Pub Date : 2025-12-15DOI: 10.1016/j.inat.2025.102167
Kedir D. Guduru , Mikiyas G. Teferi , Helina K. Teklehaimanot , Mersha A. Woldemariam , Abat Baleh , Surafel M. Mendere
Background
Traumatic brain injury is a leading cause of trauma deaths worldwide. In low- and middle-income countries, neuromonitoring is limited. Decompressive craniectomy is used as a last-resort intervention. This study assessed outcomes and key predictors in Ethiopia.
Objectives
To measure 3-month outcomes after decompressive craniectomy for traumatic brain injury and identify clinical and radiologic predictors.
Methods
A multicenter prospective cohort was conducted in Addis Ababa from January 2023 to September 2024. Ninety-four patients underwent surgery and were followed for 90 days. Outcomes were measured with the Extended Glasgow Outcome Score, grouped as favorable (≥5) or unfavorable (<5). Variables with initial associations were tested in multivariable models.
Results
Of 94 patients, 80 were male and the mean age was 38.9 years. At 3 months, 55.3 percent had favorable outcomes, 13.8 percent had unfavorable outcomes, and 30.9 percent died. Severe presentation, non-reactive pupils, unstable vital signs, poor response to osmotic diuretics, intraoperative hypotension, vasopressor need, and low postoperative Glasgow Coma Scale scores were linked to worse outcomes.
Conclusion
Certain clinical and intraoperative factors predict poor outcomes after decompressive craniectomy for traumatic brain injury in Ethiopia. Early identification of these factors may guide treatment and resource allocation.
{"title":"Determinants of outcomes following decompressive craniectomy for traumatic brain injury: a multicenter prospective cohort study in Addis Ababa, Ethiopia","authors":"Kedir D. Guduru , Mikiyas G. Teferi , Helina K. Teklehaimanot , Mersha A. Woldemariam , Abat Baleh , Surafel M. Mendere","doi":"10.1016/j.inat.2025.102167","DOIUrl":"10.1016/j.inat.2025.102167","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic brain injury is a leading cause of trauma deaths worldwide. In low- and middle-income countries, neuromonitoring is limited. Decompressive craniectomy is used as a last-resort intervention. This study assessed outcomes and key predictors in Ethiopia.</div></div><div><h3>Objectives</h3><div>To measure 3-month outcomes after decompressive craniectomy for traumatic brain injury and identify clinical and radiologic predictors.</div></div><div><h3>Methods</h3><div>A multicenter prospective cohort was conducted in Addis Ababa from January 2023 to September 2024. Ninety-four patients underwent surgery and were followed for 90 days. Outcomes were measured with the Extended Glasgow Outcome Score, grouped as favorable (≥5) or unfavorable (<5). Variables with initial associations were tested in multivariable models.</div></div><div><h3>Results</h3><div>Of 94 patients, 80 were male and the mean age was 38.9 years. At 3 months, 55.3 percent had favorable outcomes, 13.8 percent had unfavorable outcomes, and 30.9 percent died. Severe presentation, non-reactive pupils, unstable vital signs, poor response to osmotic diuretics, intraoperative hypotension, vasopressor need, and low postoperative Glasgow Coma Scale scores were linked to worse outcomes.</div></div><div><h3>Conclusion</h3><div>Certain clinical and intraoperative factors predict poor outcomes after decompressive craniectomy for traumatic brain injury in Ethiopia. Early identification of these factors may guide treatment and resource allocation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102167"},"PeriodicalIF":0.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939393","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}
Pub Date : 2025-12-15DOI: 10.1016/j.inat.2025.102168
Mohammed Alra’e, Ahmad J. Abdallah, Maaweya Jabareen, Wasef Alhroub, Ibrahim Kattoush
Background
Dermoid cyst is defined as a benign congenital tumor caused by sequestration of germ cells in the embryonic fusion lines during development. Dermoid cysts are lined with simple squamous epithelium and filled with keratin and other skin appendages. They can be present at birth or later on. They are among the most common pediatric tumors, particularly in the head and neck regions. When present in the head, they should be differentiated from other lesions, such as encephalocele. Imaging studies and surgical consultation are important before managing such cases.
Case presentation
An 8-month-old female patient presented with swelling over the anterior fontanelle, mimicking encephalocele. The history was significant to duodenal atresia. The swelling started to appear few days after birth. After performing CT scan and MRI, the neurosurgeon attempted to aspirate the cyst for histopathologic examination, but this failed, and surgical excision was planned. Surgical excision of the lesion was performed, and histopathological examination revealed a diagnosis of dermoid cyst. This underscores the importance of ruling out any intracranial communication before performing any procedure in such lesions.
