Pub Date : 2025-10-12DOI: 10.1016/j.inat.2025.102134
Guan-Sian Wu, Shih-Huang Tai, Yu-Ning Chen, E-Jian Lee
Spinal surgery following by spinal epidural hematoma is a rare condition, the Factors related to symptomatic spinal epidural hematomas include coagulopathy, trauma, surgery, and vascular lesions. Most hematomas occur spontaneously without known etiology, but some spontaneous lesions are related to vascular anomalies [1].The study showed the higher incidence of hematoma associated with spinal deformity, the location of thoracic spine, posterior approach, and minimally invasive surgery [2].
We present a case of an obese patient with spinal deformity who underwent multiple spinal surgeries and subsequently developed symptomatic spinal epidural hematomas following kyphoplasty. Early diagnosis via computed tomography scan enabled prompt surgical intervention, minimizing neurological injury.
{"title":"A rare case of spontaneous spinal epidural hematoma after kyphoplasty","authors":"Guan-Sian Wu, Shih-Huang Tai, Yu-Ning Chen, E-Jian Lee","doi":"10.1016/j.inat.2025.102134","DOIUrl":"10.1016/j.inat.2025.102134","url":null,"abstract":"<div><div>Spinal surgery following by spinal epidural hematoma is a rare condition, the Factors related to symptomatic spinal epidural hematomas include coagulopathy, trauma, surgery, and vascular lesions. Most hematomas occur spontaneously without known etiology, but some spontaneous lesions are related to vascular anomalies [<span><span>1</span></span>].The study showed the higher incidence of hematoma associated with spinal deformity, the location of thoracic spine, posterior approach, and minimally invasive surgery [<span><span>2</span></span>].</div><div>We present a case of an obese patient with spinal deformity who underwent multiple spinal surgeries and subsequently developed symptomatic spinal epidural hematomas following kyphoplasty. Early diagnosis via computed tomography scan enabled prompt surgical intervention, minimizing neurological injury.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102134"},"PeriodicalIF":0.5,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325776","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 : 2025-10-12DOI: 10.1016/j.inat.2025.102133
Fan He, Shirong Gu
A 68-year-old female patient was admitted to our outpatient clinic with back and low back pain. There were no remarkable physical or neurological findings of the patient. Imaging workup revealed two cystic lesions of the right T8 and left T11 nerve root at the level of the foramen. Conservative treatment for this patient was ineffective in a half-year follow-up period. We performed laminectomies at the level of interests and cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found there is an internal fistula at the communication between the cyst and the dura mater and nerve root passing through it. The cysts were excised and the nerve roots were preserved. Surgical resection resulted in significant improvement in patient symptoms, and pathology revealed a perineural cyst. We conclude that back pain may be generated when distention of the cyst activates neural, dural, or bone nociceptors. And surgical treatment can be curative.
{"title":"Surgical excision of symptomatic multiple nerve root perineural cysts in thoracic intervertebral foramen: A case report","authors":"Fan He, Shirong Gu","doi":"10.1016/j.inat.2025.102133","DOIUrl":"10.1016/j.inat.2025.102133","url":null,"abstract":"<div><div>A 68-year-old female patient was admitted to our outpatient clinic with back and low back pain. There were no remarkable physical or neurological findings of the patient. Imaging workup revealed two cystic lesions of the right T8 and left T11 nerve root at the level of the foramen. Conservative treatment for this patient was ineffective in a half-year follow-up period. We performed laminectomies at the level of interests and cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found there is an internal fistula at the communication between the cyst and the dura mater and nerve root passing through it. The cysts were excised and the nerve roots were preserved. Surgical resection resulted in significant improvement in patient symptoms, and pathology revealed a perineural cyst. We conclude that back pain may be generated when distention of the cyst activates neural, dural, or bone nociceptors. And surgical treatment can be curative.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102133"},"PeriodicalIF":0.5,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325125","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 : 2025-10-12DOI: 10.1016/j.inat.2025.102140
Islam Abdelsamad , Ihap Bedier
Background
Neuroendoscopy has significantly improved the neurosurgical field, offering minimally invasive solutions for various cranial and spinal conditions. As these techniques become more prevalent worldwide, including in Egypt, the demand for well-structured and high-quality training programs has grown. This study aims to evaluate the current landscape of neuroendoscopic training in Egypt, highlighting key advancements and persisting challenges. Based on practical experience and a comprehensive literature review, we propose strategies to enhance the quality, accessibility, and sustainability of neuroendoscopic education in the country.
