Ryo Aiura, Eisuke Hirose, Marina Hirato, Arisa Umesaki, S. Nakayama, T. Tsumoto
Dural arteriovenous fistulas (AVFs) are reportedly induced by trauma. We report a rare case of traumatic AVF with a direct shunt from the middle meningeal artery (MMA) to the middle meningeal vein (MMV) and multiple drainage routes after head trauma. The patient was effectively treated with selective coil embolization alone without liquid embolic material. A 56-year-old woman was admitted to the emergency department with mild disturbance of consciousness caused by a head contusion after alcohol consumption. She exhibited impaired consciousness with a Glasgow coma scale score of 14 (E4V4M6), complained of headache, and presented with a hemorrhage in the left ear. Computed tomography suggested a skull fracture and cerebral hemorrhage. Magnetic resonance imaging conducted on the 4th day after the injury indicated shunt disease with a feeder in the right MMA. Cerebral angiography on the 7th day suggested a direct shunt from the right MMA to the MMV aligned with the temporal bone fracture line, with multiple drainage route perfusion. Coil embolization was performed on the 14th day to occlude the shunt point selectively. In the final image, the MMA was absent, and the MMV, superior sagittal sinus, or pterygoid plexus was not visible through the shunt. Her symptoms improved, and she was discharged on the 20th day and did not exhibit recurrence at the 1-year follow-up. AVF with a direct shunt from the MMA to MMV after head trauma can be effectively and safely treated with coil embolization alone, despite the need for long-term postoperative follow-up.
{"title":"Traumatic arteriovenous fistula of the middle meningeal artery treated with selective coil embolization: A case report","authors":"Ryo Aiura, Eisuke Hirose, Marina Hirato, Arisa Umesaki, S. Nakayama, T. Tsumoto","doi":"10.25259/sni_19_2024","DOIUrl":"https://doi.org/10.25259/sni_19_2024","url":null,"abstract":"\u0000\u0000Dural arteriovenous fistulas (AVFs) are reportedly induced by trauma. We report a rare case of traumatic AVF with a direct shunt from the middle meningeal artery (MMA) to the middle meningeal vein (MMV) and multiple drainage routes after head trauma. The patient was effectively treated with selective coil embolization alone without liquid embolic material.\u0000\u0000\u0000\u0000A 56-year-old woman was admitted to the emergency department with mild disturbance of consciousness caused by a head contusion after alcohol consumption. She exhibited impaired consciousness with a Glasgow coma scale score of 14 (E4V4M6), complained of headache, and presented with a hemorrhage in the left ear. Computed tomography suggested a skull fracture and cerebral hemorrhage. Magnetic resonance imaging conducted on the 4th day after the injury indicated shunt disease with a feeder in the right MMA. Cerebral angiography on the 7th day suggested a direct shunt from the right MMA to the MMV aligned with the temporal bone fracture line, with multiple drainage route perfusion. Coil embolization was performed on the 14th day to occlude the shunt point selectively. In the final image, the MMA was absent, and the MMV, superior sagittal sinus, or pterygoid plexus was not visible through the shunt. Her symptoms improved, and she was discharged on the 20th day and did not exhibit recurrence at the 1-year follow-up.\u0000\u0000\u0000\u0000AVF with a direct shunt from the MMA to MMV after head trauma can be effectively and safely treated with coil embolization alone, despite the need for long-term postoperative follow-up.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"59 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139960911","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}
Omar R. Ortega-Ruiz, Jorge Armando Lara Olivas, M. Sangrador-Deitos, Ricardo Marian Magaña, Jose Augusto Ruiz Gurria, Juan Luis Gomez Amador
Parasellar plasmacytomas are rare neurosurgical entities. Intrinsic characteristics of these tumors, such as adjacent bone erosion and symptoms resulting from invasion and mass effect, may lead to the possibility of a solitary extramedullary plasmacytoma (SEP) as a differential diagnosis. We present the case of a 39-year-old male with a 1-month history of bilateral decreased visual acuity, retroocular pulsating pain, and chromatic vision loss. A computed tomography scan of the head revealed a parasellar lesion causing chiasmatic compression, as well as clival, orbital, sphenoidal, and ethmoidal invasion. A combined transorbital and endonasal endoscopic approach was found suitable, and gross total resection was achieved. Histological analysis of the lesion established the diagnosis of a SEP. After radiotherapy, a new magnetic resonance imaging was performed, revealing a recurrence of the lesion with a high grade of invasion. The patient was treated with palliative radiotherapy, as surgical resection did not seem feasible. Surgical resection and radiotherapy may achieve remission of these lesions; however, recurrence rates remain high despite any treatment modality. Patients with this condition must be followed up with a multidisciplinary team due to the high risk of multiple myeloma progression.
