Pub Date : 2025-11-13DOI: 10.1016/j.inat.2025.102142
Khushi Patel , Hamza Shaikh , Pratit Patel
Background
Duplicated origin of the left vertebral artery (LVA) is an uncommon vascular variant that is usually asymptomatic but can predispose to dissection and embolic stroke. It is often under-recognized in standard imaging.
Case Report:
We present a 63-year-old male with three posterior circulation strokes. Initial CTA, MRA, and cardiac workup were unremarkable. Digital subtraction angiography (DSA) revealed a dissected duplicated origin of the LVA. The patient underwent successful endovascular flow-diverter treatment and has remained stroke-free on follow-up.
Conclusion
This case highlights the importance of considering anatomic variants in recurrent posterior circulation strokes. DSA remains essential for diagnosis when non-invasive imaging is inconclusive. Flow-diverter embolization was safe and effective treatment for pathological duplicated LVA segment in our patient.
{"title":"Dissected duplicated origin of left vertebral artery as a rare cause of recurrent posterior circulation stroke: a case report and literature review","authors":"Khushi Patel , Hamza Shaikh , Pratit Patel","doi":"10.1016/j.inat.2025.102142","DOIUrl":"10.1016/j.inat.2025.102142","url":null,"abstract":"<div><h3>Background</h3><div>Duplicated origin of the left vertebral artery (LVA) is an uncommon vascular variant that is usually asymptomatic but can predispose to dissection and embolic stroke. It is often under-recognized in standard imaging.</div><div>Case Report:</div><div>We present a 63-year-old male with three posterior circulation strokes. Initial CTA, MRA, and cardiac workup were unremarkable. Digital subtraction angiography (DSA) revealed a dissected duplicated origin of the LVA. The patient underwent successful endovascular flow-diverter treatment and has remained stroke-free on follow-up.</div></div><div><h3>Conclusion</h3><div>This case highlights the importance of considering anatomic variants in recurrent posterior circulation strokes. DSA remains essential for diagnosis when non-invasive imaging is inconclusive. Flow-diverter embolization was safe and effective treatment for pathological duplicated LVA segment in our patient.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102142"},"PeriodicalIF":0.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525708","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}
Contrecoup acute epidural hematoma (AEDH) without skull fracture is extremely rare. We report a pediatric case with a right frontal head injury resulting in a right acute subdural hematoma (ASDH) without skull fracture. Emergency surgery to evacuate the ASDH and monitor ICP was performed. However, 3.5 h later, elevated ICP and follow-up CT revealed a new contralateral AEDH. Urgent removal was conducted, with no skull fracture observed. Following intensive postoperative management, the patient was discharged without neurological deficits.Only 21 cases of contrecoup AEDH without skull fracture have been reported, and just two occurred after surgery for ASDH on the impact side. This case highlights the clinical features of this rare condition, supported by a literature review.
{"title":"Contrecoup epidural hematoma without skull fracture after decompression of impact side acute subdural hematoma","authors":"Kiyohide Kakuta, Keita Yanagiya, Kosuke Katayama, Ai Mizukami, Yu Nomura, Shohei Kinoshita, Tomohiro Kaji, Takahiro Morita, Kenichiro Asano, Atsushi Saito","doi":"10.1016/j.inat.2025.102148","DOIUrl":"10.1016/j.inat.2025.102148","url":null,"abstract":"<div><div>Contrecoup acute epidural hematoma (AEDH) without skull fracture is extremely rare. We report a pediatric case with a right frontal head injury resulting in a right acute subdural hematoma (ASDH) without skull fracture. Emergency surgery to evacuate the ASDH and monitor ICP was performed. However, 3.5 h later, elevated ICP and follow-up CT revealed a new contralateral AEDH. Urgent removal was conducted, with no skull fracture observed. Following intensive postoperative management, the patient was discharged without neurological deficits.Only 21 cases of contrecoup AEDH without skull fracture have been reported, and just two occurred after surgery for ASDH on the impact side. This case highlights the clinical features of this rare condition, supported by a literature review.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102148"},"PeriodicalIF":0.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578598","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 : 2025-11-13DOI: 10.1016/j.inat.2025.102149
U.S. Govindarajulu , D. Rivera , C. Brown , E. Reynolds , J. Zhang , D. Cohen , A. Schupper
Background
Types of hemorrhagic stroke and other forms of bleeding within the cranial vault, account for a significant portion of neurological emergencies. External ventricular drain (EVD) placement is a common, life-saving intervention for patients presenting with acute hydrocephalus following intracranial hemorrhage. EVDs reduce intracranial pressure (ICP) by draining cerebrospinal fluid (CSF), minimizing the risk of secondary brain injury. Additionally, EVDs allow for continuous ICP monitoring, providing critical data to guide decisions. However, post-procedural complications may occur following EVD placement. While previous studies have examined EVD outcomes using traditional statistical methods, the impact of provider heterogeneity and resident learning curves on these outcomes remains poorly understood. Understanding the impact of these complications is crucial for improving surgical quality and outcomes.