Discussion
Dermoid cyst is essentially a pediatric tumor. It is important to keep in mind dermoid cysts in the differential diagnosis of head and neck swellings, particularly the anterior fontanelle swellings. When lying over the head, it is of paramount importance to rule out intracranial communication by imaging studies before proceeding into the surgical intervention.
Conclusion
Dermoid cysts are common pediatric tumors. Proper diagnosis and surgical intervention are important in this type of tumors before complicating intracranial extension.
{"title":"Infantile dermoid cyst on top of anterior fontanelle mimicking encephalocele, a case report and literature review","authors":"Mohammed Alra’e, Ahmad J. Abdallah, Maaweya Jabareen, Wasef Alhroub, Ibrahim Kattoush","doi":"10.1016/j.inat.2025.102168","DOIUrl":"10.1016/j.inat.2025.102168","url":null,"abstract":"<div><h3>Background</h3><div>Dermoid cyst is defined as a benign congenital tumor caused by sequestration of germ cells in the embryonic fusion lines during development. Dermoid cysts are lined with simple squamous epithelium and filled with keratin and other skin appendages. They can be present at birth or later on. They are among the most common pediatric tumors, particularly in the head and neck regions. When present in the head, they should be differentiated from other lesions, such as encephalocele. Imaging studies and surgical consultation are important before managing such cases.</div></div><div><h3>Case presentation</h3><div>An 8-month-old female patient presented with swelling over the anterior fontanelle, mimicking encephalocele. The history was significant to duodenal atresia. The swelling started to appear few days after birth. After performing CT scan and MRI, the neurosurgeon attempted to aspirate the cyst for histopathologic examination, but this failed, and surgical excision was planned. Surgical excision of the lesion was performed, and histopathological examination revealed a diagnosis of dermoid cyst. This underscores the importance of ruling out any intracranial communication before performing any procedure in such lesions.</div></div><div><h3>Discussion</h3><div>Dermoid cyst is essentially a pediatric tumor. It is important to keep in mind dermoid cysts in the differential diagnosis of head and neck swellings, particularly the anterior fontanelle swellings. When lying over the head, it is of paramount importance to rule out intracranial communication by imaging studies before proceeding into the surgical intervention.</div></div><div><h3>Conclusion</h3><div>Dermoid cysts are common pediatric tumors. Proper diagnosis and surgical intervention are important in this type of tumors before complicating intracranial extension.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102168"},"PeriodicalIF":0.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939471","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}
Pub Date : 2025-12-15DOI: 10.1016/j.inat.2025.102165
Yi Luo , Shaoliang Zhu , Ziquan Zeng , Shun Liu , Zhansheng Zhu
Background
Radial access is an increasingly popular approach to neuroradiology. Typically, aortic arch and cerebral angiography are performed using a 5F pigtail catheter and a 5F Simmons II catheter. This classical operation increases the operation time, radiation time, and radiation dose, and the catheters pass through the radial artery multiple times, thereby increasing the risk of radial artery spasms and occlusions. In this study, we aimed to demonstrate that using a Simmons II catheter to complete the aortic arch and cerebral angiography is safe and effective.
Methods
This study was a retrospective review of the database on aortic arch and cerebral angiography procedures using two catheters (pigtail catheter and Simmons II catheter) or one catheter (Simmons II catheter) to perform aortic arch and cerebral angiography between August 2024 and January 2025. Patient demographics, clinical data, procedural metrics and radiographic metrics were recorded. Sixty patients underwent aortic arch and cerebral angiographies. Thirty patients underwent aortic arch and cerebral angiographies with two catheters and thirty with one catheter.
Results
Total procedure and fluoroscopy times were shorter in the one catheter group. The contrast volume, dose-area product and total radiation dose were lower in the one-catheter group. Clinical outcomes between the two groups showed no statistically significant differences.
Conclusions
We confirmed for the first time that using a Simmons II catheter to complete the aortic arch and cerebral angiography was effective and safe.
