Primary spinal germ cell tumors are exceedingly rare, and standardized treatment strategies remain undefined.
Case report
We report a rare case of a mixed germ cell tumor composed of germinoma and yolk sac tumor located in the conus medullaris and filum terminale. The patient underwent partial resection followed by chemotherapy with cisplatin, etoposide, and cyclophosphamide, and craniospinal (23.4 Gy) plus local (50.6 Gy) irradiation. Post-treatment MR imaging showed marked regression of the residual tumor.
Conclusion
This case highlights the diagnostic importance of histopathology and suggests that combined chemotherapy and craniospinal plus local irradiation may be effective for tumor control in spinal germ cell tumors.
{"title":"Primary mixed yolk sac tumor and germinoma arising from conus medullaris and filum terminale: A case report and literature review","authors":"Kazuya Morita , Shingo Tanaka , Sho Tamai , Hiroko Ikeda , Mitsutoshi Nakada","doi":"10.1016/j.inat.2026.102209","DOIUrl":"10.1016/j.inat.2026.102209","url":null,"abstract":"<div><h3>Background</h3><div>Primary spinal germ cell tumors are exceedingly rare, and standardized treatment strategies remain undefined.</div></div><div><h3>Case report</h3><div>We report a rare case of a mixed germ cell tumor composed of germinoma and yolk sac tumor located in the conus medullaris and filum terminale. The patient underwent partial resection followed by chemotherapy with cisplatin, etoposide, and cyclophosphamide, and craniospinal (23.4 Gy) plus local (50.6 Gy) irradiation. Post-treatment MR imaging showed marked regression of the residual tumor.</div></div><div><h3>Conclusion</h3><div>This case highlights the diagnostic importance of histopathology and suggests that combined chemotherapy and craniospinal plus local irradiation may be effective for tumor control in spinal germ cell tumors.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102209"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419832","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 : 2026-03-01Epub Date: 2026-02-24DOI: 10.1016/j.inat.2026.102224
Moamen M. Morsy , Omar B. Nasser , Ayman M. Ismail , Khalid A. Ismail , Ahmed Soliman , Ayman M. Basha
Background
Lumbar disc prolapse (LDP) is a significant cause of low back pain and radiculopathy. While both Microlumbar Discectomy (MLD) and Microendoscopic Discectomy (MED) are established minimally invasive treatments, comparative data for double-level LDP is limited. This study aimed to compare the efficacy and safety of MED versus MLD for patients with double-level lumbar disc prolapse.
Methods
This randomized controlled trial included 50 patients with double-level LDP who failed 8 weeks of conservative treatment, randomized equally into two groups: MED group (n = 25) who underwent tubular microendoscopic interlaminar discectomy and MLD group (n = 25) who underwent standard microlumbar discectomy. Patients were followed for one year postoperatively. Primary outcomes included Visual Analogue Scale (VAS) scores for back and leg pain. Secondary outcomes encompassed Oswestry Disability Index (ODI), operative time, blood loss, wound length, hospital stay, return to work, and postoperative complications.
Results
Both MED and MLD significantly improved pain and disability. The MED group demonstrated statistically lower VAS scores for back pain at one month (2.1 ± 0.73 vs. 2.7 ± 0.84, p = 0.012), and consistently lower VAS scores for both back and leg pain at 6 and 12 months postoperatively. Operative time was significantly longer for MED (103 ± 15.6 mins vs. 73 ± 14.9 mins, p < 0.001). However, MED was associated with significantly less blood loss (49.9 ± 10.1 mL vs. 87.2 ± 26.2 mL, p < 0.001), smaller wound length (2.3 ± 0.4 cm vs. 4.7 ± 0.5 cm, p < 0.001), shorter hospital stay (1.1 ± 0.61 days vs. 1.7 ± 0.58 days, p = 0.007), and earlier return to work (39.4 ± 7.24 days vs. 43.1 ± 3.6 days, p = 0.029).
Conclusion
Both microendoscopic and microlumbar discectomy are effective and safe for double-level lumbar disc prolapse. Microendoscopic discectomy offers superior short-term pain relief, reduced invasiveness, shorter hospital stays, and earlier returns to work, despite a longer operative time. These benefits suggest MED as a favorable option for patients with double-level LDP.