Methods
To address these critical gaps and advance our understanding of EVD outcomes, we reviewed medical records of patients with subarachnoid hemorrhage (SAH), intracranial hemorrhage (ICH), or interventricular hemorrhage (IVH) who received EVDs for ICP at the Mount Sinai Health System in New York City from 2019 to 2022. We evaluated surgical complications and patient outcomes following EVD placement by neurosurgeons at different stages of their training. Random effect survival models were implemented to account for heterogeneity between providers. This novel methodological approach integrated provider heterogeneity and learning curves into EVD outcome analysis, extending beyond traditional statistical methods used in previous studies.
Conclusions
We found that in time-to-death Cox models, age was a significant predictor while for time-to-complication, device type and pre-operative modified Rankin score were significant predictors. A Cox frailty model did not show significant predictors, but our unique evaluation of restricted mean survival time with frailty showed that smoking was a significant predictor of survival. Furthermore, we also modeled learning curves amongst neurosurgeons performing EVDs to improve surgical proficiency. We found that employing the frailty modeling improved the learning curve fit.
{"title":"Assessing survival and learning curves for EVD procedures in hemorrhagic stroke patients in a New York City hospital","authors":"U.S. Govindarajulu , D. Rivera , C. Brown , E. Reynolds , J. Zhang , D. Cohen , A. Schupper","doi":"10.1016/j.inat.2025.102149","DOIUrl":"10.1016/j.inat.2025.102149","url":null,"abstract":"<div><h3>Background</h3><div>Types of hemorrhagic stroke and other forms of bleeding within the cranial vault, account for a significant portion of neurological emergencies. External ventricular drain (EVD) placement is a common, life-saving intervention for patients presenting with acute hydrocephalus following intracranial hemorrhage. EVDs reduce intracranial pressure (ICP) by draining cerebrospinal fluid (CSF), minimizing the risk of secondary brain injury. Additionally, EVDs allow for continuous ICP monitoring, providing critical data to guide decisions. However, post-procedural complications may occur following EVD placement. While previous studies have examined EVD outcomes using traditional statistical methods, the impact of provider heterogeneity and resident learning curves on these outcomes remains poorly understood. Understanding the impact of these complications is crucial for improving surgical quality and outcomes.</div></div><div><h3>Methods</h3><div>To address these critical gaps and advance our understanding of EVD outcomes, we reviewed medical records of patients with subarachnoid hemorrhage (SAH), intracranial hemorrhage (ICH), or interventricular hemorrhage (IVH) who received EVDs for ICP at the Mount Sinai Health System in New York City from 2019 to 2022. We evaluated surgical complications and patient outcomes following EVD placement by neurosurgeons at different stages of their training. Random effect survival models were implemented to account for heterogeneity between providers. This novel methodological approach integrated provider heterogeneity and learning curves into EVD outcome analysis, extending beyond traditional statistical methods used in previous studies.</div></div><div><h3>Conclusions</h3><div>We found that in time-to-death Cox models, age was a significant predictor while for time-to-complication, device type and pre-operative modified Rankin score were significant predictors. A Cox frailty model did not show significant predictors, but our unique evaluation of restricted mean survival time with frailty showed that smoking was a significant predictor of survival. Furthermore, we also modeled learning curves amongst neurosurgeons performing EVDs to improve surgical proficiency. We found that employing the frailty modeling improved the learning curve fit.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102149"},"PeriodicalIF":0.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578602","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 : 2025-11-13DOI: 10.1016/j.inat.2025.102152
Muhaimaiti Abudurezhake , Zhanjun Ma , Yajun Tian , Qiucheng Chen , Cheng Li , Kun Wang , Yifei Huang
Objective
This study compared the efficacy of unilateral dual-channel endoscopy (UBE-TLIF) with minimally invasive transforaminal lumbar fusion (MIS-TLIF) in the treatment of lumbar tuberculosis.