{"title":"Combined endoscopic transorbital and transnasal approach for the management of a solitary plasmacytoma of the sphenoid bone: A case report and literature review","authors":"Omar R. Ortega-Ruiz, Jorge Armando Lara Olivas, M. Sangrador-Deitos, Ricardo Marian Magaña, Jose Augusto Ruiz Gurria, Juan Luis Gomez Amador","doi":"10.25259/sni_915_2023","DOIUrl":"https://doi.org/10.25259/sni_915_2023","url":null,"abstract":"\u0000\u0000Parasellar plasmacytomas are rare neurosurgical entities. Intrinsic characteristics of these tumors, such as adjacent bone erosion and symptoms resulting from invasion and mass effect, may lead to the possibility of a solitary extramedullary plasmacytoma (SEP) as a differential diagnosis.\u0000\u0000\u0000\u0000We present the case of a 39-year-old male with a 1-month history of bilateral decreased visual acuity, retroocular pulsating pain, and chromatic vision loss. A computed tomography scan of the head revealed a parasellar lesion causing chiasmatic compression, as well as clival, orbital, sphenoidal, and ethmoidal invasion. A combined transorbital and endonasal endoscopic approach was found suitable, and gross total resection was achieved. Histological analysis of the lesion established the diagnosis of a SEP. After radiotherapy, a new magnetic resonance imaging was performed, revealing a recurrence of the lesion with a high grade of invasion. The patient was treated with palliative radiotherapy, as surgical resection did not seem feasible.\u0000\u0000\u0000\u0000Surgical resection and radiotherapy may achieve remission of these lesions; however, recurrence rates remain high despite any treatment modality. Patients with this condition must be followed up with a multidisciplinary team due to the high risk of multiple myeloma progression.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"30 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139962245","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}
Fahad Zahid, A. Memon, M. Siddiqui, Muhammad Hammad Deewani, Osama Asif, Amin Javer, Ahsan Ali Khan
3-Dimensional (3D) printing has proven its role in various fields. Recently, 3D printing has also been introduced in the otolaryngology domain. The nasopharynx, paranasal sinuses, and the anterior skull base have a complex anatomy. Critical structures must be delicately protected and preserved during a surgical procedure. It is, therefore, very important for the surgeon to have an excellent spatial understanding of the complex surgical field that is being traversed. Our case is of a 19-year-old male with a 2-month history of recurrent epistaxis, nasal blockage, and headache. Based on the computed tomography scan and the clinical presentation, the patient was diagnosed with juvenile nasopharyngeal angiofibroma. The patient underwent angioembolization of the tumor followed by endoscopic surgical resection. The patient remained stable postoperatively and demonstrated a good recovery in the follow-up visit with no signs of cranial deficits. This case report highlights the use of a patient-specific 3D-printed biomodel to visualize this rare tumor of the nasopharynx. The benefits of using the model in surgical planning, patient education, and resident training are reported. We found that the ability to visualize the tumor on a tangible model, viewing its actual size in relation to the adjacent anatomy and all the structures associated with it, greatly enhances the surgeon’s capacity to tackle such a difficult tumor endoscopically. Incorporating 3D-printed biomodels in surgical practice should result in improved outcomes for the patients.