{"title":"A modified technique for aortic arch and cerebral angiography using one Simmons II catheter","authors":"Yi Luo , Shaoliang Zhu , Ziquan Zeng , Shun Liu , Zhansheng Zhu","doi":"10.1016/j.inat.2025.102165","DOIUrl":"10.1016/j.inat.2025.102165","url":null,"abstract":"<div><h3>Background</h3><div>Radial access is an increasingly popular approach to neuroradiology. Typically, aortic arch and cerebral angiography are performed using a 5F pigtail catheter and a 5F Simmons II catheter. This classical operation increases the operation time, radiation time, and radiation dose, and the catheters pass through the radial artery multiple times, thereby increasing the risk of radial artery spasms and occlusions. In this study, we aimed to demonstrate that using a Simmons II catheter to complete the aortic arch and cerebral angiography is safe and effective.</div></div><div><h3>Methods</h3><div>This study was a retrospective review of the database on aortic arch and cerebral angiography procedures using two catheters (pigtail catheter and Simmons II catheter) or one catheter (Simmons II catheter) to perform aortic arch and cerebral angiography between August 2024 and January 2025. Patient demographics, clinical data, procedural metrics and radiographic metrics were recorded. Sixty patients underwent aortic arch and cerebral angiographies. Thirty patients underwent aortic arch and cerebral angiographies with two catheters and thirty with one catheter.</div></div><div><h3>Results</h3><div>Total procedure and fluoroscopy times were shorter in the one catheter group. The contrast volume, dose-area product and total radiation dose were lower in the one-catheter group. Clinical outcomes between the two groups showed no statistically significant differences.</div></div><div><h3>Conclusions</h3><div>We confirmed for the first time that using a Simmons II catheter to complete the aortic arch and cerebral angiography was effective and safe.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102165"},"PeriodicalIF":0.5,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799063","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}
Pub Date : 2025-12-14DOI: 10.1016/j.inat.2025.102166
Xiujiao Wei , Jimei Meng , Qinghong Duan
Ewing sarcoma (EWS) is a highly aggressive malignant tumor that primarily affects bones and soft tissues, with primary intracerebral cases being exceptionally rare. While sporadic cases have been reported, a systematic analysis of their radiological features—particularly calcification patterns—is lacking. We present what we believe to be the first case of a right parieto-occipital EWS exhibiting characteristic curvilinear calcification. A comparative review of 8 intracerebral EWS cases revealed that while cystic changes are common (75 %), curvilinear calcification is unique, and marked enhancement is a consistent finding. Our patient was treated with craniotomy, VDC/IE chemotherapy, and IMRT, and achieved no evidence of disease at 12-month follow-up. This systematic contextualization highlights that curvilinear calcification is a novel diagnostic clue for intracerebral EWS, which generally has a favorable outcome with multimodal therapy.
{"title":"Primary intracerebral Ewing sarcoma featuring curvilinear calcification: a case report","authors":"Xiujiao Wei , Jimei Meng , Qinghong Duan","doi":"10.1016/j.inat.2025.102166","DOIUrl":"10.1016/j.inat.2025.102166","url":null,"abstract":"<div><div>Ewing sarcoma (EWS) is a highly aggressive malignant tumor that primarily affects bones and soft tissues, with primary intracerebral cases being exceptionally rare. While sporadic cases have been reported, a systematic analysis of their radiological features—particularly calcification patterns—is lacking. We present what we believe to be the first case of a right parieto-occipital EWS exhibiting characteristic curvilinear calcification. A comparative review of 8 intracerebral EWS cases revealed that while cystic changes are common (75 %), curvilinear calcification is unique, and marked enhancement is a consistent finding. Our patient was treated with craniotomy, VDC/IE chemotherapy, and IMRT, and achieved no evidence of disease at 12-month follow-up. This systematic contextualization highlights that curvilinear calcification is a novel diagnostic clue for intracerebral EWS, which generally has a favorable outcome with multimodal therapy.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102166"},"PeriodicalIF":0.5,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939541","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}
Pub Date : 2025-12-14DOI: 10.1016/j.inat.2025.102161
Masoud Yavari , Amir Bisadi , Fatemeh Abbasi , Mohammad Abbasalizadeh , Negar Emamzadeh , Morteza Gholipour
Background
Schwannomas arising from the middle trunk of the brachial plexus represent an exceptionally rare subset of peripheral nerve sheath tumors. While brachial plexus schwannomas account for approximately 5% of all schwannomas, those originating specifically from the trunks constitute only 4–5% of peripheral nerve sheath tumors. The middle trunk, formed exclusively by the C7 nerve root, is particularly uncommon as a site of origin, making detailed documentation of such cases clinically valuable due to the unique surgical challenges and risk of compromising critical motor function.