Methods
Thirty-eight patients from 2019 to 2024 were retrospectively analyzed and divided into UBE-TLIF group (20 patients) and MIS-TLIF group (18 patients). There was no statistically significant difference between the baseline data of the two groups.
Results
The results showed that the UBE-TLIF group had shorter operation time (P < 0.05), less intraoperative bleeding (P < 0.05), and shorter hospitalization time (P < 0.05). For postoperative complications, two dural sac tears occurred in the UBE-TLIF group and two nerve root traction injuries in the MIS-TLIF group, both of which recovered with conservative treatment. At a mean follow-up of 16 months, The mean follow-up period was15.8 ± 3.1 months in the MIS-TLIF group and16.2 ± 2.9 months in the UBE group, with no statistically significant difference between the groups(P = 0.674),no tuberculosis recurrence or implant loosening was observed in either group. Postoperative VAS(Visual Analogue Scale) low back pain scores were significantly better in the UBE-TLIF group than in the MIS-TLIF group at 1 and 3 months (P < 0.05), but the difference between the two groups disappeared at 6 months and at the final follow-up. ODI(Oswestry Disability Index), intervertebral space height and inflammatory indexes (blood sedimentation, C-reactive protein, calcitoninogen) were significantly improved after surgery (P < 0.05), with no difference between groups. At the final follow-up, there was no statistically significant difference between the two groups in terms of bone fusion rate and MacNab efficacy evaluation (P > 0.05).
Conclusion
Both surgical approaches proved effective, but UBE-TLIF demonstrated certain advantages in operative time, intraoperative blood loss, and early postoperative pain control, making it a preferred option for the surgical treatment of spinal tuberculosis. This study confirms the safety and feasibility of combining minimally invasive techniques with standardized anti-tuberculosis therapy, offering a new alternative for clinical practice.
{"title":"Comparative analysis of unilateral biportal endoscopy and minimally invasive transforaminal lumbar interbody fusion in treating lumbar spinal tuberculosis","authors":"Muhaimaiti Abudurezhake , Zhanjun Ma , Yajun Tian , Qiucheng Chen , Cheng Li , Kun Wang , Yifei Huang","doi":"10.1016/j.inat.2025.102152","DOIUrl":"10.1016/j.inat.2025.102152","url":null,"abstract":"<div><h3>Objective</h3><div>This study compared the efficacy of unilateral dual-channel endoscopy (UBE-TLIF) with minimally invasive transforaminal lumbar fusion (MIS-TLIF) in the treatment of lumbar tuberculosis.</div></div><div><h3>Methods</h3><div>Thirty-eight patients from 2019 to 2024 were retrospectively analyzed and divided into UBE-TLIF group (20 patients) and MIS-TLIF group (18 patients). There was no statistically significant difference between the baseline data of the two groups.</div></div><div><h3>Results</h3><div>The results showed that the UBE-TLIF group had shorter operation time (<em>P</em> < 0.05), less intraoperative bleeding (<em>P</em> < 0.05), and shorter hospitalization time (<em>P</em> < 0.05). For postoperative complications, two dural sac tears occurred in the UBE-TLIF group and two nerve root traction injuries in the MIS-TLIF group, both of which recovered with conservative treatment. At a mean follow-up of 16 months, The mean follow-up period was15.8 ± 3.1 months in the MIS-TLIF group and16.2 ± 2.9 months in the UBE group, with no statistically significant difference between the groups(<em>P</em> = 0.674),no tuberculosis recurrence or implant loosening was observed in either group. Postoperative VAS(Visual Analogue Scale) low back pain scores were significantly better in the UBE-TLIF group than in the MIS-TLIF group at 1 and 3 months (<em>P</em> < 0.05), but the difference between the two groups disappeared at 6 months and at the final follow-up. ODI(Oswestry Disability Index), intervertebral space height and inflammatory indexes (blood sedimentation, C-reactive protein, calcitoninogen) were significantly improved after surgery (<em>P</em> < 0.05), with no difference between groups. At the final follow-up, there was no statistically significant difference between the two groups in terms of bone fusion rate and MacNab efficacy evaluation (P > 0.05).