Methods
Our analysis draws from our extensive clinical and academic involvement in neuroendoscopic procedures and educational courses conducted in Egypt and the United Kingdom. A targeted literature review was performed using PubMed and Google Scholar with relevant search terms. Comparative evaluation of training infrastructure in Egypt versus developed countries was also conducted. Additionally, we assessed existing collaborations, local initiatives, and regulatory frameworks affecting neuroendoscopic education.
Results
Three primary domains of advancement were identified: Specialized Workshops: Over 35 cadaveric and non-cadaveric workshops have been conducted since 2009 to the best of our knowledge, significantly improving practical skill acquisition among Egyptian neurosurgeons, International Collaborations: Partnerships have introduced structured fellowships and global training exposure, and Personal Efforts: Individual neurosurgeons have actively pursued external fellowships, initiated local training, and introduced neuroendoscopic practice into their hospitals despite financial and logistical barriers.
Conclusion
Egypt has laid a solid foundation for neuroendoscopic education through focused efforts by academic institutions, professional societies, and individual neurosurgeons. With strategic national planning and international support, Egypt is well-positioned to emerge as a regional leader in neuroendoscopic training, setting an example for other developing countries aiming to integrate advanced minimally invasive neurosurgical techniques.
{"title":"Advancements and challenges in neuroendoscopic training in Egypt","authors":"Islam Abdelsamad , Ihap Bedier","doi":"10.1016/j.inat.2025.102140","DOIUrl":"10.1016/j.inat.2025.102140","url":null,"abstract":"<div><h3>Background</h3><div>Neuroendoscopy has significantly improved the neurosurgical field, offering minimally invasive solutions for various cranial and spinal conditions. As these techniques become more prevalent worldwide, including in Egypt, the demand for well-structured and high-quality training programs has grown. This study aims to evaluate the current landscape of neuroendoscopic training in Egypt, highlighting key advancements and persisting challenges. Based on practical experience and a comprehensive literature review, we propose strategies to enhance the quality, accessibility, and sustainability of neuroendoscopic education in the country.</div></div><div><h3>Methods</h3><div>Our analysis draws from our extensive clinical and academic involvement in neuroendoscopic procedures and educational courses conducted in Egypt and the United Kingdom. A targeted literature review was performed using PubMed and Google Scholar with relevant search terms. Comparative evaluation of training infrastructure in Egypt versus developed countries was also conducted. Additionally, we assessed existing collaborations, local initiatives, and regulatory frameworks affecting neuroendoscopic education.</div></div><div><h3>Results</h3><div>Three primary domains of advancement were identified: <em>Specialized Workshops</em>: Over 35 cadaveric and non-cadaveric workshops have been conducted since 2009 to the best of our knowledge, significantly improving practical skill acquisition among Egyptian neurosurgeons, <em>International Collaborations</em>: Partnerships have introduced structured fellowships and global training exposure, and <em>Personal Efforts</em>: Individual neurosurgeons have actively pursued external fellowships, initiated local training, and introduced neuroendoscopic practice into their hospitals despite financial and logistical barriers.</div></div><div><h3>Conclusion</h3><div>Egypt has laid a solid foundation for neuroendoscopic education through focused efforts by academic institutions, professional societies, and individual neurosurgeons. With strategic national planning and international support, Egypt is well-positioned to emerge as a regional leader in neuroendoscopic training, setting an example for other developing countries aiming to integrate advanced minimally invasive neurosurgical techniques.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102140"},"PeriodicalIF":0.5,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325762","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 : 2025-10-12DOI: 10.1016/j.inat.2025.102139
Salman Sharif , Uzair Ahmed Siddiqui , Corinna Zygourakis , Mehmet Zileli , Vashisht Sekar
Objective
To formulate the most current, evidence-based recommendations for the role of radiation therapy and stereotactic radiosurgery for Primary Malignant Vertebral tumors.