三维（3D）打印技术已在多个领域发挥了作用。最近，耳鼻喉科领域也引入了三维打印技术。鼻咽、副鼻窦和前颅底具有复杂的解剖结构。在手术过程中，必须精细地保护和保留关键结构。我们的病例是一名 19 岁的男性，有 2 个月的反复鼻衄、鼻塞和头痛病史。根据计算机断层扫描和临床表现，患者被诊断为幼年鼻咽血管纤维瘤。患者接受了肿瘤血管栓塞术，随后进行了内窥镜手术切除。患者术后病情稳定，随访时恢复良好，没有出现颅脑损伤的迹象。本病例报告强调了使用患者特异性 3D 打印生物模型来观察这种罕见的鼻咽肿瘤。报告了在手术规划、患者教育和住院医师培训中使用该模型的益处。我们发现，在有形的模型上可视化肿瘤，查看其与邻近解剖结构和所有相关结构的实际大小，大大提高了外科医生在内窥镜下处理这种疑难肿瘤的能力。
{"title":"Successful use of a patient specific 3D-printed biomodel as surgical guide for excision of juvenile nasopharyngeal angiofibroma extending to skull base: A case report","authors":"Fahad Zahid, A. Memon, M. Siddiqui, Muhammad Hammad Deewani, Osama Asif, Amin Javer, Ahsan Ali Khan","doi":"10.25259/sni_743_2023","DOIUrl":"https://doi.org/10.25259/sni_743_2023","url":null,"abstract":"\u0000\u00003-Dimensional (3D) printing has proven its role in various fields. Recently, 3D printing has also been introduced in the otolaryngology domain. The nasopharynx, paranasal sinuses, and the anterior skull base have a complex anatomy. Critical structures must be delicately protected and preserved during a surgical procedure. It is, therefore, very important for the surgeon to have an excellent spatial understanding of the complex surgical field that is being traversed.\u0000\u0000\u0000\u0000Our case is of a 19-year-old male with a 2-month history of recurrent epistaxis, nasal blockage, and headache. Based on the computed tomography scan and the clinical presentation, the patient was diagnosed with juvenile nasopharyngeal angiofibroma. The patient underwent angioembolization of the tumor followed by endoscopic surgical resection. The patient remained stable postoperatively and demonstrated a good recovery in the follow-up visit with no signs of cranial deficits. This case report highlights the use of a patient-specific 3D-printed biomodel to visualize this rare tumor of the nasopharynx. The benefits of using the model in surgical planning, patient education, and resident training are reported. We found that the ability to visualize the tumor on a tangible model, viewing its actual size in relation to the adjacent anatomy and all the structures associated with it, greatly enhances the surgeon’s capacity to tackle such a difficult tumor endoscopically.\u0000\u0000\u0000\u0000Incorporating 3D-printed biomodels in surgical practice should result in improved outcomes for the patients.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"15 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139960972","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}
Y. Yanagawa, Chihiro Maekawa, Noriko Tanaka, Michika Hamada, Soichiro Ota, Hiroaki Taniguchi, Kenji Kawai, Tatsuro Sakai, Tadashi Ishihara, H. Nagasawa
{"title":"Outcomes of patients with head injuries transported by a physician-staffed helicopter using the keyword method in Japan","authors":"Y. Yanagawa, Chihiro Maekawa, Noriko Tanaka, Michika Hamada, Soichiro Ota, Hiroaki Taniguchi, Kenji Kawai, Tatsuro Sakai, Tadashi Ishihara, H. Nagasawa","doi":"10.25259/sni_976_2023","DOIUrl":"https://doi.org/10.25259/sni_976_2023","url":null,"abstract":"","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"48 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139961409","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}
Despite encouraging developments after its initial founding in Indonesia more than seven decades ago, inequity in access and availability of neurosurgical services throughout the country continues to pose a challenge. We aimed to elaborate on the start-up of a previously inactive neurosurgical service in North Maluku, an archipelagic province in East Indonesia, and describe cases managed within the first two years of service. In the North Maluku Database in the Neurosurgery register, demographic and clinical information of neurosurgical patients admitted to Chasan Boesoirie General Hospital, Ternate, from January 2021 to December 2022, were analyzed. Surgically managed patients were rendered visually according to their decades of life and districts of events. There were 998 new patients (mean age ± standard deviation [SD]: 34.7 ± 19.6 years, 60.3% male) managed and 216 neurosurgical procedures (mean age ± SD: 33 ± 20.4 years, 67.1% male) performed. The majority of patients operated were within the 1st decade of life (18.5%), presented to the emergency room (56.5%), covered by national health insurance (69.4%), from outside Ternate (62.5%), diagnosed with neurotrauma (40.7%), and discharged alive (80.1%). Ternate was the only district where all seven types of neurological diseases were encountered. No surgeries were performed for patients from Taliabu, the farthest district from Ternate. A large portion of neurosurgical patients in North Maluku were those young and at productive age who were transported from outside Ternate with acute neurological disease (particularly neurotrauma). Distance and geographical circumstances may have a profound effect on access to neurosurgical services.