背景腰椎间盘突出（LDP）是腰痛和神经根病的重要原因。虽然显微腰椎间盘切除术（MLD）和显微内镜腰椎间盘切除术（MED）都是公认的微创治疗方法，但双水平腰椎间盘切除术的比较数据有限。本研究旨在比较MED与MLD治疗双节段腰椎间盘突出症的疗效和安全性。方法随机对照试验纳入50例保守治疗8周失败的双水平LDP患者，随机分为MED组（n = 25）和MLD组（n = 25）， MED组（n = 25）行管状显微内窥镜椎间盘切除术，MLD组（n = 25）行标准显微椎间盘切除术。术后随访1年。主要结果包括视觉模拟量表（VAS）对背部和腿部疼痛的评分。次要结局包括Oswestry残疾指数（ODI）、手术时间、出血量、伤口长度、住院时间、重返工作岗位和术后并发症。结果MED和MLD均能显著改善疼痛和残疾。MED组术后1个月腰痛VAS评分较低（2.1±0.73比2.7±0.84,p = 0.012），术后6个月和12个月腰痛和腿痛VAS评分持续较低。MED组手术时间明显更长（103±15.6 min vs. 73±14.9 min, p < 0.001）。然而，MED与出血量明显减少（49.9±10.1 mL比87.2±26.2 mL, p < 0.001）、伤口长度更短（2.3±0.4 cm比4.7±0.5 cm, p < 0.001）、住院时间更短（1.1±0.61天比1.7±0.58天，p = 0.007）、更早恢复工作（39.4±7.24天比43.1±3.6天，p = 0.029）相关。结论显微内镜和显微腰椎间盘切除术治疗双节段腰椎间盘突出是安全有效的。显微内窥镜椎间盘切除术提供了较好的短期疼痛缓解，减少了侵入性，缩短了住院时间，尽管手术时间较长，但更早恢复工作。这些益处表明MED是双级别LDP患者的有利选择。
{"title":"Efficacy and safety of microendoscopic vs. microlumbar discectomy for patients with double-level lumbar disc prolapse: a randomized clinical trial","authors":"Moamen M. Morsy , Omar B. Nasser , Ayman M. Ismail , Khalid A. Ismail , Ahmed Soliman , Ayman M. Basha","doi":"10.1016/j.inat.2026.102224","DOIUrl":"10.1016/j.inat.2026.102224","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar disc prolapse (LDP) is a significant cause of low back pain and radiculopathy. While both Microlumbar Discectomy (MLD) and Microendoscopic Discectomy (MED) are established minimally invasive treatments, comparative data for double-level LDP is limited. This study aimed to compare the efficacy and safety of MED versus MLD for patients with double-level lumbar disc prolapse.</div></div><div><h3>Methods</h3><div>This randomized controlled trial included 50 patients with double-level LDP who failed 8 weeks of conservative treatment, randomized equally into two groups: MED group (n = 25) who underwent tubular microendoscopic interlaminar discectomy and MLD group (n = 25) who underwent standard microlumbar discectomy. Patients were followed for one year postoperatively. Primary outcomes included Visual Analogue Scale (VAS) scores for back and leg pain. Secondary outcomes encompassed Oswestry Disability Index (ODI), operative time, blood loss, wound length, hospital stay, return to work, and postoperative complications.</div></div><div><h3>Results</h3><div>Both MED and MLD significantly improved pain and disability. The MED group demonstrated statistically lower VAS scores for back pain at one month (2.1 ± 0.73 vs. 2.7 ± 0.84, p = 0.012), and consistently lower VAS scores for both back and leg pain at 6 and 12 months postoperatively. Operative time was significantly longer for MED (103 ± 15.6 mins vs. 73 ± 14.9 mins, p < 0.001). However, MED was associated with significantly less blood loss (49.9 ± 10.1 mL vs. 87.2 ± 26.2 mL, p < 0.001), smaller wound length (2.3 ± 0.4 cm vs. 4.7 ± 0.5 cm, p < 0.001), shorter hospital stay (1.1 ± 0.61 days vs. 1.7 ± 0.58 days, p = 0.007), and earlier return to work (39.4 ± 7.24 days vs. 43.1 ± 3.6 days, p = 0.029).</div></div><div><h3>Conclusion</h3><div>Both microendoscopic and microlumbar discectomy are effective and safe for double-level lumbar disc prolapse. Microendoscopic discectomy offers superior short-term pain relief, reduced invasiveness, shorter hospital stays, and earlier returns to work, despite a longer operative time. These benefits suggest MED as a favorable option for patients with double-level LDP.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102224"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419834","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 : 2026-03-01Epub Date: 2026-02-28DOI: 10.1016/j.inat.2026.102227
Feierkaiti Abudukeyimu , Zulimire Anniwaer , Yinan Pei , Lei Jiang , Yiliyasijiang MaimaitiTuerxun , Zhaohai Feng , Xixian Wang
Objective
To preliminarily explore the mid‑ to long‑term efficacy and safety of bilateral nucleus accumbens–anterior limb of the internal capsule (NAc–ALIC) stimulation combined with medial globus pallidus (GPi) stimulation for treating obsessive‑compulsive disorder (OCD) complicated by tardive dyskinesia (TD).
