Intraventricular hemorrhages (IVH) are common pathologies in neurosurgery practice and are associated with the worst clinical outcome among all intracranial hemorrhages. Blood in the ventricles is thought to worsen the clinical condition by triggering inflammatory processes. In recent years, NLR value is a frequently used inflammatory parameter, and there are many publications reporting that a high NLR value is an important marker in predicting the severity of inflammation.
Our study aimed to evaluate the effect of NLR values at admission on the clinical outcome of patients undergoing EVD due to IVH in our clinic.
Material and methods
In our study, age and gender data, admission Glasgow Coma Scale (GCS), NLR value at the time of admission and clinical status at discharge of 36 patients, who underwent EVD following IVH in our hospital neurosurgery clinic between 2019 and 2024, were examined.
Results
Of the 36 cases in our study, 16 were female and 20 were male. For all cases, the mean age was 61.88, and the mean GCS values at admission were calculated as 8.5. In the laboratory of our hospital, the normal NLR range was determined as 0.78-3.53, and the mean NLR values at admission were evaluated as 16.57. When the clinical outcomes of the cases were examined, it was seen that 30 cases ended with exitus after intensive care follow-up, and 6 cases were discharged with good clinical outcomes (GCS:15). The mean NLR value was calculated as 18.00 for the patients who ended with exitus and 8.12 for the patients discharged with good clinical outcomes.
Conclusion
NLR, which has been used to determine the severity of inflammation in recent years, has been reported to be a marker that can predict clinical outcomes of many diseases. In our study, NLR was observed to be high at admission in all cases, but it was significantly higher in the cases ending with exitus than in the cases not ending with exitus. As a result, it is thought that NLR value is a parameter that can be used to predict the clinical course in IVH patients undergoing EVD.
{"title":"Relationship between NLR (Neutrophil/Lymphocyte ratio) value and clinical outcome in patients with external ventricular drainage due to intraventricular hemorrhage","authors":"Eylem Burcu Kahraman Özlü, Kaan Durmuş, Elçin Tuğce Mutlu, Ezgi Akar, Selin Tural, Arif Tarkan Çalışaneller","doi":"10.1016/j.neucir.2024.10.007","DOIUrl":"10.1016/j.neucir.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Intraventricular hemorrhages (IVH) are common pathologies in neurosurgery practice and are associated with the worst clinical outcome among all intracranial hemorrhages. Blood in the ventricles is thought to worsen the clinical condition by triggering inflammatory processes. In recent years, NLR value is a frequently used inflammatory parameter, and there are many publications reporting that a high NLR value is an important marker in predicting the severity of inflammation.</div><div>Our study aimed to evaluate the effect of NLR values at admission on the clinical outcome of patients undergoing EVD due to IVH in our clinic.</div></div><div><h3>Material and methods</h3><div>In our study, age and gender data, admission Glasgow Coma Scale (GCS), NLR value at the time of admission and clinical status at discharge of 36 patients, who underwent EVD following IVH in our hospital neurosurgery clinic between 2019 and 2024, were examined.</div></div><div><h3>Results</h3><div>Of the 36 cases in our study, 16 were female and 20 were male. For all cases, the mean age was 61.88, and the mean GCS values at admission were calculated as 8.5. In the laboratory of our hospital, the normal NLR range was determined as 0.78-3.53, and the mean NLR values at admission were evaluated as 16.57. When the clinical outcomes of the cases were examined, it was seen that 30 cases ended with exitus after intensive care follow-up, and 6 cases were discharged with good clinical outcomes (GCS:15). The mean NLR value was calculated as 18.00 for the patients who ended with exitus and 8.12 for the patients discharged with good clinical outcomes.</div></div><div><h3>Conclusion</h3><div>NLR, which has been used to determine the severity of inflammation in recent years, has been reported to be a marker that can predict clinical outcomes of many diseases. In our study, NLR was observed to be high at admission in all cases, but it was significantly higher in the cases ending with exitus than in the cases not ending with exitus. As a result, it is thought that NLR value is a parameter that can be used to predict the clinical course in IVH patients undergoing EVD.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 2","pages":"Pages 98-103"},"PeriodicalIF":0.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.neucir.2024.10.010
Andrey Grin, Vasily Karanadze, Ivan Lvov , Aleksandr Talypov, Anton Kordonskiy, Rinat Abdrafiev
Objectives
To conduct a systematic review and single-arm meta-analysis to evaluate and compare radiological indicators, as well as short-term and long-term outcomes, in patients with neurologically intact thoracolumbar burst fractures (TLBF) who underwent anterior fusion, combined anterior-posterior procedure, or short-segment pedicle screw fixation (PSF).
