Neurocirugia最新文献_第3页

Topical and systemic effects of medical ozone therapy on epidural fibrosis: Experimental research 医用臭氧治疗硬膜外纤维化的局部和全身效应：实验研究

IF 0.8 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-09-01 DOI: 10.1016/j.neucir.2025.500663

Nur Balcin , Mine Ozsen , Pinar Eser , Tamer Kala , Gokhan Ocakoglu , Seref Dogan

Introduction

Epidural fibrosis (EF) causes adhesions in the epidural distance, resulting in chronic low back and leg pain symptoms during the postoperative period. Currently, ozone is used for treating lumbar disk herniation and low back pain. However, its effect on epidural fibrosis is largely unknown.

Material and methods

This rodent study examined the histopathological and biochemical effects of ozone therapy on epidural fibrosis. Forty-seven male Sprague–Dawley rats were divided into four groups, as follows: Control Group (CG) (n = 12): Laminectomy was performed, and no substance was applied. Saline Group (SG) (n = 11): Rats underwent intraoperative washing with 50 mL saline after laminectomy. Local Ozone Group (LOG) (n = 12): Rats underwent intraoperative washing with 50 mL ozonated distilled water after laminectomy. Systemic Ozone Group (SOG) (n = 12): Ozone was administered intraperitoneally (0.7 mg/kg) for 7 consecutive days postoperatively. At the end of 4 weeks, all subjects were sacrificed. Histopathological and biochemical data obtained from the tissues were analyzed in terms of EF.

Results

No statistically significant differences regarding EF, spinal cord retraction, inflammation, and fibroblast density were observed between the groups (p = 0.728; p = 0.813; p = 0.152; and p = 0.226, respectively). Hydroxyproline levels were higher in LOG than in SOG (p = 0.007); however, no statistically significant differences were observed among other groups (p > 0.05).

Conclusions

In our study, we could not record the positive effect of ozone therapy in terms of histopathology and biochemistry with the current doses and application methods. We think that caution should be exercised in the ozone dose and method of application in the clinical approach. In addition, we are of the opinion that statistically significant results can be obtained by creating a treatment protocol that includes different dose applications.

硬膜外纤维化（EF）引起硬膜外粘连，导致术后出现慢性腰痛和腿部疼痛症状。目前，臭氧用于治疗腰椎间盘突出和腰痛。然而，其对硬膜外纤维化的影响在很大程度上是未知的。材料和方法本实验研究了臭氧治疗对硬膜外纤维化的组织病理学和生化影响。雄性Sprague-Dawley大鼠47只，随机分为4组：对照组（CG）（n = 12）：行椎板切除术，不给药。生理盐水组（SG）（n = 11）：椎板切除术后，术中用50 mL生理盐水冲洗大鼠。局部臭氧组（LOG）（n = 12）：椎板切除术后，术中用50 mL臭氧蒸馏水冲洗大鼠。系统臭氧组（SOG）（n = 12）：术后连续7天腹腔注射臭氧（0.7 mg/kg）。4周结束时，所有受试者均被处死。从组织中获得的组织病理学和生化数据根据EF进行分析。结果两组间EF、脊髓回缩、炎症、成纤维细胞密度差异无统计学意义（p = 0.728;p = 0.813; p = 0.152;p = 0.226）。LOG组羟脯氨酸水平高于SOG组（p = 0.007）；其他组间差异无统计学意义（p >； 0.05）。结论在我们的研究中，在目前的剂量和应用方法下，我们无法记录到臭氧治疗在组织病理学和生物化学方面的积极作用。我们认为在临床应用中，臭氧剂量和应用方法应谨慎。此外，我们认为，通过创建包括不同剂量应用的治疗方案，可以获得统计上显著的结果。

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引用次数: 0

ALIF in a Spanish female cohort: No urinary and sexual complications or a gender bias? ALIF在西班牙女性队列中：没有泌尿和性并发症还是性别偏见？

IF 0.8 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-09-01 DOI: 10.1016/j.neucir.2025.500662

Cristina Romero-López , Santiago Rocha-Romero , María de los Ángeles Cañizares-Méndez , Julio Valencia-Anguita

Background

The objective of the present study is to analyze urinary and sexual functions in females treated with ALIF and to describe possible complications not previously reported in the literature.