Case presentation
A 28-year-old female presented with a 2-year history of a painless, gradually enlarging 5 cm mass in the left supraclavicular region. Core needle biopsy and MRI confirmed a schwannoma. The patient underwent microsurgical excision via an anterolateral approach with intraoperative neurophysiological monitoring. The tumor was completely excised while preserving the middle trunk integrity. Histopathological examination confirmed schwannoma with characteristic biphasic Antoni A and Antoni B patterns. The patient experienced no postoperative neurological deficits, had uneventful wound healing, and returned to normal activities within three weeks.
Conclusion
Complete microsurgical resection of middle trunk schwannomas with preservation of neurological function is achievable through meticulous dissection and intraoperative monitoring. The anterolateral approach provides optimal exposure while protecting surrounding neurovascular structures. Given the rarity of middle trunk involvement and the low recurrence rate following complete excision, early surgical intervention in symptomatic cases is recommended. Continued documentation through detailed case reports remains essential for advancing surgical understanding and optimizing patient outcomes in this challenging anatomical location.
{"title":"Brachial plexus Schwannoma: a case report involving the middle trunk","authors":"Masoud Yavari , Amir Bisadi , Fatemeh Abbasi , Mohammad Abbasalizadeh , Negar Emamzadeh , Morteza Gholipour","doi":"10.1016/j.inat.2025.102161","DOIUrl":"10.1016/j.inat.2025.102161","url":null,"abstract":"<div><h3>Background</h3><div>Schwannomas arising from the middle trunk of the brachial plexus represent an exceptionally rare subset of peripheral nerve sheath tumors. While brachial plexus schwannomas account for approximately 5% of all schwannomas, those originating specifically from the trunks constitute only 4–5% of peripheral nerve sheath tumors. The middle trunk, formed exclusively by the C7 nerve root, is particularly uncommon as a site of origin, making detailed documentation of such cases clinically valuable due to the unique surgical challenges and risk of compromising critical motor function.</div></div><div><h3>Case presentation</h3><div>A 28-year-old female presented with a 2-year history of a painless, gradually enlarging 5 cm mass in the left supraclavicular region. Core needle biopsy and MRI confirmed a schwannoma. The patient underwent microsurgical excision via an anterolateral approach with intraoperative neurophysiological monitoring. The tumor was completely excised while preserving the middle trunk integrity. Histopathological examination confirmed schwannoma with characteristic biphasic Antoni A and Antoni B patterns. The patient experienced no postoperative neurological deficits, had uneventful wound healing, and returned to normal activities within three weeks.</div></div><div><h3>Conclusion</h3><div>Complete microsurgical resection of middle trunk schwannomas with preservation of neurological function is achievable through meticulous dissection and intraoperative monitoring. The anterolateral approach provides optimal exposure while protecting surrounding neurovascular structures. Given the rarity of middle trunk involvement and the low recurrence rate following complete excision, early surgical intervention in symptomatic cases is recommended. Continued documentation through detailed case reports remains essential for advancing surgical understanding and optimizing patient outcomes in this challenging anatomical location.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102161"},"PeriodicalIF":0.5,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799097","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}
Microvascular decompression is the main operative method to treat hemifascial spasm. In this study we aimed to explore the effect and safety of key-hole dual-mirror combined microvascular decompression for the treatment of hemifacial spasm.
Methods
There were 18 males and 52 females in this group. Their age ranged from 27 to 79 years, and their illness duration from 1 to 10 years. Among them there were 38 cases with hemifacial spasm in the left side, 32 cases in the right side. All the patients underwent MRI 3D-TOF examination. After confirming the possibility of vessel compressing the nerve root, key-hole dual-mirror combined microvascular decompression was performed under general anesthesia.Symptom improvement was followed up for 3–120 months postoperatively.
Results
After the operation the effective rate of hemifacial spasm was 91.43%(64/70). Hearing loss appeared in 3 cases, delayed facial paralysis in 2 cases, transient dizziness and tinnitus in 2 cases, CSF otorrhea in 2 cases and SAH in 1 case. After active treatments all the symptoms improved. The follow-up showed 2 cases(2.86%) recurred.
Conclusion
This study shows that microvascular decompression is the most effective way for the treatment of hemifacial spasm. In order to improve the surgical effect and to reduce symptom recurrence, the key points are skilled microsurgical technique、correct identification of the responsible vessel under the combination of microscope and endoscope 、adequate decompression during the operation.
