Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献

Intradural extramedullary Ewing's sarcoma(IDEM) is a rare form of spinal tumor that requires a multidisciplinary approach and has high rates of recurrence and metastasis. This case report describes a 28-year-old male who presented with two months history of back pain and with sudden exacerbation and acute onset rapidly progressing lower limb weakness and numbness below the umbilicus with bowel and bladder incontinence. MRI spine showed a well-defined homogeneously enhancing IDEM at D11 – D12 vertebral level with the lesion pushing the spinal cord to the right side. The patient underwent laminectomy and excision of the lesion, and histopathology confirmed Ewing's sarcoma. He received adjuvant chemotherapy and radiotherapy based on multidisciplinary team advice, and at 12 months follow-up, he was able to walk on his own and carry out his daily activities with minimal support. This case emphasizes the importance of early diagnosis and multidisciplinary management in improving the prognosis of intradural extramedullary Ewing's sarcoma. Given the rarity of this lesion, further research is needed to standardize its management. This report also includes a review of the existing literature on intradural extramedullary Ewing's sarcoma, highlighting the clinical features, radiological findings, treatment options, and outcomes.

Introduction

Spinal surgical procedures became very frequent in the last decades with fusion techniques being widely used for several indications. Many of these surgeries imply a significant tissue disruption and muscle atrophy with subsequent pain and functional impairment.

Research question

How to prepare and manage patients according to a rapid/enhanced recovery (RR/ERAS) protocol in a private setting while improving patient’s peri-operative experience and minimizing surgical footprint?

Material and methods

All patients suffering from a thoracolumbar degenerative disease and with an indication for fusion between January 2018 and October 2021 were screened. Pain control, functional recovery, complication rate and patient’ satisfaction were recorded for at least one-year of follow-up (FU).

Results

100 patients were prospectively followed for at least one year after surgery. More than two thirds (n = 69, 69.0 %) had a trans-psoas extreme lateral interbody fusion (X-LIF) or anterior approach with posterior instrumentation and direct decompression when needed, 14 (14.0 %) had an anterior lumbar interbody fusion (ALIF) and 17 (17.0 %) patients had a posterior approach only (posterior LIF or transforaminal LIF). Most patients had multi-level surgery (n = 56, 56.0 %). All patients improved their quality of life and back and leg pain at one year FU with those having an antero-lateral approach improving significantly more. Overall satisfaction rate was higher than 90 %.

Discussion and Conclusion

The application of RR/ERAS protocols to fusion surgery in degenerative spine proves to feasible and beneficial in a private care setting. Patients having anterolateral approaches tend to improve more than those with posterior only approaches.

Background

Depressed skull fractures constitute a common trauma condition in neurosurgery. Their surgical aspects and outcome remain less studied at Niamey.

Objective

To study the surgical aspects and describe the outcome of surgical depressed skull fractures at Niamey National Hospital in Niger republic.

Method

This is a three years retro and prospective study from January 1st, 2020 to December 31st, 2022 run at National Hospital of Niamey in Niger republic.

Results

A total of 233 patients were included of which, 202 men (86.7 %) and 31 females (13,3%) with a sex-ratio of 6.51. Road traffic accident was the common cause (n = 141; 60.5 %) followed by assault (n = 43; 18.5 %) and fall (n = 27; 11.6 %). Patients from urban area were predominant (n = 161; 69.1 %). Head CT Scan constituted the most common diagnosis tool. Considering the type of depressed fractures, greenstick depressed fractures were the most frequent (n = 139; 59.7 %) followed by comminuted ones (n = 70; 30 %). Ping-pond fractures accounted for 24 cases (10.3 %) and were only seen in children. About the type of associated injury, cranio-cerebral wound (n = 73; 31,3%), extradural hematoma (n = 31; 13.3 %), and cerebral contusion (n = 10; 4.3 %) were commonly seen. Most of the patients had mild head trauma (n = 194; 83.3 %). Craniotomy with bone fragment replacement was commonly performed (n = 102; 43.8 %) followed by simple fracture elevation in 42.5 % (n = 99;). Most of the patients experienced an uneventful outcome (n = 227; 97.4 %). The death rate was very low (0.9 %; n = 2).