Methods
A systematic literature search in PubMed and Google Scholar databases was performed from 2013 to 2023 using the search terms, “radiosurgery”, “radiotherapy”, “radiation therapy”, “Ewing’s Sarcoma”, “Osteosarcoma”, “Chondrosarcoma”, and “Primary Spinal Sarcoma”. Standardized screening criteria resulted in a total of 28 articles that were analyzed, including 3 RCTs, 11 retrospective studies, 10 systematic reviews and 4 case series and reports.
This up-to-date information was reviewed and presented at WFNS Spine Committee Spine Tumor consensus meeting. Two rounds of Delphi method were utilized to vote on the statements and arrive at a positive or negative consensus.
Results and conclusion
The WFNS Spine Committee finalized nine recommendation guidelines on the role of different modalities of radiation therapy and stereotactic radiosurgery (SRS) for the primary vertebral tumors. In conclusion, the effective treatment of primary malignant spinal tumors relies on a combined approach, with radiation therapy crucial in challenging surgical cases. Patient survival depends on age, tumor size, dose, and surgery quality, especially in sarcoma cases. Advanced radiation techniques, such as SRS and IMPT/IMRT combination, show promise. CSI is effective for intraspinal Ewing Sarcoma, while charged-particle therapies offer comparable outcomes to surgery. As conventional radiotherapy is phased out, precision and reduced collateral damage are prioritized for better patient outcomes.
{"title":"Radiation therapy and stereotactic radiosurgery for primary vertebral tumors","authors":"Salman Sharif , Uzair Ahmed Siddiqui , Corinna Zygourakis , Mehmet Zileli , Vashisht Sekar","doi":"10.1016/j.inat.2025.102139","DOIUrl":"10.1016/j.inat.2025.102139","url":null,"abstract":"<div><h3>Objective</h3><div>To formulate the most current, evidence-based recommendations for the role of radiation therapy and stereotactic radiosurgery for Primary Malignant Vertebral tumors.</div></div><div><h3>Methods</h3><div>A systematic literature search in PubMed and Google Scholar databases was performed from 2013 to 2023 using the search terms, “radiosurgery”, “radiotherapy”, “radiation therapy”, “Ewing’s Sarcoma”, “Osteosarcoma”, “Chondrosarcoma”, and “Primary Spinal Sarcoma”. Standardized screening criteria resulted in a total of 28 articles that were analyzed, including 3 RCTs, 11 retrospective studies, 10 systematic reviews and 4 case series and reports.</div><div>This up-to-date information was reviewed and presented at WFNS Spine Committee Spine Tumor consensus meeting. Two rounds of Delphi method were utilized to vote on the statements and arrive at a positive or negative consensus.</div></div><div><h3>Results and conclusion</h3><div>The WFNS Spine Committee finalized nine recommendation guidelines on the role of different modalities of radiation therapy and stereotactic radiosurgery (SRS) for the primary vertebral tumors. In conclusion, the effective treatment of primary malignant spinal tumors relies on a combined approach, with radiation therapy crucial in challenging surgical cases. Patient survival depends on age, tumor size, dose, and surgery quality, especially in sarcoma cases. Advanced radiation techniques, such as SRS and IMPT/IMRT combination, show promise. CSI is effective for intraspinal Ewing Sarcoma, while charged-particle therapies offer comparable outcomes to surgery. As conventional radiotherapy is phased out, precision and reduced collateral damage are prioritized for better patient outcomes.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102139"},"PeriodicalIF":0.5,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145473823","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}
Aplasia of the internal carotid artery (ICA) is rare. Patients with ICA aplasia are complicated with intercranial aneurysms due to hemodynamic factors more often than others, although they are asymptomatic.