Methods
A systematic review following PRISMA guidelines was conducted. Inclusion criteria comprised articles published between 2004 and 2023, full-text availability in English, burst fractures without spinal cord or nerve root injuries at admission, short-segment PSF without fusion, anterior or combined fusion methods, patients aged 18 or older, and a minimum 12-month follow-up.
Meta-analysis was carried out using Comprehensive Meta-Analysis software. Using a single-arm meta-analysis method, pooled indicators of short- and long-term outcomes for each studied group were determined. The obtained data were then compared using simple comparison.
Results
The pooled mean Cobb angle at admission for the anterior, combined, and PSF groups was 18.2° (95% CI, 14.6−21.8), 11.7° (95% CI, 9.7−13.5), and 17.1° (95% CI, 15.1–19.1), respectively. Anterior fusion achieved a greater degree of kyphosis correction across all groups, but only the combined group showed a nonsignificant loss of correction after discharge (SMD = 0.809 [95% CI, 0.270, 1.348]). The anterior vertebral body compression rate at admission was 55.2% (95% CI, 46.3−64.0) in the combined group and 37.8% (95% CI, 33.7−41.9) in the PSF group.
Operative time, blood loss, and hospitalization duration were lowest in the percutaneous PSF group, with means of 96.5 min (95% CI, 82.4–110.6), 83.8 ml (95% CI, 71.7–95.9), and 6.6 days (95% CI, 4.7–8.5), respectively. All techniques demonstrated a similar incidence of deep wound infections and implant-related complications.
The pooled Oswestry Disability Index (ODI) scores were 17.2 (95% CI, 10.4−23.9) for the anterior group, 15.4 (95% CI, 11.5–19.3) for the combined group, and 13.4 (95% CI, 10.4–16.3) for the PSF group.
Conclusions
For patients with neurologically intact thoracolumbar burst fractures, with a kyphotic angle of less than 19.1° and an anterior vertebral body compression rate of less than 41.9%, short-segment pedicle screw fixation without fusion may be preferable option due to reduced intraoperative blood loss, shorter operation duration, shorter hospital stay, and better ODI scores at final follow-up. Routine anterior fusion has demonstrated high potential for kyphosis correction. The loss of the Cobb angle from surgery to final follow-up was nonsignificant only in patients who underwent combined surgery. When determining the surgical approach, surgeons should carefully weigh the advantages of anterior and combined fusion against the significantly higher sur
{"title":"Is anterior fusion still necessary in patients with neurologically intact thoracolumbar burst fractures? A systematic review and meta-analysis","authors":"Andrey Grin, Vasily Karanadze, Ivan Lvov , Aleksandr Talypov, Anton Kordonskiy, Rinat Abdrafiev","doi":"10.1016/j.neucir.2024.10.010","DOIUrl":"10.1016/j.neucir.2024.10.010","url":null,"abstract":"<div><h3>Objectives</h3><div>To conduct a systematic review and single-arm meta-analysis to evaluate and compare radiological indicators, as well as short-term and long-term outcomes, in patients with neurologically intact thoracolumbar burst fractures (TLBF) who underwent anterior fusion, combined anterior-posterior procedure, or short-segment pedicle screw fixation (PSF).</div></div><div><h3>Methods</h3><div>A systematic review following PRISMA guidelines was conducted. Inclusion criteria comprised articles published between 2004 and 2023, full-text availability in English, burst fractures without spinal cord or nerve root injuries at admission, short-segment PSF without fusion, anterior or combined fusion methods, patients aged 18 or older, and a minimum 12-month follow-up.</div><div>Meta-analysis was carried out using Comprehensive Meta-Analysis software. Using a single-arm meta-analysis method, pooled indicators of short- and long-term outcomes for each studied group were determined. The obtained data were then compared using simple comparison.</div></div><div><h3>Results</h3><div>The pooled mean Cobb angle at admission for the anterior, combined, and PSF groups was 18.2° (95% CI, 14.6−21.8), 11.7° (95% CI, 9.7−13.5), and 17.1° (95% CI, 15.1–19.1), respectively. Anterior fusion achieved a greater degree of kyphosis correction across all groups, but only the combined group showed a nonsignificant loss of correction after discharge (SMD = 0.809 [95% CI, 0.270, 1.348]). The anterior vertebral body compression rate at admission was 55.2% (95% CI, 46.3−64.0) in the combined group and 37.8% (95% CI, 33.7−41.9) in the PSF group.</div><div>Operative time, blood loss, and hospitalization duration were lowest in the percutaneous PSF group, with means of 96.5 min (95% CI, 82.4–110.6), 83.8 ml (95% CI, 71.7–95.9), and 6.6 days (95% CI, 4.7–8.5), respectively. All techniques demonstrated a similar incidence of deep wound infections and implant-related complications.