Methods

We conducted a retrospective study of urinary and sexual functions in females treated with this technique in our hospital between 2019 and 2022. Inclusion criteria were: females treated with ALIF who provided informed consent.

Results

22 patients consented to participate. The median age was 51.5 years, the median follow-up was 11.5 months, and there was an improvement in low back pain of 4 points on the postoperative (postop) visual analogue scale (VAS). Overall, 36.3% of patients reported postoperative urinary deterioration, including 27.3% with new-onset urinary incontinence. The international consultation on incontinence questionnaire-short form score worsened by 3.5 points. 77.2% maintained an active sexual life; within this group, there was a worsening of 2.4 points in the postop female sexual function index and 35.2% described worsening in sexual function. We hypothesized that age, underlying lumbar pathology and changes in postoperative VAS scores could be confounding factors; however, only the relationship between age and postoperative urinary deterioration reached statistical significance (p = 0.034).

Conclusions

The present study describes deterioration in urinary function in 36.3% and in sexual function in 35.2% after the procedure, findings also supported by specific scales. In view of the above, we cannot discount a possible gender bias in the literature. Despite that, we believe that ALIF is still an adequate technique, but studies of higher level of evidence should be conducted to improve the information process of our patients.

本研究的目的是分析接受ALIF治疗的女性的泌尿和性功能，并描述以前文献中未报道的可能的并发症。方法回顾性分析2019 ~ 2022年在我院接受该技术治疗的女性患者的泌尿功能和性功能。纳入标准为：接受ALIF治疗并提供知情同意的女性。结果22例患者同意参与。中位年龄为51.5岁，中位随访时间为11.5个月，术后（术后）视觉模拟评分（VAS）腰痛改善4分。总体而言，36.3%的患者报告术后尿功能恶化，其中27.3%为新发尿失禁。国际咨询失禁问卷-简短形式得分下降3.5分。77.2%的人性生活活跃；在该组中，女性术后性功能指数恶化了2.4点，35.2%的人描述了性功能恶化。我们假设年龄、腰椎潜在病理和术后VAS评分的变化可能是混杂因素；但只有年龄与术后尿功能恶化的关系有统计学意义（p = 0.034）。结论本研究发现，手术后泌尿功能和性功能分别有36.3%和35.2%的患者出现恶化，这一结果也得到了特定量表的支持。鉴于上述情况，我们不能忽视文献中可能存在的性别偏见。尽管如此，我们认为ALIF仍然是一种足够的技术，但应该进行更高水平的证据研究，以改善我们患者的信息处理。

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引用次数: 0

Fully percutaneous posterior transarticular C1-C2 stand-alone screw instrumentation: A case series and technical note 完全经皮后路经关节C1-C2独立螺钉内固定：一个病例系列和技术说明

IF 0.8 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-09-01 DOI: 10.1016/j.neucir.2025.500665

Ivan Lvov, Andrey Grin, Anton Kordonskiy, Zaali Barbakadze, Aleksandr Talypov, Aleksandr Tupikin

Magerl’s technique remains a widely accepted method for achieving C1-C2 fusion. Although two approaches using intermuscular corridors and biplanar X-ray guidance have been reported, there are no published studies dedicated to fully percutaneous techniques employing cannulated screws.

Objective

To demonstrate the feasibility of a fully percutaneous C1-C2 fixation technique using cannulated screws and to analyze the short- and long-term outcomes of the initial case series.

Material and methods

This case series included patients over 15 years of age who were presented with acute or subacute atlantoaxial instability at C1-C2 due to fractures of the odontoid process, C1 vertebra, or C2 vertebral body. Surgical details and fusion criteria were described. Due to the absence of comparison groups, only descriptive statistical methods were employed.

