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Preoperative planning of craniectomy and reconstruction using three–dimension-printed cranioplasty for treatment of calvarial lesion 利用三维打印颅骨成形术治疗颅骨病变的颅骨切除和重建术前规划
Q3 Medicine Pub Date : 2024-07-12 DOI: 10.25259/sni_250_2024
Md. Rezaul Amin, K. T. Islam, Moududul Haque
Common calvarial lesions include fibrous dysplasia (FD), intraosseous meningioma, osteoma, Langerhans cell histiocytosis (LCH), intraosseous hemangioma, dermoid and epidermoid cyst, and malignancy. Surgical removal with removal of the involved skull is the choice of treatment for these lesions. Previously, the skull defect was repaired using allograft, and alloplastic materials have been replaced with newer polyetheretherketone (PEEK) material, which is more resistant, biocompatible, and can be 3-dimension (3D)--printed. High-resolution 3D printing uses very fine extruders to put materials in fine layers to recreate patients’ anatomy authentically, which gives superior cosmetic outcomes. Our objectives were preoperative planning of craniectomy and reconstruction for calvarial lesions and reconstruction of skull defects using 3D-printed cranioplasty with PEEK materials.In this series, we describe 11 cases in which skull lesions were removed and reconstructed in the same sitting using a 3D-printed PEEK implant designed preoperatively using high-resolution computer tomography. All the cases were done in the neurosurgery department of Bangabandhu Sheikh Mujib Medical University from 2021 to 2023. Patients were followed up for 6 months after surgery.Regarding 11 cases, six cases were FD, three cases were intraosseous meningioma, one case was intraosseous hemangioma, and one case was LCH. Average lesion size were 12.73-5.77 cm. Cranioplasty was done with PEEK material. Minor complications were treated conservatively. Seroma, postoperative fever, and nausea were among these.The human bone-like biocompatibility and resistance to physical forces leads to more frequent use of PEEK, which enables to repair of complex craniofacial defects with better cosmesis. Despite some limitations, the PEEK cranioplasty implant continued to thrive and showed its promise to be an excellent material. Further, research and investment should be put into developing the technique.
常见的颅骨病变包括纤维发育不良(FD)、骨内脑膜瘤、骨瘤、朗格汉斯细胞组织细胞增生症(LCH)、骨内血管瘤、皮样囊肿和表皮样囊肿以及恶性肿瘤。手术切除受累颅骨是治疗这些病变的首选方法。以前,颅骨缺损使用异体移植进行修复,现在异体材料已被更新的聚醚醚酮(PEEK)材料取代,这种材料更耐磨、生物相容性更好,而且可以进行三维(3D)打印。高分辨率三维打印使用非常精细的挤出机将材料分层打印,以真实再现患者的解剖结构,从而达到更佳的美容效果。我们的目标是术前规划颅骨切除和颅骨钙化病变的重建,以及使用3D打印的PEEK材料颅骨成形术重建颅骨缺损。所有病例均于 2021 年至 2023 年在班加班杜谢赫-穆吉布医科大学神经外科完成。11例患者中,6例为FD,3例为骨内脑膜瘤,1例为骨内血管瘤,1例为LCH。病灶平均大小为 12.73-5.77 厘米。使用PEEK材料进行了颅骨成形术。对轻微并发症采取了保守治疗。PEEK材料具有与人体骨骼相似的生物相容性和抗物理力的能力,因此被越来越多地用于修复复杂的颅面缺损,并具有更好的外观效果。尽管存在一些局限性,但 PEEK 颅骨成形术植入体仍在不断发展壮大,并有望成为一种优秀的材料。应进一步研究和投资开发这种技术。
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引用次数: 0
Non-granulomatous meningoencephalitis with Balamuthia mandrillaris mimicking a tumor: First confirmed case from Pakistan 模仿肿瘤的山魈巴拉姆瘤非肉芽肿性脑膜脑炎:巴基斯坦首例确诊病例
Q3 Medicine Pub Date : 2024-07-12 DOI: 10.25259/sni_181_2024
Zanibb Javed, Mustafa Mushtaq Hussain, Najia Ghanchi, Ahmed Gilani, S. Enam
Free-living amoebae rarely instigate intracranial infections that may resemble neoplastic conditions on imaging. Naegleria fowleri precipitates an acute, swiftly fatal meningoencephalitis, whereas Acanthamoeba and Balamuthia species typically manifest with a less aggressive onset but carry equally dire consequences.The case describes a 33-year-old woman with subacute encephalitis caused by Balamuthia mandrillaris. She experienced 2 months of back pain, 1 month of headaches, and 2 weeks of vomiting without fever, recent travel, aquatic activities, or animal exposure. Brain magnetic resonance imaging revealed a sizable, heterogeneous enhancing mass in the right temporal and frontal lobes, accompanied by vasogenic edema and midline shift. Histopathology showed marked inflammation and damage to blood vessels with amoebic trophozoites present. The trophozoites displayed specific characteristics, leading to the diagnosis of amoebic meningoencephalitis. Polymerase chain reaction and Sanger sequencing confirmed B. mandrillaris infection while testing for N. fowleri and Acanthamoeba was negative. Despite antibiotic treatment, the patient’s condition deteriorated rapidly, resulting in death within 2 weeks of presentation.This is the first confirmed case of B. mandrillaris central nervous system (CNS) infection from Pakistan. The incidence of this disease is expected to rise due to increasing temperatures due to climate change and the deteriorating quality of the water supply. Balamuthia meningoencephalitis should, therefore be on the differential for non-neoplastic CNS lesions. Furthermore, an atypical histopathologic picture, including the absence of granulomatous inflammation, needs to be recognized.