</div></div><div><h3>Conclusion</h3><div>Both surgical approaches proved effective, but UBE-TLIF demonstrated certain advantages in operative time, intraoperative blood loss, and early postoperative pain control, making it a preferred option for the surgical treatment of spinal tuberculosis. This study confirms the safety and feasibility of combining minimally invasive techniques with standardized anti-tuberculosis therapy, offering a new alternative for clinical practice.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102152"},"PeriodicalIF":0.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579270","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 : 2025-11-12DOI: 10.1016/j.inat.2025.102153
Gurpreet S. Gandhoke , Karishma Kondapalli , Andrew Graziano , Rubani Kaur , Samuel A. Goldlust , Eric Ewing , Amy Savage , Stephanie A. Kolakowsky-Hayner
Myxopapillary ependymoma (MPE) is a rare and slow-growing central nervous system tumor that typically presents in adults between the ages of 30–50 years. The incidence rate is 1.00 per million person-years. Histology is typically low grade (WHO 2) but MPE does harbor a risk of anaplastic transformation and dissemination through the neuraxis. Standard treatment for MPE is attempt at gross total resection; radiotherapy should be considered for subtotal resection. In this report, we describe a 28-year-old man who presented with immune thrombocytopenia (ITP) and subsequent paraparesis. Imaging revealed a large intradural thoracolumbar mass and a small cranial lesion. Surgical debulking was performed, and the intraoperative course was complicated by diabetes insipidus (DI). To the authors’ knowledge, this is the first case of MPE complicated by ITP and DI. Although the relationship between MPE, ITP and DI have not been extensively documented, this merits further investigation to explore implications for prognosis and treatment.
{"title":"Myxopapillary ependymoma complicated by immune thrombocytopenia and intraoperative diabetes Insipidus: A case report","authors":"Gurpreet S. Gandhoke , Karishma Kondapalli , Andrew Graziano , Rubani Kaur , Samuel A. Goldlust , Eric Ewing , Amy Savage , Stephanie A. Kolakowsky-Hayner","doi":"10.1016/j.inat.2025.102153","DOIUrl":"10.1016/j.inat.2025.102153","url":null,"abstract":"<div><div>Myxopapillary ependymoma (MPE) is a rare and slow-growing central nervous system tumor that typically presents in adults between the ages of 30–50 years. The incidence rate is 1.00 per million person-years. Histology is typically low grade (WHO 2) but MPE does harbor a risk of anaplastic transformation and dissemination through the neuraxis. Standard treatment for MPE is attempt at gross total resection; radiotherapy should be considered for subtotal resection. In this report, we describe a 28-year-old man who presented with immune thrombocytopenia (ITP) and subsequent paraparesis. Imaging revealed a large intradural thoracolumbar mass and a small cranial lesion. Surgical debulking was performed, and the intraoperative course was complicated by diabetes insipidus (DI). To the authors’ knowledge, this is the first case of MPE complicated by ITP and DI. Although the relationship between MPE, ITP and DI have not been extensively documented, this merits further investigation to explore implications for prognosis and treatment.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102153"},"PeriodicalIF":0.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525709","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 : 2025-11-12DOI: 10.1016/j.inat.2025.102141
Xiaoli Chen , Xiangyi Meng , Jialuo Li , Cheng Wang , Dianhui Han , Qingchun Mu , Xiaoxiong Wang , Xiaofeng Chen
Objective
Meningiomas and schwannomas are the most commonly encountered intradural extramedullary (IDEM) spinal cord tumors, which can lead to spinal cord compression and limb dysfunction. Due to the unique anatomical barrier provided by the arachnoid or pia mater, complete excision of these tumors is achievable through surgical intervention. While some studies have suggested the feasibility of using the posterior approach for ventral IDEM tumors, there is a lack of research on surgical management strategies and functional outcomes for these tumors.