Results

A total of 11 patients (8 men, 3 women; mean age 41.5 ± 18.2 years) underwent fully percutaneous transarticular C1-C2 fixation. The mean operative time was 115.0 ± 30.8 min for patients stabilized using a Halo device and 80.6 ± 33.2 min for those immobilized with a Mayfield clamp. The mean blood loss across all cases was 38.8 ± 8.7 mL. One patient died from concurrent cardiac pathology. Two patients were lost to follow-up due to relocation, leaving 8 patients for final assessment. At final follow-up, the mean VAS score was 2 ± 1.5 and the mean NDI score was 5.3 ± 5.2. All patients with preoperative neurological deficits improved by one level on the ASIA scale. Fusion was achieved in 7 of 8 cases (87.5%), and 1 patient (12.5%) developed a stable C1-C2 pseudoarthrosis.

Conclusion

Our initial clinical experience demonstrated that fully percutaneous posterior transarticular C1-C2 stand-alone screw fixation using cannulated instruments could be a feasible and safe procedure. Critical requirements for this technique include complete reduction of atlantoaxial dislocation, compression in the lateral joint region, adequate intraoperative visualization, and strict adherence to specific screw trajectories.

Magerl技术仍然是一种被广泛接受的实现C1-C2融合的方法。虽然已经报道了两种采用肌间通道和双平面x线引导的入路，但没有发表的研究专门用于采用空心螺钉的全经皮技术。目的探讨全经皮C1-C2空心螺钉内固定技术的可行性，并分析初步病例系列的短期和长期疗效。材料和方法本病例系列包括15岁以上因齿状突、C1椎体或C2椎体骨折而表现为C1-C2急性或亚急性寰枢椎不稳定的患者。描述了手术细节和融合标准。由于没有对照组，因此仅采用描述性统计方法。结果11例患者（男8例，女3例，平均年龄41.5 ± 18.2岁）行全经皮经关节C1-C2内固定。使用Halo装置稳定的患者平均手术时间为115.0 ± 30.8 min，使用Mayfield钳固定的患者平均手术时间为80.6 ± 33.2 min。所有病例的平均失血量为38.8 ± 8.7 mL。1例患者死于并发心脏病理。2例患者因移位失访，8例患者待最后评估。末次随访时，VAS平均评分为2 ± 1.5分，NDI平均评分为5.3 ± 5.2分。所有术前神经功能缺损的患者在ASIA量表上均提高一个等级。8例患者中有7例（87.5%）实现融合，1例（12.5%）发展为稳定的C1-C2假关节。结论我们的初步临床经验表明，使用空心器械完全经皮后路经关节C1-C2独立螺钉固定是可行且安全的手术。该技术的关键要求包括完全复位寰枢关节脱位，压迫外侧关节区域，术中充分的可视化，严格遵守特定的螺钉轨迹。

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引用次数: 0

Ossification of posterior longitudinal ligament of the cervical spine: A review article 颈椎后纵韧带骨化：一篇综述文章

IF 0.8 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-09-01 DOI: 10.1016/j.neucir.2025.500668

Shengyu Cui , Jinze Li , Xiaoxu Yu , Hongyu Zhao , Fengzeng Jian

This article reviews the literature on the status of cervical OPLL in recent years, and reviews the etiology, clinical manifestations, imaging features, treatment and prognosis. Evidence was collected through PubMed and Google Scholar databases. After screening, weight removal and irrelevant articles, 57 articles were finally included in the review. Imaging is the only way to confirm the diagnosis, and CT and MRI are used to assess the patient's ossified material and spinal cord compression. Because there are hundreds of surgical approaches to cervical OPLL, each with advantages and disadvantages, clinicians must develop a personalized surgical plan based on the patient’s preoperative relevant factors to maximize prognosis. Clinicians should also actively follow up on discharged patients, carefully analyze cases with a poor prognosis, and summarize their experiences.