自由生活的阿米巴原虫很少引发颅内感染,在影像学上可能类似于肿瘤性疾病。瑙格勒氏阿米巴原虫会引发急性、迅速致命的脑膜脑炎,而棘阿米巴原虫和巴拉穆氏阿米巴原虫通常起病较轻,但后果同样严重。她经历了 2 个月的背痛、1 个月的头痛和 2 周的呕吐,但没有发烧、近期旅行、水上活动或动物接触。脑磁共振成像显示,右侧颞叶和额叶有一个相当大的异质强化肿块,伴有血管源性水肿和中线移位。组织病理学显示,血管有明显的炎症和损伤,并伴有阿米巴滋养体。滋养体显示出特殊的特征,因此被诊断为阿米巴脑膜脑炎。聚合酶链式反应和桑格测序证实了曼迪拉氏阿米巴原虫感染,而福氏阿米巴原虫和棘阿米巴原虫的检测结果均为阴性。尽管接受了抗生素治疗,但患者的病情迅速恶化,最终在发病后两周内死亡。这是巴基斯坦首例确诊的山魈鲍曼中枢神经系统(CNS)感染病例。由于气候变化导致气温升高,加上水源质量不断恶化,预计这种疾病的发病率还会上升。因此,Balamuthia 脑膜脑炎应与非肿瘤性中枢神经系统病变相鉴别。此外,还需要认识到非典型的组织病理学表现,包括没有肉芽肿性炎症。
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引用次数: 0
Retrospective analysis of the outcomes of endoscopic transsphenoidal surgery for Cushing’s disease 内窥镜经蝶窦手术治疗库欣氏病疗效的回顾性分析
Q3 Medicine Pub Date : 2024-07-12 DOI: 10.25259/sni_278_2024
Anurag Srivastava, Anmol Anant Dobriyal, Anmol Singh Randhawa, Pavan Kumar Jain, Shiteez Agrawal, Jitendra Singh Verma, Pankaj Gupta, Bhawani Shanker Sharma, Yogesh Agrawal, Medha Bhardwaj
The first-line surgical management of an adrenocorticotropic hormone (ACTH)--secreting pituitary adenoma causing Cushing’s disease (CD) is endoscopic transsphenoidal resection of the tumor. This study was performed to assess postoperative (postop) complications and remission in endoscopic surgically resected cases of CD.Data of patients who underwent endoscopic transsphenoidal surgery (ETSS) for CD were collected from the neurosurgery department at a tertiary care center in a retrospective manner from January 2015 to February 2022 and analyzed. Postoperative remission was categorized as – early morning serum cortisol <138 nmol/L within 7 days of the surgery, as per the Endocrine Society Guidelines, with significant clinical improvement in features of hypercortisolism in the operated patient and strict cutoff rate of <50 nmol/L at postop day 3 was also utilized, to look for the early identification of remission.A total of 41 patients were identified who underwent 44 ETSS during the same timeframe. Preoperative magnetic resonance imaging localized an adenoma in all 41 patients, out of which 32 were microadenoma, and nine were macroadenoma (2 with cavernous sinus invasion). Intrapetrosal sinus sampling was performed in 35 (85%) patients. The rate of remission for the initial surgery was 85.4% using the standard criteria and 68.3% using strict criteria. Three patients underwent early repeat surgery for the persistent disease as the day 3 cortisol was high (306–555 nmol/L). Once the outcome of this surgery was also included, the overall rate of remission was 90.2% (37/41). None of the patients had meningitis, cerebrospinal fluid leakage, visual deterioration, or vascular injury. Permanent and transient diabetes insipidus (DI) occurred in 9.75% and 26.8% following the first ETSS, respectively. We also noted a single case of CD recurrence in 9 months during the total follow-up period of 84 months.ETSS has satisfactory rates of remission for the primary treatment of CD, with rates being higher for microadenomas. A long follow-up period is needed to assess the rates of recurrence. Patients must be counseled regarding the risk of postop DI, whether transient or permanent, as a possible complication.