Methods
In May 2023, one patient with OCD complicated by TD underwent bilateral NAc–ALIC and GPi deep brain stimulation (DBS) at the Department of Neurosurgery IV, the First Affiliated Hospital of Xinjiang Medical University. Clinical efficacy and safety were retrospectively analyzed. The Yale–Brown Obsessive‑Compulsive Scale (Y‑BOCS) was used to assess OCD symptoms, and the Abnormal Involuntary Movement Scale (AIMS) was used to assess TD severity. The patient was followed for 30 months to evaluate outcomes and possible adverse events.
Results
At 6 months after stimulator activation, Y‑BOCS and AIMS improvement rates were 73.07% and 70%, respectively; at 12 months, 88.46% and 90%; and at 30 months, 96.15% and 95%. No serious complications such as intracranial hemorrhage, infection, or permanent neurological deficit occurred.
Conclusion
Bilateral NAc–ALIC combined with GPi DBS may represent a safe and effective therapeutic option for treatment‑resistant OCD accompanied by TD, showing stable mid‑ to long‑term efficacy.
{"title":"Bilateral nucleus Accumbens–Anterior limb of the internal capsule stimulation combined with medial globus pallidus stimulation for the treatment of Obsessive‑Compulsive disorder with tardive Dyskinesia: A case report and therapeutic Exploration","authors":"Feierkaiti Abudukeyimu , Zulimire Anniwaer , Yinan Pei , Lei Jiang , Yiliyasijiang MaimaitiTuerxun , Zhaohai Feng , Xixian Wang","doi":"10.1016/j.inat.2026.102227","DOIUrl":"10.1016/j.inat.2026.102227","url":null,"abstract":"<div><h3>Objective</h3><div>To preliminarily explore the mid‑ to long‑term efficacy and safety of bilateral nucleus accumbens–anterior limb of the internal capsule (NAc–ALIC) stimulation combined with medial globus pallidus (GPi) stimulation for treating obsessive‑compulsive disorder (OCD) complicated by tardive dyskinesia (TD).</div></div><div><h3>Methods</h3><div>In May 2023, one patient with OCD complicated by TD underwent bilateral NAc–ALIC and GPi deep brain stimulation (DBS) at the Department of Neurosurgery IV, the First Affiliated Hospital of Xinjiang Medical University. Clinical efficacy and safety were retrospectively analyzed. The Yale–Brown Obsessive‑Compulsive Scale (Y‑BOCS) was used to assess OCD symptoms, and the Abnormal Involuntary Movement Scale (AIMS) was used to assess TD severity. The patient was followed for 30 months to evaluate outcomes and possible adverse events.</div></div><div><h3>Results</h3><div>At 6 months after stimulator activation, Y‑BOCS and AIMS improvement rates were 73.07% and 70%, respectively; at 12 months, 88.46% and 90%; and at 30 months, 96.15% and 95%. No serious complications such as intracranial hemorrhage, infection, or permanent neurological deficit occurred.</div></div><div><h3>Conclusion</h3><div>Bilateral NAc–ALIC combined with GPi DBS may represent a safe and effective therapeutic option for treatment‑resistant OCD accompanied by TD, showing stable mid‑ to long‑term efficacy.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102227"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147420729","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}
Dropped head syndrome (DHS) is traditionally considered a cervical paraspinal muscle disorder, often associated with isolated neck extensor myopathy (INEM). However, emerging evidence suggests that thoracolumbar malalignment may contribute to its pathology. This study presents two DHS cases in which symptoms improved after thoracolumbar corrective surgery with cervical electromyography (EMG) changes, suggesting a possible secondary etiology related to global spinal malalignment.