{"title":"Key-hole dual-mirror combined microvascular decompression for the treatment of hemifacial spasm","authors":"Huanming Wang, Fei Hu, Jun Chen, Yubo Xiong, Chongyang Yang, Shengxu Tu, Yu Li, Pei Duan","doi":"10.1016/j.inat.2025.102163","DOIUrl":"10.1016/j.inat.2025.102163","url":null,"abstract":"<div><h3>Objective</h3><div>Microvascular decompression is the main operative method to treat hemifascial spasm. In this study we aimed to explore the effect and safety of key-hole dual-mirror combined microvascular decompression for the treatment of hemifacial spasm.</div></div><div><h3>Methods</h3><div>There were 18 males and 52 females in this group. Their age ranged from 27 to 79 years, and their illness duration from 1 to 10 years. Among them there were 38 cases with hemifacial spasm in the left side, 32 cases in the right side. All the patients underwent MRI 3D-TOF examination. After confirming the possibility of vessel compressing the nerve root, key-hole dual-mirror combined microvascular decompression was performed under general anesthesia.Symptom improvement was followed up for 3–120 months postoperatively.</div></div><div><h3>Results</h3><div>After the operation the effective rate of hemifacial spasm was 91.43%(64/70). Hearing loss appeared in 3 cases, delayed facial paralysis in 2 cases, transient dizziness and tinnitus in 2 cases, CSF otorrhea in 2 cases and SAH in 1 case. After active treatments all the symptoms improved. The follow-up showed 2 cases(2.86%) recurred.</div></div><div><h3>Conclusion</h3><div>This study shows that microvascular decompression is the most effective way for the treatment of hemifacial spasm. In order to improve the surgical effect and to reduce symptom recurrence, the key points are skilled microsurgical technique、correct identification of the responsible vessel under the combination of microscope and endoscope 、adequate decompression during the operation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102163"},"PeriodicalIF":0.5,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799064","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}
Pub Date : 2025-12-14DOI: 10.1016/j.inat.2025.102164
Talhah Chaudri , Nicholas Gikas , Antonio Belli , Mark Svolkinas , Emilia Hargreaves , Andrew R. Stevens , David J. Davies
Background
Syndrome of the trephined is a rare but significant complication which can develop after large craniectomy, characterised by neurological deterioration that typically improves after cranioplasty. Advanced cases can lead to severe neurological impairment, such as impaired consciousness or respiratory failure, requiring urgent surgical intervention. Standard supply chains for custom implants, such as those fashioned from titanium or PEEK, often have prohibitively long turnaround times, unsuitable for emergency cases. The authors present a case of a patient experiencing recurrent apnoeic episodes as a manifestation of the syndrome of the trephined, who underwent an emergent, customised bi-frontal cranioplasty produced using in-house computer-aided design and 3D printing techniques.
Observation
A 29-year-old patient who suffered a severe traumatic brain injury developed apnoeic episodes post-decompressive craniectomy. Imaging demonstrated significant sinking of the skin flap and distortion of the brainstem, suggestive of syndrome of the trephined. In order to expedite cranioplasty and mitigate the risk of further deterioration, an inlay PMMA graft was rapidly designed and fabricated on-site. The technique involved creation of a MED-610 acrylic positive model from pre-operative imaging, followed by a negative silicone mould, into which a vancomycin- and gentamicin-impregnated PMMA mixture was poured and allowed to cure. The graft was secured with plates and hitch sutures used to relieve brain slump. The production process took approximately 48 h at a fraction of the cost of commercially-available alternatives. The procedure had minimal complications. A favourable cosmetic outcome was achieved, and within days the patient’s apnoeic episodes resolved, allowing ventilation to be weaned.
Conclusion
This case illustrates the potential for in-house CAD and 3D printing techniques to significantly reduce turnaround time for cranioplasty in urgent cases. Prefabrication of PMMA grafts reduces operative time and the risk of thermal injury and helps to achieve a good anatomical fit. Use of PMMA cement also allows incorporation of antimicrobial agents, possibly reducing the risk of surgical site infection and the risk of bone flap removal and recurrence of neurological deficits.