</div><div>The pooled Oswestry Disability Index (ODI) scores were 17.2 (95% CI, 10.4−23.9) for the anterior group, 15.4 (95% CI, 11.5–19.3) for the combined group, and 13.4 (95% CI, 10.4–16.3) for the PSF group.</div></div><div><h3>Conclusions</h3><div>For patients with neurologically intact thoracolumbar burst fractures, with a kyphotic angle of less than 19.1° and an anterior vertebral body compression rate of less than 41.9%, short-segment pedicle screw fixation without fusion may be preferable option due to reduced intraoperative blood loss, shorter operation duration, shorter hospital stay, and better ODI scores at final follow-up. Routine anterior fusion has demonstrated high potential for kyphosis correction. The loss of the Cobb angle from surgery to final follow-up was nonsignificant only in patients who underwent combined surgery. When determining the surgical approach, surgeons should carefully weigh the advantages of anterior and combined fusion against the significantly higher sur","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 2","pages":"Pages 112-128"},"PeriodicalIF":0.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.neucir.2024.09.004
Rafael Aponte-Caballero , Julian Alfonso Sierra-Peña , Juan Felipe Abaunza-Camacho , William Mauricio Riveros-Castillo , Javier M. Saavedra
Malignant peripheral nerve sheath tumors (MPNST) are uncommon aggressive neoplasms, frequently associated with type I neurofibromatosis. This is the first case of intradural lumbar spine MPNST with intraoperative findings of associated subarachnoid hemorrhage (SAH). A 72-year-old man presented to the emergency department with severe acute low back pain. Neurological examination was unremarkable. Gadolinium-enhanced MRI of the lumbar spine showed an irregularly shaped intradural lesion extending from L3 to L5. The lesion exhibited a medium signal both on T1 and T2-weighted imaging with peripheral enhancement. Through an L3-L5 laminectomy, a diffuse SAH, and a tumor tightly adherent to cauda equina nerve roots were found. Specimen examination revealed a fusocelular tumor with pleomorphic and hyperchromatic nuclei, positive for S100, and SOX10. On an 8-month follow-up, he had no neurological deficit, with a Karnofsky performance score of 90 points. Surgical evidence of SAH in lumbar spine intradural MPNST is a novel finding.
{"title":"Cauda equina malignant peripheral nerve sheath tumor presenting with subarachnoid hemorrhage: a case report","authors":"Rafael Aponte-Caballero , Julian Alfonso Sierra-Peña , Juan Felipe Abaunza-Camacho , William Mauricio Riveros-Castillo , Javier M. Saavedra","doi":"10.1016/j.neucir.2024.09.004","DOIUrl":"10.1016/j.neucir.2024.09.004","url":null,"abstract":"<div><div>Malignant peripheral nerve sheath tumors (MPNST) are uncommon aggressive neoplasms, frequently associated with type I neurofibromatosis. This is the first case of intradural lumbar spine MPNST with intraoperative findings of associated subarachnoid hemorrhage (SAH). A 72-year-old man presented to the emergency department with severe acute low back pain. Neurological examination was unremarkable. Gadolinium-enhanced MRI of the lumbar spine showed an irregularly shaped intradural lesion extending from L3 to L5. The lesion exhibited a medium signal both on T1 and T2-weighted imaging with peripheral enhancement. Through an L3-L5 laminectomy, a diffuse SAH, and a tumor tightly adherent to cauda equina nerve roots were found. Specimen examination revealed a fusocelular tumor with pleomorphic and hyperchromatic nuclei, positive for S100, and SOX10. On an 8-month follow-up, he had no neurological deficit, with a Karnofsky performance score of 90 points. Surgical evidence of SAH in lumbar spine intradural MPNST is a novel finding.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 2","pages":"Pages 129-134"},"PeriodicalIF":0.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.neucir.2024.10.004
Cristina Romero-López , Javier Ros de San Pedro , Francisco Arteaga-Romero , Beatriz Cuartero-Pérez , Ignacio Martín-Schrader
Background
An acute subdural hematoma (aSDH) is a rare presentation of a ruptured intracranial aneurysm with pathophysiology and prognosis poorly defined. According to literature, prognosis might be improved with prompt diagnosis, hematoma evacuation and aneurysm treatment. The objective is to specify pathophysiology, prognostic factors and management of this pathology.
Methods
We reported 23 cases of aSDH due to ruptured MCA aneurysm from literature revision and 2 cases from our center.