Conclusion

Depressed skull fractures constitute a common traumatic neurosurgical pathologies met at Niamey National Hospital. CT Scan constitutes the main diagnosis tool. Its treatment is often surgical.

Purpose

This study aims to evaluate axonal injury in supratentorial acute stroke patients and predict motor function recovery.

Methods

A cross-sectional descriptive study was performed on 28 patients with supratentorial acute stroke. All patients underwent brain magnetic resonance imaging (MRI) at Bach Mai Hospital from September 2021 to August 2022. Diffuse tensor imaging (DTI) was conducted using a 3-Tesla MRI machine to evaluate the association between the corticospinal tract and infarct area. Therefore, axonal injury and motor function recovery levels could be predicted.

Results

Almost patients had no change in the signal of the axons, which did not pass through the infarct lesion (28.6%), and the signals strongly decreased in patients whose axons completely stayed inside the infarct lesion (32.1%). The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) indices of the axons on the infarcted side were lower than those of axons on the contralateral side. The patient group, in which the axons did not pass through the infarct lesion or had no change in axonal signals, had a higher rate of better motor function recovery after 3 months than the other groups (39.3% and 25 %, respectively), whereas the axon group, in which the axons stayed completely inside the infarct lesion or had a remarkably decreased signal, had a very poor rate of recovery (32.1% and 39.3 %, respectively). The FA index of the axons on the infarct side in the poor recovery group was lower than that in the good recovery group. The ADC index did not differ between the groups.

Conclusion

MRI finding with axonal signal, location, and infarct side could significantly predict motor recovery after 3 months in acute stroke patients.

Objective

Puncture site complications in neuro-endovascular therapy, which represent a significant cause of morbidity, are often difficult to treat. Vascular closure devices have evolved in endovascular therapy. We analyzed risk factors for puncture site complications and examined the efficacy of hemostasis methods in neuro-endovascular therapy.

Methods

This retrospective, observational, single-center study was conducted from January 2021 to January 2023. We enrolled 202 puncture sites of patients who underwent neuro-endovascular therapy at Kawaguchi Municipal Medical Center and analyzed the complications requiring additional intervention.

Results

There were 12 (5.94%) puncture site complications. No patient had permanent puncture-related complications. Univariate analyses revealed that a higher risk of puncture site complications was significantly associated with multiple antiplatelet agents (p = 0.03), hypertension (p = 0.03), scheduled treatment (p < 0.01), higher activated clotting time (ACT) immediately before sheath removal (>310 seconds, p < 0.01), and the non-use of Perclose (manual compression or Angio-seal, p < 0.01). Multivariate analyses revealed that puncture site complications were significantly higher in patients with an ACT immediately before sheath removal >310 s (HR: 10.4, 95% CI: 2.45–44.15, p < 0.01), scheduled treatment (HR: 10.16, 95% CI: 1.81–56.95, p < 0.01), and the non-use of Perclose (HR: 21.97, 95% CI: 2.42–199.34, p < 0.01).

Conclusion

A higher ACT immediately before sheath removal was significantly associated with puncture site complications. Perclose is an efficient device, and it may reduce the risk of puncture site complications.

Endoscopic third ventriculostomy (ETV) is a major treatment procedure for obstructive hydrocephalus in children and adults. However, previous studies to predict the outcome of ETV, such as ETV success score, were primarily based on pediatric populations; hence, the effectiveness of ETV in elderly populations remains unclear. Here, we report the case of an 80-year-old woman with cognitive impairment and gait disturbance due to obstructive hydrocephalus caused by a pineal region meningioma. Considering that the radical resection was risky for this patient, simultaneous endoscopic tumor biopsy and ETV was performed. Based on the histopathological findings, the patient was diagnosed with meningioma. Cognition improved and gait disturbances diminished gradually 2 months after the operation. Surgical treatments for the elderly patients should not compromise activity of daily living (ADL). Our findings might help the management of elderly patients with obstructive hydrocephalus, especially in aging societies.