{"title":"The start-up of a neurosurgical service in an East Indonesian archipelagic province: The first 2-year experience of North Maluku Database in Neurosurgery (NOMADEN)","authors":"Aryandhito Widhi Nugroho","doi":"10.25259/sni_1026_2023","DOIUrl":"https://doi.org/10.25259/sni_1026_2023","url":null,"abstract":"\u0000\u0000Despite encouraging developments after its initial founding in Indonesia more than seven decades ago, inequity in access and availability of neurosurgical services throughout the country continues to pose a challenge. We aimed to elaborate on the start-up of a previously inactive neurosurgical service in North Maluku, an archipelagic province in East Indonesia, and describe cases managed within the first two years of service.\u0000\u0000\u0000\u0000In the North Maluku Database in the Neurosurgery register, demographic and clinical information of neurosurgical patients admitted to Chasan Boesoirie General Hospital, Ternate, from January 2021 to December 2022, were analyzed. Surgically managed patients were rendered visually according to their decades of life and districts of events.\u0000\u0000\u0000\u0000There were 998 new patients (mean age ± standard deviation [SD]: 34.7 ± 19.6 years, 60.3% male) managed and 216 neurosurgical procedures (mean age ± SD: 33 ± 20.4 years, 67.1% male) performed. The majority of patients operated were within the 1st decade of life (18.5%), presented to the emergency room (56.5%), covered by national health insurance (69.4%), from outside Ternate (62.5%), diagnosed with neurotrauma (40.7%), and discharged alive (80.1%). Ternate was the only district where all seven types of neurological diseases were encountered. No surgeries were performed for patients from Taliabu, the farthest district from Ternate.\u0000\u0000\u0000\u0000A large portion of neurosurgical patients in North Maluku were those young and at productive age who were transported from outside Ternate with acute neurological disease (particularly neurotrauma). Distance and geographical circumstances may have a profound effect on access to neurosurgical services.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"51 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139961503","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}
Albert Alan, Michelle Ennabe, James Withers, Neil Joshi, Martin Weinand
Homelessness is a growing concern in the US, with 3.5 million people experiencing it annually and 600,000 on any given night. Homeless individuals face increased vulnerability to 30-day hospital readmissions and higher mortality rates, straining the healthcare system and exacerbating existing disparities. This study aims to inform neurosurgeons on evidence-based strategies to reduce readmission and mortality rates among homeless patients by reviewing the literature on the impact of medical respite on 30-day readmission rates. The study aims to gauge the efficacy of medical respite in reducing hospital readmissions and improving health outcomes for homeless individuals. A comprehensive literature search was conducted across PubMed, Embase/Medline, and Cochrane databases, as well as consulting the National Institute for Medical Respite Care and the Department of Health Care Access and Information. Ten articles were chosen from an initial 296 to investigate the impact of respite programs on readmission rates among homeless patients. Homeless patients experience high readmission rates due to various factors. Interventions such as respite programs and a comprehensive approach to healthcare can lower these rates. Collaboration between hospitals and medical respites has proven particularly effective. Inadequate healthcare for homeless individuals leads to increased readmissions, longer hospital stays, and higher costs. Medical respites are a viable solution, but limited resources hamper their effectiveness. Therefore, it is crucial to facilitate cooperation between hospitals, respites, and other entities. Future research should focus on disparity in neurosurgical procedures and explore alternative services. An interdisciplinary approach is key to addressing healthcare inequalities.
