Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献

Objective

Limited data on the treatment and outcomes of patients with intracranial aneurysms (ICAs) in the (coronavirus disease 2019) COVID-19 era is available. Our objective was hence to investigate the impact of the pandemic on the overall complication rate and postprocedural ischemic strokes specifically, in patients treated for ICAs.

Methods

The National Inpatient sample database was used. The main outcomes were the occurrence of postprocedural ischemic strokes, as well as death, non-routine discharge, total charges (US dollars), and length of stay (days). Propensity score matching was applied to compare the pre- and COVID-19 periods. Trends were assessed using piecewise joinpoint regression with the Mann-Kendall test.

Results

A total of 57,715 patients were included in the study. The mean age was 65 years, with most of the patients (69.9 %) being females. After matching, no differences in length of stay (p = 0.266), non-home discharge (p = 0.475), and in-hospital mortality rates (p = 0.305) between the two periods were found. However, the overall complication rate was significantly higher during the pandemic (31.1 % vs. 28.3 %; p < 0.001). Patients hospitalized after treatment of ICAs during the COVID-19 pandemic had significantly higher odds of ischemic strokes (OR 1.13; 95 % CI 1.05 to 1.22; p = 0.03), even when adjusting for other factors.

Conclusions

There is no denying that the COVID-19 pandemic has significantly impacted the healthcare system in several aspects. One aspect highlighted in this study, patient outcomes, was especially notable among patients’ receiving treatment for ICAs. Our results suggest a correlation between the COVID-19 pandemic and postprocedural complications, of which ischemic strokes were the most notable.

Background

Traumatic brain injury (TBI) is a global concern, and many people suffer from TBI annually. Determining the outcome of patients with brain injury has a valuable clinical impact and results in better management of patients. In this study, we aimed to investigate the predictive value of magnetic resonance spectrometry (MRS) in patients with diffuse axonal injury (DAI).

Method

This is a prospective cohort study on patients with DAI in 6 months at a tertiary medical center. According to the eligibility criteria, the patients were enrolled in the study. The MRS scan was conducted on days 3 and 30, and the correlation of metabolites of MRS according to the GCS score of patients on days 3 and 30 was investigated to determine the prognostic impact of MRS in patients with DAI.

Results

A total of 50 patients with DAI, including 39 males and 11 females, were recruited. MRS of patients on day 3 and 30 was conducted and showed that the level phosphocreatine (r = -0.56, P < 0.001), NAA/choline ratio (r = 0.86, P < 0.001), and hunter angle (r = 0.59, P < 0.001) on day 3 are significantly correlated with the GCS score of patients on day 30. Phosphocreatine (r = -0.84, P < 0.001), phosphocholine (r = -0.86, P < 0.001), NAA/choline (r = 0.89, P < 0.001), myoinositol (r = -0.75, P < 0.001), and hunter angle (r = 0.89, P < 0.001) on day 30 are substantially associated with day 30 GCS score.

Conclusion

Among different investigated metabolites, the level of phosphocreatine, NAA/choline ratio, and hunter angle on day three significantly correlated with patients' GCS on day 30.

Background

Central Neurocytoma (CNCy) is an exceedingly rare brain tumor occurring within the ventricles in young adults. Anecdotal cases of CNCy occurring simultaneously with other brain lesions have been reported but to the best of our knowledge, no one was accompanied by brain AVM.

Case presentation: A 12-year-old girl presented with signs of increased intracranial pressure. A multi-bleb CNCy originated from the septum in the midline, expanding to the lateral and third ventricles, back to the incisura and infratentorial- supra-cerebellar cistern concomitant with a left frontal parafalx AVM. The tumor excised successfully, and hydrocephalus controlled by ventriculoperitoneal shunting. The AVM bled after 7 years and was removed surgically. She is tumor free after 10 years.

Conclusion

We present the first case of CNCy concomitant with brain AVM in a 12-year-old girl with more than 10 years follow up.

Background

Symptomatic Tarlov cysts are extremely rare, and there is no consensus on the optimal treatment for this condition. Here, we encountered a patient with a symptomatic giant sacral Tarlov cyst and reviewed the relevant literature.

Case description

A 55-year-old male patient was diagnosed with a large sacral canal cyst based on an MRI examination four years ago. Due to mild symptoms, the patient received conservative treatment. In 2023, the patient's symptoms worsened, significantly affecting daily activities. It was suspected that the symptoms were related to the cyst. Subsequently, the patient underwent laminectomy and microsurgical excision of the cyst. Postoperatively, the patient experienced an improvement in symptoms. We conducted a review of the surgical approach used for this patient and explored alternative treatment methods proposed in the literature for similar conditions.

Conclusions

We achieved favorable outcomes by performing microsurgical excision of symptomatic giant Tarlov cysts in a 55-year-old patient. Additionally, we reviewed relevant literature regarding Tarlov cysts. The treatment approaches for this condition vary, and conservative, interventional, or surgical treatments have all shown efficacy. Therefore, it is crucial to choose an appropriate treatment plan based on the patient's specific circumstances.

Introduction

Pseudotumor cerebri is one of the complex diseases in the field of neurology and neurosurgery. Although it’s classical form manifests with headache and blurred vision, and papilledema is seen in the ophthalmological examination, but its clinical manifestations can be without blurred vision and papilledema, and even without headache.

Here, we present a diagnostically challenging pseudotumor cerebri case who presented only with refractory tinnitus and had increased intracranial pressure, and the tinnitus was completely resolved with transverse sinus stenting.