Methods
This study composed of 58 consecutive patients who underwent complete resection of IDEM tumors. Ventral IDEM tumors were removed through a narrow space between the dura and the spinal cord, without retracting or rotating the spinal cord, using the posterior approach. The baseline characteristics of the patients, including sex, age, tumor position at the spinal level, histopathological type, percentage of tumor occupying the intradural space, duration of surgery, perioperative neurological complications, neurological outcomes, and recurrence, were retrospectively analyzed.
Results
The study included 28 cases of meningiomas and 30 cases of schwannomas. Among these, 24 patients had ventral IDEM tumors, while 34 had dorsal IDEM tumors. There was no statistically significant difference in operative time between the two groups. Importantly, the comparison of preoperative and postoperative McCormick scores or KPS changes showed no statistically significant difference (p = 0.063), indicating similar improvements in neurological function post-surgery. Each group had one case of cerebrospinal fluid leakage identified, and no recurrences were observed in either group during the follow-up period.
Conclusion
Complete resection of ventral IDEM tumors can be achieved with clinical outcomes comparable to dorsal IDEM tumors through a posterior approach. Therefore, a thorough understanding of the anatomical and growth characteristics of IDEM tumors is essential for safe excision. However, the posterior approach should be used cautiously and with a full understanding of its limitations.
{"title":"Microsurgical management of ventrally located intradural extramedullary spinal cord tumors via posterior approach: Technical considerations and outcomes","authors":"Xiaoli Chen , Xiangyi Meng , Jialuo Li , Cheng Wang , Dianhui Han , Qingchun Mu , Xiaoxiong Wang , Xiaofeng Chen","doi":"10.1016/j.inat.2025.102141","DOIUrl":"10.1016/j.inat.2025.102141","url":null,"abstract":"<div><h3>Objective</h3><div>Meningiomas and schwannomas are the most commonly encountered intradural extramedullary (IDEM) spinal cord tumors, which can lead to spinal cord compression and limb dysfunction. Due to the unique anatomical barrier provided by the arachnoid or pia mater, complete excision of these tumors is achievable through surgical intervention. While some studies have suggested the feasibility of using the posterior approach for ventral IDEM tumors, there is a lack of research on surgical management strategies and functional outcomes for these tumors.</div></div><div><h3>Methods</h3><div>This study composed of 58 consecutive patients who underwent complete resection of IDEM tumors. Ventral IDEM tumors were removed through a narrow space between the dura and the spinal cord, without retracting or rotating the spinal cord, using the posterior approach. The baseline characteristics of the patients, including sex, age, tumor position at the spinal level, histopathological type, percentage of tumor occupying the intradural space, duration of surgery, perioperative neurological complications, neurological outcomes, and recurrence, were retrospectively analyzed.</div></div><div><h3>Results</h3><div>The study included 28 cases of meningiomas and 30 cases of schwannomas. Among these, 24 patients had ventral IDEM tumors, while 34 had dorsal IDEM tumors. There was no statistically significant difference in operative time between the two groups. Importantly, the comparison of preoperative and postoperative McCormick scores or KPS changes showed no statistically significant difference (p = 0.063), indicating similar improvements in neurological function post-surgery. Each group had one case of cerebrospinal fluid leakage identified, and no recurrences were observed in either group during the follow-up period.</div></div><div><h3>Conclusion</h3><div>Complete resection of ventral IDEM tumors can be achieved with clinical outcomes comparable to dorsal IDEM tumors through a posterior approach. Therefore, a thorough understanding of the anatomical and growth characteristics of IDEM tumors is essential for safe excision. However, the posterior approach should be used cautiously and with a full understanding of its limitations.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102141"},"PeriodicalIF":0.5,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525706","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}
It is paramount to monitor and regulate intracranial pressure (ICP) in patients diagnosed with posterior fossa tumors (PFT) prior to surgical intervention. This study aims to find out optimal therapeutic management in patients with hydrocephalus induced by PFT through evaluating the changes in ICP following endoscopic third ventriculostomy (ETV).
Methods
This study included 18 fully conscious patients with obstructive hydrocephalus due to PFT. They underwent ETV surgery at Rasoul Akram Hospital between 2020 and 2023. Intracranial pressure was monitored and recorded hourly after ETV and continuous after PFT resection.