Clinical presentation
We herein report a case of subarachnoid hemorrhaging due to a ruptured basilar artery (BA) aneurysm associated with congenital left ICA aplasia treated with endovascular therapy. The patient had been diagnosed with congenital ICA aplasia 15 years earlier; however, no aneurysm had been found at that time.
Conclusions
Hemodynamic factors associated with ICA aplasia may lead to de novo aneurysm formation. And also, wall share stress may lead to aneurysm formation.
{"title":"Basilar artery aneurysm with aplasia of internal carotid artery: A case presentation","authors":"Kumpei Takao, Mitsuhiro Anan, Kouhei Onishi, Masaki Morishige, Nobuhiro Hata, Minoru Fujiki","doi":"10.1016/j.inat.2025.102132","DOIUrl":"10.1016/j.inat.2025.102132","url":null,"abstract":"<div><h3>Background</h3><div>Aplasia of the internal carotid artery (ICA) is rare. Patients with ICA aplasia are complicated with intercranial aneurysms due to hemodynamic factors more often than others, although they are asymptomatic.</div><div>Clinical presentation</div><div>We herein report a case of subarachnoid hemorrhaging due to a ruptured basilar artery (BA) aneurysm associated with congenital left ICA aplasia treated with endovascular therapy. The patient had been diagnosed with congenital ICA aplasia 15 years earlier; however, no aneurysm had been found at that time.</div></div><div><h3>Conclusions</h3><div>Hemodynamic factors associated with ICA aplasia may lead to <em>de novo</em> aneurysm formation. And also, wall share stress may lead to aneurysm formation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102132"},"PeriodicalIF":0.5,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325763","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}
Cardiac myxomas are rare, predominantly benign tumors that most commonly occur in individuals aged 40–60 years, with a higher incidence in females. These tumors often exhibit friable surfaces, predisposing them to embolization. Systemic embolism occurs in up to 45 % of cases, frequently affecting cerebral circulation and leading to ischemic events.
Case presentation
We report the case of a 41-year-old female with a history of left atrial myxoma who presented with recurrent transient paresthesia of the right upper limb. Imaging revealed multiple intracranial myxomatous aneurysms, including a large fusiform aneurysm in the M2 segment of the left middle cerebral artery. Surgical intervention involving aneurysm trapping and a superficial temporal artery–M2 (STA-M2) bypass was successfully performed. Neurological function remained symptom-free at 6-month follow up.
Conclusion
Delayed-onset myxomatous fusiform aneurysms are rare and require tailored treatment. This case demonstrates the significance of STA-M2 bypass assisted trapping for complex intracranial aneurysms unsuitable for endovascular therapy, adding to the limited surgical literature.
