Pub Date : 2025-05-01DOI: 10.1016/j.neucir.2024.10.006
Alejandro Augusto Ortega Rodriguez, Santiago Nicolás Valbuena Dussan, José Luís Caro Cardera, Jordi de Manuel-Rimbau Muñoz
During lymphoma’s natural history of disease, 5–10% of cases may develop Central Nervous affectation. We present the case of a 57-years-old man with less than 24 h of onset symptoms of paraparesis, lower limb hypoesthesia and sphincter dysfunction who was operated due to dorsal tumor with epidural component which caused severe cord compression. Pathological analysis concluded atypical T-cell lymphoblastic lymphoma, a rare subtype of lymphoma which accounts 1%−2% of all Non-Hodgkin Lymphomas. Our case was particularly aggressive and atypical due to its origin in paraspinal soft tissue. Despite specific treatment, the patient presented an early epidural relapse, frequent in this lymphoma subtype.
{"title":"Cord compression due to atypical T-cell lymphoma from paraspinal soft tissue: Report of a case","authors":"Alejandro Augusto Ortega Rodriguez, Santiago Nicolás Valbuena Dussan, José Luís Caro Cardera, Jordi de Manuel-Rimbau Muñoz","doi":"10.1016/j.neucir.2024.10.006","DOIUrl":"10.1016/j.neucir.2024.10.006","url":null,"abstract":"<div><div>During lymphoma’s natural history of disease, 5–10% of cases may develop Central Nervous affectation. We present the case of a 57-years-old man with less than 24 h of onset symptoms of paraparesis, lower limb hypoesthesia and sphincter dysfunction who was operated due to dorsal tumor with epidural component which caused severe cord compression. Pathological analysis concluded atypical T-cell lymphoblastic lymphoma, a rare subtype of lymphoma which accounts 1%−2% of all Non-Hodgkin Lymphomas. Our case was particularly aggressive and atypical due to its origin in paraspinal soft tissue. Despite specific treatment, the patient presented an early epidural relapse, frequent in this lymphoma subtype.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 199-203"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895900","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 : 2025-05-01DOI: 10.1016/j.neucir.2024.11.002
Adrián Fernández García, Carlos Alberto Rodríguez Arias, Estefanía Utiel Monsálvez, Herbert Daniel Jiménez Zapata
Trigeminal neuralgia is a well-characterized disorder of high prevalence among the current population. It may be caused, among many other causes, by a tumor which contacts with the trigeminal nerve, often of large volume. We present the case of a middle-aged woman without any remarkable medical background who suffered a trigeminal neuralgia caused by a subcentimeter tumor which appeared to be a meningioma. Some small tumors like this one may be symptomatic whereas larger ones will not. We discuss the pathogenesis and characterization of the trigeminal neuralgia in such cases proposing some mechanisms that could be involved in the development of a secondary neuralgia.
{"title":"Trigeminal neuralgia secondary to minor size lesion, anatomical considerations and pathophysiology","authors":"Adrián Fernández García, Carlos Alberto Rodríguez Arias, Estefanía Utiel Monsálvez, Herbert Daniel Jiménez Zapata","doi":"10.1016/j.neucir.2024.11.002","DOIUrl":"10.1016/j.neucir.2024.11.002","url":null,"abstract":"<div><div>Trigeminal neuralgia is a well-characterized disorder of high prevalence among the current population. It may be caused, among many other causes, by a tumor which contacts with the trigeminal nerve, often of large volume. We present the case of a middle-aged woman without any remarkable medical background who suffered a trigeminal neuralgia caused by a subcentimeter tumor which appeared to be a meningioma. Some small tumors like this one may be symptomatic whereas larger ones will not. We discuss the pathogenesis and characterization of the trigeminal neuralgia in such cases proposing some mechanisms that could be involved in the development of a secondary neuralgia.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 204-207"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895901","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 : 2025-05-01DOI: 10.1016/j.neucir.2024.09.001
Kim Hoang , Jeffrey Santos , Areg Grigorian , Lourdes Swentek , Hansen Bow , Jeffry Nahmias
Introduction and objectives
Halo braces treat upper cervical spine fractures and serve as the most rigid form of external immobilization. Recently, halo braces have lost favor due to known complications and advances in surgical stabilization. This study aims to determine the contemporary incidence for use of halo braces and identify risk factors associated with mortality in trauma patients undergoing halo brace for cervical spine fractures.
Materials and methods
The 2017–2019 Trauma Quality Improvement Program Database was queried for patients ≥18 years-old with a cervical spine fracture undergoing halo brace. Patients sustaining penetrating trauma and severe torso injuries (abbreviated injury scale >3 for the abdomen or thorax) were excluded. Bivariate and multivariable logistic regression analyses were performed.