分泌促肾上腺皮质激素(ACTH)的垂体腺瘤导致库欣病(CD)的一线手术治疗方法是内镜下经蝶窦切除肿瘤。这项研究旨在评估内镜手术切除的CD病例的术后并发症和缓解情况。研究人员以回顾性方式收集了2015年1月至2022年2月期间某三级医疗中心神经外科接受内镜经蝶手术(ETSS)治疗CD的患者数据,并对其进行了分析。根据内分泌学会指南,术后缓解被归类为--术后7天内清晨血清皮质醇<138 nmol/L,且手术患者高皮质醇血症的临床特征明显改善,同时还采用术后第3天血清皮质醇<50 nmol/L的严格临界值,以寻找缓解的早期识别。术前磁共振成像确定了所有 41 例患者的腺瘤位置,其中 32 例为微腺瘤,9 例为大腺瘤(2 例伴有海绵窦侵犯)。35名患者(85%)进行了海绵窦内取样。根据标准标准,初次手术的缓解率为 85.4%,根据严格标准,缓解率为 68.3%。有三名患者由于第 3 天皮质醇偏高(306-555 nmol/L)而再次接受了早期手术。如果将这次手术的结果也计算在内,总缓解率为 90.2%(37/41)。没有一名患者出现脑膜炎、脑脊液漏、视力恶化或血管损伤。首次 ETSS 后,分别有 9.75% 和 26.8% 的患者出现永久性和一过性糖尿病(DI)。我们还注意到,在总计 84 个月的随访期中,有一例 CD 病例在 9 个月后复发。ETSS 对 CD 的初级治疗具有令人满意的缓解率,微腺瘤的缓解率更高。要评估复发率,需要长时间的随访。必须告知患者术后DI的风险,无论是暂时性还是永久性的,这都是可能出现的并发症。
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引用次数: 0
Patients with meningioma hemorrhage should undergo an autopsy if they die from it despite successful surgery 脑膜瘤出血患者如果在手术成功后死亡,应进行尸检
Q3 Medicine Pub Date : 2024-07-12 DOI: 10.25259/sni_413_2024
Josef Finsterer
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引用次数: 0
Expanded endoscopic endonasal approach for resection of residual parasellar growth hormone-secreting pituitary adenoma in a patient with kissing internal carotid arteries: Technical nuances 在一名颈内动脉吻合患者身上采用扩大内窥镜鼻内入路切除残留的蝶鞍旁分泌生长激素的垂体腺瘤:技术细节
Q3 Medicine Pub Date : 2024-07-12 DOI: 10.25259/sni_292_2024
Mustafa Motiwala, P. Gimenez, M. W. Baqai, Jahangir Sajjad, Faisal Hasan, Karin Bradley, Alison Evans, Adam Williams, Warren Bennett, Kumar Abhinav
Growth hormone (GH)--secreting pituitary adenomas can be aggressive and difficult to manage. Surgical resection for GH-secreting tumors remains the gold standard with increasing use of expanded endoscopic endonasal (EEA) techniques. Certain anatomical considerations make postsurgical biochemical remission challenging.We describe the case of a 43-year-old male presenting with acromegaly after a lack of biochemical remission from a previous surgery. Resection of the residual tumor invading the retrogenu compartment of the cavernous sinus was challenging for several reasons: (a) its location adjacent to the right parasellar horizontal internal carotid artery (ICA) with involvement of the medial wall, (b) the large kissing bilateral ICAs reducing the intercarotid distance, and (c) potential scar tissue. EEA was undertaken with key surgical steps, including wide bilateral sphenoidotomies, right middle clinoidectomy to access the clinoidal ICA and the retrogenu compartment, identification of the top of the paraclival ICA by drilling across the sella floor, division of the sellar floor dura to increase the intercarotid distance and transcavernous mobilization of medial wall, and the tumor capsule away from the horizontal parasellar ICA and across to the diaphragm and pituitary gland. Postoperatively, biochemical remission was achieved with no new endocrine deficits.These surgical nuances permit biochemical remission in complex revisional cases with acromegaly.