Conclusion

This case showed that pseudotumor cerebri can have atypical manifestations such as resistant tinnitus without papilledema, and in these cases, intracranial pressure should be measured and its causes, especially cerebral venous sinus stenosis should be investigated and treated.

Backgroung

Primary dural lymphoma is a very rare pathology arising from the dura mater. its clinical and radiological presentation is often similar to a meningioma. Treatment typically involves surgery followed by adjuvant radiotherapy/chemotherapy. Fewer than twenty cases have been described in the literature.

Case presentation

A 73-year-old woman with a medical history of hypertension, type 2 diabetes, and dyslipidemia presented with progressive right hemiparesis. Following diagnostic evaluation, a left fronto-temporal meningioma was initially diagnosed. Complete macroscopic excision was made and the immunohistochemical showed a follicular B lymphoma according. the patient had radiotherapy and chemotherapy sessions. Follow-up at 18 months was unremarkable.

Conclusion

Primary dural lymphoma is an exceptionally rare pathology, often mimicking the radiological appearance of a meningioma. The management relies on complete tumor excision, along with a combination of radiotherapy and chemotherapy. When administered appropriately, this treatment approach offers a favorable prognosis for patients.

Aneurysms arising from fenestrated proximal anterior cerebral arteries are rare. Previous studies primarily reported performing clipping. In contrast, endovascular treatment is rarely selected. In this report, we present a case of coil embolization for a ruptured aneurysm arising from a fenestrated proximal anterior cerebral artery.

A sixty-five-year-old woman was transferred to the emergency department of our hospital owing to sudden onset of severe headache and vomiting. A head computed tomography scan showed a diffuse subarachnoid hemorrhage. A cerebral angiogram revealed an aneurysm at the fenestration of the A1 segment. Coil embolization of the aneurysm was performed, and the aneurysm was completely occluded. Both fenestration channels were preserved.

The patient’s clinical course was good, and she was discharged from the hospital twenty-six days after admission. Coil embolization of a ruptured aneurysm in the fenestration of the A1 segment was possible without sacrificing the parent arteries forming the fenestration. However, securing a working projection proved difficult due to the aneurysm being surrounded by two parent arteries forming the fenestration.

Background

Adult-onset tethered cord syndrome (ATCS) is occasionally reported, but older adult onset is very rare. We treated a patient who was asymptomatic until older adulthood and then developed subacute exacerbation of neurological symptoms.

Case description

A 76-year-old woman presented with bilateral leg pain, numbness, and weakness plus low back pain and dysuria for 1 month. Imaging showed a retained medullary cord with a syrinx and an enhanced mass lesion. She was diagnosed with symptomatic ATCS and underwent surgery. Intraoperative findings were an intramedullary syrinx and inflammatory granulation due to adhesive arachnoiditis.

Conclusion

We experienced a very rare case in which an older adult developed ATCS. Caution is required because idiopathic adhesive arachnoiditis can exacerbate the neurological symptoms.

Introduction

Choosing a promising specialty for medical students is not an easy decision, particularly in a field like neurosurgery known for its high levels of stress. However, in recent years, there has been a decrease in interest, especially among female students, in choosing surgical specialties. Therefore, the present study aimed to identify influential factors in the selection of neurosurgery as a specialty from the perspective of medical students.

Methods

This descriptive-analytical study was conducted in 2023 at the Shahr-e Kord University of Medical Sciences. we estimated a sample size of 425 individuals from the study population. We collected the data using a questionnaire, which was administered through an online questionnaire system.

Results

Male and female perceptions of neurosurgery was similar across many of the surveyed factors, except for: “Male dominated”,“ Tolerant of criticism”, “Duration of residency” and “Must be an athlete”. The factor analysis reduced the 28-variable dimensionality to six latent factors that accounted for 60.72% of the variance found. The factor analysis recognized that, although male and female medical students do have some similar Survey Variable, the influence or weighing of those preferences is different for male and female students. The first latent factor for females consisted of: “Diverse patient population,” and “Procedural based.” The first latent factor for males consisted of: “Male dominated,” and “Prestige.”

Conclusion

The factor analysis indicated that male and female students weight differently when selecting a specialty; this difference may account for the large differences in proportion between males and females in Neurosurgery residency.

Introduction

Due to less than favorable conditions in low and low-middle-income countries, surgeons have had to carefully craft improvised devices to try and mimic the functionality and level of innovation in the developed countries. In this review, we sought to examine the existing literature to review the alternative ways by which intracranial pressure is measured when standard devices are inaccessible. Furthermore, we aimed to see how these devices are made and how much they cost.

Methodology

The PRISMA extension for scoping reviews was utilized. Databases and Grey Literature (PubMed, Google Scholar, and AJOL) were searched extensively, and papers reporting on the use of improvised intracranial pressure monitoring were included. The devices were grouped into two setups and described extensively. The cost of the devices was also estimated. We extracted the relevant information after identifying the papers that would be used in our review study.

Results

3 papers satisfied our eligibility criteria and were used in the review. Two setups were discussed. The first setup involved the use of a makeshift device made up of a size 6 feeding tube/soft silicon catheter, a central venous pressure manometer and sterile 0.9% saline as the coupling agent, while the second setup involved the use of a size 8 feeding tube, a pressure line extension, dome, transducer, and monitor. Both devices cost less than USD 20, a price far cheaper than the standard ICP devices quoted at about USD 800.

Conclusion

Our review posits that these makeshift devices have certain advantages and may be useful in the rural and less developed parts of the world. It also serves as an area for intervention, especially in the context of global neurosurgery.