Results
The mean age of the patients was 20.94 years, with 55.6 % being male. Astrocytoma (38.9 %) and medulloblastoma (22.2 %) were the most common pathologies. The mean time interval between undergoing ETV and tumor resection was 4 days. Analysis of ICP patterns in 4-hour timeframes revealed a decreasing pattern in the early hours after ETV. The mean ICP decreased from 18.44 mmHg at 4 h after ETV to 14.11 mmHg at 36 h after ETV. After 36 h, there was a fluctuation in the ICP pattern. A significant reduction in ICP was also observed after tumor resection (P > 0.05).
Conclusion
ETV is an effective technique for reducing intracranial pressure in patients with hydrocephalus due to PFTs. Furthermore, the best time for tumor resection appears to be within the first 36–48 h after ETV, when ICP reaches its lowest point.
{"title":"Validating the therapeutic efficacy of preoperative endoscopic third ventriculostomy in the management of patients with posterior fossa tumors by monitoring changes in intracranial pressure","authors":"Alireza Tabibkhooei , Farid Kazemi Gazik , Danial Kiani , Parisa Javadnia","doi":"10.1016/j.inat.2025.102143","DOIUrl":"10.1016/j.inat.2025.102143","url":null,"abstract":"<div><h3>Background</h3><div>It is paramount to monitor and regulate intracranial pressure (ICP) in patients diagnosed with posterior fossa tumors (PFT) prior to surgical intervention. This study aims to find out optimal therapeutic management in patients with hydrocephalus induced by PFT through evaluating the changes in ICP following endoscopic third ventriculostomy (ETV).</div></div><div><h3>Methods</h3><div>This study included 18 fully conscious patients with obstructive hydrocephalus due to PFT. They underwent ETV surgery at Rasoul Akram Hospital between 2020 and 2023. Intracranial pressure was monitored and recorded hourly after ETV and continuous after PFT resection.</div></div><div><h3>Results</h3><div>The mean age of the patients was 20.94 years, with 55.6 % being male. Astrocytoma (38.9 %) and medulloblastoma (22.2 %) were the most common pathologies. The mean time interval between undergoing ETV and tumor resection was 4 days. Analysis of ICP patterns in 4-hour timeframes revealed a decreasing pattern in the early hours after ETV. The mean ICP decreased from 18.44 mmHg at 4 h after ETV to 14.11 mmHg at 36 h after ETV. After 36 h, there was a fluctuation in the ICP pattern. A significant reduction in ICP was also observed after tumor resection (P > 0.05).</div></div><div><h3>Conclusion</h3><div>ETV is an effective technique for reducing intracranial pressure in patients with hydrocephalus due to PFTs. Furthermore, the best time for tumor resection appears to be within the first 36–48 h after ETV, when ICP reaches its lowest point.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102143"},"PeriodicalIF":0.5,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525707","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 : 2025-10-17DOI: 10.1016/j.inat.2025.102135
Philip Zitser , Michael Brisman , Jonathan Brisman
Introduction
Spinal meningiomas are relatively rare. Multiple spinal meningomas causing symptomatic compression requiring surgery are extremely uncommon. The insidious presentation may delay clinical and surgical intervention.
Case report
A 67-year-old diabetic patient with a remote history of prior thoracic spine tumor resections presented with worsening back pain radiating to both legs, bilateral lower extremity weakness, and gait disturbance. Lumbar MRI revealed severe lumbar stenosis. Prior history of tumor excision prompted a full spine MRI, revealing two large intradural extramedullary lesions. The patient underwent a posterior laminectomy and gross total resection of both lesions through separate incisions. Histopathology confirmed meningiomas. Postoperatively, the patient experienced improved neurological function.
Outcome
Patient is neurologically recovering well and is fully participating in physical therapy for post-surgical pain.
Conclusion
The case highlights the importance of full-spine imaging in patients with prior surgical spinal procedures or when current symptoms are not entirely explained by current imaging. The surgical approach utilizing two separate incisions with separate laminectomies emphasized a less invasive strategy for multilevel tumor resection. This might be relevant to a patient with already extensive laminectomies. In patients with diabetes, additional suspicion should be raised for atypical presentations of surgical spinal pathology. This case highlights the need for routine surveillance in patients with prior spinal tumor excisions. This report adds to the literature by detailing neurosurgical planning and operative technique for a rare and potentially confounding clinical presentation.