{"title":"Rapid antimicrobial-impregnated 3D-printed negative mould technique for PMMA cranioplasty in emergent management of syndrome of the trephined","authors":"Talhah Chaudri , Nicholas Gikas , Antonio Belli , Mark Svolkinas , Emilia Hargreaves , Andrew R. Stevens , David J. Davies","doi":"10.1016/j.inat.2025.102164","DOIUrl":"10.1016/j.inat.2025.102164","url":null,"abstract":"<div><h3>Background</h3><div>Syndrome of the trephined is a rare but significant complication which can develop after large craniectomy, characterised by neurological deterioration that typically improves after cranioplasty. Advanced cases can lead to severe neurological impairment, such as impaired consciousness or respiratory failure, requiring urgent surgical intervention. Standard supply chains for custom implants, such as those fashioned from titanium or PEEK, often have prohibitively long turnaround times, unsuitable for emergency cases. The authors present a case of a patient experiencing recurrent apnoeic episodes as a manifestation of the syndrome of the trephined, who underwent an emergent, customised bi-frontal cranioplasty produced using in-house computer-aided design and 3D printing techniques.</div></div><div><h3>Observation</h3><div>A 29-year-old patient who suffered a severe traumatic brain injury developed apnoeic episodes post-decompressive craniectomy. Imaging demonstrated significant sinking of the skin flap and distortion of the brainstem, suggestive of syndrome of the trephined. In order to expedite cranioplasty and mitigate the risk of further deterioration, an inlay PMMA graft was rapidly designed and fabricated on-site. The technique involved creation of a MED-610 acrylic positive model from pre-operative imaging, followed by a negative silicone mould, into which a vancomycin- and gentamicin-impregnated PMMA mixture was poured and allowed to cure. The graft was secured with plates and hitch sutures used to relieve brain slump. The production process took approximately 48 h at a fraction of the cost of commercially-available alternatives. The procedure had minimal complications. A favourable cosmetic outcome was achieved, and within days the patient’s apnoeic episodes resolved, allowing ventilation to be weaned.</div></div><div><h3>Conclusion</h3><div>This case illustrates the potential for in-house CAD and 3D printing techniques to significantly reduce turnaround time for cranioplasty in urgent cases. Prefabrication of PMMA grafts reduces operative time and the risk of thermal injury and helps to achieve a good anatomical fit. Use of PMMA cement also allows incorporation of antimicrobial agents, possibly reducing the risk of surgical site infection and the risk of bone flap removal and recurrence of neurological deficits.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102164"},"PeriodicalIF":0.5,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799095","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}
Pub Date : 2025-12-13DOI: 10.1016/j.inat.2025.102157
Zongyu Xiao , Ji Wang , Liang He , Yulun Huang
Background
In rare cases, the superficial temporal artery (STA) is not the optimal donor vessel for extracranial-intracranial (EC-IC) bypass procedures. This situation can arise due to factors such as congenital abnormalities, hypoplastic development, trauma-related alterations, or prior surgical interventions. In such scenarios, a well-developed robust and sizable posterior auricular artery (PAA) can be considered a viable alternative for facilitating EC-IC revascularization surgeries.
Objective
To assess the feasibility of the surgical technique for posterior auricular artery (PAA) and middle cerebral artery (MCA) side-to-side (S-S) microvascular anastomosis, and to explore the blood flow distribution patterns following the establishment of PAA-MCA S-S anastomosis.
Results
A PAA-MCA S-S microvascular anastomosis was successfully performed. Intraoperatively, indocyanine green videoangiography (ICG-VA) confirmed immediate anastomotic patency, which was further validated by digital subtraction angiography (DSA). The recipient MCA received blood flow from two directions: antegrade blood flow originated from the proximal preanastomotic PAA, whereas retrograde blood flow traveled from the distal postanastomotic PAA via the ipsilateral and contralateral OAs.
Conclusions
Side-to-side microvascular anastomosis between the posterior auricular artery and middle cerebral artery is an effective alternative revascularization strategy in moyamoya disease. This approach optimizes the blood supply to the recipient MCA territory through dual-directional flow from the donor PAA, enhancing hemodynamic augmentation.