Case presentation
Two older adults with DHS and a history of thoracolumbar compression fractures presented with progressive neck pain and difficulty maintaining horizontal gaze. Neurological evaluation and EMG revealed myopathic changes in the cervical extensors without systemic neuromuscular disease. Conservative treatment, including physical therapy and cervical orthosis, was ineffective. Both patients underwent thoracolumbar surgery for spinal realignment. Postoperatively, symptoms improved significantly, and follow-up EMG showed reduced spontaneous activity of cervical extensor.
Conclusion
These cases suggest that thoracolumbar malalignment may contribute to DHS and that symptom improvement can be observed after thoracolumbar corrective surgery without direct cervical intervention. The observed EMG changes following surgical correction indicate this dysfunction may be improved by addressing the underlying global spinal malalignment. These observations are hypothesis-generating and support careful assessment of global spinal alignment in DHS diagnosis and management.
{"title":"Postoperative changes in cervical paraspinal muscle electromyography after thoracolumbar corrective surgery in dropped head syndrome: a report of 2 cases","authors":"Soji Tani , Takeshi Kuroda , Yutaro Momma , Shimpei Koyama , Yohei Miyamoto , Koki Tsuchiya , Chikara Hayakawa , Ryo Yamamura , Ichiro Okano , Tomoaki Toyone , Hidetomo Murakami , Yoshifumi Kudo","doi":"10.1016/j.inat.2026.102219","DOIUrl":"10.1016/j.inat.2026.102219","url":null,"abstract":"<div><h3>Background and study objectives</h3><div>Dropped head syndrome (DHS) is traditionally considered a cervical paraspinal muscle disorder, often associated with isolated neck extensor myopathy (INEM). However, emerging evidence suggests that thoracolumbar malalignment may contribute to its pathology. This study presents two DHS cases in which symptoms improved after thoracolumbar corrective surgery with cervical electromyography (EMG) changes, suggesting a possible secondary etiology related to global spinal malalignment.</div></div><div><h3>Case presentation</h3><div>Two older adults with DHS and a history of thoracolumbar compression fractures presented with progressive neck pain and difficulty maintaining horizontal gaze. Neurological evaluation and EMG revealed myopathic changes in the cervical extensors without systemic neuromuscular disease. Conservative treatment, including physical therapy and cervical orthosis, was ineffective. Both patients underwent thoracolumbar surgery for spinal realignment. Postoperatively, symptoms improved significantly, and follow-up EMG showed reduced spontaneous activity of cervical extensor.</div></div><div><h3>Conclusion</h3><div>These cases suggest that thoracolumbar malalignment may contribute to DHS and that symptom improvement can be observed after thoracolumbar corrective surgery without direct cervical intervention. The observed EMG changes following surgical correction indicate this dysfunction may be improved by addressing the underlying global spinal malalignment. These observations are hypothesis-generating and support careful assessment of global spinal alignment in DHS diagnosis and management.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102219"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147420731","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 : 2026-03-01DOI: 10.1016/j.inat.2026.102244
Ali Tarik Abdul Wahid
Background
Spina bifida, a neurological disorder affecting approximately 1 in 1,000 births worldwide, is the most severe form of myelomeningocele, often causing significant neurological disabilities. Early surgical intervention is required to decrease the risk of infection and prevent further tissue damage. This study aims to compare longitudinal and transverse wound closure methods, focusing on their impact on healing, scarring, and revision rates to improve patients’ quality of life and reduce healthcare burdens.