Results
From 144,434 patients with a cervical spine fracture, 272 (0.2%) underwent halo brace and 14 (5%) of these died. Those who died were older (73.5 vs. 53 years-old, p = 0.011) and had higher rates of hypertension (78.6% vs 33.1%, p < 0.001) and chronic kidney disease (14.3% vs. 1.2%, p < 0.001). Glasgow Coma Scale ≤8 (46.2% vs. 8.2%, p < 0.001) and cervical spinal cord injury (71.4% vs. 21.3%, p < 0.001) were more common in patients who died. In addition, those who died more often sustained respiratory complications (7.1% vs. 0.4%, p = 0.004) and sepsis (7.1% vs. 0.4%, p = 0.004). On multivariable logistic regression analysis, only Glasgow Coma Scale ≤8 (OR 19.77, 3.04–128.45, p = 0.002) was associated with increased mortality.
Conclusions
Only 5% of cervical spine fracture patients undergoing halo brace died. Respiratory complications and sepsis were more common in those who died. On multivariable analysis only Glasgow Coma Scale ≤8 remained an independent associated risk factor for mortality.
halo牙套用于治疗上颈椎骨折，是最刚性的外固定形式。最近，由于已知的并发症和手术稳定的进展，光环牙套已经失去了青睐。本研究旨在确定当前使用晕轮支架的发生率，并确定与创伤患者接受晕轮支架治疗颈椎骨折死亡率相关的危险因素。材料和方法查询2017-2019年创伤质量改善计划数据库中≥18岁颈椎骨折行晕轮支具的患者。排除有穿透性创伤和严重躯干损伤的患者（腹部或胸部的简略损伤量表>；3）。进行了双变量和多变量logistic回归分析。结果144434例颈椎骨折患者中，272例（0.2%）采用了晕支具，其中14例（5%）死亡。死亡的患者年龄较大（73.5岁vs. 53岁，p = 0.011），高血压（78.6% vs. 33.1%, p <； 0.001）和慢性肾病（14.3% vs. 1.2%, p <； 0.001）的发病率较高。格拉斯哥昏迷评分≤8 （46.2% vs. 8.2%, p <； 0.001）和颈脊髓损伤（71.4% vs. 21.3%, p <； 0.001）在死亡患者中更为常见。此外，死亡患者更常出现呼吸系统并发症（7.1% vs. 0.4%, p = 0.004）和脓毒症（7.1% vs. 0.4%, p = 0.004）。在多变量logistic回归分析中，只有格拉斯哥昏迷量表≤8 （OR 19.77, 3.04-128.45, p = 0.002）与死亡率增加相关。结论颈晕支具治疗颈椎骨折患者死亡率仅为5%。呼吸道并发症和败血症在死亡患者中更为常见。在多变量分析中，只有格拉斯哥昏迷评分≤8仍然是死亡率的独立相关危险因素。
{"title":"Mortality risk factors for adult trauma patients treated with halo brace for cervical spine fracture","authors":"Kim Hoang , Jeffrey Santos , Areg Grigorian , Lourdes Swentek , Hansen Bow , Jeffry Nahmias","doi":"10.1016/j.neucir.2024.09.001","DOIUrl":"10.1016/j.neucir.2024.09.001","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Halo braces treat upper cervical spine fractures and serve as the most rigid form of external immobilization. Recently, halo braces have lost favor due to known complications and advances in surgical stabilization. This study aims to determine the contemporary incidence for use of halo braces and identify risk factors associated with mortality in trauma patients undergoing halo brace for cervical spine fractures.</div></div><div><h3>Materials and methods</h3><div>The 2017–2019 Trauma Quality Improvement Program Database was queried for patients ≥18 years-old with a cervical spine fracture undergoing halo brace. Patients sustaining penetrating trauma and severe torso injuries (abbreviated injury scale >3 for the abdomen or thorax) were excluded. Bivariate and multivariable logistic regression analyses were performed.</div></div><div><h3>Results</h3><div>From 144,434 patients with a cervical spine fracture, 272 (0.2%) underwent halo brace and 14 (5%) of these died. Those who died were older (73.5 vs. 53 years-old, p = 0.011) and had higher rates of hypertension (78.6% vs 33.1%, p < 0.001) and chronic kidney disease (14.3% vs. 1.2%, p < 0.001). Glasgow Coma Scale ≤8 (46.2% vs. 8.2%, p < 0.001) and cervical spinal cord injury (71.4% vs. 21.3%, p < 0.001) were more common in patients who died. In addition, those who died more often sustained respiratory complications (7.1% vs. 0.4%, p = 0.004) and sepsis (7.1% vs. 0.4%, p = 0.004). On multivariable logistic regression analysis, only Glasgow Coma Scale ≤8 (OR 19.77, 3.04–128.45, p = 0.002) was associated with increased mortality.</div></div><div><h3>Conclusions</h3><div>Only 5% of cervical spine fracture patients undergoing halo brace died. Respiratory complications and sepsis were more common in those who died. On multivariable analysis only Glasgow Coma Scale ≤8 remained an independent associated risk factor for mortality.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 145-150"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896041","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 : 2025-05-01DOI: 10.1016/j.neucir.2024.11.003
Iván Federico Narváez Moscoso, Bienvenido Ros López, Sara Iglesias Moroño, Julia Casado Ruiz, Raquel Simón Wolter, Miguel Ángel Arráez Sánchez
Introduction
Shunt overdrainage is one of the long-term complications associated with ventriculoperitoneal shunts. Treatment of refractory cases may require further upgrading of both the valve opening pressure and antisiphon device. The aim of this paper is to describe the results of this combination in a selected group of patients.