本文综述了近年来有关颈椎OPLL的文献，并对其病因、临床表现、影像学特征、治疗及预后进行了综述。证据是通过PubMed和谷歌Scholar数据库收集的。经筛选、去权重和不相关文献后，最终纳入57篇文献。影像学是确认诊断的唯一方法，CT和MRI用于评估患者的骨化物质和脊髓压迫。由于颈椎OPLL有数百种手术入路，各有优缺点，临床医生必须根据患者术前相关因素制定个性化的手术方案，以最大限度地提高预后。临床医生还应积极随访出院患者，认真分析预后差的病例，总结经验。

引用次数: 0

Symptomatic thrombosed venous aneurysm after stereotactic radiosurgery for brain arteriovenous malformation: Case report of a late complication mimicking radiation necrosis 立体定向放射治疗脑动静脉畸形后的症状性血栓性静脉动脉瘤：一例模拟放射坏死的晚期并发症

IF 0.8 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-09-01 DOI: 10.1016/j.neucir.2025.500669

Gino A. Mendoza-Vega , Jason Riveros-Ruiz , Juan E. Basilio-Flores

Late complications of radiosurgery for brain arteriovenous malformation include cystic formation, chronic encapsulated hematoma and radiation-induced tumors. Other complications are rarely reported.

We present a case of an adult patient who received radiosurgery for treatment of an unruptured parietal arteriovenous malformation. He was followed-up for 10 years and angiographic cure was documented. Fifteen-years after radiosurgery, he complained of new-onset progressive focal seizures associated with a thrombosed venous aneurysm with persistent arteriovenous shunt angiographically occult but evidenced intraoperatively. After resection of the lesion, symptoms disappeared.

This case depicts a symptomatic thrombosed venous aneurysm presenting as a rare delayed complication of radiosurgery for the treatment of brain arteriovenous malformation, which can be associated with angiographically-occult persistent arteriovenous shunt.

脑动静脉畸形放射治疗的晚期并发症包括囊性形成、慢性囊性血肿和放射性肿瘤。其他并发症很少报道。我们提出一个病例的成人病人接受放射手术治疗未破裂的顶骨动静脉畸形。随访10年，血管造影治疗记录在案。放射手术后15年，他主诉新发进行性局灶性癫痫与血栓形成的静脉动脉瘤有关，并伴有持续的动静脉分流，血管造影上隐匿，但术中证实。病变切除后症状消失。这个病例描述了一个有症状的血栓性静脉动脉瘤，作为治疗脑动静脉畸形的放射手术中一种罕见的延迟并发症，它可能与血管造影隐匿的持续性动静脉分流有关。

引用次数: 0

Removal of a giant musculocutaneous nerve schwannoma under intraoperative neurophysiological monitoring: Case report video and review of the literature 术中神经生理监测下切除巨大肌皮神经鞘瘤：病例报告录像及文献复习

IF 0.8 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-09-01 DOI: 10.1016/j.neucir.2025.500667

Edward Emerson Susanibar Mesías , Alba León Jorba , Antoni Raventós Estellé , Christian Abel Schinder , David Rodriguez Rubio

Schwannomas of the musculocutaneous nerve (MCN) are rare benign tumors of the peripheral nerve sheath. Due to their slow growth, they are often diagnosed late. In the upper limbs, schwannomas typically affect longer peripheral nerves at a distal level, making MCN cases uncommon. Ultrasound (US) and magnetic resonance imaging (MRI) are essential tools for early detection. While most schwannomas can be surgically removed without damaging the nerve, intraoperative neurophysiological monitoring (IONM) is critical if fascicular involvement exists.

We present a 73-year-old right-handed Jehovah's Witness with a history of mild polio affecting the right arm. MRI showed a slow-growing, cystic mass in the right biceps, originating from the MCN and suggestive of schwannoma. Surgery achieved gross total resection without nerve damage. Histopathology confirmed a cystic schwannoma.

In atypical proximal upper limb tumors, MCN schwannoma should be considered, with US/MRI crucial for diagnosis. IONM-assisted removal can minimize postoperative complications.