Methods
This prospective cohort study included 48 neonates with myelomeningocele requiring surgical closure. Closure technique (longitudinal or transverse) was determined by intraoperative assessment of the defect size, shape, and available skin tissue, rather than randomized allocation. Healing time, infection rate, cerebrospinal fluid (CSF) leakage, and scar formation were evaluated using standardized scales. Patients requiring urgent ventriculoperitoneal (VP) shunting were not excluded to maintain clinical representativeness.
Results
The study involved 48 patients, predominantly female (58.3%), aged between 2 and 14 days, with 66.7% presenting within the first 6 days. All patients exhibited myelomeningocele lesions, primarily in the thoracolumbar region (62.5%). Surgical results showed that despite longitudinal closure techniques significantly reduced both operative time (2.5 h versus 3.0 h) and healing time (4 weeks versus 6 weeks) compared with a transverse technique, there was a lower infection rate in the longitudinal group (4.2% versus 25.0%), as were cerebrospinal fluid leakages (8.3% vs. 20.8%). The assessment of Scar visibility was significantly better in the longitudinal group (1.2 vs. 3.5), with 100% achieving satisfactory wound healing compared with 75% in the transverse group.
Conclusions
The longitudinal wound closure techniques are the preferred approach in spina bifida repair clinical guidelines for pediatric neurosurgery. Future research should emphasize assessing long-term effects on neurological function, quality of life, and patient satisfaction.
{"title":"Comparing longitudinal and transverse wound closure methods for spina bifida","authors":"Ali Tarik Abdul Wahid","doi":"10.1016/j.inat.2026.102244","DOIUrl":"10.1016/j.inat.2026.102244","url":null,"abstract":"<div><h3>Background</h3><div>Spina bifida, a neurological disorder affecting approximately 1 in 1,000 births worldwide, is the most severe form of myelomeningocele, often causing significant neurological disabilities. Early surgical intervention is required to decrease the risk of infection and prevent further tissue damage. This study aims to compare longitudinal and transverse wound closure methods, focusing on their impact on healing, scarring, and revision rates to improve patients’ quality of life and reduce healthcare burdens.</div></div><div><h3>Methods</h3><div>This prospective cohort study included 48 neonates with myelomeningocele requiring surgical closure. Closure technique (longitudinal or transverse) was determined by intraoperative assessment of the defect size, shape, and available skin tissue, rather than randomized allocation. Healing time, infection rate, cerebrospinal fluid (CSF) leakage, and scar formation were evaluated using standardized scales. Patients requiring urgent ventriculoperitoneal (VP) shunting were not excluded to maintain clinical representativeness.</div></div><div><h3>Results</h3><div>The study involved 48 patients, predominantly female (58.3%), aged between 2 and 14 days, with 66.7% presenting within the first 6 days. All patients exhibited myelomeningocele lesions, primarily in the thoracolumbar region (62.5%). Surgical results showed that despite longitudinal closure techniques significantly reduced both operative time (2.5 h versus 3.0 h) and healing time (4 weeks versus 6 weeks) compared with a transverse technique, there was a lower infection rate in the longitudinal group (4.2% versus 25.0%), as were cerebrospinal fluid leakages (8.3% vs. 20.8%). The assessment of Scar visibility was significantly better in the longitudinal group (1.2 vs. 3.5), with 100% achieving satisfactory wound healing compared with 75% in the transverse group.</div></div><div><h3>Conclusions</h3><div>The longitudinal wound closure techniques are the preferred approach in spina bifida repair clinical guidelines for pediatric neurosurgery. Future research should emphasize assessing long-term effects on neurological function, quality of life, and patient satisfaction.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102244"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421078","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 : 2026-03-01Epub Date: 2026-02-26DOI: 10.1016/j.inat.2026.102234
Rivan Dwiutomo , Muhammad Adam Pribadi , Akhmad Imron
Background
Neurovascular compression syndrome (NCS) is a disorder caused by the compression of cranial nerves at the root entry zone (REZ), manifesting primarily as trigeminal neuralgia (TN) and hemifacial spasm (HFS). Despite the established efficacy of microvascular decompression (MVD), the application of this procedure in Indonesia is still under-explored, with limited data on its outcomes in local populations.
Objectives
To evaluate the outcomes of patients with primary TN and HFS who underwent MVD and to present our experience with a single-surgeon approach.
