Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献

Background

Brucellosis is a zoonotic infectious disease. Neurobrucellosis occurs when Borrelia burgdorferi infects the nervous system and is a complication of brucellosis. Infection is a common post-cranioplasty complication, although co-infection with B. burgdorferi is rare. In this article, we report a case of neurobrucellosis caused by B. burgdorferi infection after cranioplasty in a female patient with traumatic brain injury and review the literature.

Case Description

A 37-year-old woman with traumatic brain injury underwent emergency clot removal and decompression craniectomy. Three-dimensional titanium mesh cranioplasty was performed 4 years later. Unfortunately, only 1 year later, the skull repair material had to be removed because of a localized scalp infection in the area of the skull repair. Cranioplasty was performed 5 months later with polyetheretherketone material. The patient remained free of symptoms until July 27, 2022, when the patient was readmitted for a headache. The final diagnosis of neurobrucellosis was made after relevant examinations, tests, and subcutaneous puncture of aspirated pus for bacterial cultures and special genus tests. Following the standard protocol, the patient was treated effectively.

Conclusion

Neurobrucellosis occurs after a patient contracts a neurological infection through contact with the excrement of an infected animal or ingestion of food from an infected or diseased animal. Any postoperative complications of specific infections can cause physical pain and a heavy financial burden on the patient because of the special and expensive materials used for cranial repair. Therefore, we recommend screening patients from areas at epidemiological risk for relevant diseases before undergoing cranioplasty.

Hypertensive intracerebral hemorrhage rarely develops into chronic encapsulated intracerebral hematoma (CEIH). We encountered 2 cases of CEIH, one with initial CEIH and the other with CEIH following minimally invasive endoscopic surgery for hypertensive intracerebral hemorrhage. Case 1 was a 46-year-old man with Glasgow Coma Scale (GCS) 12 (E4V3M5), complete hemiplegia, and motor aphasia who was brought to our hospital. A head computed tomography scan showed a left putaminal hemorrhage, and he was treated conservatively. However, because the hematoma enlarged and cerebral herniation appeared, we performed endoscopic hematoma removal. His paralysis improved and he transferred to a convalescent hospital with modified Rankin Scale 2. Case 2 was an 84-year-old man with GCS 9 (E3V2M4), right conjugate deviation, and complete hemiplegia who was brought to our hospital. We performed endoscopic hematoma removal. Because of gradual regrowth of the hematoma and cerebral herniation, endoscopic hematoma removal was performed again on day 12 after surgery. His consciousness improved postoperatively, and he was transferred to a convalescent hospital. The pathogenesis of CEIH is still not known, and we newly suggest the involvement of pia mater collapse and cerebral spinal fluid accumulation. We report the effectiveness of minimally invasive endoscopic surgery and reconsider the mechanism of CEIH based on a literature review.

Cavernous angiomas are benign vascular malformations that are occasionally found in the central nervous system. They comprise about 3% of all subdural spinal cord tumors, with only 24 cases of cavernomas of the cauda equina described in the literature.

This paper reports the case of a 55-year-old man who presented with back pain radiating to both legs. The patient followed several sessions of physiotherapy with only short pain relief. A lumbar magnetic resonance imaging showed a lesion with diameter of 12 mm located at the L1/L2 level under the conus medullaris. The patient underwent L2 and partially L1 laminectomy with complete resection of the lesion. The pathohistological examination was consistent with a cavernous angioma of the cauda equina. Full recovery of the patient was obtained without any neurological deficit.

Background

The coexistence of intracranial aneurysms and dysraphic cysts is a rare manifestation. The response triggered by the cyst and its proinflammatory content could play a role in the rupture or growth of a neighboring aneurysm.

Methods

We performed a systematic review according to the PRISMA guidelines searching PubMed, Medline, Google Scholar and Embase. Additionally, we report a case of one patient with both a dermoid cyst and an ipsilateral anterior cerebral artery aneurysm, illustrating a progressive formation of the vascular lesion during the follow-up of the cyst.

Results

Out of 103 papers fulfilling the inclusion criteria for the systematic review, 79 articles were selected for eligibility. Finally, a total of 9 cases, including our own case, were considered for the review. We found that all aneurysms were in the anterior circulation and all cysts were supratentorial. The aneurysms or parent vessels were in proximity or in contact with the dysraphic lesion, presenting a strong adherence to its capsule. The 3 dermoids presented with cysts rupture and showed simultaneous or delayed subarachnoid aneurysmal hemorrhage. Two epidermoid cysts were diagnosed after aneurysm rupture, while the others due to focal mass effect, as in the case of the neurenteric cyst.