Results
Median age was 51 years and 48% (12/25) were females. At their arrival, 76% (19/25) presented decreased level of consciousness and 55.55% (10/18) neurological deficits. Aneurysmal location was left MCA in 57.14% (8/14) and MCA segments were M4 in 76.92% (10/13) and bifurcation in 23.07% (3/13), median aneurysmal size was 6 mm, median hematoma size was 10 mm, median midline shift was 9 mm, aneurysmal projection and MCA concavity were anterior in 100% (3/3), subarachnoid hemorrhage (SAH) was present in 52.17% (12/23). The treatment was surgery in 84% (21/25), endovascular in 12% (3/25) and in 20% (5/25) decompressive craniectomy (DC) was necessary. Glasgow Outcome Scale (GOS) was >3/favorable in 66.66% (16/24) and death in 16.66% (4/2).
Conclusions
Anterior MCA concavity and aneurysmal projection might be related with aSDH presentation in proximal MCA aneurysms. We should suspect aneurysm origin when there is no history or stigma of trauma, and CT shows disproportionately massive aSDH. Hematoma evacuation solves the compressive mechanism which is the main cause of neurological deterioration in pure aSDH cases, because of that, immediate hematoma evacuation could justify better outcome in these patients.
{"title":"Acute subdural hematoma from ruptured middle cerebral artery aneurysm: A rare and critical analysis of 25 cases","authors":"Cristina Romero-López , Javier Ros de San Pedro , Francisco Arteaga-Romero , Beatriz Cuartero-Pérez , Ignacio Martín-Schrader","doi":"10.1016/j.neucir.2024.10.004","DOIUrl":"10.1016/j.neucir.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>An acute subdural hematoma (aSDH) is a rare presentation of a ruptured intracranial aneurysm with pathophysiology and prognosis poorly defined. According to literature, prognosis might be improved with prompt diagnosis, hematoma evacuation and aneurysm treatment. The objective is to specify pathophysiology, prognostic factors and management of this pathology.</div></div><div><h3>Methods</h3><div>We reported 23 cases of aSDH due to ruptured MCA aneurysm from literature revision and 2 cases from our center.</div></div><div><h3>Results</h3><div>Median age was 51 years and 48% (12/25) were females. At their arrival, 76% (19/25) presented decreased level of consciousness and 55.55% (10/18) neurological deficits. Aneurysmal location was left MCA in 57.14% (8/14) and MCA segments were M4 in 76.92% (10/13) and bifurcation in 23.07% (3/13), median aneurysmal size was 6 mm, median hematoma size was 10 mm, median midline shift was 9 mm, aneurysmal projection and MCA concavity were anterior in 100% (3/3), subarachnoid hemorrhage (SAH) was present in 52.17% (12/23). The treatment was surgery in 84% (21/25), endovascular in 12% (3/25) and in 20% (5/25) decompressive craniectomy (DC) was necessary. Glasgow Outcome Scale (GOS) was >3/favorable in 66.66% (16/24) and death in 16.66% (4/2).</div></div><div><h3>Conclusions</h3><div>Anterior MCA concavity and aneurysmal projection might be related with aSDH presentation in proximal MCA aneurysms. We should suspect aneurysm origin when there is no history or stigma of trauma, and CT shows disproportionately massive aSDH. Hematoma evacuation solves the compressive mechanism which is the main cause of neurological deterioration in pure aSDH cases, because of that, immediate hematoma evacuation could justify better outcome in these patients.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 2","pages":"Pages 83-92"},"PeriodicalIF":0.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.neucir.2024.10.001
Juan Sebastián Solis-Mata , Fernando Castro-Soto , José Alfonso Alvarez-Castro , Sonia Iliana Mejía-Pérez
Dandy–Walker malformation (DWM) and pilocytic astrocytoma are entities that manifest themselves at an early age. DWM is a cerebella type associated with several anatomical changes. Very few cases of concomitant occurrence of DWM and pilocytic astrocytoma have been reported on the literature. Male 20 years old, clinical history of 6 months of evolution with nausea, dizziness, headache, photophobia, phonofobia, vomiting, walking laterality, diplopia, tonic–clonic seizures, nystagmus, dysmetria, and dysdiadochokinesia. Cranial tomography was performed, reporting hydrocephaly data with significant dilation of the IV ventricle and the presence of a tumor lesion in the posterior fossa of the right cerebellar hemisphere. Pediatric tumors that manifest in adulthood are rare, with signs such as intracranial hypertension and compress the cranial nerves. The prognosis will be determined by the accompanying abnormalities as well as the effectiveness of the appropriate treatment.