在美国，无家可归是一个日益令人担忧的问题，每年有 350 万人无家可归，任何特定夜晚都有 60 万人无家可归。无家可归者更容易出现 30 天内再次入院的情况，死亡率也更高，这给医疗保健系统造成了压力，并加剧了现有的差距。本研究旨在通过回顾有关医疗暂休对 30 天再入院率影响的文献，让神经外科医生了解减少无家可归患者再入院率和死亡率的循证策略。该研究旨在评估医疗暂休在减少无家可归者再入院率和改善其健康状况方面的功效。研究人员在PubMed、Embase/Medline和Cochrane数据库中进行了全面的文献检索，并咨询了国家医疗暂休护理研究所（National Institute for Medical Respite Care）和医疗保健获取与信息部（Department of Health Care Access and Information）。从最初的 296 篇文章中选出了 10 篇，以调查暂休计划对无家可归病人再入院率的影响。由于各种因素，无家可归的病人再入院率很高。暂休计划和综合医疗保健等干预措施可以降低再入院率。事实证明，医院与医疗暂住机构之间的合作尤为有效。无家可归者的医疗服务不足会导致再入院率上升、住院时间延长、费用增加。医疗暂住地是一个可行的解决方案，但有限的资源阻碍了其有效性。因此，促进医院、临时医疗机构和其他实体之间的合作至关重要。未来的研究应关注神经外科手术中的差异，并探索替代服务。跨学科方法是解决医疗不平等的关键。
{"title":"Addressing healthcare disparities in homeless neurosurgical patients: A comprehensive literature review on strategies for equitable care and improved outcomes","authors":"Albert Alan, Michelle Ennabe, James Withers, Neil Joshi, Martin Weinand","doi":"10.25259/sni_549_2023","DOIUrl":"https://doi.org/10.25259/sni_549_2023","url":null,"abstract":"\u0000\u0000Homelessness is a growing concern in the US, with 3.5 million people experiencing it annually and 600,000 on any given night. Homeless individuals face increased vulnerability to 30-day hospital readmissions and higher mortality rates, straining the healthcare system and exacerbating existing disparities. This study aims to inform neurosurgeons on evidence-based strategies to reduce readmission and mortality rates among homeless patients by reviewing the literature on the impact of medical respite on 30-day readmission rates. The study aims to gauge the efficacy of medical respite in reducing hospital readmissions and improving health outcomes for homeless individuals.\u0000\u0000\u0000\u0000A comprehensive literature search was conducted across PubMed, Embase/Medline, and Cochrane databases, as well as consulting the National Institute for Medical Respite Care and the Department of Health Care Access and Information. Ten articles were chosen from an initial 296 to investigate the impact of respite programs on readmission rates among homeless patients.\u0000\u0000\u0000\u0000Homeless patients experience high readmission rates due to various factors. Interventions such as respite programs and a comprehensive approach to healthcare can lower these rates. Collaboration between hospitals and medical respites has proven particularly effective.\u0000\u0000\u0000\u0000Inadequate healthcare for homeless individuals leads to increased readmissions, longer hospital stays, and higher costs. Medical respites are a viable solution, but limited resources hamper their effectiveness. Therefore, it is crucial to facilitate cooperation between hospitals, respites, and other entities. Future research should focus on disparity in neurosurgical procedures and explore alternative services. An interdisciplinary approach is key to addressing healthcare inequalities.\u0000","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"40 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139961647","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}
Joshua Olexa, Annie Trang, Rebecca Flessner, M. Labib
Ventriculoperitoneal (VP) shunt placement is one of the most commonly performed neurosurgical procedures, yet failure rates remain very high. Surface landmarks are typically used to guide VP shunt placement, but they are not reliable in identifying the target anatomy. Augmented reality (AR) is a promising new technology that has the potential to improve the accuracy and effectiveness of neurosurgical procedures. We describe the use of AR for the surgical planning of a VP shunt. A 62-year-old male with a history of subarachnoid hemorrhage presented with delayed hydrocephalus. A computed tomography scan was obtained that confirmed dilated ventricles, requiring a right VP shunt. The patient was brought to the operating room, where the AR system was used for visualization and planning. In this study, we describe the use of AR for VP shunt placement. The AR system consists of a Microsoft HoloLens 2 head-mounted display and a novel markerless registration system, which was used to register patient-specific 3D models onto the patient’s head for visualizing target anatomy and planning an operative approach. The AR system was used to plan the VP shunt placement in the operating room. This system is easy to use and provides a visualization of the patient’s anatomy, which can be used to plan an optimal trajectory. We believe that this has the potential to improve the accuracy and outcomes of VP shunt placements, and further studies are needed to characterize the system’s accuracy and benefits.