Background

The aim of this study was to assess the efficacy of indocyanine green (ICG) angiography during full endoscopic microvascular decompression for trigeminal neuralgia.

Methods

We extracted retrospective data of patients who received ICG videoangiography during full endoscopic microvascular decompression for trigeminal neuralgia. Preoperative neurovascular contact was evaluated by three-dimensional (3D) fusion images using image analysis software Ziostation2 (ZIOSOFT, Tokyo, Japan) and Intraoperative ICG angiography was used in pre and post ICG injection to identify and assess blood flow in the offending vessel for adequate transposition planification and assess for immediate post transposition blood flow or vasospasm respectively. Patients were assessed the next morning for early signs of brainstem infarction and at one month follow up.

Results

There were 44 patients. All patients had ICG videoangiography done during the procedure. The mean age was 65.5 and male female ratio 3.4:1. Some anatomical variants were identified during this procedure. Five patients (11.3%) had a trigeminocerebellar artery, three patients (6.8%) had a developed superior petrosal vein and one patient (2.2%) had dural adhesions with encasement of anterior inferior cerebellar artery. Among the 44 patients enrolled, 34 had transposition done and 10 had combined transposition either with neurolysis or Teflon interposition. The main offending vessel was Superior cerebellar artery (SCA) in 23 patients (67.6%). In 5 (14.7%) of 34 patients who underwent Transposition, vasospasm was seen and no complications were observed in all patients but 93.1% had good pain control in postoperative.

Conclusion

ICG angiography in endoscopic microvascular decompression is safe and effective in depicting the offending vessel, its branches and some perforators and contributes significantly to the determination of treatment strategy.

Introduction

The association of a frontal extra dural hematoma and an intra orbital hematoma is very rare, all the cases reported in the literature are case reports to our knowledge.

Observation

We report the case of an 18-year-old patient who suffered a head injury fifteen days before his admission to our department. The examination on admission found a conscious patient presenting a frontal syndrome, a non-pulsatile right exophthalmos. The cerebral CT scan objectified a right frontal extra-dural hematoma associated with a right intra-orbital hematoma. The patient was operated on, benefiting from evacuation of the two hematomas through a fronto-orbital flap with removal of the roof of the orbit in one piece. The immediate post-operative outcome was uneventfull.

Conclusion

The association of a frontal extra-dural hematoma and an intra-orbital hematoma is rare and early management allows good results.

Background and objective

Gross total resection of skull base meningioma is so challenging due to its relevant high morbidity. Gamma knife radiosurgery is concerned by providing a favorable therapeutic option in the management of SBM. This study aims to evaluate the neurological outcome after GKRS as an adjuvant or primary treatment for SBM according to their locations.

Methods

This retrospective cross-sectional study consisted of 108 patients with SBM who underwent GKRS as an adjuvant or primary treatment. We found 40 patients with cavernous sinus meningioma (CSM), 36 patients with petroclival meningioma (PCM), and 22 patients with cerebellopontine angle meningioma (CPM). 81.1% of whom were female (n = 90) with a median age of 52.68 years. The mean tumor volume was 4.5 cm3 and the mean marginal dose was 13 Gy.

Results

Tumor control was achieved in 96.4 % of patients at a median follow-up of 38.4 months. Over all 17 of 108 patients (15.6%) report improvement in their neurological symptoms. Patients with CPM demonstrated lower rates of neurological symptoms improvement compared to patients with PCM and CSM. Deterioration of neurological symptoms after GKRS developed in 11 patients (10.1%) which was more reported by patients with CSM than the others. The most improvement in cranial nerve deficit was in CN Ⅵ, Ⅴ, VIII among patients with CSM, PCM, and CPM respectively.

Conclusion

GKRS is acceptable as a primary or adjuvant treatment for SBM by providing an appreciable rate of improvement in neurological symptoms.