{"title":"A case report on a late diagnosis of pilocytic astrocytoma in a Dandy–Walker complex","authors":"Juan Sebastián Solis-Mata , Fernando Castro-Soto , José Alfonso Alvarez-Castro , Sonia Iliana Mejía-Pérez","doi":"10.1016/j.neucir.2024.10.001","DOIUrl":"10.1016/j.neucir.2024.10.001","url":null,"abstract":"<div><div>Dandy–Walker malformation (DWM) and pilocytic astrocytoma are entities that manifest themselves at an early age. DWM is a cerebella type associated with several anatomical changes. Very few cases of concomitant occurrence of DWM and pilocytic astrocytoma have been reported on the literature. Male 20 years old, clinical history of 6 months of evolution with nausea, dizziness, headache, photophobia, phonofobia, vomiting, walking laterality, diplopia, tonic–clonic seizures, nystagmus, dysmetria, and dysdiadochokinesia. Cranial tomography was performed, reporting hydrocephaly data with significant dilation of the IV ventricle and the presence of a tumor lesion in the posterior fossa of the right cerebellar hemisphere. Pediatric tumors that manifest in adulthood are rare, with signs such as intracranial hypertension and compress the cranial nerves. The prognosis will be determined by the accompanying abnormalities as well as the effectiveness of the appropriate treatment.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 2","pages":"Pages 139-143"},"PeriodicalIF":0.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.neucir.2024.07.004
Ernesto F. Ardisana Santana , Juan F. Villalonga-Penna , Mauro M. Suárez Marin , Alvaro Campero
The coincidence in a patient of Hemifacial Spasm and Trigeminal Neuralgia is not frequent. A case is presented with the objective of showing this association due to the abnormal activation of the Trigemino-Facial Reflex.
A 55-year-old woman with an 8-year history of left-sided hemifacial spasm and typical trigeminal pain in the ipsilateral V1 and V2 territory.
The physical examination shows spasms in the left hemiface, with reproduction of intense pain upon sensory stimulation of the skin on the forehead and upper dental arch.
The MRI showed a vessel in intimate contact with the entrance area of ??the left trigeminal nerve.
A left retrosigmoid approach was performed. First, the entrance area of ??the trigeminal nerve was accessed, finding a clear vascular conflict, which was isolated with Teflon. Then, the trajectory was changed and the exit zone of the facial nerve was accessed, and no type of vascular conflict was identified.
The patient presented complete resolution of the Hemifacial Spasm and the associated trigeminal pain.
The analysis of this case allows us to conclude that during microvascular decompression of the Facial Nerve, if frank proximal compression is not evident, the Trigeminofacial structural relationship must be taken into account, making it necessary to explore the Trigeminal Nerve.
{"title":"Espasmo hemifacial asociado a neuralgia trigeminal secundario a compresión vascular trigeminal","authors":"Ernesto F. Ardisana Santana , Juan F. Villalonga-Penna , Mauro M. Suárez Marin , Alvaro Campero","doi":"10.1016/j.neucir.2024.07.004","DOIUrl":"10.1016/j.neucir.2024.07.004","url":null,"abstract":"<div><div>The coincidence in a patient of Hemifacial Spasm and Trigeminal Neuralgia is not frequent. A case is presented with the objective of showing this association due to the abnormal activation of the Trigemino-Facial Reflex.</div><div>A 55-year-old woman with an 8-year history of left-sided hemifacial spasm and typical trigeminal pain in the ipsilateral V1 and V2 territory.</div><div>The physical examination shows spasms in the left hemiface, with reproduction of intense pain upon sensory stimulation of the skin on the forehead and upper dental arch.</div><div>The MRI showed a vessel in intimate contact with the entrance area of ??the left trigeminal nerve.</div><div>A left retrosigmoid approach was performed. First, the entrance area of ??the trigeminal nerve was accessed, finding a clear vascular conflict, which was isolated with Teflon. Then, the trajectory was changed and the exit zone of the facial nerve was accessed, and no type of vascular conflict was identified.</div><div>The patient presented complete resolution of the Hemifacial Spasm and the associated trigeminal pain.</div><div>The analysis of this case allows us to conclude that during microvascular decompression of the Facial Nerve, if frank proximal compression is not evident, the Trigeminofacial structural relationship must be taken into account, making it necessary to explore the Trigeminal Nerve.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 1","pages":"Pages 69-73"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.neucir.2024.10.009
Juan Ramón Gras-Cabrerizo , Maria Casasayas-Plass , Katarzyna Kolanczak , Fernando Muñoz Hernández , María Martel Martin , Esther Granell Moreno
Petroclival lesions represent a surgical challenge during the endonasal endoscopic approach, as they may involve maneuvers with severe comorbidity. To avoid the morbidity caused by these maneuvers, a contralateral transmaxillary approach (CTA) has been proposed to complement the endoscopic endonasal approach. The aim of our study is to review the safety and efficacy of this approach.