脑室腹腔分流术（VP）是最常用的神经外科手术之一，但失败率仍然很高。表面地标通常用于指导 VP 分流置管，但它们在识别目标解剖结构方面并不可靠。增强现实（AR）是一种前景广阔的新技术，有望提高神经外科手术的准确性和有效性。我们介绍了使用 AR 进行 VP 分流手术规划的情况。 一名 62 岁的男性患者有蛛网膜下腔出血病史，并伴有迟发性脑积水。计算机断层扫描证实患者脑室扩张，需要进行右侧 VP 分流术。患者被送入手术室，AR 系统被用于可视化和规划。 在本研究中，我们介绍了在 VP 分流术中使用 AR 的情况。该 AR 系统由微软 HoloLens 2 头戴式显示器和新颖的无标记注册系统组成，用于将患者特定的三维模型注册到患者头部，以可视化目标解剖结构并规划手术方法。AR 系统用于规划手术室内的 VP 分流安置。该系统易于使用，能提供患者解剖结构的可视化，可用于规划最佳路径。我们相信，这有可能提高 VP 分流置管的准确性和效果，但还需要进一步的研究来确定该系统的准确性和优点。
{"title":"Case report: Use of markerless augmented reality system for ventriculoperitoneal shunt placement","authors":"Joshua Olexa, Annie Trang, Rebecca Flessner, M. Labib","doi":"10.25259/sni_856_2023","DOIUrl":"https://doi.org/10.25259/sni_856_2023","url":null,"abstract":"Ventriculoperitoneal (VP) shunt placement is one of the most commonly performed neurosurgical procedures, yet failure rates remain very high. Surface landmarks are typically used to guide VP shunt placement, but they are not reliable in identifying the target anatomy. Augmented reality (AR) is a promising new technology that has the potential to improve the accuracy and effectiveness of neurosurgical procedures. We describe the use of AR for the surgical planning of a VP shunt. A 62-year-old male with a history of subarachnoid hemorrhage presented with delayed hydrocephalus. A computed tomography scan was obtained that confirmed dilated ventricles, requiring a right VP shunt. The patient was brought to the operating room, where the AR system was used for visualization and planning. In this study, we describe the use of AR for VP shunt placement. The AR system consists of a Microsoft HoloLens 2 head-mounted display and a novel markerless registration system, which was used to register patient-specific 3D models onto the patient’s head for visualizing target anatomy and planning an operative approach. The AR system was used to plan the VP shunt placement in the operating room. This system is easy to use and provides a visualization of the patient’s anatomy, which can be used to plan an optimal trajectory. We believe that this has the potential to improve the accuracy and outcomes of VP shunt placements, and further studies are needed to characterize the system’s accuracy and benefits.","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139146219","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}
Marina Hirato, T. Tsumoto, Yuta Kobayashi, Ryo Aiura, Eisuke Hirose, Arisa Umesaki, S. Nakayama
Delayed rupture after flow diverter (FD) placement is a serious complication, and often it leads to death; however, the exact mechanism leading to the rupture remains unclear. Therefore, in this case, study, we report a case of delayed rupture after FD placement and discuss its causes. This study presents the case of a 69-year-old female with multiple aneurysms who underwent FD placement with coil embolization for a large intracranial internal carotid artery aneurysm. Postoperatively, the patient had no significant symptoms, and angiography and magnetic resonance imaging revealed decreased intra-aneurysmal blood flow. However, on the 3rd postoperative day, she developed a sudden disturbance of consciousness. Computed tomography revealed a massive subarachnoid hemorrhage, diagnosed as a delayed rupture. We decided to withhold therapy due to her serious condition. Previous studies have suggested that hemodynamic mechanisms can cause delayed aneurysm rupture. Based on the computational fluid dynamics (CFD) of the aneurysm, we suggest that an increase in intra-aneurysmal pressure after FD placement may have caused the delayed rupture. Preoperative CFD analysis may help evaluate the risk of delayed rupture for large aneurysms with a high inflow from the parent vessel.