摘要肌皮神经鞘瘤是一种少见的外周神经鞘良性肿瘤。由于其生长缓慢，通常诊断较晚。在上肢，神经鞘瘤通常影响远端较长的周围神经，使得MCN病例不常见。超声（US）和磁共振成像（MRI）是早期发现的重要工具。虽然大多数神经鞘瘤可以手术切除而不损害神经，但如果存在神经束累及，术中神经生理监测（IONM）是至关重要的。MRI显示右二头肌生长缓慢的囊性肿块，起源于MCN，提示神经鞘瘤。手术实现了大体全切除，无神经损伤。组织病理学证实为囊性神经鞘瘤。在非典型上肢近端肿瘤中，应考虑MCN神经鞘瘤，US/MRI对诊断至关重要。离子离子辅助切除可减少术后并发症。

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引用次数: 0

Craniopharyngioma and abscess: When tumor and infection co-exist 颅咽管瘤和脓肿：肿瘤和感染并存

IF 0.8 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-09-01 DOI: 10.1016/j.neucir.2025.500657

Luis Miguel Moreno-Gómez , Pablo M. Munarriz , Aurelio Hernández-Laín , Alfonso Lagares

Pituitary abscesses are rare entities that may occur in a previously healthy gland or in the setting of a pituitary tumor. Only eleven cases of abscesses associated with craniopharyngioma have been reported in the literature. The etiology is unknown and the diagnosis is difficult because there are no specific clinical or radiologic features that allow us to suspect the synchrony of both entities before surgery. Intraoperative findings and culture are the only definitive signs to confirm this association.

Here we present the first surgical video showing this unique association and highlighting the technical pearls of the procedure. In a 9-year-old boy, we performed a transphenoidal approach to resect the tumor and saw pus during surgery. Pathology revealed a papillary craniopharyngioma, with microbiology showing Staphylococcus aureus. The tumor resection resulted in ophthalmologic improvement but pituitary insufficiency. A brief review of the literature is presented.

垂体脓肿是罕见的实体，可能发生在以前健康的腺体或垂体肿瘤的设置。文献中仅报道了11例与颅咽管瘤相关的脓肿。病因不明，诊断困难，因为没有具体的临床或放射学特征，使我们在手术前怀疑这两个实体的同步。术中发现和培养是证实这种关联的唯一明确迹象。在这里，我们展示了第一个外科视频，展示了这种独特的联系，并强调了手术的技术要点。在一名9岁男孩中，我们采用经蝶窦入路切除肿瘤，术中发现脓液。病理显示乳头状颅咽管瘤，微生物学显示金黄色葡萄球菌。肿瘤切除后视力改善，但垂体功能不全。简要回顾一下相关文献。

引用次数: 0

Anastomosis intradurales entre los nervios raquídeos cervicales: estudio anatómico 颈椎神经间的鼻内解剖：解剖学研究

IF 0.8 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-09-01 DOI: 10.1016/j.neucir.2025.500666

Matilde Lissarrague , Franklin Miranda Solís , Fernando Martínez Benia

Introduction

Peripheral nerves can present anastomoses at different levels, with intraspinal anastomoses being relatively common, but little studied.

Objective

To study the presence and number of intradural anastomoses of the cervical spinal nerves in the Latin population.

Materials and methods

14 adult corpses of both sexes were dissected, fixed in formaldehyde solution. Sex of the corpse, existence of anastomosis, side, height of the anastomoses and sensory/motor origin were recorded.

Results

Of the 14 corpses, 8 were male and 6 were female. Eleven cases presented anastomoses (79%), 8 of them bilaterally. In the total number of corpses, 52 anastomoses were found, 43 were between sensory roots (83%) and 9 between motor roots (17%). The levels where anastomoses were found most frequently were C1-C2 and C2-C3 (63% of the total).

Discussion and conclusions

Intraspinal anastomoses between motor or sensory nerves can vary the clinical presentation of spinal cord injuries, radicular or medullar compressions, brachial plexus lesions or nerve root tumors, because the sensory or motor information of a given spinal cord level may be exiting the neuraxis with the adjacent spinal nerve.