We included three patients with lesions affecting the petroclival region, one cholesterol granuloma and two macroadenomas, who were surgically treated with a combined ipsilateral transpterygoid approach and a CTA. The latter was performed by wide osteotomy on the anterior wall of the maxillary sinus through a gingivolabial incision.
Complete resection was achieved in the patient with a cholesterol granuloma and subtotal resection in the two patients diagnosed with macroadenoma. One patient presented ecchymosis of the malar area as the only complication.
The contralateral transmaxillary approach may improve exposure and dissection of the petroclival area compared to the homolateral endoscopic endonasal approach allowing reaching the most lateral and posterior region of this territory without the need to manipulate the internal carotid artery.
{"title":"Nuestra experiencia en la cirugía de lesiones petroclivales mediante un abordaje transmaxilar contralateral","authors":"Juan Ramón Gras-Cabrerizo , Maria Casasayas-Plass , Katarzyna Kolanczak , Fernando Muñoz Hernández , María Martel Martin , Esther Granell Moreno","doi":"10.1016/j.neucir.2024.10.009","DOIUrl":"10.1016/j.neucir.2024.10.009","url":null,"abstract":"<div><div>Petroclival lesions represent a surgical challenge during the endonasal endoscopic approach, as they may involve maneuvers with severe comorbidity. To avoid the morbidity caused by these maneuvers, a contralateral transmaxillary approach (CTA) has been proposed to complement the endoscopic endonasal approach. The aim of our study is to review the safety and efficacy of this approach.</div><div>We included three patients with lesions affecting the petroclival region, one cholesterol granuloma and two macroadenomas, who were surgically treated with a combined ipsilateral transpterygoid approach and a CTA. The latter was performed by wide osteotomy on the anterior wall of the maxillary sinus through a gingivolabial incision.</div><div>Complete resection was achieved in the patient with a cholesterol granuloma and subtotal resection in the two patients diagnosed with macroadenoma. One patient presented ecchymosis of the malar area as the only complication.</div><div>The contralateral transmaxillary approach may improve exposure and dissection of the petroclival area compared to the homolateral endoscopic endonasal approach allowing reaching the most lateral and posterior region of this territory without the need to manipulate the internal carotid artery.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 1","pages":"Pages 54-58"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143179916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The sellar region is an area in the base of the skull that is among the most common sites for tumors of the central nervous system. Surgical interventions are currently performed via different routes. While the optic chiasm occupies its expected position in 70% of the population, it can deviate from this position. In such cases, surgery involving this region becomes more difficult as the known surgical routes are narrowed. Advance awareness of these variations can help surgeons to identify the optimal route for safe surgical intervention in the sellar region. By performing simple measurements of both the lengths of the optic nerves and the angle between them, a surgeon can predict the location of the chiasm.
Materials and methods
Twenty specimens collected from autopsies performed at Bursa Forensic Medicine İnstitute were examined to determine the optic chiasm types and the relationships between the surrounding subchiasmal structures.
Results
Among the 20 specimens, we found two prefixed (10%), 10 normo-fixed (50%), and eight postfixed chiasms (40%). The mean interoptic angle was 81.03 (±17.41)⁰. Prefixed chiasms had angles in the range 115.36°–124.76 ° (mean 120.06 [±6.65]⁰), normo-fixed chiasm angles were between 83.11° and 97.53 ° (mean 86.07 [±6.73]⁰), and postfixed chiasms ranged between 53.01 ° and 78.71 ° (mean 69.20 [±9.13]⁰). The length of the right optic nerve ranged between 6.95 and 13.83 mm (mean 10.25 [±1.81] mm), and the length of the left between 7.25 and 12.51 mm (mean 10.40 [±1.47] mm). Obtuse angles indicated that the chiasm was prefixed, and acute angles were indicative of a postfixed chiasm. There was a strong negative correlation between optic nerve lengths and the interoptic angle; thus, as the length of the nerves increases, the interoptic angle becomes more acute.
Conclusions
We have proposed a simple measurement of the optic nerve lengths and the angle between them to predict the relative location of the OC, which can be done easily on MRI.