{"title":"Trapping and superficial temporal artery to middle cerebral artery bypass for treating middle cerebral myxomatous fusiform aneurysm: a case report and literature review","authors":"Dacheng Ding , Weidong Xia , Minggang Shi , Yanguo Shang , Xiaoguang Tong","doi":"10.1016/j.inat.2025.102130","DOIUrl":"10.1016/j.inat.2025.102130","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac myxomas are rare, predominantly benign tumors that most commonly occur in individuals aged 40–60 years, with a higher incidence in females. These tumors often exhibit friable surfaces, predisposing them to embolization. Systemic embolism occurs in up to 45 % of cases, frequently affecting cerebral circulation and leading to ischemic events.</div></div><div><h3>Case presentation</h3><div>We report the case of a 41-year-old female with a history of left atrial myxoma who presented with recurrent transient paresthesia of the right upper limb. Imaging revealed multiple intracranial myxomatous aneurysms, including a large fusiform aneurysm in the M2 segment of the left middle cerebral artery. Surgical intervention involving aneurysm trapping and a superficial temporal artery–M2 (STA-M2) bypass was successfully performed. Neurological function remained symptom-free at 6-month follow up.</div></div><div><h3>Conclusion</h3><div>Delayed-onset myxomatous fusiform aneurysms are rare and require tailored treatment. This case demonstrates the significance of STA-M2 bypass assisted trapping for complex intracranial aneurysms unsuitable for endovascular therapy, adding to the limited surgical literature.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102130"},"PeriodicalIF":0.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267786","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 : 2025-10-07DOI: 10.1016/j.inat.2025.102126
Mehmet Zileli , Artem O. Gushcha , Salman Sharif , Francesca Costa , Zan Chen , Onur Yaman , Mirza Pojskic , Corinna C Zygourakis
Objective
This retrospective review aims to provide the most up-to-date information on the management of chordomas and sarcomas of the spine.
Material and methods
We performed separate literature searches on chordomas and spinal sarcomas from the last ten years (2014–2024), excluding non-English literature, case reports, and irrelevant papers. Using the Delphi method and two rounds of voting at international meetings, ten members of the World Federation of Neurosurgical Societies (WFNS) Spine Committee developed nine consensus statements.
Results and discussion
Management of chordomas is complex due to high recurrence rates, with an average life expectancy of six years. Total sacrectomy is viable for sacral chordomas at S2 and below. The preferred management strategy remains surgical resection followed by radiation therapy, as chordomas exhibit high resistance to chemotherapy. Conversely, en bloc resection with wide margins is the gold standard for chondrosarcomas, while radiation therapy is recommended after piecemeal resection. Chondrosarcomas and osteosarcomas are primarily treated with surgical resection, whereas Ewing sarcoma requires a multimodal approach that includes neoadjuvant chemotherapy, surgery, and radiation therapy.
Conclusions
Management of spinal chordomas and sarcomas features distinct challenges. Chordomas, particularly in the sacrum, often recur. Sacrectomy is effective for sacral chordomas at S2 and below. Surgical resection is crucial for chondrosarcomas, which are unresponsive to chemotherapy. In contrast, radical surgery is often required for osteosarcoma and Ewing’s sarcoma following neoadjuvant therapy.
{"title":"Management of spinal chordomas and sarcomas: WFNS spine committee recommendations","authors":"Mehmet Zileli , Artem O. Gushcha , Salman Sharif , Francesca Costa , Zan Chen , Onur Yaman , Mirza Pojskic , Corinna C Zygourakis","doi":"10.1016/j.inat.2025.102126","DOIUrl":"10.1016/j.inat.2025.102126","url":null,"abstract":"<div><h3>Objective</h3><div>This retrospective review aims to provide the most up-to-date information on the management of chordomas and sarcomas of the spine.</div></div><div><h3>Material and methods</h3><div>We performed separate literature searches on chordomas and spinal sarcomas from the last ten years (2014–2024), excluding non-English literature, case reports, and irrelevant papers. Using the Delphi method and two rounds of voting at international meetings, ten members of the World Federation of Neurosurgical Societies (WFNS) Spine Committee developed nine consensus statements.</div></div><div><h3>Results and discussion</h3><div>Management of chordomas is complex due to high recurrence rates, with an average life expectancy of six years. Total sacrectomy is viable for sacral chordomas at S2 and below. The preferred management strategy remains surgical resection followed by radiation therapy, as chordomas exhibit high resistance to chemotherapy. Conversely, en bloc resection with wide margins is the gold standard for chondrosarcomas, while radiation therapy is recommended after piecemeal resection. Chondrosarcomas and osteosarcomas are primarily treated with surgical resection, whereas Ewing sarcoma requires a multimodal approach that includes neoadjuvant chemotherapy, surgery, and radiation therapy.</div></div><div><h3>Conclusions</h3><div>Management of spinal chordomas and sarcomas features distinct challenges. Chordomas, particularly in the sacrum, often recur. Sacrectomy is effective for sacral chordomas at S2 and below. Surgical resection is crucial for chondrosarcomas, which are unresponsive to chemotherapy. In contrast, radical surgery is often required for osteosarcoma and Ewing’s sarcoma following neoadjuvant therapy.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102126"},"PeriodicalIF":0.5,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267787","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}
The ventriculoperitoneal shunting (VPS) is a frequently performed neurosurgical procedure with common complications. Delayed intracerebral hemorrhage (DICH) is one of the rarest, with mechanisms and etiology still under debate. The currently described cases of DICH occur within 2 weeks of shunt placement.