{"title":"Delayed rupture of a large intracranial internal carotid artery aneurysm after flow diverter placement","authors":"Marina Hirato, T. Tsumoto, Yuta Kobayashi, Ryo Aiura, Eisuke Hirose, Arisa Umesaki, S. Nakayama","doi":"10.25259/sni_804_2023","DOIUrl":"https://doi.org/10.25259/sni_804_2023","url":null,"abstract":"Delayed rupture after flow diverter (FD) placement is a serious complication, and often it leads to death; however, the exact mechanism leading to the rupture remains unclear. Therefore, in this case, study, we report a case of delayed rupture after FD placement and discuss its causes. This study presents the case of a 69-year-old female with multiple aneurysms who underwent FD placement with coil embolization for a large intracranial internal carotid artery aneurysm. Postoperatively, the patient had no significant symptoms, and angiography and magnetic resonance imaging revealed decreased intra-aneurysmal blood flow. However, on the 3rd postoperative day, she developed a sudden disturbance of consciousness. Computed tomography revealed a massive subarachnoid hemorrhage, diagnosed as a delayed rupture. We decided to withhold therapy due to her serious condition. Previous studies have suggested that hemodynamic mechanisms can cause delayed aneurysm rupture. Based on the computational fluid dynamics (CFD) of the aneurysm, we suggest that an increase in intra-aneurysmal pressure after FD placement may have caused the delayed rupture. Preoperative CFD analysis may help evaluate the risk of delayed rupture for large aneurysms with a high inflow from the parent vessel.","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":"34 S130","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139146784","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}
Ghaleb Shihadah Almesedin, Hanan Odah Alshmaily, K. A. Alshammari, Reem Sultan Albalawi
Glanzmann’s thrombasthenia (GT) is a rare autosomal recessive disorder characterized by impaired platelet function. Symptoms range from mild to life-threatening bleeding. However, it is extremely rare for a patient to have intracranial bleeding. This study presents two cases of GT: one with a spontaneous epidural hematoma (EDH) and the other with a subarachnoid hemorrhage due to traumatic causes. The discussion that follows then derives relevant supporting insights through a review of the literature. Case Report 1: A 9-year-old girl with a known case of GT presented to an emergency department with a severe headache but no other complaints or history of trauma. The physical examination was normal. Computed tomography (CT) head without contrast revealed multiple EDHs with no midline shift. She received factor VII, tranexamic acid, and platelets transfusion and was admitted to the intensive care unit to be managed conservatively. After a month, a CT head follow-up showed complete resolution of all hematomas. Case Report 2: A 20-year-old male with a known case of GT was brought to the hospital with a history of loss of consciousness for several minutes after a road traffic accident. He suffered from a headache on regaining consciousness and received analgesia. CT head showed diffuse subarachnoid hemorrhage. He was managed with factor VII, tranexamic acid, and platelets transfusion and was admitted to an intermediate care unit for close observation. In a GT patient with intracranial hemorrhage, conservative management with close clinical observation and platelet transfusion in combination with recombinant activated factor VII and/or antifibrinolytics can be safely conducted.
{"title":"Two case reports of Glanzmann thrombocytopenia with intracranial hemorrhage and a review of the literature","authors":"Ghaleb Shihadah Almesedin, Hanan Odah Alshmaily, K. A. Alshammari, Reem Sultan Albalawi","doi":"10.25259/sni_680_2023","DOIUrl":"https://doi.org/10.25259/sni_680_2023","url":null,"abstract":"Glanzmann’s thrombasthenia (GT) is a rare autosomal recessive disorder characterized by impaired platelet function. Symptoms range from mild to life-threatening bleeding. However, it is extremely rare for a patient to have intracranial bleeding. This study presents two cases of GT: one with a spontaneous epidural hematoma (EDH) and the other with a subarachnoid hemorrhage due to traumatic causes. The discussion that follows then derives relevant supporting insights through a review of the literature. Case Report 1: A 9-year-old girl with a known case of GT presented to an emergency department with a severe headache but no other complaints or history of trauma. The physical examination was normal. Computed tomography (CT) head without contrast revealed multiple EDHs with no midline shift. She received factor VII, tranexamic acid, and platelets transfusion and was admitted to the intensive care unit to be managed conservatively. After a month, a CT head follow-up showed complete resolution of all hematomas. Case Report 2: A 20-year-old male with a known case of GT was brought to the hospital with a history of loss of consciousness for several minutes after a road traffic accident. He suffered from a headache on regaining consciousness and received analgesia. CT head showed diffuse subarachnoid hemorrhage. He was managed with factor VII, tranexamic acid, and platelets transfusion and was admitted to an intermediate care unit for close observation. In a GT patient with intracranial hemorrhage, conservative management with close clinical observation and platelet transfusion in combination with recombinant activated factor VII and/or antifibrinolytics can be safely conducted.","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":" 43","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139145089","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}
