Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献_第4页

Liliequist’s membrane anatomical variations impact the probability of successful endoscopic third ventriculostomy: discussion of surgical techniques with novel illustrations and 3D animation Liliequist的膜解剖变异影响内镜下第三脑室造瘘成功的概率：用新颖的插图和3D动画讨论手术技术

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2026-03-01 Epub Date: 2026-02-25 DOI: 10.1016/j.inat.2026.102229

Austin J. Allen , Olivia E. Gilbert , Carolyn S. Quinsey

Background

A naked basilar artery has been demonstrated to improve ETV success rates; however, existing literature does not adequately convey variation in Liliequist’s Membrane (LM) anatomy in relationship to performing a successful ETV. This publication summarizes published literature examining LM anatomy and adds novel illustrations and discussion on surgical technique to improve the probability of ETV success.

Methods

A qualitative literature review was undertaken to elucidate anatomical descriptions of LM. Information from this review, along with insights from a pediatric neurosurgeon and cadaveric dissections, guided development of novel illustrations of LM and other relevant ETV anatomy.

Results

LM has been reported to have either 2 or 3 leaflets that separate the suprasellar, interpeduncular/intercrural, and prepontine cisterns. There is some variability in the attachment sites of LM; however, classical definitions report the dorsum sella as the anterior attachment, the mamillary bodies and ventral midbrain-pontine junction as posterior attachments, and the oculomotor nerves as the lateral attachments. Variation in positioning of LM leaflets in relationship to the floor of the third ventricle and basilar artery influences the probability of successful ETV.

Conclusions

A naked basilar artery is defined by a clear pathway for CSF flow from the third ventricle into prepontine cistern, with no unpunctured arachnoid membranes or leaflets of LM remaining as a barrier to flow. There is variable favorability in LM and other arachnoid membrane anatomy for achieving a naked basilar artery. Novel illustrations in this manuscript highlight this variation and discuss techniques for improving the probability of ETV success.

裸基底动脉已被证明可以提高ETV的成功率；然而，现有文献并没有充分传达Liliequist膜（LM）解剖结构的变化与成功进行ETV的关系。本出版物总结了已发表的LM解剖学研究文献，并增加了新的插图和讨论手术技术，以提高ETV成功的可能性。方法对LM的解剖描述进行定性文献复习。来自这篇综述的信息，以及来自儿科神经外科医生和尸体解剖的见解，指导了LM和其他相关ETV解剖的新插图的发展。结果据报道，slm有2或3个小叶，将鞍上池、针间/脚间池和鞍前池分开。LM附着部位存在一定的变异性；然而，经典的定义报告鞍背为前附着，乳状体和腹侧中脑-脑桥连接处为后附着，动眼神经为外侧附着。LM小叶相对于第三脑室底和基底动脉的位置变化影响ETV成功的概率。结论裸基底动脉的定义是脑脊液从第三脑室流向前基底池的通道清晰，没有未穿刺的蛛网膜或LM小叶残留作为流动障碍。在LM和其他蛛网膜解剖中，有不同的有利条件来获得裸露的基底动脉。本手稿中新颖的插图突出了这种变异，并讨论了提高ETV成功概率的技术。

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引用次数: 0

The relationship between pain level and satisfaction following lumbar spinal stenosis surgery and psychiatric medication use 腰椎管狭窄手术后疼痛程度和满意度与精神药物使用的关系

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2026-03-01 DOI: 10.1016/j.inat.2026.102243

Bilal Ertuğrul, Harun Kömürcü

Background

Lumbar spinal stenosis is a common degenerative spinal disorder that often requires surgery. In addition to technical factors, postoperative pain perception and patient satisfaction are influenced by psychosocial and psychiatric factors. However, the relationship between psychiatric medication use and postoperative outcomes remains unclear.

Objective

To examine the association between the use of psychiatric medication, postoperative pain, and patient satisfaction following surgery for lumbar spinal stenosis.