{"title":"Relationship between optic nerve length and interoptic angle in the prediction of optic chiasm location","authors":"Reyhan Kasab , Selcuk Yilmazlar , Oguz Altunyuva , Recep Fedakar","doi":"10.1016/j.neucir.2024.09.003","DOIUrl":"10.1016/j.neucir.2024.09.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The sellar region is an area in the base of the skull that is among the most common sites for tumors of the central nervous system. Surgical interventions are currently performed via different routes. While the optic chiasm occupies its expected position in 70% of the population, it can deviate from this position. In such cases, surgery involving this region becomes more difficult as the known surgical routes are narrowed. Advance awareness of these variations can help surgeons to identify the optimal route for safe surgical intervention in the sellar region. By performing simple measurements of both the lengths of the optic nerves and the angle between them, a surgeon can predict the location of the chiasm.</div></div><div><h3>Materials and methods</h3><div>Twenty specimens collected from autopsies performed at Bursa Forensic Medicine İnstitute were examined to determine the optic chiasm types and the relationships between the surrounding subchiasmal structures.</div></div><div><h3>Results</h3><div>Among the 20 specimens, we found two prefixed (10%), 10 normo-fixed (50%), and eight postfixed chiasms (40%). The mean interoptic angle was 81.03 (±17.41)⁰. Prefixed chiasms had angles in the range 115.36°–124.76 ° (mean 120.06 [±6.65]⁰), normo-fixed chiasm angles were between 83.11° and 97.53 ° (mean 86.07 [±6.73]⁰), and postfixed chiasms ranged between 53.01 ° and 78.71 ° (mean 69.20 [±9.13]⁰). The length of the right optic nerve ranged between 6.95 and 13.83 mm (mean 10.25 [±1.81] mm), and the length of the left between 7.25 and 12.51 mm (mean 10.40 [±1.47] mm). Obtuse angles indicated that the chiasm was prefixed, and acute angles were indicative of a postfixed chiasm. There was a strong negative correlation between optic nerve lengths and the interoptic angle; thus, as the length of the nerves increases, the interoptic angle becomes more acute.</div></div><div><h3>Conclusions</h3><div>We have proposed a simple measurement of the optic nerve lengths and the angle between them to predict the relative location of the OC, which can be done easily on MRI.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 1","pages":"Pages 39-46"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.neucir.2024.09.005
Emilio González Martínez, Giancarlo Mattos-Piaggio, David Santamarta Gómez
Introduction
Microvascular decompression (MVD) is a non-ablative technique aimed at relieving pain in trigeminal neuralgia (TN) by resolving a neurovascular conflict. Despite reported high success rates, a significant percentage of patients experience therapeutic failure.
Methods
Retrospective observational study of patients with suspected TN undergoing MVD was performed with the goal of identifying factors contributing to the persistence and recurrence of pain.
Results
In the present study, 31 patients undergoing 38 MVD procedures for TN were included (7 patients underwent reoperation after the failure of the initial operation). The mean age was 58.5 years with a male predominance (58.1%). The mean duration of pain was 6.4 years, mainly affecting branches V2 and V3 (46.7%). The most frequently described neurovascular conflict was with the superior cerebellar artery (54.8%), predominantly resolved with Teflon (75.9%).
In our case series, MVD achieved pain control in 80.6% of patients at one-year post-intervention and 61.3% at the end of the follow-up period. Twelve patients experienced MVD failure: 5 cases of persistent pain and 7 cases of pain recurrence. A detailed analysis of these failures identified misdiagnosis as the reason of persistent pain in 4 patients, while inadequate surgical technique could be the cause of pain recurrence in 6 patients.
Conclusion
In our study, therapeutic failures could mainly be attributed to two factors: misdiagnosis or the use of inappropriate materials. These factors should be considered when optimizing the management of DMV in patients with NT.