分泌生长激素(GH)的垂体腺瘤可能具有侵袭性且难以控制。手术切除分泌 GH 的肿瘤仍是金标准,但扩大内窥镜鼻内镜(EEA)技术的使用越来越多。我们描述了一例 43 岁男性肢端肥大症患者的病例,该患者在前一次手术后生化缓解不明显。由于以下几个原因,切除侵犯海绵窦后区的残余肿瘤具有挑战性:(a)肿瘤位置毗邻右侧髌下水平颈内动脉(ICA),内侧壁受累;(b)双侧ICA吻合较大,缩短了颈动脉间的距离;(c)潜在的瘢痕组织。EEA手术的关键步骤包括:双侧蝶窦大范围切除术、右侧蝶窦中段切除术以进入蝶窦ICA和蝶窦后室、通过钻孔穿过蝶窦底确定蝶窦旁ICA的顶部、分割蝶窦底硬脑膜以增加颈动脉间距、经腹腔移动内侧壁、肿瘤囊远离水平蝶窦旁ICA并穿过膈肌和垂体。术后,患者的生化指标得到了缓解,且未出现新的内分泌功能障碍。
{"title":"Expanded endoscopic endonasal approach for resection of residual parasellar growth hormone-secreting pituitary adenoma in a patient with kissing internal carotid arteries: Technical nuances","authors":"Mustafa Motiwala, P. Gimenez, M. W. Baqai, Jahangir Sajjad, Faisal Hasan, Karin Bradley, Alison Evans, Adam Williams, Warren Bennett, Kumar Abhinav","doi":"10.25259/sni_292_2024","DOIUrl":"https://doi.org/10.25259/sni_292_2024","url":null,"abstract":"\u0000\u0000Growth hormone (GH)--secreting pituitary adenomas can be aggressive and difficult to manage. Surgical resection for GH-secreting tumors remains the gold standard with increasing use of expanded endoscopic endonasal (EEA) techniques. Certain anatomical considerations make postsurgical biochemical remission challenging.\u0000\u0000\u0000\u0000We describe the case of a 43-year-old male presenting with acromegaly after a lack of biochemical remission from a previous surgery. Resection of the residual tumor invading the retrogenu compartment of the cavernous sinus was challenging for several reasons: (a) its location adjacent to the right parasellar horizontal internal carotid artery (ICA) with involvement of the medial wall, (b) the large kissing bilateral ICAs reducing the intercarotid distance, and (c) potential scar tissue. EEA was undertaken with key surgical steps, including wide bilateral sphenoidotomies, right middle clinoidectomy to access the clinoidal ICA and the retrogenu compartment, identification of the top of the paraclival ICA by drilling across the sella floor, division of the sellar floor dura to increase the intercarotid distance and transcavernous mobilization of medial wall, and the tumor capsule away from the horizontal parasellar ICA and across to the diaphragm and pituitary gland. Postoperatively, biochemical remission was achieved with no new endocrine deficits.\u0000\u0000\u0000\u0000These surgical nuances permit biochemical remission in complex revisional cases with acromegaly.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"76 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653274","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}
引用次数: 0
Cauda equina syndrome due to posttraumatic syringomyelia in conus medullaris – A case report 髓内圆锥部外伤后鞘膜积液导致的马尾综合征 - 病例报告
Q3 Medicine Pub Date : 2024-07-12 DOI: 10.25259/sni_386_2024
Shu Ueda, Shusuke Yamamoto, Yuichiro Koga, Satoshi Kuroda
Most posttraumatic syringomyelias occur in the cervical or thoracic spinal cord, where they contribute to myelopathic deficits. Here, a 40-year-old patient presented with the left leg monoparesis due to syringomyelia involving the conus medullaris 10 years after an L2 vertebral “crush” fracture.Ten years following an L2 vertebral “crush” fracture, a 40-year-old male presented with the new onset of left lower leg paresis. The magnetic resonance imaging showed a T12–L1 syrinx associated with accompanying high-intensity areas above the syrinx located between the T11 and T12 levels. One month after placing a syringosubarachnoid (SS) shunt, both the syrinx and high-intensity area rapidly disappeared, and the left distal motor weakness resolved.Ten years following an L2 “crush” fracture, a 40-year-old male presented with the new onset of a cauda equina syndrome secondary to a posttraumatic T12–L1 syringomyelia causing expansion of the conus medullaris.
大多数外伤后鞘膜积液发生在颈椎或胸椎脊髓,导致脊髓病变。在这里,一名 40 岁的患者在 L2 椎体 "粉碎性 "骨折 10 年后,因髓内锥体受累而出现左腿单瘫。磁共振成像显示,T12-L1鞘膜积液伴有位于 T11 和 T12 水平之间鞘膜积液上方的高强度区。在放置鞘膜下蛛网膜(SS)分流术一个月后,鞘膜瘤和高强度区迅速消失,左侧远端运动无力症状也得到缓解。在发生 L2 "粉碎性 "骨折 10 年后,一名 40 岁的男性因外伤后 T12-L1 鞘膜瘤导致髓尾扩张而新发马尾综合征。