Methods
Retrospective cohort study that included 18 pediatric patients between 2003–2022. Previous shunts were exchanged for the combination of a SOPHYSA Polaris® SPVA-300 valve and upgraded fixed or adjustable antigravitatory devices. The following variables were collected: etiology of the hydrocephalus, age at first shunt and type of valve, number of shunt revisions, other surgical procedures, age at inclusion, clinical and radiological outcomes, and follow-up time. A descriptive analysis was done with means, medians and ranges for quantitative variables; percentages and frequencies for the analysis of qualitative data.
Results
The median age at first shunt was two months (0–67). The mean number of shunt revisions before inclusion was three. Shunt removal was attempted in seven patients without success; temporary success was observed in two patients who underwent ETV. Two patients had previous cranial expansions. The mean age at inclusion was 9.1 years (2.7–15.2). After the shunt system was exchanged and upgraded, clinical improvement was observed in 94.4% (17/18) of patients, and radiological improvement was observed in 83.3% (15/18) of patients. The median follow-up was 21 months.
Conclusions
Before considering more invasive therapeutic measures, shunt system optimization by the combination of very high-pressure valves and upgraded in-line antisiphon devices is a valid and safe strategy for refractory symptomatic shunt overdrainage.
{"title":"Utility of very high-pressure valves in persistent symptomatic shunt overdrainage","authors":"Iván Federico Narváez Moscoso, Bienvenido Ros López, Sara Iglesias Moroño, Julia Casado Ruiz, Raquel Simón Wolter, Miguel Ángel Arráez Sánchez","doi":"10.1016/j.neucir.2024.11.003","DOIUrl":"10.1016/j.neucir.2024.11.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Shunt overdrainage is one of the long-term complications associated with ventriculoperitoneal shunts. Treatment of refractory cases may require further upgrading of both the valve opening pressure and antisiphon device. The aim of this paper is to describe the results of this combination in a selected group of patients.</div></div><div><h3>Methods</h3><div>Retrospective cohort study that included 18 pediatric patients between 2003–2022. Previous shunts were exchanged for the combination of a SOPHYSA Polaris® SPVA-300 valve and upgraded fixed or adjustable antigravitatory devices. The following variables were collected: etiology of the hydrocephalus, age at first shunt and type of valve, number of shunt revisions, other surgical procedures, age at inclusion, clinical and radiological outcomes, and follow-up time. A descriptive analysis was done with means, medians and ranges for quantitative variables; percentages and frequencies for the analysis of qualitative data.</div></div><div><h3>Results</h3><div>The median age at first shunt was two months (0–67). The mean number of shunt revisions before inclusion was three. Shunt removal was attempted in seven patients without success; temporary success was observed in two patients who underwent ETV. Two patients had previous cranial expansions. The mean age at inclusion was 9.1 years (2.7–15.2). After the shunt system was exchanged and upgraded, clinical improvement was observed in 94.4% (17/18) of patients, and radiological improvement was observed in 83.3% (15/18) of patients. The median follow-up was 21 months.</div></div><div><h3>Conclusions</h3><div>Before considering more invasive therapeutic measures, shunt system optimization by the combination of very high-pressure valves and upgraded in-line antisiphon devices is a valid and safe strategy for refractory symptomatic shunt overdrainage.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 3","pages":"Pages 161-168"},"PeriodicalIF":0.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895896","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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