Methods

This retrospective cohort study included 202 patients who underwent surgery for degenerative lumbar spinal stenosis. Patients were divided into a psychiatric medication group (n = 98) and a control group (n = 104). Pain was assessed using the Visual Analogue Scale preoperatively and at 24 h, one week, and one month postoperatively. Patient satisfaction was evaluated at one month using a 0–10 Likert scale.

Results

Postoperative pain scores were significantly higher in patients using psychiatric medication at all time points (p < 0.001). At one month, patient satisfaction was significantly lower in the psychiatric medication group compared to controls (6.3 ± 1.7 vs. 8.1 ± 1.4, p < 0.001).

Conclusion

Psychiatric medication use was associated with higher early postoperative pain scores and lower short-term patient satisfaction following lumbar spinal stenosis surgery. These findings should be interpreted cautiously, as psychiatric medication use may reflect underlying psychiatric disease burden rather than a direct pharmacological effect.

背景：腰椎管狭窄是一种常见的退行性脊柱疾病，通常需要手术治疗。除技术因素外，术后疼痛感知和患者满意度还受心理社会和精神因素的影响。然而，精神科药物使用与术后预后之间的关系尚不清楚。目的探讨精神科药物的使用、术后疼痛和腰椎管狭窄术后患者满意度之间的关系。方法回顾性队列研究纳入202例行退行性腰椎管狭窄手术的患者。将患者分为精神药物治疗组（98例）和对照组（104例）。术前、术后24小时、1周和1个月采用视觉模拟量表评估疼痛。使用0-10李克特量表在一个月内评估患者满意度。结果使用精神科药物的患者术后疼痛评分在各时间点均显著增高（p < 0.001）。1个月时，精神科药物治疗组患者满意度显著低于对照组（6.3±1.7比8.1±1.4,p < 0.001）。结论精神药物的使用与腰椎管狭窄术后早期疼痛评分较高、短期患者满意度较低有关。这些发现应谨慎解释，因为精神科药物的使用可能反映了潜在的精神疾病负担，而不是直接的药理作用。

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引用次数: 0

Help from outer space: Denoising of confocal laser endomicroscopic images of brain tissue using pretrained astronomy software 来自外太空的帮助：使用预训练的天文学软件对脑组织的共聚焦激光内窥镜图像进行降噪

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2026-03-01 Epub Date: 2026-02-24 DOI: 10.1016/j.inat.2026.102222

Leon Colin Hoffmann , Roberta Galli , Sven Richter , Ilker Eyüpoglu , Ortrud Uckermann

Background

Confocal laser endomicroscopy (CLE) allows imaging of tissue autofluorescence (AF) in situ and is promising for brain tumor margin detection and diagnosis. However, comprehensive analysis of CLE images beyond visual inspection is restricted by their high noise level. Because image acquisition parameters cannot be accordingly optimized in medical devices, image preprocessing constitutes an option for noise removal. Here, we utilized an AI-based algorithm trained on astronomy images and investigated its capacity to denoise AF images of brain tumors.

Methods

Tissue samples of human brain tumors and non-neoplastic brain were investigated. Images of tissue AF (518–573 nm) were acquired on bulk tissue samples using a clinical CLE system with 488 nm excitation. Multiphoton microscopy was employed to investigate tissue sections and image averaging was used to modify the noise level in AF images (500–550 nm). Signal to noise ratio (SNR) of AF images were compared before and after denoising with NoiseXTerminator software.

Results

Denoising improved SNR of multiphoton and CLE images and intensity plots indicated a profound improvement in the visibility of structures. Comparison of denoised high noise (4× and 8× averaging) with low noise (16× averaging) multiphoton images confirmed that image structures were correctly extracted. Upon the introduction of synthetic noise, Gaussian noise was eliminated, however limitations were identified in the ability to remove bright pixels induced by salt-and-pepper noise.

Conclusions

Efficient denoising of CLE images of tissue AF constitutes the basis for mathematical analysis and will allow the development of objective clinical protocols for intraoperative decision support in neurosurgery.