{"title":"Cauda equina syndrome due to posttraumatic syringomyelia in conus medullaris – A case report","authors":"Shu Ueda, Shusuke Yamamoto, Yuichiro Koga, Satoshi Kuroda","doi":"10.25259/sni_386_2024","DOIUrl":"https://doi.org/10.25259/sni_386_2024","url":null,"abstract":"\u0000\u0000Most posttraumatic syringomyelias occur in the cervical or thoracic spinal cord, where they contribute to myelopathic deficits. Here, a 40-year-old patient presented with the left leg monoparesis due to syringomyelia involving the conus medullaris 10 years after an L2 vertebral “crush” fracture.\u0000\u0000\u0000\u0000Ten years following an L2 vertebral “crush” fracture, a 40-year-old male presented with the new onset of left lower leg paresis. The magnetic resonance imaging showed a T12–L1 syrinx associated with accompanying high-intensity areas above the syrinx located between the T11 and T12 levels. One month after placing a syringosubarachnoid (SS) shunt, both the syrinx and high-intensity area rapidly disappeared, and the left distal motor weakness resolved.\u0000\u0000\u0000\u0000Ten years following an L2 “crush” fracture, a 40-year-old male presented with the new onset of a cauda equina syndrome secondary to a posttraumatic T12–L1 syringomyelia causing expansion of the conus medullaris.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"21 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141652254","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}
引用次数: 0
Microsurgery resection of giant cervicothoracic spinal ependymoma: Two-dimensional operative video 巨型颈胸椎上皮瘤显微手术切除术:二维手术视频
Q3 Medicine Pub Date : 2024-07-12 DOI: 10.25259/sni_317_2024
Ahmed Habib, Hansen Deng, N. F. Hameed, Scott Kulich, Pascal Zinn
Ependymomas, rare glial brain tumors, account for <5% of all brain tumors. Interestingly, over 60% of ependymomas occur in the spinal cord of adults, including those originating from the filum terminale, while the rest are found within the brain. The World Health Organization (WHO) categorizes ependymomas into three grades: subependymomas and myxopapillary ependymomas ([MEPNs]; WHO grade I), classic ependymomas (WHO grade II), and anaplastic ependymomas (WHO grade III). Spinal ependymomas generally exhibit a more favorable prognosis compared to their intracranial counterparts and are primarily treated through gross total resection, which is considered the most effective surgical approach. As such, they are recognized as a distinct clinical entity that demands tailored management strategies. MEPNs, which constitute 13% of ependymomas, typically occur in the cauda equina and sometimes extend into the conus medullaris. Most other spinal ependymomas are of the classic type and predominantly arise in the cervical and thoracic regions of the spine. The mean age at diagnosis is 45 years of age. While prognosis varies based on molecular subtypes, complete resection is associated with improved survival.Here, we demonstrate the technical nuances to safely achieve gross total resection of a giant spinal ependymoma in a 29-year-old female with a medical history notable for sept-optic dysplasia, and panhypopituitarism. The patient presented with progressive neck pain, upper and lower extremity weakness, and numbness for 1 year. On physical examination, she demonstrated mild weakness in her left arm. The preoperative magnetic resonance imaging revealed a cervicothoracic intramedullary mass extending from C4 to T2 with an associated syrinx at C4. Under intraoperative neural monitoring (somatosensory evoked potentials, motor-evoked potentials, and epidural direct wave recordings), the patient underwent a C4 – T2 laminectomy. In addition, spinal ultrasonography helped differentiate solid tumor mass from syrinx formation, thus guiding the focus and extent of the decompression .Gross total resection was achieved; at 18 postoperative months, the patient had mild residual motor deficit. The pathological evaluation revealed a WHO grade II ependymoma. Subsequent sequential enhanced MR studies at 3, 6, and 12 months confirmed no tumor recurrence.
附肢瘤是一种罕见的胶质脑肿瘤,占所有脑肿瘤的5%以下。有趣的是,超过 60% 的附肢瘤发生在成人的脊髓中,包括那些起源于终丝的肿瘤,而其余的则发生在大脑中。世界卫生组织(WHO)将附殖瘤分为三个等级:亚独立瘤和肌乳头状附肢瘤([MEPNs];WHO I 级)、典型附肢瘤(WHO II 级)以及无弹性附肢瘤(WHO III 级)。脊柱上皮瘤的预后一般比颅内上皮瘤好,主要通过全切除术治疗,这被认为是最有效的手术方法。因此,它们被认为是一种独特的临床实体,需要量身定制的治疗策略。脊髓内皮瘤占脊髓外皮瘤的 13%,通常发生在马尾,有时会扩展到延髓。其他大多数脊柱外皮瘤属于典型类型,主要发生在颈椎和胸椎部位。确诊时的平均年龄为 45 岁。虽然预后因分子亚型而异,但完全切除与生存率的提高有关。在此,我们展示了在一名29岁女性患者身上安全实现巨大脊柱外胚瘤大体全切除的细微技术差别,该患者的病史有明显的视神经隔发育不良和泛垂体功能障碍。患者出现进行性颈部疼痛、上下肢无力和麻木已有一年。体格检查显示,她的左臂轻度无力。术前磁共振成像显示,颈胸椎髓内肿块从C4延伸至T2,C4处伴有鞘膜积液。在术中神经监测(体感诱发电位、运动诱发电位和硬膜外直接波记录)下,患者接受了 C4 - T2 椎板切除术。此外,脊柱超声波检查有助于区分实性肿瘤肿块和鞘膜积液,从而指导减压的重点和范围。 术后 18 个月,患者出现轻度残余运动障碍。病理评估显示为 WHO II 级上皮瘤。随后在 3 个月、6 个月和 12 个月进行的连续增强磁共振检查证实肿瘤没有复发。