周围神经可以出现不同程度的吻合，其中椎管内吻合较为常见，但研究较少。目的探讨拉丁人群颈脊神经硬膜内吻合术的存在及数量。材料与方法解剖成人尸体14具，用甲醛溶液固定。记录尸体的性别、吻合口的存在、吻合口的侧面、高度和感觉/运动来源。结果14具尸体中，男8具，女6具。吻合11例（79%），其中8例为双侧吻合。其中感觉根间吻合43例（83%），运动根间吻合9例（17%）。吻合最常见的是C1-C2和C2-C3（占总数的63%）。讨论与结论椎间运动神经或感觉神经的吻合可以改变脊髓损伤、神经根或髓质受压、臂丛病变或神经根肿瘤的临床表现，因为某一脊髓水平的感觉或运动信息可能与邻近的脊神经一起离开神经轴。

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引用次数: 0

Modelo de entrenamiento neuroquirúrgico en encéfalo bovino para resección de tumores intraaxiales 牛脑轴向内肿瘤切除神经外科训练模型

IF 0.7 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-07-01 DOI: 10.1016/j.neucir.2025.500659

Miguel Nuñez Rodriguez, Alexis Tovar, Victoria Herrera Gunn, Pablo Kuchlewski, Guido Carlomagno, Florencia Beldi

Background

Practice in simulation models optimizes learning and manual skills necessary in neurosurgical training.

Objectives

To describe a neurosurgical simulation model for the resection of brain tumors using easily accessible materials and to evaluate the acceptance of the model through a questionnaire.

Material and methods

An artificial tumor based on gelatin and spongostan with infiltrative characteristics was elaborated. It was injected into a bovine brain and the latter into a dry skull. Its location was studied to later operate it using microsurgical instruments. Dural opening, corticotomy, biopsy and debulking with supramarginal resection were performed and the participants evaluated the model through a Likert-type questionnaire.

Results

In vivo simulation models, cadaveric preparations, 3D printing, virtual reality and injection of artificial lesions into animal brains ex vivo are described. In the latter, the creation of tumors based on different materials, including gelatin, is mentioned. It is important that the tumor is easy to inject and resistant to heat, so a mixture of gelatin - spongostan was created. This model describes qualities to emulate tumor surgery as well as pre-surgical planning, reconstruction of the subarachnoid space and continuous instillation of artificial blood to the surgical bed.

Conclusion

An intraaxial tumor simulation model was described as a useful tool to improve surgical techniques in oncological neurosurgery. It proved to have a good degree of acceptance in the participants.

模拟模型的实践优化了神经外科训练中必要的学习和手工技能。目的建立一种易于获取的脑肿瘤切除神经外科模拟模型，并通过问卷调查的方式评价该模型的可接受性。材料和方法阐述了一种具有浸润性的基于明胶和海绵的人工肿瘤。它被注射到牛的大脑中，后者被注射到干燥的头骨中。研究了它的位置，然后用显微外科器械进行手术。进行硬脑膜切开、皮质切除术、活检和切除边缘上肿物，参与者通过likert型问卷对模型进行评估。结果描述了动物体内模拟模型、尸体制备、3D打印、虚拟现实和人工病变脑内注射。在后者中，提到了基于不同材料（包括明胶）的肿瘤的产生。重要的是，肿瘤易于注射和耐热，因此创造了明胶-海绵的混合物。该模型描述了模拟肿瘤手术以及术前计划、重建蛛网膜下腔和持续向手术床注入人工血液的特性。结论轴内肿瘤模拟模型是提高肿瘤神经外科手术技术的有效工具。它被证明在参与者中有很好的接受程度。

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引用次数: 0

Dr. Máximo Poza y Poza 马克西莫·波扎和波扎博士

IF 0.7 4区医学 Q4 NEUROSCIENCES

Neurocirugia

Pub Date : 2025-07-01 DOI: 10.1016/j.neucir.2025.500661

Juan F. Martínez-Lage Sánchez

引用次数: 0