{"title":"Posterior auricular artery-to-middle cerebral artery side-to-side microvascular anastomosis","authors":"Zongyu Xiao , Ji Wang , Liang He , Yulun Huang","doi":"10.1016/j.inat.2025.102157","DOIUrl":"10.1016/j.inat.2025.102157","url":null,"abstract":"<div><h3>Background</h3><div>In rare cases, the superficial temporal artery (STA) is not the optimal donor vessel for extracranial-intracranial (EC-IC) bypass procedures. This situation can arise due to factors such as congenital abnormalities, hypoplastic development, trauma-related alterations, or prior surgical interventions. In such scenarios, a well-developed robust and sizable posterior auricular artery (PAA) can be considered a viable alternative for facilitating EC-IC revascularization surgeries.</div></div><div><h3>Objective</h3><div>To assess the feasibility of the surgical technique for posterior auricular artery (PAA) and middle cerebral artery (MCA) side-to-side (S-S) microvascular anastomosis, and to explore the blood flow distribution patterns following the establishment of PAA-MCA S-S anastomosis.</div></div><div><h3>Results</h3><div>A PAA-MCA S-S microvascular anastomosis was successfully performed. Intraoperatively, indocyanine green videoangiography (ICG-VA) confirmed immediate anastomotic patency, which was further validated by digital subtraction angiography (DSA). The recipient MCA received blood flow from two directions: antegrade blood flow originated from the proximal preanastomotic PAA, whereas retrograde blood flow traveled from the distal postanastomotic PAA via the ipsilateral and contralateral OAs.</div></div><div><h3>Conclusions</h3><div>Side-to-side microvascular anastomosis between the posterior auricular artery and middle cerebral artery is an effective alternative revascularization strategy in moyamoya disease. This approach optimizes the blood supply to the recipient MCA territory through dual-directional flow from the donor PAA, enhancing hemodynamic augmentation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102157"},"PeriodicalIF":0.5,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799096","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}
Pub Date : 2025-12-13DOI: 10.1016/j.inat.2025.102155
Ali Tarik Abdul Wahid
Background
Primary spinal cord tumors present significant diagnostic and clinical challenges, particularly in elderly patients, due to their impact on the neural axis and the complexity of treatment. This study aims to compare surgical outcomes, complications, and long-term functional recovery between elderly vs younger patients undergoing spinal cord tumor resection.
Methods
A chart review of 100 patients at Baghdad Medical City from 2021 through 2023 divided them into two groups: young adults (18–60 years) and elderly (60 + years). Preoperative, intraoperative, and postoperative parameters, including demographics, surgical duration, blood loss, complications, hospital stay, postoperative assessment, and recovery outcomes, were collected from medical records.
Results
Elderly patients had significantly longer surgeries (160 ± 40 vs. 120 ± 30 min) and greater blood loss (300 ± 90 vs. 250 ± 80 mL) than young adults for both intramural and extramural spinal cord tumors. Complications in the elderly group (30 % vs. 10 %), with 24 % requiring blood transfusions compared to 8 %. Postoperatively, elderly patients had longer hospital stays (7 ± 4 vs. 5 ± 2 days) and higher pain scores (6 ± 2 vs. 4 ± 2). Mobility recovery was slower in elderly patients, averaging 14 ± 5 versus 8 ± 3 days for younger patients. Elderly patients experienced a higher rate of postoperative delirium (10 % vs. none).
Conclusion
Elderly patients undergoing spinal cord tumor resection face higher risks of intraoperative complications, blood loss, and prolonged recovery. This underscores the need for age-adjusted surgical techniques and postoperative care to improve outcomes for elderly patients with spinal cord tumors.
{"title":"Surgical outcomes and challenges in spinal cord tumor resection: a comparative study of elderly vs. young patients","authors":"Ali Tarik Abdul Wahid","doi":"10.1016/j.inat.2025.102155","DOIUrl":"10.1016/j.inat.2025.102155","url":null,"abstract":"<div><h3>Background</h3><div>Primary spinal cord tumors present significant diagnostic and clinical challenges, particularly in elderly patients, due to their impact on the neural axis and the complexity of treatment. This study aims to compare surgical outcomes, complications, and long-term functional recovery between elderly vs younger patients undergoing spinal cord tumor resection.</div></div><div><h3>Methods</h3><div>A chart review of 100 patients at Baghdad Medical City from 2021 through 2023 divided them into two groups: young adults (18–60 years) and elderly (60 + years). Preoperative, intraoperative, and postoperative parameters, including demographics, surgical duration, blood loss, complications, hospital stay, postoperative assessment, and recovery outcomes, were collected from medical records.</div></div><div><h3>Results</h3><div>Elderly patients had significantly longer surgeries (160 ± 40 vs. 120 ± 30 min) and greater blood loss (300 ± 90 vs. 250 ± 80 mL) than young adults for both intramural and extramural spinal cord tumors. Complications in the elderly group (30 % vs. 10 %), with 24 % requiring blood transfusions compared to 8 %. Postoperatively, elderly patients had longer hospital stays (7 ± 4 vs. 5 ± 2 days) and higher pain scores (6 ± 2 vs. 4 ± 2). Mobility recovery was slower in elderly patients, averaging 14 ± 5 versus 8 ± 3 days for younger patients. Elderly patients experienced a higher rate of postoperative delirium (10 % vs. none).</div></div><div><h3>Conclusion</h3><div>Elderly patients undergoing spinal cord tumor resection face higher risks of intraoperative complications, blood loss, and prolonged recovery. This underscores the need for age-adjusted surgical techniques and postoperative care to improve outcomes for elderly patients with spinal cord tumors.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102155"},"PeriodicalIF":0.5,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799062","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}
Pub Date : 2025-12-12DOI: 10.1016/j.inat.2025.102162
Logan D. Tlam , Joseph X. Anders , Maggie M. Minett , Chad J. Hungerford , Ethan L. Snow
Background
Intervertebral discs (IVDs) permit resilient deformability and shock absorption between vertebrae. IVD herniation from damage or disease most commonly occurs in the lumbar and cervical spines, in the posterolateral direction, and to a single IVD. This investigation seeks to examine a unique case of successive thoracic anterolateral IVD herniations with gross and magnetic resonance imaging (MRI) analyses and present the case with a literature-based clinical narrative.