共聚焦激光内镜（CLE）可以原位组织自身荧光（AF）成像，有望用于脑肿瘤边缘的检测和诊断。然而，除了视觉检查之外，CLE图像的综合分析受到其高噪声水平的限制。由于图像采集参数不能在医疗设备中相应地优化，图像预处理构成了去噪的一种选择。在这里，我们使用了一种基于人工智能的天文图像训练算法，并研究了它对脑肿瘤AF图像的去噪能力。方法对人脑肿瘤和非肿瘤性脑的组织样本进行研究。使用临床CLE系统获得组织AF （518-573 nm）在大块组织样品上的图像，激发为488 nm。采用多光子显微镜观察组织切片，并用图像平均法修正AF图像（500-550 nm）的噪声水平。用NoiseXTerminator软件对自动对焦图像去噪前后的信噪比进行比较。结果对多光子图像、CLE图像和强度图进行降噪后，结构的可见性明显提高。将降噪后的高噪多光子图像（4倍和8倍平均）与低噪多光子图像（16倍平均）进行对比，验证了图像结构提取的正确性。在引入合成噪声后，高斯噪声被消除，但是在去除盐和胡椒噪声引起的明亮像素的能力方面存在局限性。结论对组织AF的CLE图像进行有效去噪是数学分析的基础，为神经外科术中决策支持制定客观的临床方案提供了基础。

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引用次数: 0

Arteriovenous fistula involving the foramen cecum vein 动静脉瘘累及盲肠孔静脉

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2026-03-01 Epub Date: 2026-02-07 DOI: 10.1016/j.inat.2026.102200

Chloe F. Looman , Stephen Duggan , Aaron Kucinski , Theresa A. Elder , Joseph G. Adel

Background

Dural arteriovenous fistulas (dAVF) arising in the anterior fossa require treatment as they inherently possess cortical venous drainage. The foramen cecum (FC) contains a venous structure that is infrequently observed in humans due to its small size, and dAVF rarely involve the FC.

Case Presentation

We report a unique case of an ethmoidal dAVF with venous drainage via the FC vein. This fistula was successfully treated through a bicoronal craniotomy for disconnection.

Conclusions

The FC vein is clinically relevant when involved in the drainage pathway of dAVF. Given the predictable location of anterior fossa dAVF draining via the foramen cecum vein, more minimally invasive surgical approaches exposing the foramen cecum are sufficient to disconnect the fistula.

背景硬脑膜动静脉瘘（dAVF）起源于前窝，由于其固有的皮质静脉引流，需要治疗。盲肠孔（FC）包含一个静脉结构，由于其体积小，在人类中很少观察到，dAVF很少涉及FC。病例介绍：我们报告一例独特的经腹侧静脉引流的筛窦性房颤。该瘘管通过双冠状开颅术成功治疗。结论FC静脉参与dAVF引流通路具有临床意义。考虑到经盲肠孔静脉引流的前窝dAVF的可预测位置，更微创的手术入路暴露盲肠孔足以断开瘘管。

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 : 2026-03-01 Epub 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。

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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 : 2026-03-01 Epub 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":"2026-03-01","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

A novel radiation-free technique for navigated direct pars repair in patients with spondylolysis and congenital vertebral anomalies: A report of two cases 一种新的无辐射技术用于峡部裂和先天性椎体畸形患者的导航直接修复：附两例报告

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2026-03-01 Epub Date: 2026-01-03 DOI: 10.1016/j.inat.2025.102191

Matthew Aceto , Scott Gronowicz , Michael S. Barnum , Maahir Haque

Background

Pars defects affect up to 7 % of adults. Patients with pars defects often experience progressively worsening pain and some develop spinal deformity due to the development of lytic spondylolisthesis. In symptomatic pars fractures who have failed non-operative management and have only mild deformity and degeneration, a decision can be made to fuse the affected motion segment or perform a direct pars repair. The purpose of this study is to describe a novel technique for direct pars repair using a novel radiation-free stereotactic navigation. We further describe the clinical outcomes in two cases managed with this technique.

Case

Two adult patients with L5 spondylolysis and spina bifida occulta − a 33-year-old male and a 41-year-old male who also had sacral dysraphism − underwent direct pars repair using radiation-free 7D Navigation.