{"title":"Revisión de los fracasos terapéuticos de la descompresión microvascular en la neuralgia del trigémino en un hospital terciario","authors":"Emilio González Martínez, Giancarlo Mattos-Piaggio, David Santamarta Gómez","doi":"10.1016/j.neucir.2024.09.005","DOIUrl":"10.1016/j.neucir.2024.09.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Microvascular decompression (MVD) is a non-ablative technique aimed at relieving pain in trigeminal neuralgia (TN) by resolving a neurovascular conflict. Despite reported high success rates, a significant percentage of patients experience therapeutic failure.</div></div><div><h3>Methods</h3><div>Retrospective observational study of patients with suspected TN undergoing MVD was performed with the goal of identifying factors contributing to the persistence and recurrence of pain.</div></div><div><h3>Results</h3><div>In the present study, 31 patients undergoing 38 MVD procedures for TN were included (7 patients underwent reoperation after the failure of the initial operation). The mean age was 58.5 years with a male predominance (58.1%). The mean duration of pain was 6.4 years, mainly affecting branches V2 and V3 (46.7%). The most frequently described neurovascular conflict was with the superior cerebellar artery (54.8%), predominantly resolved with Teflon (75.9%).</div><div>In our case series, MVD achieved pain control in 80.6% of patients at one-year post-intervention and 61.3% at the end of the follow-up period. Twelve patients experienced MVD failure: 5 cases of persistent pain and 7 cases of pain recurrence. A detailed analysis of these failures identified misdiagnosis as the reason of persistent pain in 4 patients, while inadequate surgical technique could be the cause of pain recurrence in 6 patients.</div></div><div><h3>Conclusion</h3><div>In our study, therapeutic failures could mainly be attributed to two factors: misdiagnosis or the use of inappropriate materials. These factors should be considered when optimizing the management of DMV in patients with NT.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 1","pages":"Pages 47-53"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.neucir.2024.07.008
Sergio García García , Ignacio Arrese Regañón , Santiago Cepeda Chafla , Rosario Sarabia Herrero
Introduction
Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition with an increasing incidence due to the rising life expectancy and the widespread use of anticoagulant and antiplatelet therapies. Insights into the inflammatory origins of cSDH led to the exploration of Middle Meningeal Artery (MMA) embolization as a therapeutic strategy. In recent years the endovascular treatment of MMA has gained momentum. Herein we present the initial experience of a dual trained neurovascular unit implementing this therapeutic technique.
Methods
This single-center, prospective pilot study aimed to evaluate the feasibility, safety, and efficacy of MMA embolization in the treatment of cSDH. Following ethical approval and informed consent, demographic, clinical, and radiological data were collected. Patients requiring emergent surgical treatment were excluded. The study focused on assessing clinical outcomes, including the Modified Rankin Score (mRS) and volumetric analysis of cSDH, before and after embolization.
Results
Fifteen patients underwent MMA embolization, with a predominance of males (80%) and a mean age of 72.4 years. The most common presenting symptom was headache (53.3%). The average hospital stay was 3.9 days. Various embolization techniques were employed, with DMSO-EVOH being the most frequent. All procedures were successfully conducted without complications. Although not statistically significant, trends suggested better outcomes in patients with homogeneous cSDH on the CT scan, displaying the cotton wool sign on angiography and treated with EVOH-DMSO.
Conclusion
MMA embolization for cSDH demonstrates promise as a safe and effective treatment, potentially reducing the need for surgical intervention and recurrence rates. This study lays the groundwork for a larger, randomized controlled trial which protocol is herein presented.
{"title":"Endovascular treatment of chronic subdural hematoma in a dual-trained neurosurgical unit: Results and proposal of a randomized controlled trial protocol","authors":"Sergio García García , Ignacio Arrese Regañón , Santiago Cepeda Chafla , Rosario Sarabia Herrero","doi":"10.1016/j.neucir.2024.07.008","DOIUrl":"10.1016/j.neucir.2024.07.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition with an increasing incidence due to the rising life expectancy and the widespread use of anticoagulant and antiplatelet therapies. Insights into the inflammatory origins of cSDH led to the exploration of Middle Meningeal Artery (MMA) embolization as a therapeutic strategy. In recent years the endovascular treatment of MMA has gained momentum. Herein we present the initial experience of a dual trained neurovascular unit implementing this therapeutic technique.</div></div><div><h3>Methods</h3><div>This single-center, prospective pilot study aimed to evaluate the feasibility, safety, and efficacy of MMA embolization in the treatment of cSDH. Following ethical approval and informed consent, demographic, clinical, and radiological data were collected. Patients requiring emergent surgical treatment were excluded. The study focused on assessing clinical outcomes, including the Modified Rankin Score (mRS) and volumetric analysis of cSDH, before and after embolization.</div></div><div><h3>Results</h3><div>Fifteen patients underwent MMA embolization, with a predominance of males (80%) and a mean age of 72.4 years. The most common presenting symptom was headache (53.3%). The average hospital stay was 3.9 days. Various embolization techniques were employed, with DMSO-EVOH being the most frequent. All procedures were successfully conducted without complications. Although not statistically significant, trends suggested better outcomes in patients with homogeneous cSDH on the CT scan, displaying the cotton wool sign on angiography and treated with EVOH-DMSO.</div></div><div><h3>Conclusion</h3><div>MMA embolization for cSDH demonstrates promise as a safe and effective treatment, potentially reducing the need for surgical intervention and recurrence rates. This study lays the groundwork for a larger, randomized controlled trial which protocol is herein presented.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 1","pages":"Pages 28-38"},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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