{"title":"Microsurgery resection of giant cervicothoracic spinal ependymoma: Two-dimensional operative video","authors":"Ahmed Habib, Hansen Deng, N. F. Hameed, Scott Kulich, Pascal Zinn","doi":"10.25259/sni_317_2024","DOIUrl":"https://doi.org/10.25259/sni_317_2024","url":null,"abstract":"\u0000\u0000Ependymomas, rare glial brain tumors, account for <5% of all brain tumors. Interestingly, over 60% of ependymomas occur in the spinal cord of adults, including those originating from the filum terminale, while the rest are found within the brain. The World Health Organization (WHO) categorizes ependymomas into three grades: subependymomas and myxopapillary ependymomas ([MEPNs]; WHO grade I), classic ependymomas (WHO grade II), and anaplastic ependymomas (WHO grade III). Spinal ependymomas generally exhibit a more favorable prognosis compared to their intracranial counterparts and are primarily treated through gross total resection, which is considered the most effective surgical approach. As such, they are recognized as a distinct clinical entity that demands tailored management strategies. MEPNs, which constitute 13% of ependymomas, typically occur in the cauda equina and sometimes extend into the conus medullaris. Most other spinal ependymomas are of the classic type and predominantly arise in the cervical and thoracic regions of the spine. The mean age at diagnosis is 45 years of age. While prognosis varies based on molecular subtypes, complete resection is associated with improved survival.\u0000\u0000\u0000\u0000Here, we demonstrate the technical nuances to safely achieve gross total resection of a giant spinal ependymoma in a 29-year-old female with a medical history notable for sept-optic dysplasia, and panhypopituitarism. The patient presented with progressive neck pain, upper and lower extremity weakness, and numbness for 1 year. On physical examination, she demonstrated mild weakness in her left arm. The preoperative magnetic resonance imaging revealed a cervicothoracic intramedullary mass extending from C4 to T2 with an associated syrinx at C4. Under intraoperative neural monitoring (somatosensory evoked potentials, motor-evoked potentials, and epidural direct wave recordings), the patient underwent a C4 – T2 laminectomy. In addition, spinal ultrasonography helped differentiate solid tumor mass from syrinx formation, thus guiding the focus and extent of the decompression .\u0000\u0000\u0000\u0000Gross total resection was achieved; at 18 postoperative months, the patient had mild residual motor deficit. The pathological evaluation revealed a WHO grade II ependymoma. Subsequent sequential enhanced MR studies at 3, 6, and 12 months confirmed no tumor recurrence.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"31 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653608","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}
引用次数: 0
Simultaneous sampling of both cingulate gyri using a single interhemispheric depth electrode: A technical note 使用单个大脑半球间深度电极同时对两个扣带回采样技术说明
Q3 Medicine Pub Date : 2024-07-12 DOI: 10.25259/sni_946_2023
Sahar Farhat, Jawad M. Melhem, Houssein Darwish, Shadi Bsat, Sarah Kawtharani, Hiba Fadlallah, Marwan Najjar, Ahmad Beydoun
Simultaneous sampling of the cingulate gyri through a single depth electrode inserted underneath the falx cerebri is clinically useful in certain cases of drug-resistant epilepsy. However, the frequency at which each region of the cingulate gyri – namely, anterior, middle, and posterior – can be simultaneously sampled with a single electrode remains uncertain.We assessed the anatomical relationship between the falx cerebri and the cingulate gyrus in 50 adults and children. Subsequently, we determined whether an arbitrary line, denoted as A (representing a 5 mm gap between the falx cerebri and corpus callosum necessary for depth electrode insertion), fell within the anterior, middle, or posterior cingulate gyrus.The shape of the falx cerebri and its intersection point with the corpus callosum varied substantially across individuals, with a significant difference between children and adults (P = 0.02). The A line was located in the middle cingulate gyrus in 18 children (72%), while 3 (12%) and 4 (16%) had it located in the posterior and anterior cingulate gyrus, respectively. Among adults, 15 individuals (60%) had the A line in the middle cingulate gyrus, 10 (40%) in the posterior cingulate gyrus, and none in the anterior cingulate gyrus.This study demonstrates the feasibility of simultaneous sampling of both the anterior and middle cingulate gyri in adults and children. Moreover, it represents the first investigation to document the wide interindividual variability in the morphology of the falx cerebri and its association with the cingulate gyrus.