{"title":"Dual-incision resection of multiple thoracic meningiomas presenting as lumbar stenosis: Case report","authors":"Philip Zitser , Michael Brisman , Jonathan Brisman","doi":"10.1016/j.inat.2025.102135","DOIUrl":"10.1016/j.inat.2025.102135","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal meningiomas are relatively rare. Multiple spinal meningomas causing symptomatic compression requiring surgery are extremely uncommon. The insidious presentation may delay clinical and surgical intervention.</div></div><div><h3>Case report</h3><div>A 67-year-old diabetic patient with a remote history of prior thoracic spine tumor resections presented with worsening back pain radiating to both legs, bilateral lower extremity weakness, and gait disturbance. Lumbar MRI revealed severe lumbar stenosis. Prior history of tumor excision prompted a full spine MRI, revealing two large intradural extramedullary lesions. The patient underwent a posterior laminectomy and gross total resection of both lesions through separate incisions. Histopathology confirmed meningiomas. Postoperatively, the patient experienced improved neurological function.</div></div><div><h3>Outcome</h3><div>Patient is neurologically recovering well and is fully participating in physical therapy for post-surgical pain.</div></div><div><h3>Conclusion</h3><div>The case highlights the importance of full-spine imaging in patients with prior surgical spinal procedures or when current symptoms are not entirely explained by current imaging. The surgical approach utilizing two separate incisions with separate laminectomies emphasized a less invasive strategy for multilevel tumor resection. This might be relevant to a patient with already extensive laminectomies. In patients with diabetes, additional suspicion should be raised for atypical presentations of surgical spinal pathology. This case highlights the need for routine surveillance in patients with prior spinal tumor excisions. This report adds to the literature by detailing neurosurgical planning and operative technique for a rare and potentially confounding clinical presentation.</div></div><div><h3>Study design</h3><div>Case report.</div></div><div><h3>Patient sample</h3><div>One patient presented to our clinical locations.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102135"},"PeriodicalIF":0.5,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325123","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}
This case report describes a 19-year-old primigravida who presented with acute neurological symptoms three months post-delivery, ultimately diagnosed with cerebral metastatic choriocarcinoma complicated by intracranial hemorrhage. Diagnostic evaluation revealed elevated serum β-hCG (80678 IU/L), pulmonary metastases, and a hemorrhagic frontoparietal lesion on neuroimaging. Emergency hematoma evacuation confirmed choriocarcinoma through characteristic histopathological and immunohistochemical findings (CKp +, β-hCG + and H3K27me3 + ). The patient was classified as FIGO stage IV and successfully treated with EMA/CO chemotherapy, demonstrating biochemical response (β-hCG decline to 105 IU/L) without complications. This case highlights several key clinical insights: (1) the diagnostic challenge of differentiating metastatic choriocarcinoma from primary intracranial hemorrhage in reproductive-aged women; (2) the critical importance of serum β-hCG testing in atypical neurological presentations; and (3) the effectiveness of multimodal therapy combining neurosurgical intervention with prompt chemotherapy initiation. The temporal relationship to recent pregnancy (3 months postpartum) and rapid hematogenous spread underscore the aggressive nature of this trophoblastic malignancy. These findings reinforce current management guidelines while emphasizing the need for heightened clinical suspicion when evaluating young women with unexplained neurological deficits and a recent pregnancy history.