We report on a unique case of extremely delayed intracerebral hemorrhage (eDICH) 15 years after ventricular catheter placement. The patient, an otherwise healthy female aged 30, was admitted with an acute onset of headache and vomiting for 4 days. She had a VPS procedure shortly after birth due to hydrocephalus secondary to perinatal intraventricular hemorrhage. Subsequent ventricular catheter replacement was required 15 years later due to acute catheter obstruction. On admission, the head CT showed a small volume of intracerebral hemorrhage adjacent to the catheter with even smaller intraventricular breakthrough. Current medical history was unremarkable, and the patient had none of the already recognized risk factors. Conservative management was undertaken with satisfactory results. Serial imaging showed a significant variation in ventricle volume by 6 weeks after the incident.
Currently, the few case reports and series of DICH offer a glimpse into the possible sensitizing factors for its occurrence. Management is on a case-by-case basis since clinical manifestations vary widely. This unique case of eDICH was managed conservatively with a good patient outcome. We believe that variation in ventricle volume and contraction/expansion of brain parenchyma around the ventricular catheter could explain the etiology behind this case and be a yet undescribed mechanism of DICH.
{"title":"How late is too late? Delayed intracerebral hemorrhage 15 years after ventriculoperitoneal shunting − a unique case report and review of the literature","authors":"Dimo Yankov , Assen Bussarsky , Dilyan Ferdinandov","doi":"10.1016/j.inat.2025.102129","DOIUrl":"10.1016/j.inat.2025.102129","url":null,"abstract":"<div><div>The ventriculoperitoneal shunting (VPS) is a frequently performed neurosurgical procedure with common complications. Delayed intracerebral hemorrhage (DICH) is one of the rarest, with mechanisms and etiology still under debate. The currently described cases of DICH occur within 2 weeks of shunt placement.</div><div>We report on a unique case of extremely delayed intracerebral hemorrhage (eDICH) 15 years after ventricular catheter placement. The patient, an otherwise healthy female aged 30, was admitted with an acute onset of headache and vomiting for 4 days. She had a VPS procedure shortly after birth due to hydrocephalus secondary to perinatal intraventricular hemorrhage. Subsequent ventricular catheter replacement was required 15 years later due to acute catheter obstruction. On admission, the head CT showed a small volume of intracerebral hemorrhage adjacent to the catheter with even smaller intraventricular breakthrough. Current medical history was unremarkable, and the patient had none of the already recognized risk factors. Conservative management was undertaken with satisfactory results. Serial imaging showed a significant variation in ventricle volume by 6 weeks after the incident.</div><div>Currently, the few case reports and series of DICH offer a glimpse into the possible sensitizing factors for its occurrence. Management is on a case-by-case basis since clinical manifestations vary widely. This unique case of eDICH was managed conservatively with a good patient outcome. We believe that variation in ventricle volume and contraction/expansion of brain parenchyma around the ventricular catheter could explain the etiology behind this case and be a yet undescribed mechanism of DICH.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102129"},"PeriodicalIF":0.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267788","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 : 2025-10-04DOI: 10.1016/j.inat.2025.102127
Boyan Zhang , Can Zhang , Mirza Pojskic , Mehmet Zileli , Salman Sharif , Francesco Costa , Onur Yaman , Artem O. Gushcha , Corinna C Zygourakis , Zan Chen
Objective
This review is prepared to formulate the most current, evidence-based recommendations regarding the incidence, epidemiology, classification and radiological features of primary vertebral tumors.