Conclusions

Coexistence of intracranial aneurysm and disraphic cyst is a rare finding with multiple possible presentations. In managing patients harboring disraphic cyst, the presence of the aneurysm should be ruled out during the standard workup. A coexistence of these pathologies could affect their natural histories, and this could justify a more active management protocol.

Objective

This case report aims to describe a rare occurrence of a purely intraosseous meningioma, presenting as a lytic bone lesion in the skull.

Case Report

We present the case of a 67-year-old female patient who presented with a persistent headache and underwent diagnostic imaging, including CT scan and MRI. Surgical resection with wide margins and cranial reconstruction was performed, followed by histopathological examination of the tumor.

Discussion

The radiological investigation revealed an infiltrative and lytic heterogeneous lesion in the left parietal bone. Whole-body PET-CT scan showed no signs of primary involvement. The patient underwent successful surgery, and the histopathological examination confirmed the diagnosis of a grade I meningothelial meningioma with adjacent hyperostosis. Primary intraosseous meningiomas are exceedingly rare and challenging to diagnose due to their mimicry of other benign and malignant skull lesions. Surgical resection with wide margins is recommended, and histopathological examination with immunohistochemistry aids in confirming the diagnosis. Long-term surveillance is necessary due to the potential for recurrence and malignant transformation.

Background

CSM is the most common cause of spinal dysfunction in adults older than 55 years of age and surgery is the mainstay of treatment for patients with CSM.The objective of our study was to assess the outcome of patients operated for CSM by using m-JOA and Recovery rate using Hirabayashi formula and evaluate clinical factors predicting surgical outcomes in patients undergoing decompressive surgeries.

Methodology

Adult CSM patients fulfilling inclusion and exclusion criteria were enrolled at two hospitals. Patients were followed prospectively for a minimum of 06 month, with mJOA score, recovery rate (using Hirabayashi formula) and Postoperative complications assessments. Possible clinical predictive factors were also assessed.

Results

There were 38 men and 19 women (mean age, 50.63 yr) enrolled in our study. 48 patients had anterior cervical procedure, 9 patients had posterior procedures.The mean mJOA scores at 6 months (13.33) and 1 year(14.74) after surgery were significantly higher than the mean preoperative mJOA (10.44) (P value = 0.01). 42(73.4 %)patients had recovery, 7 patients (11.9 %) remained the same while 8 (13.6 %) patients worsened. Average recovery rate was 36.59 ± 37.12 % in younger patients(<65yrs) and 2.4 ± 47.10 % in the group older than 65 years (P value = 0.043). Rate of recovery in patients with symptom duration of < 1 year was found to be better than those presented with symptom duration of > 1 year(39.11 % vs 15.54 %) with p-value = 0.035. Six patients had new neurologic deficit in the immediate postoperative period.

Conclusions

Surgical treatment of CSM was associated with significant improvement in mJOA and recovery rate at 6 and 12 months. Age and duration of symptom were highly predictive of surgical. Our study showed a high rate of immediate post op neurologic deterioration but other complications in our study were comparable with those in previously reported CSM series.

Background

Intracranial aneurysms are associated with a high mortality rate in the event of a rupture and significant morbidity during subsequent treatment. Hybrid treatment approaches for vascular diseases have been incorporated into modern operating rooms as guides for surgical interventions now. The current study evaluates the feasibility and effectiveness of hybrid operating room system and its application in the surgical treatment of intracranial aneurysms.

Aims

To evaluate the feasibility and effectiveness of hybrid operating room system and its application in the surgical treatment for aneurysms.

Methods

76 patients with 84 intracranial aneurysms were surgically treated in Hybrid operating room with intraoperative angiography between March 2018 and March 2021. Aneurysm clipping was performed in 76 (94.7 %) cases; Aneurysm trapping with extracranial-intracranial (EC-IC) bypass in 4 (5.3 %) cases. Patient demographics, aneurysm size, location, Hunt and Hess score, were recorded. 69 (90.8 %) patients were followed up 6–12 months post operation.

Results

Intraoperative angiography demonstrated 5 (6.9%) unexpected aneurysm neck residuals leading to adjustment; 6 (8.3%) parent vessel stenosis in which 5 returned to normal after adjustment. Four giant paraclinoid aneurysms trapping with EC-IC bypass showed total successful vessel reconstruction and complete aneurysm exclusion (100%). The postoperative outcome was evaluated with the modified Rankin Scale (mRS). 53 (76.8%) patients showed good outcome (mRS 0), 11 (15.9%) showed mild neurological defect (mRS 1–2), 3 (4.3%) showed poor outcome (mRS 5), and 2 (2.9%) patients died (mRS 6, Hunt-Hess grade V before surgery). Conclusion: Hybrid operating room provides new concepts in the surgically treatment of intracranial aneurysms, especially valuable for the complex aneurysms. The combination of intraoperative imaging of angiography and clipping surgery may offer the opportunity of radical clipping and reduced complications for aneurysm patients.