{"title":"Postpartum intracranial hemorrhage: Diagnostic and therapeutic insights into metastatic choriocarcinoma","authors":"Guizhong Yan, Dengfeng Wang, Kefeng Zhang, Boru Hou","doi":"10.1016/j.inat.2025.102131","DOIUrl":"10.1016/j.inat.2025.102131","url":null,"abstract":"<div><div>This case report describes a 19-year-old primigravida who presented with acute neurological symptoms three months post-delivery, ultimately diagnosed with cerebral metastatic choriocarcinoma complicated by intracranial hemorrhage. Diagnostic evaluation revealed elevated serum β-hCG (80678 IU/L), pulmonary metastases, and a hemorrhagic frontoparietal lesion on neuroimaging. Emergency hematoma evacuation confirmed choriocarcinoma through characteristic histopathological and immunohistochemical findings (CKp +, β-hCG + and H3K27me3 + ). The patient was classified as FIGO stage IV and successfully treated with EMA/CO chemotherapy, demonstrating biochemical response (β-hCG decline to 105 IU/L) without complications. This case highlights several key clinical insights: (1) the diagnostic challenge of differentiating metastatic choriocarcinoma from primary intracranial hemorrhage in reproductive-aged women; (2) the critical importance of serum β-hCG testing in atypical neurological presentations; and (3) the effectiveness of multimodal therapy combining neurosurgical intervention with prompt chemotherapy initiation. The temporal relationship to recent pregnancy (3 months postpartum) and rapid hematogenous spread underscore the aggressive nature of this trophoblastic malignancy. These findings reinforce current management guidelines while emphasizing the need for heightened clinical suspicion when evaluating young women with unexplained neurological deficits and a recent pregnancy history.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102131"},"PeriodicalIF":0.5,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325775","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}
Optic pathway gliomas (OPG) are the most common primary neoplasm of the optic pathway. They are most commonly seen in children less than 8 years of age. Adult onsets OPG are rare entity. Hemorrhage (Apoplexy) in these tumors is rare and it is extremely rare to occur late after a biopsy.
Case presentation
We describe a 33 years old right handed male patient presented with status epilepticus and right side motor preference of 5 h duration. He was on 3rd month post operation after Craniotomy and open biopsy was taken for a suspected OPG. Imaging showed massive intatumoral hemorrhage with no evident vascular abnormalities. The initial Pathology report showed pilocytic astrocytoma (PCA). He underwent Craniotomy and hematoma evacuation with right side Kochers point external ventricular drain (EVD). He had significant initial neurologic improvement but on 5th post-operative day (POD) he had re-bleeding with a fatal outcome.
Discussion
Apoplexy in optic pathway and hypothalamic gliomas is a rare event. While some risk factors for tumor apoplexy in optic pathway gliomas have been identified, the potential for a biopsy to precipitate delayed bleeding merits cautious consideration. Ultimately, clinical management strategies for these delicate lesions must be individually tailored, weighing the diagnostic yield against the potential for procedural complication.
{"title":"The hidden dangers: Delayed fatal apoplexy in adult-onset optic pathway glioma following biopsy","authors":"Dawit Workneh Gechu , Mehari Wale Alem , Abel Gizaw Woldegabriel , Yordanos Girma Legesse , Mieraf Bayouh Alemu , Peniel Zewdie Abera","doi":"10.1016/j.inat.2025.102136","DOIUrl":"10.1016/j.inat.2025.102136","url":null,"abstract":"<div><h3>Background</h3><div>Optic pathway gliomas (OPG) are the most common primary neoplasm of the optic pathway. They are most commonly seen in children less than 8 years of age. Adult onsets OPG are rare entity. Hemorrhage (Apoplexy) in these tumors is rare and it is extremely rare to occur late after a biopsy.</div></div><div><h3>Case presentation</h3><div>We describe a 33 years old right handed male patient presented with status epilepticus and right side motor preference of 5 h duration. He was on 3rd month post operation after Craniotomy and open biopsy was taken for a suspected OPG. Imaging showed massive intatumoral hemorrhage with no evident vascular abnormalities. The initial Pathology report showed pilocytic astrocytoma (PCA). He underwent Craniotomy and hematoma evacuation with right side Kochers point external ventricular drain (EVD). He had significant initial neurologic improvement but on 5th post-operative day (POD) he had re-bleeding with a fatal outcome.</div></div><div><h3>Discussion</h3><div>Apoplexy in optic pathway and hypothalamic gliomas is a rare event. While some risk factors for tumor apoplexy in optic pathway gliomas have been identified, the potential for a biopsy to precipitate delayed bleeding merits cautious consideration. Ultimately, clinical management strategies for these delicate lesions must be individually tailored, weighing the diagnostic yield against the potential for procedural complication.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102136"},"PeriodicalIF":0.5,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325764","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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