Materials and methods
A systematic literature search in PubMed, MEDLINE, and CENTRAL was performed from 2013 to 2023 using the search terms “primary vertebral tumors”, “incidence”, “epidemiology”, “classification,” and “radiological diagnosis”. Screening criteria resulted in 6, 5, and 34 studies respectively that were analyzed regarding incidence, epidemiology, clinical diagnosis, and radiographic diagnosis of primary vertebral tumors. Using the Delphi method and two rounds of voting at two separate international meetings, ten members of the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated nine final consensus statements.
Results
Primary tumors of the vertebral column are relatively rare, with an overall prevalence of 2.5 to 8.5 cases per 100,000 persons per year. In adults, hemangioma is the most common benign tumor of the spine, other common benign tumors in adults include osteoblastomas and osteochondromas. The most common malignant primary spinal neoplasm in adults is plasmocytoma (30 %) and other malignant tumors in adults include chondrosarcoma and osteosarcoma. Chordoma represents about 2–4 % of all spinal column tumors, 40 % of primary spinal tumors and has a high propensity for the sacral and cervical regions. Incidence of primary malignant vertrebral tumors is correlated with patient’s age. The risk increased significantly when patients were older than 40 years. CT and MRI are both required for proper diagnosis, with correlation of findings to age and clinical presentation. Biopsy can identify tumors and accurately determine the type, grade, and stage of tumors. Complication rates for percutaneous biopsy range between 1 and 3 %, compared to 16 % for open biopsy. Lower accuracy rates have also been reported in fibrotic, collagenous, and inflammatory lesions, as well as for specific lesions such as aneurysmal bone cysts and hemangiomas. Osteolytic or mixed lesions have a reported diagnostic yield of up to 88 %, compared with sclerotic lesions at 67 %.
Conclusions
Final nine consensus statements provide current, evidence-based guidelines on the incidence, epidemiology, classification and radiographic diagnosis of primary vertebral tumors for practicing spine surgeons worldwide.
{"title":"Incidence, epidemiology, classification and radiology of primary vertebral tumors: WFNS spine committee recommendations","authors":"Boyan Zhang , Can Zhang , Mirza Pojskic , Mehmet Zileli , Salman Sharif , Francesco Costa , Onur Yaman , Artem O. Gushcha , Corinna C Zygourakis , Zan Chen","doi":"10.1016/j.inat.2025.102127","DOIUrl":"10.1016/j.inat.2025.102127","url":null,"abstract":"<div><h3>Objective</h3><div>This review is prepared to formulate the most current, evidence-based recommendations regarding the incidence, epidemiology, classification and radiological features of primary vertebral tumors.</div></div><div><h3>Materials and methods</h3><div>A systematic literature search in PubMed, MEDLINE, and CENTRAL was performed from 2013 to 2023 using the search terms “primary vertebral tumors”, “incidence”, “epidemiology”, “classification,” and “radiological diagnosis”. Screening criteria resulted in 6, 5, and 34 studies respectively that were analyzed regarding incidence, epidemiology, clinical diagnosis, and radiographic diagnosis of primary vertebral tumors. Using the Delphi method and two rounds of voting at two separate international meetings, ten members of the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated nine final consensus statements.</div></div><div><h3>Results</h3><div>Primary tumors of the vertebral column are relatively rare, with an overall prevalence of 2.5 to 8.5 cases per 100,000 persons per year. In adults, hemangioma is the most common benign tumor of the spine, other common benign tumors in adults include osteoblastomas and osteochondromas. The most common malignant primary spinal neoplasm in adults is plasmocytoma (30 %) and other malignant tumors in adults include chondrosarcoma and osteosarcoma. Chordoma represents about 2–4 % of all spinal column tumors, 40 % of primary spinal tumors and has a high propensity for the sacral and cervical regions. Incidence of primary malignant vertrebral tumors is correlated with patient’s