Methods
The case was discovered in an adult human cadaver. T1-weighted MRI was performed on the implicated spine, and serial cross-sectioning was completed through each IVD. The herniations were photographed at each stage, and linear parameters of the spinal pathologies were measured.
Results
The ossified herniations extruded 11.1 ± 2.1 mm from the typical IVD border, and the ossified bridging over the vertebral bodies extruded 6.9 ± 2.6 mm from the typical vertebral body border. The extrusions displaced the functionality of the anterior longitudinal ligament 7.37 mm left of midline, and comparison of gross in situ and cross-sectional imaging with MRI illustrated the extent of IVD herniation and vertebral fusion in the clinical perspective.
Conclusions
The present cadaveric case involving multiple uncommon features of IVD herniation accompanied by MRI and clinical narrative may enhance clinical awareness among spine specialists, particularly in recognizing uncommon presentations of thoracic IVD ossification and vertebral hyperostosis. This report may also serve as a valuable reference for to clinical anatomists, Doctors of Chiropractic Medicine, spine neurosurgeons, and other healthcare experts when discussing or treating related patient cases.
{"title":"Successive thoracic anterolateral intervertebral disc herniations with ossification-fusion: a cadaveric case analysis with MRI and clinical review","authors":"Logan D. Tlam , Joseph X. Anders , Maggie M. Minett , Chad J. Hungerford , Ethan L. Snow","doi":"10.1016/j.inat.2025.102162","DOIUrl":"10.1016/j.inat.2025.102162","url":null,"abstract":"<div><h3>Background</h3><div>Intervertebral discs (IVDs) permit resilient deformability and shock absorption between vertebrae. IVD herniation from damage or disease most commonly occurs in the lumbar and cervical spines, in the posterolateral direction, and to a single IVD. This investigation seeks to examine a unique case of successive thoracic anterolateral IVD herniations with gross and magnetic resonance imaging (MRI) analyses and present the case with a literature-based clinical narrative.</div></div><div><h3>Methods</h3><div>The case was discovered in an adult human cadaver. T1-weighted MRI was performed on the implicated spine, and serial cross-sectioning was completed through each IVD. The herniations were photographed at each stage, and linear parameters of the spinal pathologies were measured.</div></div><div><h3>Results</h3><div>The ossified herniations extruded 11.1 ± 2.1 mm from the typical IVD border, and the ossified bridging over the vertebral bodies extruded 6.9 ± 2.6 mm from the typical vertebral body border. The extrusions displaced the functionality of the anterior longitudinal ligament 7.37 mm left of midline, and comparison of gross in situ and cross-sectional imaging with MRI illustrated the extent of IVD herniation and vertebral fusion in the clinical perspective.</div></div><div><h3>Conclusions</h3><div>The present cadaveric case involving multiple uncommon features of IVD herniation accompanied by MRI and clinical narrative may enhance clinical awareness among spine specialists, particularly in recognizing uncommon presentations of thoracic IVD ossification and vertebral hyperostosis. This report may also serve as a valuable reference for to clinical anatomists, Doctors of Chiropractic Medicine, spine neurosurgeons, and other healthcare experts when discussing or treating related patient cases.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102162"},"PeriodicalIF":0.5,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145799098","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}
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