Interdisciplinary Neurosurgery: Advanced Techniques and Case Management最新文献

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.

Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for Parkinson's disease (PD) in whom medical treatment fails to provide adequate symptom control. Skin-related complications, particularly skin erosion, may lead to exposure of the DBS device, compromising the effectiveness of the DBS device. We presented a patient who suffered from skin erosion over bilateral burr hole site. A Multidisciplinary Team (MDT) approach was used to provide staged surgical treatment for scalp reconstruction. Without the removal of the DBS system. No alteration of DBS system efficacy was observed and the bilateral wounds healed well during the follow-up period.

The mainstay treatment of uncomplicated cerebral venous sinus thrombosis (CVST) is an anticoagulant medication and gets rid of the cause of the disease as soon as possible. Endovascular treatment is recommended in complicated cases without definite standard guidelines for timing of intervention. In contrast to, the guideline and timing of intervention for acute convulsive status epilepticus.

With predictable of the critically complicated CVST with acute status epilepticus and bifrontal hemorrhages, urgent thrombectomy within 48 h after medical failure is able to restoration of venous flow in time for rescue the edematous brain, stop further venous bleeding, ease seizure controlled and finally lead to rapidly recovery of the devastating conditions with an excellent outcome.

Background

Due to the compressive effect of the brain masses, hydrocephalus treatment is mainly achieved by shunting and discharge of fluid. However, some reports have shown the potential adverse effects of this method and its potential contraindications that result in focusing on preventive approaches like endoscopic third ventriculostomy (ETV). Hence, in the present study, the authors undertook a study to examine the hypothesis that preoperative ETV could reduce the likelihood of hydrocephalus and the need for shunting in patients undergoing surgery for posterior fossa tumors.

Methods

In the current cross-sectional study, 40 consecutive patients were scheduled for surgery to remove posterior fossa masses using ETV preoperatively (n = 23) or were considered as the controls with no preoperative ETV (n = 17). Afterward, these patients were followed up for 2 months after surgery regarding hydrocephalus and the need for shunt insertion. The postoperative change in the ventricular-cranial ratio (VCR) was also compared in 2 groups.

Results

Of 23 patients in the ETV group, none required postoperative shunting due to the lack of evidence supporting hydrocephalus; however, 7 patients were found to require shunting in the non-ETV group. Notably, the value of VCR significantly reduced in both groups with no significant difference.

Conclusion

ETV protocol before the surgical removal of posterior fossa tumors can effectively reduce the rate of postoperative hydrocephalus, decreasing the need for postoperative shunting.

Cervical dystonia is the most common focal dystonia affecting adults. It frequently causes postural control problems, neck pain and spasm attacks of the cervical musculature. One of the surgical options available is selective cervical denervation. We report the case of a 32-year-old patient with cervical dystonia refractory to conservative treatment and an injection of botulinum toxin A, which was finally completed by bilateral selective cervical denervation, with considerable regression of cervical spasm at 16 months post-operatively.

The clinical presentation of cervical dystonia includes abnormal movements or postural changes of the head, neck and shoulders caused by involuntary contractions of the cervical muscles. When the spasmodic attacks are recurrent, they can cause real handicaps for the patient. The causes of the disease and its pathophysiological mechanism are still poorly understood. There are a number of treatment options, including pharmacological therapy and surgery in cases of therapeutic failure. Repeated intramuscular injections of botulinum toxin are the first-line treatment. Some conservative measures such as physiotherapy are also used, although there is little literature on these approaches.

Selective peripheral denervation is currently the main surgical treatment for refractory cervical dystonia. A combination of conservative treatment with BT-A injection and denervation appears to be an effective treatment option.

Background

Anterior cervical discectomy with fusion is a commonly performed procedure for symptomatic cervical disc herniation. However, Cerebrospinal fluid (CSF) leak is a rare complication accounting for about 0.2–3% and there is no definitive management algorithm for the management of the same.

Case description: We report, case of a 32 year old quadriplegic gentleman with C3–C4 level traumatic disc prolapse with cord contusion and edema following road traffic accident. He developed incidental durotomy with significant CSF leak during ACDF surgery. It was managed successfully using a small rolled piece of surgicel, acetazolamide and lumbar drain. He has been on regular follow up and at 10 months postoperatively, there is no CSF related complication with Karnofsky Performance score of 90.

Conclusion

Our treatment approach provides a viable option of managing CSF leak in low to medium income countries or in situations where ready access to fibrin glue or tacho sealant is not possible. In case of traumatic disc prolapse with cord contusion, it reduces the chances of mass effect, infection, foreign body reaction and overall cost of surgery. In this case of traumatic disc prolapse, CSF leak had actually hastened recovery of neurological deficits.

Objective

The aim of this prospective study is to identify the factors influencing postoperative hearing loss (HL) and explore effective strategies for reducing postoperative hearing complications following microvascular decompression (MVD) for hemifacial spasm (HFS).

Methods

From January 2018 to January 2023, we enrolled a total of 55 patients who underwent MVD for HFS at our institution. Intraoperative monitoring of brainstem auditory evoked potentials (BAEPs) was conducted in all surgeries, beginning from the induction of general anesthesia and continuing until skin closure. Prior to surgery and one month after, pure-tone audiometry (PTA) evaluations were performed to evaluate HL. We conducted an analysis to identify factors that influenced postoperative HL. Our examination focused on the occurrence of postoperative HL, considering changes in BAEPs, and we evaluated the diagnostic accuracy of significant warning criteria.

Results

In this study, a total of 55 patients (37 women and 18 men) with a mean age of 52.5 ± 13.4 years (range 24–80) were included. Among them, 5 patients (9.1 %) experienced postoperative HL. The variations in other risk factors based on the pattern of HL were not statistically significant (p > 0.05), whereas surgical experience showed significance (p = 0.028). Notably, the group of patients who showed wave V loss in intraoperative BAEPs was found to be significantly associated with postoperative HL.

Conclusion

Surgical experience is a factor influencing postoperative HL. Intraoperative changes in BAEPs, particularly loss of wave V, were found to be a significant indicator of poorer recovery of hearing capacity after MVD for HFS.

Background

Lumbar disc herniation (LDH) at the upper levels (L1–2 and L2–3) is different from that at the lower levels with regard to clinical characteristics and surgical outcomes. Discectomy using the transdural approach is a good option for central LDH at the upper levels; however, postoperative instability and recurrence are the major concerns.

Case presentation

A 57-year-old woman experienced severe back pain and dysuria. Magnetic resonance imaging (MRI) revealed a massive LDH at the L1–2 level. Despite conservative treatment for 3 months, her low back pain was not relieved. Posterior lumbar interbody fusion (PLIF) with bilateral facetectomy was performed, and the residual LDH was subsequently removed using the transdural approach. The patient’s preoperative symptoms were relieved after surgery.

Conclusions

PLIF followed by discectomy using the transdural approach is a safe and useful surgical method to treat a massive LDH at the upper levels.