984"},"PeriodicalIF":0.4,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214751924000306/pdfft?md5=bf22c12f610365fdca47f61c4fb657b6&pid=1-s2.0-S2214751924000306-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900828","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}
Pub Date : 2024-04-26DOI: 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.
{"title":"Cerebellopontine angle epidermoid cyst presenting with only trigeminal neuralgia: A retrospective study at the single-center in Vietnam","authors":"Phuoc Trong Do , Chung Kim Nguyen , Viet-Thang Le","doi":"10.1016/j.inat.2024.101987","DOIUrl":"https://doi.org/10.1016/j.inat.2024.101987","url":null,"abstract":"<div><h3>Objective</h3><p>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).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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 %.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"37 ","pages":"Article 101987"},"PeriodicalIF":0.4,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2214751924000331/pdfft?md5=baffea07f25ad52835ea95d7bb1ad5d9&pid=1-s2.0-S2214751924000331-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140807257","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}
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