age. The risk increased significantly when patients were older than 40 years. CT and MRI are both required for proper diagnosis, with correlation of findings to age and clinical presentation. Biopsy can identify tumors and accurately determine the type, grade, and stage of tumors. Complication rates for percutaneous biopsy range between 1 and 3 %, compared to 16 % for open biopsy. Lower accuracy rates have also been reported in fibrotic, collagenous, and inflammatory lesions, as well as for specific lesions such as aneurysmal bone cysts and hemangiomas. Osteolytic or mixed lesions have a reported diagnostic yield of up to 88 %, compared with sclerotic lesions at 67 %.</div></div><div><h3>Conclusions</h3><div>Final nine consensus statements provide current, evidence-based guidelines on the incidence, epidemiology, classification and radiographic diagnosis of primary vertebral tumors for practicing spine surgeons worldwide.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102127"},"PeriodicalIF":0.5,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325124","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}
Hydrocephalus is excessive accumulation of cerebrospinal fluid within the cerebral ventricles. It has a complex pathogenesis with various causes. Periventricular edema refers to the abnormal accumulation of fluid in the brain tissue surrounding the cerebral ventricles, an indicative of elevated intracranial pressure or disruption in cerebrospinal fluid flow. Periventricular edema can serve as one of the severity indicators of hydrocephalus, and can assist physicians in predicting the outcomes of treatments and determining appropriate therapeutic interventions. In this study, our goal is to identify periventricular edema in hydrocephalus disease. In this regard, the smoothing-sharpening image filter (SSIF) algorithm is applied to enhance hydrocephalic CT images due to the low quality of CT images and the ambiguity between the boundaries of periventricular edema, ventricles, and other brain regions. Some well-known deep learning models including UNet, PSPNet, LinkNet and FPN are suggested to segment periventricular edema. From the obtained results, the FPN model, compared to the other models, achieves the best evaluation criteria with AUC, dice score, F1-score, precision, and recall values of 95 %, 93 %, 91 %, 91 %, and 92 %, respectively.
{"title":"Artificial intelligence-based determination of periventricular edema in hydrocephalic brain CT scan","authors":"Mahtab Gholami , Shirin Kordnoori , Maliheh Sabeti , Yashar Goorakani , Hamed Mohseni Takallou , Ehsan Moradi","doi":"10.1016/j.inat.2025.102128","DOIUrl":"10.1016/j.inat.2025.102128","url":null,"abstract":"<div><div>Hydrocephalus is excessive accumulation of cerebrospinal fluid within the cerebral ventricles. It has a complex pathogenesis with various causes. Periventricular edema refers to the abnormal accumulation of fluid in the brain tissue surrounding the cerebral ventricles, an indicative of elevated intracranial pressure or disruption in cerebrospinal fluid flow. Periventricular edema can serve as one of the severity indicators of hydrocephalus, and can assist physicians in predicting the outcomes of treatments and determining appropriate therapeutic interventions. In this study, our goal is to identify periventricular edema in hydrocephalus disease. In this regard, the smoothing-sharpening image filter (SSIF) algorithm is applied to enhance hydrocephalic CT images due to the low quality of CT images and the ambiguity between the boundaries of periventricular edema, ventricles, and other brain regions. Some well-known deep learning models including UNet, PSPNet, LinkNet and FPN are suggested to segment periventricular edema. From the obtained results, the FPN model, compared to the other models, achieves the best evaluation criteria with AUC, dice score, F1-score, precision, and recall values of 95 %, 93 %, 91 %, 91 %, and 92 %, respectively.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102128"},"PeriodicalIF":0.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267785","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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