Patients and methods
This study retrospectively analyzed 32 patients who underwent MVD for TN and HFS between 2021 and 2025. We evaluated their clinical and operative findings, and outcomes.
Results
Among the 25 patients with TN, MVD resulted in good post-operative pain control (BNI grade I–II) in 88% of TN cases and favorable numbness outcomes in 92%. Severe neurovascular conflict (NVC) grades were significantly associated with improved pain (p = 0.038) and numbness (p = 0.003). The presence of basilar artery or complex vascular involvement showed less favorable outcomes (pain: p = 0.101; numbness: p < 0.001). For 7 patients with HFS, age and pre-operative SMC grades were significantly associated with good outcomes (age: p = 0.003; SMC: p = 0.008).
Conclusion
MVD under single-surgeon protocol delivers high efficacy and safety for TN and HFS with low complication rates and NVC severity contributes significantly in predicting success of this procedure.
{"title":"The clinical outcomes of microvascular decompression for neurovascular compression syndromes: A single surgeon approach and insights from an Indonesian tertiary level single neurosurgical center","authors":"Rivan Dwiutomo , Muhammad Adam Pribadi , Akhmad Imron","doi":"10.1016/j.inat.2026.102234","DOIUrl":"10.1016/j.inat.2026.102234","url":null,"abstract":"<div><h3>Background</h3><div>Neurovascular compression syndrome (NCS) is a disorder caused by the compression of cranial nerves at the root entry zone (REZ), manifesting primarily as trigeminal neuralgia (TN) and hemifacial spasm (HFS). Despite the established efficacy of microvascular decompression (MVD), the application of this procedure in Indonesia is still under-explored, with limited data on its outcomes in local populations.</div></div><div><h3>Objectives</h3><div>To evaluate the outcomes of patients with primary TN and HFS who underwent MVD and to present our experience with a single-surgeon approach.</div></div><div><h3>Patients and methods</h3><div>This study retrospectively analyzed 32 patients who underwent MVD for TN and HFS between 2021 and 2025. We evaluated their clinical and operative findings, and outcomes.</div></div><div><h3>Results</h3><div>Among the 25 patients with TN, MVD resulted in good post-operative pain control (BNI grade I–II) in 88% of TN cases and favorable numbness outcomes in 92%. Severe neurovascular conflict (NVC) grades were significantly associated with improved pain (p = 0.038) and numbness (p = 0.003). The presence of basilar artery or complex vascular involvement showed less favorable outcomes (pain: p = 0.101; numbness: p < 0.001). For 7 patients with HFS, age and pre-operative SMC grades were significantly associated with good outcomes (age: p = 0.003; SMC: p = 0.008).</div></div><div><h3>Conclusion</h3><div>MVD under single-surgeon protocol delivers high efficacy and safety for TN and HFS with low complication rates and NVC severity contributes significantly in predicting success of this procedure.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"43 ","pages":"Article 102234"},"PeriodicalIF":0.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421152","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":"2025-12-01","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}
Pub Date : 2025-12-01Epub Date: 2025-11-17DOI: 10.1016/j.inat.2025.102144
K.S.V. Angu Bala Ganesh , Ved Prakash Mishra , A. Jayanthiladevi , Amit Kumar Verma
Neurodiagnostics and AI: How Artificial Intelligence is changing the Future of Neurodiagnostics. Clinician trust is critical for successfully adopting AI-assisted tools in clinical settings. Here, we evaluate clinician trust in AI-based neurodiagnostic solutions using a simulated multicast-medicine scenario about stroke, neurodegenerative disease, and traumatic brain injury (TBI). Then, we study the reliability, explainability, and acceptance of the AI-generated diagnoses by both the deep learning models and XAI (explainable AI) methods. These results pinpoint significant predictors of clinician confidence and pathways for potential interventions to induce AI adaptation in neurodiagnostics. AI revolutionizes neurodiagnostics and provides more effective and cost-effective methods to detect neuro diseases. But clinicians’ trust in these tools is essential for the successful implementation of AI in clinical practice. This study evaluates clinician trust in AI neurodiagnostic tools in different clinical vignette cases based on those associated with reliability, interpretability, and agreement between AI models and expert judgments. We assess clinician responses (including those of IS, TBI, and neurodegenerative diseases) to AI-generated diagnoses using an AI-based decision-support system with deep learning and explainable AI methods. Our findings add to a growing understanding of factors that could influence clinician uptake and strategies to optimize AI-enabled diagnostic use in neurologic practice.