Outcome

Both cases demonstrated clinical improvement and good radiographic outcomes at more than 1 year follow-up.

Conclusion

Direct pars repair using radiation-free stereotactic navigation offers a safe, effective, and more efficient means for the surgical treatment of symptomatic spondylolysis. This is especially true for patients with lumbosacral anatomical variability, in whom conventional techniques may lead to screw malpositioning, a need for revision surgery, and poor outcomes.

高达7%的成年人患有自闭症。伴有部部缺损的患者通常会经历逐渐加重的疼痛，一些患者会由于滑脱性椎体滑移而发展为脊柱畸形。对于非手术治疗失败且仅有轻度畸形和退变的有症状的部分骨折，可决定融合受影响的运动节段或直接进行部分修复。本研究的目的是描述一种使用新型无辐射立体定向导航的直接局部修复新技术。我们进一步描述了用这种技术管理的两个病例的临床结果。2例L5椎弓峡部裂和隐性脊柱裂的成年患者（一名33岁男性和一名41岁男性，同时患有骶骨畸形）采用无辐射7D导航进行直接局部修复。结果在1年多的随访中，两例患者均表现出临床改善和良好的影像学结果。结论无辐射立体定向导航直接修复是一种安全、有效、高效的治疗症状性峡部裂的手术方法。对于腰骶解剖结构变异的患者尤其如此，传统技术可能导致螺钉错位，需要翻修手术，结果不佳。

{"title":"A novel radiation-free technique for navigated direct pars repair in patients with spondylolysis and congenital vertebral anomalies: A report of two cases","authors":"Matthew Aceto , Scott Gronowicz , Michael S. Barnum , Maahir Haque","doi":"10.1016/j.inat.2025.102191","DOIUrl":"10.1016/j.inat.2025.102191","url":null,"abstract":"<div><h3>Background</h3><div>Pars defects affect up to 7 % of adults. Patients with pars defects often experience progressively worsening pain and some develop spinal deformity due to the development of lytic spondylolisthesis. In symptomatic pars fractures who have failed non-operativemanagement and have only mild deformity and degeneration, a decision can be made to fuse the affected motion segment or perform a direct pars repair.The purpose of this study is to describe a novel technique for direct pars repair using a novel radiation-free stereotactic navigation. We further describe the clinical outcomes in two cases managed with this technique.</div></div><div><h3>Case</h3><div>Two adult patients with L5 spondylolysis and spina bifida occulta − a 33-year-old male and a 41-year-old male who also had sacral dysraphism − underwent direct pars repair using radiation-free 7D Navigation.</div></div><div><h3>Outcome</h3><div>Both cases demonstrated clinical improvement and good radiographic outcomes at more than 1 year follow-up.</div></div><div><h3>Conclusion</h3><div>Direct pars repair using radiation-free stereotactic navigation offers a safe, effective, and more efficient means for the surgical treatment of symptomatic spondylolysis. This is especially true for patients with lumbosacral anatomical variability, in whom conventional techniques may lead to screw malpositioning, a need for revision surgery, and poor outcomes.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102191"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939543","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

Unusual cause of pituitary abscess due to enterococcus faecalis: A case report 粪肠球菌所致垂体脓肿异常原因1例

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2026-03-01 Epub Date: 2026-02-24 DOI: 10.1016/j.inat.2026.102218

Joel Brou , Landry Konan , Grace Djonde , Wilfried Meuga , Hermann Nda , Oka Ndri

Background

Pituitary abscess is a rare and life-threatening condition, representing less than 1% of all pituitary lesions. It may arise de novo or complicate pre-existing lesions. Early diagnosis through imaging and prompt surgical drainage with antibiotic therapy are essential to prevent serious complications. Microbiological identification is essential but not always achieved. Recurrent cases are rare and pose diagnostic and therapeutic challenges.

Observation

A 32-year-old woman with type II diabetes presented with visual loss and amenorrhea due to a pituitary abscess. Initial sterile drainage and empirical antibiotics failed. Recurrence led to reoperation, revealing Enterococcus faecalis. Targeted antibiotics achieved clinical and radiological resolution. The patient remains asymptomatic after three years of follow-up.