Background

Alkaptonuria (AKU) is a rare autosomal recessive disease characterized by a deficiency in an enzyme involved in the tyrosine and phenylalanine degradation. Patients suffering from this disorder develop a black coloration of cartilages known as ochronosis, leading to debilitating cartilage and arthritis at early ages. The spine is commonly involved but reports of lumbar disc disease are rare.

Methods

We present a case of a lumbar disc herniation secondary to ochronosis, and we also provide a comparative analysis with other cases documented in the literature. For the literature search we selected manuscripts published in PubMed, Embase, Scopus, Ovid, and Science Direct between 1963 and 2022.

Results

The mean age of the 25 included patients was 44.2 years (range: 22–69), and most of them were males (n = 19). The most common presentations were back pain and leg pain (n = 10), followed by lumbar radiculopathy (n = 9). Cauda equina syndrome (n = 2), thoracic myelopathy (n = 2), and cervical radiculopathy (n = 1) were less frequently observed. The lumbar region was the most affected area, with L4-L5 being the most affected level (n = 7), followed by L5-S1 (n = 4).

Conclusion

AKU can lead to ochronotic spondyloarthropathy and, rarely, disc herniation, particularly in the lower lumbar region. Surgeons should note that black cartilage during a discectomy indicates likely ochronotic disc involvement. Diagnosis requires histopathologic and biochemical analyses of blood and urine, usually done retrospectively. Genetic confirmation is crucial due to the multisystem nature of alkaptonuria. Our case contributes to the literature on this rare condition, emphasizing the need for comprehensive diagnostics.

Background

Re-resections is one of the treatment options for recurrence brain tumors, including both benign and malignant brain tumors, such as meningioma and glioblastoma. Re-resection for recurrent brain tumor sometimes needs extension of original craniotomy. However, extending original craniotomy is troublesome and can easily damage the adhered brain tissue and reconstruct of bone flap sometimes cause cosmetic problems, thus ideal way to re-resect recurrent brain tumor is to use the same original craniotomy.

However, when using an operative microscope, performing re-resections without extending craniotomy requires the surgeon to operate in an awkward position. A recently developed high-definition (4 K-HD) 3-D exoscope system, ORBEYE, can improve this problem. In this study, we analyzed the utility of 4 K-HD 3-D exoscope system, ORBEYE, for re-resecting recurrent brain tumor.

Methods

We report 32 cases managed by re-resecting recurrent brain tumor by ORBEYE. Perioperative clinical, surgical, and radiographic data were retrospectively examined.

Results

Re-resecting tumors for recurrent brain tumor by ORBEYE were successfully performed for all 32 resections, using ORBEYE, without any severe postoperative neurological deficit. In addition, we could avoid extending original craniotomy as much as possible by adjusting the ORBEYE camera angle.

Conclusion

Re-resecting tumors for recurrent brain tumors by ORBEYE are feasible and can avoid extending original craniotomy as much as possible.

Background

Epidural hematoma often develops in a single side in the skull box. However, even though this is quite rare, it may also arise from two sides: the so-called bilateral extradural hematoma (BEDH). Here, we report three cases of BEDH occurring in three young male patients following a head trauma.

Methods

We present three cases of BEDH and relate our experience with its management in general and discuss the relevant literature.

Cases description: The first case is a 15-year old male with no past history, referred to our emergency department for sustained headache, nausea/vomiting following a head trauma due to a wood blow with brief loss of consciousness. The head CT (Computed Tomography) scan performed showed a biparietal extradural hematoma. The 2nd case was a 41-year-old male, with no past history, referred to our emergency department for headache, nausea/vomiting following a head injury due to a wood blow with brief loss of consciousness. The head CT scan showed a double (frontal and parietal) bilateral extradural hematoma. The 3rd case was about a 20-year-old male patient referred to our casualty for sustained loss of consciousness with vomiting following head trauma caused by a machete blow. The head CT scan revealed a biparieto-frontal extradural hematoma. The three patients underwent hematomas evacuation through craniotomy. The post-operative follow-up was uneventful.

Conclusion

Post‑traumatic bilateral acute extradural hematoma remains uncommon. Its management requires careful planning, judicious surgical approach, and time management for good results.