{"title":"Building clinician trust in AI-assisted neurodiagnostics: A case-based evaluation","authors":"K.S.V. Angu Bala Ganesh , Ved Prakash Mishra , A. Jayanthiladevi , Amit Kumar Verma","doi":"10.1016/j.inat.2025.102144","DOIUrl":"10.1016/j.inat.2025.102144","url":null,"abstract":"<div><div>Neurodiagnostics and AI: How Artificial Intelligence is changing the Future of Neurodiagnostics. Clinician trust is critical for successfully adopting AI-assisted tools in clinical settings. Here, we evaluate clinician trust in AI-based neurodiagnostic solutions using a simulated multicast-medicine scenario about stroke, neurodegenerative disease, and traumatic brain injury (TBI). Then, we study the reliability, explainability, and acceptance of the AI-generated diagnoses by both the deep learning models and XAI (explainable AI) methods. These results pinpoint significant predictors of clinician confidence and pathways for potential interventions to induce AI adaptation in neurodiagnostics. AI revolutionizes neurodiagnostics and provides more effective and cost-effective methods to detect neuro diseases. But clinicians’ trust in these tools is essential for the successful implementation of AI in clinical practice. This study evaluates clinician trust in AI neurodiagnostic tools in different clinical vignette cases based on those associated with reliability, interpretability, and agreement between AI models and expert judgments. We assess clinician responses (including those of IS, TBI, and neurodegenerative diseases) to AI-generated diagnoses using an AI-based decision-support system with deep learning and explainable AI methods. Our findings add to a growing understanding of factors that could influence clinician uptake and strategies to optimize AI-enabled diagnostic use in neurologic practice.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102144"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579271","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}
Parkinson’s disease (PD) is characterized by high rates of refractory pain, with >60 % of the patients experiencing lower back and lower limb pain. Although spinal cord stimulation (SCS) has emerged as a promising treatment for PD-related symptoms, previous studies have not specifically documented the onset time of therapeutic effects. However, the temporal dynamics of its effects, particularly with burst stimulation, remain poorly understood.
Case presentation
We report two cases of burst stimulation SCS applied at the lower thoracic spine level for the treatment of PD-related lower back pain, lower limb pain, and postural abnormalities. Conventional treatments, including medication and nerve blocks, failed in both patients. The first patient showed significant improvement, with numerical rating scale (NRS) pain scores decreasing from 5 to 1 at rest and 8 to 3 during activity, along with improved sagittal vertical axis measurements (118 mm to 67 mm). The second patient, who had previously undergone deep brain stimulation, demonstrated NRS improvement from 7 to 3 and a marked improvement in cervical anteflexion. Both patients experienced immediate pain relief upon stimulation and rapid symptom recurrence upon deactivation. These improvements were maintained over a two-year follow-up period without requiring increased medication.
Conclusions
These cases demonstrate that burst stimulation SCS can provide immediate, reversible pain relief and postural improvement in patients with PD, even after deep brain stimulation. The rapid onset and offset of these effects suggest direct modulation of neural circuits rather than gradual neuroplastic changes, presenting a novel therapeutic mechanism worthy of further investigation.