Lessons: This report underscores the importance of considering atypical pathogens in recurrent or unclear cases and highlights the need for repeated microbiological sampling. Prompt surgical drainage and targeted antibiotic therapy are crucial for favorable outcomes.

垂体脓肿是一种罕见且危及生命的疾病，占所有垂体病变的不到1%。它可能是新发的，也可能使原有病变复杂化。早期影像学诊断和及时手术引流及抗生素治疗对预防严重并发症至关重要。微生物鉴定是必不可少的，但并不总是能做到。复发病例是罕见的，并提出诊断和治疗的挑战。一位32岁的2型糖尿病女性患者因垂体脓肿导致视力丧失和闭经。初步无菌引流及经验性抗生素治疗失败。复发导致再次手术，发现粪肠球菌。靶向抗生素获得了临床和放射学上的解决。患者随访3年后仍无症状。经验教训：本报告强调了在复发或不明确病例中考虑非典型病原体的重要性，并强调了重复微生物取样的必要性。及时手术引流和靶向抗生素治疗是获得良好结果的关键。

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引用次数: 0

AICA compression causing dual cranial neuropathy: A case of trigeminal neuralgia and facial nerve palsy AICA压迫致双颅神经病变：三叉神经痛及面神经麻痹1例

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2026-03-01 Epub Date: 2026-02-24 DOI: 10.1016/j.inat.2026.102215

Carlos Alcaraz-Fuerte , Alfonso Arellano-Mata , José Airan Cruz-Aquino , César Iván Hernández-Díaz , Ulises García-Gonzalez

Background

Classical trigeminal neuralgia (TN) is most often caused by neurovascular compression of the trigeminal root. The coexistence of TN and facial nerve palsy due to compression by the same vessel is exceptionally rare.

Case Description

A 61-year-old man presented with medically refractory right-sided TN accompanied by mild ipsilateral facial weakness. MRI demonstrated neurovascular conflict involving both the trigeminal and facial nerves by the anterior inferior cerebellar artery (AICA). The patient underwent single-stage microvascular decompression (MVD) with favorable outcome.

Discussion

Neurovascular compression syndromes typically affect a single cranial nerve in isolation. Unlike previously reported dual neurovascular syndromes that typically involve hemifacial spasm, this case represents a destructive facial neuropathy secondary to chronic vascular compression. Awareness of this condition underscores the link between chronic vascular compression and neural damage, with meticulous decompression offering sustained clinical benefit.

Conclusion

We report a rare case of concurrent TN and facial palsy caused by AICA compression, successfully managed with MVD. This highlights the need to consider atypical neurovascular conflicts in patients with combined cranial neuropathies.

背景：经典三叉神经痛（TN）通常是由神经血管压迫三叉神经根引起的。由于同一血管压迫，TN和面神经麻痹共存是非常罕见的。病例描述：一名61岁男性，右侧难治性TN伴轻度同侧面部无力。MRI显示经小脑前下动脉（AICA）累及三叉和面神经的神经血管冲突。患者接受了一期微血管减压术（MVD），结果良好。神经血管压迫综合征通常孤立地影响单个颅神经。不同于先前报道的双神经血管综合征通常涉及面肌痉挛，本病例为继发于慢性血管压迫的破坏性面神经病变。意识到这种情况强调慢性血管压迫和神经损伤之间的联系，细致的减压提供持续的临床益处。结论我们报告了一例罕见的由AICA压迫引起的并发TN和面瘫，并成功地用MVD治疗。这突出了需要考虑非典型神经血管冲突患者合并颅神经病变。