通过插入大脑镰下方的单个深度电极对扣带回进行同时取样在某些耐药性癫痫的临床治疗中非常有用。我们评估了 50 名成人和儿童的大脑镰与扣带回之间的解剖关系。随后,我们确定了一条任意线(表示大脑镰与胼胝体之间 5 毫米的间隙,是深度电极插入所必需的)是位于扣带回的前部、中部还是后部,并将其命名为 A 线(表示大脑镰与胼胝体之间 5 毫米的间隙,是深度电极插入所必需的)。18 名儿童(72%)的 A 线位于扣带回中部,3 名(12%)和 4 名(16%)分别位于扣带回后部和前部。在成人中,15 人(60%)的 A 线位于扣带回中部,10 人(40%)位于扣带回后部,没有人位于扣带回前部。此外,它还是首次记录大脑镰形态及其与扣带回关联的个体间差异的研究。
{"title":"Simultaneous sampling of both cingulate gyri using a single interhemispheric depth electrode: A technical note","authors":"Sahar Farhat, Jawad M. Melhem, Houssein Darwish, Shadi Bsat, Sarah Kawtharani, Hiba Fadlallah, Marwan Najjar, Ahmad Beydoun","doi":"10.25259/sni_946_2023","DOIUrl":"https://doi.org/10.25259/sni_946_2023","url":null,"abstract":"\u0000\u0000Simultaneous sampling of the cingulate gyri through a single depth electrode inserted underneath the falx cerebri is clinically useful in certain cases of drug-resistant epilepsy. However, the frequency at which each region of the cingulate gyri – namely, anterior, middle, and posterior – can be simultaneously sampled with a single electrode remains uncertain.\u0000\u0000\u0000\u0000We assessed the anatomical relationship between the falx cerebri and the cingulate gyrus in 50 adults and children. Subsequently, we determined whether an arbitrary line, denoted as A (representing a 5 mm gap between the falx cerebri and corpus callosum necessary for depth electrode insertion), fell within the anterior, middle, or posterior cingulate gyrus.\u0000\u0000\u0000\u0000The shape of the falx cerebri and its intersection point with the corpus callosum varied substantially across individuals, with a significant difference between children and adults (P = 0.02). The A line was located in the middle cingulate gyrus in 18 children (72%), while 3 (12%) and 4 (16%) had it located in the posterior and anterior cingulate gyrus, respectively. Among adults, 15 individuals (60%) had the A line in the middle cingulate gyrus, 10 (40%) in the posterior cingulate gyrus, and none in the anterior cingulate gyrus.\u0000\u0000\u0000\u0000This study demonstrates the feasibility of simultaneous sampling of both the anterior and middle cingulate gyri in adults and children. Moreover, it represents the first investigation to document the wide interindividual variability in the morphology of the falx cerebri and its association with the cingulate gyrus.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"51 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141654815","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}
引用次数: 0
Successful stent-assisted coil embolization for a recurrent distal posterior inferior cerebellar artery aneurysm: A case presentation 支架辅助线圈栓塞治疗复发性远端小脑后下动脉动脉瘤获得成功:病例介绍
Q3 Medicine Pub Date : 2024-07-05 DOI: 10.25259/sni_334_2024
Shimpei Tsuboki, Yukihiro Imaoka, T. Todaka
Distal posterior inferior cerebellar artery (PICA) aneurysms are exceedingly rare intracranial aneurysms. In the acute phase of rupture, interventions commonly involve parent artery occlusion through endovascular treatment or direct trapping surgery. There is no consensus on the best treatment of chronic ruptured or unruptured aneurysms, and stent-assisted coil embolization has not yet been reported in the chronic phase of rupture.We present a case of a 46-year-old female with a recurrent distal PICA aneurysm at 18 months following the initial treatment for subarachnoid hemorrhage and was treated by stent-assisted coil embolization with Neuroform Atlas (Stryker, USA), with a favorable outcome.Distal PICA aneurysms occur at the apical curvature, where primitive arterial anastomoses existed during development, pointing to the potential vulnerability of the vessel wall at these sites. Stent-assisted coil embolization has shown effectiveness in preserving the parent artery for chronic ruptured and unruptured distal PICA aneurysms. Nonetheless, the narrowness and tortuosity of the PICA present obstacles to treatment. In our case, the procedure was feasible utilizing the Neuroform Atlas (Stryker, USA) with the Transcell approach. A thorough grasp of the characteristics of stents and their application is pivotal for achieving effective treatment outcomes.