{"title":"Immediate pain relief with burst spinal cord stimulation in Parkinson’s disease: A two-case report","authors":"Yoshimi Nakamura , Kumiko Tanabe , Noritaka Yoshimura , Shinobu Yamaguchi , Yoshinori Kamiya","doi":"10.1016/j.inat.2025.102124","DOIUrl":"10.1016/j.inat.2025.102124","url":null,"abstract":"<div><h3>Background</h3><div>Parkinson’s disease (PD) is characterized by high rates of refractory pain, with >60 % of the patients experiencing lower back and lower limb pain. Although spinal cord stimulation (SCS) has emerged as a promising treatment for PD-related symptoms, previous studies have not specifically documented the onset time of therapeutic effects. However, the temporal dynamics of its effects, particularly with burst stimulation, remain poorly understood.</div></div><div><h3>Case presentation</h3><div>We report two cases of burst stimulation SCS applied at the lower thoracic spine level for the treatment of PD-related lower back pain, lower limb pain, and postural abnormalities. Conventional treatments, including medication and nerve blocks, failed in both patients. The first patient showed significant improvement, with numerical rating scale (NRS) pain scores decreasing from 5 to 1 at rest and 8 to 3 during activity, along with improved sagittal vertical axis measurements (118 mm to 67 mm). The second patient, who had previously undergone deep brain stimulation, demonstrated NRS improvement from 7 to 3 and a marked improvement in cervical anteflexion. Both patients experienced immediate pain relief upon stimulation and rapid symptom recurrence upon deactivation. These improvements were maintained over a two-year follow-up period without requiring increased medication.</div></div><div><h3>Conclusions</h3><div>These cases demonstrate that burst stimulation SCS can provide immediate, reversible pain relief and postural improvement in patients with PD, even after deep brain stimulation. The rapid onset and offset of these effects suggest direct modulation of neural circuits rather than gradual neuroplastic changes, presenting a novel therapeutic mechanism worthy of further investigation.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102124"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050162","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 : 2025-12-01Epub Date: 2025-10-12DOI: 10.1016/j.inat.2025.102138
Yoichiro Kawamura MD, PhD, Patrick Brouwer MD
Mechanical thrombectomy has significantly improved outcomes for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), yet challenges remain, necessitating further advancements. A key factor influencing thrombectomy success is the aspiration catheter-to-vessel size ratio, with larger-diameter aspiration catheters demonstrating superior efficacy. This has led to the development of super large-bore aspiration catheters (SLACs), particularly those with an inner diameter of 0.088 in. or larger, which are expected to enhance thrombus retrieval.
SLACs have the possibility to revolutionize thrombectomy, especially for LVOs in critical arteries such as the internal carotid artery, the M1 segment of the middle cerebral artery. Recent clinical trials have shown highly favorable results, supporting their imminent adoption. With a bore size comparable to balloon guide catheters (BGCs), SLACs improve thrombus ingestion and reduce the risk of clot fragmentation during navigation through tortuous vessels. Additionally, they provide a stable base camp for multiple retrieval attempts, increasing procedural efficiency.
Direct aspiration thrombectomy with SLACs offers advantages such as shorter procedural times, and reduced device usage. As these devices enter clinical practice, they are expected to further refine thrombectomy techniques and improve outcomes for AIS patients.
{"title":"A new era in thrombectomy: the emergence of super large bore aspiration catheters","authors":"Yoichiro Kawamura MD, PhD, Patrick Brouwer MD","doi":"10.1016/j.inat.2025.102138","DOIUrl":"10.1016/j.inat.2025.102138","url":null,"abstract":"<div><div>Mechanical thrombectomy has significantly improved outcomes for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), yet challenges remain, necessitating further advancements. A key factor influencing thrombectomy success is the aspiration catheter-to-vessel size ratio, with larger-diameter aspiration catheters demonstrating superior efficacy. This has led to the development of super large-bore aspiration catheters (SLACs), particularly those with an inner diameter of 0.088 in. or larger, which are expected to enhance thrombus retrieval.</div><div>SLACs have the possibility to revolutionize thrombectomy, especially for LVOs in critical arteries such as the internal carotid artery, the M1 segment of the middle cerebral artery. Recent clinical trials have shown highly favorable results, supporting their imminent adoption. With a bore size comparable to balloon guide catheters (BGCs), SLACs improve thrombus ingestion and reduce the risk of clot fragmentation during navigation through tortuous vessels. Additionally, they provide a stable base camp for multiple retrieval attempts, increasing procedural efficiency.</div><div>Direct aspiration thrombectomy with SLACs offers advantages such as shorter procedural times, and reduced device usage. As these devices enter clinical practice, they are expected to further refine thrombectomy techniques and improve outcomes for AIS patients.</div></div>","PeriodicalId":38138,"journal":{"name":"Interdisciplinary Neurosurgery: Advanced Techniques and Case Management","volume":"42 ","pages":"Article 102138"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325765","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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