{"title":"AICA compression causing dual cranial neuropathy: A case of trigeminal neuralgia and facial nerve palsy","authors":"Carlos Alcaraz-Fuerte , Alfonso Arellano-Mata , José Airan Cruz-Aquino , César Iván Hernández-Díaz , Ulises García-Gonzalez","doi":"10.1016/j.inat.2026.102215","DOIUrl":"10.1016/j.inat.2026.102215","url":null,"abstract":"<div><h3>Background</h3><div>Classical trigeminal neuralgia (TN) is most often caused by neurovascular compression of the trigeminal root. The coexistence of TN and facial nerve palsy due to compression by the same vessel is exceptionally rare.</div></div><div><h3>Case Description</h3><div>A 61-year-old man presented with medically refractory right-sided TN accompanied by mild ipsilateral facial weakness. MRI demonstrated neurovascular conflict involving both the trigeminal and facial nerves by the anterior inferior cerebellar artery (AICA). The patient underwent single-stage microvascular decompression (MVD) with favorable outcome.</div></div><div><h3>Discussion</h3><div>Neurovascular compression syndromes typically affect a single cranial nerve in isolation. Unlike previously reported dual neurovascular syndromes that typically involve hemifacial spasm, this case represents a destructive facial neuropathy secondary to chronic vascular compression. Awareness of this condition underscores the link between chronic vascular compression and neural damage, with meticulous decompression offering sustained clinical benefit.</div></div><div><h3>Conclusion</h3><div>We report a rare case of concurrent TN and facial palsy caused by AICA compression, successfully managed with MVD. This highlights the need to consider atypical neurovascular conflicts in patients with combined cranial neuropathies.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102215"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419830","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

Single-stage aneurysm clipping and revascularization for moyamoya disease with ruptured aneurysm: a case report 单期动脉瘤夹闭及血管重建术治疗烟雾病并发动脉瘤破裂1例

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management

Pub Date : 2026-03-01 Epub Date: 2026-02-24 DOI: 10.1016/j.inat.2026.102223

Jie Wei , Ben Chat Fong Ng , Zhenyu Li , Haitao Xu , Yong Li , Zhimeng Zhang , Tao Feng , Youchao Xiao , Xiang Gao , Jinghui Lin

Background

The optimal treatment strategy for moyamoya disease (MMD) complicated by ruptured intracranial aneurysms remains controversial. Most studies recommend addressing the aneurysms in the first stage and treating the MMD in a delayed fashion. Reports of simultaneous surgical interventions are exceptionally rare.

Case description

A 58-year-old male patient was admitted for a spontaneous left frontal hemorrhage. Preoperative computed tomography angiography (CTA) revealed aneurysm in the left middle cerebral artery (LMCA). Subsequent digital subtraction angiography (DSA) showed an occlusion of the main trunk of the LMCA accompanied by moyamoya vessel formation. The aneurysm originated from the atretic LMCA trunk. The patient underwent microsurgical clipping of the aneurysm. Concurrently, a left superficial temporal artery–middle cerebral artery (STA–MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) was performed for the MMD. The patient recovered well after the surgery, and follow-up CTA confirmed patency of the bypass graft with no filling of the aneurysm.

Conclusion

For patients with moyamoya disease complicated by an ipsilaterally ruptured intracranial aneurysm (IA), a simultaneous clipping of the aneurysm with revascularization procedures is a technically feasible treatment option, yet surgical indications must be carefully evaluated.

背景烟雾病并发颅内动脉瘤破裂的最佳治疗策略仍存在争议。大多数研究建议在第一阶段处理动脉瘤，并以延迟的方式治疗烟雾病。同时手术干预的报道是非常罕见的。病例描述：一名58岁男性患者因自发性左额叶出血入院。术前计算机断层血管造影（CTA）显示左侧大脑中动脉（LMCA）动脉瘤。随后的数字减影血管造影（DSA）显示LMCA主干闭塞并伴有烟雾血管形成。动脉瘤起源于锁骨LMCA干。病人接受了显微手术切除动脉瘤。同时，左侧颞浅动脉-大脑中动脉（STA-MCA）搭桥联合脑-硬膜-肌合症（EDMS）治疗MMD。术后患者恢复良好，随访CTA证实搭桥通畅，动脉瘤未充盈。结论对于烟雾病并发同侧颅内动脉瘤破裂（IA）的患者，同时夹闭动脉瘤并行血管重建术是一种技术上可行的治疗选择，但手术指征必须仔细评估。

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引用次数: 0