小脑后下动脉(PICA)远端动脉瘤是极其罕见的颅内动脉瘤。在动脉瘤破裂的急性期,干预措施通常包括通过血管内治疗或直接诱导手术进行母动脉闭塞。我们报告了一例 46 岁女性的病例,她在初次治疗蛛网膜下腔出血 18 个月后复发了远端 PICA 动脉瘤,采用 Neuroform Atlas(美国史赛克公司)支架辅助线圈栓塞治疗,结果良好。远端 PICA 动脉瘤发生在顶端弧度处,在发育过程中存在原始动脉吻合处,这表明这些部位的血管壁可能很脆弱。支架辅助线圈栓塞术在保留慢性破裂和未破裂的 PICA 远端动脉瘤的母动脉方面显示出了有效性。然而,PICA 的狭窄和迂曲给治疗带来了障碍。在我们的病例中,利用 Neuroform Atlas(美国史赛克公司)的 Transcell 方法进行手术是可行的。全面掌握支架的特性及其应用是取得有效治疗效果的关键。
{"title":"Successful stent-assisted coil embolization for a recurrent distal posterior inferior cerebellar artery aneurysm: A case presentation","authors":"Shimpei Tsuboki, Yukihiro Imaoka, T. Todaka","doi":"10.25259/sni_334_2024","DOIUrl":"https://doi.org/10.25259/sni_334_2024","url":null,"abstract":"\u0000\u0000Distal posterior inferior cerebellar artery (PICA) aneurysms are exceedingly rare intracranial aneurysms. In the acute phase of rupture, interventions commonly involve parent artery occlusion through endovascular treatment or direct trapping surgery. There is no consensus on the best treatment of chronic ruptured or unruptured aneurysms, and stent-assisted coil embolization has not yet been reported in the chronic phase of rupture.\u0000\u0000\u0000\u0000We present a case of a 46-year-old female with a recurrent distal PICA aneurysm at 18 months following the initial treatment for subarachnoid hemorrhage and was treated by stent-assisted coil embolization with Neuroform Atlas (Stryker, USA), with a favorable outcome.\u0000\u0000\u0000\u0000Distal PICA aneurysms occur at the apical curvature, where primitive arterial anastomoses existed during development, pointing to the potential vulnerability of the vessel wall at these sites. Stent-assisted coil embolization has shown effectiveness in preserving the parent artery for chronic ruptured and unruptured distal PICA aneurysms. Nonetheless, the narrowness and tortuosity of the PICA present obstacles to treatment. In our case, the procedure was feasible utilizing the Neuroform Atlas (Stryker, USA) with the Transcell approach. A thorough grasp of the characteristics of stents and their application is pivotal for achieving effective treatment outcomes.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141676094","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}
引用次数: 0
Intraoperative goal-directed fluid therapy in neurosurgical patients: A systematic review 神经外科患者的术中目标导向液体疗法:系统综述
Q3 Medicine Pub Date : 2024-07-05 DOI: 10.25259/sni_412_2024
Chayanika Kutum, Prashant Lakhe, Niraj Ghimire, A. Bc, Uzma Begum, Karandeep Singh
Perioperative fluid management is critical in neurosurgery as over perfusion can lead to brain edema whereas under perfusion may lead to brain hypoperfusion or ischemia. We aimed to determine the effectiveness of intraoperative goal-directed fluid therapy (GDFT) in patients undergoing intracranial surgeries.We searched MEDLINE, Cochrane, and PubMed databases and forward-backward citations for studies published between database inception and February 22, 2024. Randomized controlled trials where intraoperative GDFT was performed in neurosurgery and compared to the conventional regime were included in the study. GDFT was compared with the conventional regime as per primary outcomes – total intraoperative fluid requirement, serum lactate, hemodynamics, brain relaxation, urine output, serum biochemistry, and secondary outcomes – intensive care unit and hospital length of stay. The quality of evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO (CRD42024518816).Of 75 records identified, eight were eligible, the majority of which had a low to moderate risk of overall bias. In four studies, more fluid was given in the control group. No difference in postoperative lactate values was noted in 50% of studies. In the remaining 50%, lactate was more in the control group. Three out of four studies did not find any significant difference in the incidence of intraoperative hypotension, and four out of six studies did not find a significant difference in vasopressor requirement. The majority of studies did not show significant differences in urine output, brain relaxation, and length of stay between both groups. None found any difference in acid base status or electrolyte levels.GDFT, when compared to the conventional regime in neurosurgery, showed that the total volume of fluids administered was lesser in the GDFT group with no increase in serum lactate. There was no difference in the hemodynamics, urine output, brain relaxation, urine output, length of stay, and biochemical parameters.
围手术期液体管理在神经外科手术中至关重要,因为过度灌注会导致脑水肿,而灌注不足则可能导致脑灌注不足或缺血。我们检索了MEDLINE、Cochrane和PubMed数据库,并向前向后引证了从数据库建立到2024年2月22日期间发表的研究。研究纳入了在神经外科术中实施 GDFT 并与传统方法进行比较的随机对照试验。GDFT与传统方法的比较主要结果为术中液体总需求量、血清乳酸、血液动力学、脑松弛、尿量、血清生化,次要结果为重症监护室和住院时间。证据质量采用 Cochrane 偏倚风险工具进行评估。本研究已在 PROSPERO(CRD42024518816)上注册。在确定的 75 条记录中,有 8 条符合条件,其中大部分的总体偏倚风险为低至中度。在四项研究中,对照组给予了更多的液体。50%的研究未发现术后乳酸值有差异。在其余 50%的研究中,对照组的乳酸值更高。四项研究中有三项未发现术中低血压发生率有显著差异,六项研究中有四项未发现血管加压剂需求量有显著差异。大多数研究显示,两组患者的尿量、脑松弛程度和住院时间没有明显差异。GDFT 与神经外科的传统疗法相比,GDFT 组的输液总量较少,但血清乳酸没有增加。血液动力学、尿量、脑松弛、尿量、住院时间和生化指标均无差异。
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Surgical Neurology International
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