Abdul Haseeb, Muhammad Ashir Shafique, Aashish Kumar, Moosa Abdur Raqib, Z. Mughal, R. Nasir, Syed Muhammad Sinaan Ali, Tagwa Kalool Fadlalla Ahmad, M. Mustafa
Chronic subdural hematoma (CSDH) is a condition characterized by the accumulation of fluid, blood, and blood breakdown products between the brain’s arachnoid and dura mater coverings. While steroids have been explored as a potential treatment option, their efficacy and safety remain uncertain. This meta-analysis and systematic review aimed to assess the impact of steroids on CSDH management, including mortality, recurrence, complications, and functional outcomes. We conducted a comprehensive literature search in major electronic databases up to June 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane Handbook for Systematic Reviews and Interventions. Inclusion criteria encompassed adult patients with CSDH, the use of steroids as monotherapy or adjuvant therapy, and clearly defined outcomes. Randomized controlled trials and cohort studies meeting these criteria were included in the study. The initial search yielded 4315 articles, with 12 studies meeting the inclusion criteria. Our findings indicate a non-significant trend toward reduced mortality with steroids in combination with standard care (Odds ratios [OR] = 0.66, 95% confidence interval [CI] 0.20–2.18). However, substantial heterogeneity was observed (I2 = 70%). Sensitivity analysis, excluding influential studies, suggested a potential increased mortality risk associated with steroids (OR = 1.47, 95% CI 0.87–2.48). Steroids showed a possible benefit in reducing the recurrence of CSDH (OR = 0.58, 95% CI 0.20–1.67), but with significant heterogeneity (I2 = 89%). No clear advantage of steroids was observed in terms of functional outcomes at three months (modified Rankin scale scores). Furthermore, steroids were associated with a significantly higher incidence of adverse effects and complications (OR = 2.17, 95% CI 1.48–3.17). Steroids may have a potential role in reducing CSDH recurrence but do not appear to confer significant advantages in terms of mortality or functional outcomes. However, their use is associated with a higher risk of adverse effects and complications. Given the limitations of existing studies, further research is needed to refine the role of steroids in CSDH management, considering patient-specific factors and treatment protocols.
{"title":"Efficacy and safety of steroids for chronic subdural hematoma: A systematic review and meta-analysis","authors":"Abdul Haseeb, Muhammad Ashir Shafique, Aashish Kumar, Moosa Abdur Raqib, Z. Mughal, R. Nasir, Syed Muhammad Sinaan Ali, Tagwa Kalool Fadlalla Ahmad, M. Mustafa","doi":"10.25259/sni_771_2023","DOIUrl":"https://doi.org/10.25259/sni_771_2023","url":null,"abstract":"Chronic subdural hematoma (CSDH) is a condition characterized by the accumulation of fluid, blood, and blood breakdown products between the brain’s arachnoid and dura mater coverings. While steroids have been explored as a potential treatment option, their efficacy and safety remain uncertain. This meta-analysis and systematic review aimed to assess the impact of steroids on CSDH management, including mortality, recurrence, complications, and functional outcomes. We conducted a comprehensive literature search in major electronic databases up to June 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane Handbook for Systematic Reviews and Interventions. Inclusion criteria encompassed adult patients with CSDH, the use of steroids as monotherapy or adjuvant therapy, and clearly defined outcomes. Randomized controlled trials and cohort studies meeting these criteria were included in the study. The initial search yielded 4315 articles, with 12 studies meeting the inclusion criteria. Our findings indicate a non-significant trend toward reduced mortality with steroids in combination with standard care (Odds ratios [OR] = 0.66, 95% confidence interval [CI] 0.20–2.18). However, substantial heterogeneity was observed (I2 = 70%). Sensitivity analysis, excluding influential studies, suggested a potential increased mortality risk associated with steroids (OR = 1.47, 95% CI 0.87–2.48). Steroids showed a possible benefit in reducing the recurrence of CSDH (OR = 0.58, 95% CI 0.20–1.67), but with significant heterogeneity (I2 = 89%). No clear advantage of steroids was observed in terms of functional outcomes at three months (modified Rankin scale scores). Furthermore, steroids were associated with a significantly higher incidence of adverse effects and complications (OR = 2.17, 95% CI 1.48–3.17). Steroids may have a potential role in reducing CSDH recurrence but do not appear to confer significant advantages in terms of mortality or functional outcomes. However, their use is associated with a higher risk of adverse effects and complications. Given the limitations of existing studies, further research is needed to refine the role of steroids in CSDH management, considering patient-specific factors and treatment protocols.","PeriodicalId":38981,"journal":{"name":"Surgical Neurology International","volume":" 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139143277","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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