Pub Date : 2023-11-23DOI: 10.1186/s41984-023-00260-7
Hany Elkholy, Mohamed Ahmed El Tabl, Osama Saber El Sherif
Multisegment cervical canal stenosis is one of the most common causes of spinal cord dysfunction. Cervical laminectomy affords direct relief from dorsal stenosis, but many concerns were raised regarding its effect on spinal stability and cervical sagittal alignment. Laminectomy in conjunction with lateral mass screws is aiming to prevent recurrence of stenosis and to achieve much improvement of the cervical spine range of motion and curvature. To compare the clinical and radiological outcome of laminectomy alone versus laminectomy with lateral mass screw fixation in the treatment of patients with multisegment cervical canal stenosis. A retrospective study conducted on 46 patients with multisegment cervical canal stenosis who were treated between April 2018 and April 2021. Patients were divided into two groups. The 20 cases in group (A) underwent conventional laminectomies and the 26 cases in group (B) underwent laminectomies with lateral mass screw fixation. Operative complications, visual analogue scale (VAS), neurological functional recovery and cervical curvature changes were compared between the two groups. Operative times in group A were significantly less than it was in group B (P < 0.001). The postoperative VAS scores in group B were significantly lower than those in group A (P < 0.05). No statistical differences in the modified Japanese Orthopedic Association score could be found between the two groups after surgery. Patients in group B in comparison with those in group A had good alignment of the cervical spine with maintenance of curvature index (P < 0.001). In multilevel cervical canal stenosis, internal fixation using lateral mass screws in conjunction with laminectomy can be of a considerable significance than laminectomy alone in improving the axial symptoms and ceasing further disease progression through stabilization of the cervical spine and maintaining the sagittal alignment.
{"title":"Laminectomy alone versus laminectomy with lateral mass screw fixation in the treatment of multisegment cervical spinal canal stenosis: a comparative analysis","authors":"Hany Elkholy, Mohamed Ahmed El Tabl, Osama Saber El Sherif","doi":"10.1186/s41984-023-00260-7","DOIUrl":"https://doi.org/10.1186/s41984-023-00260-7","url":null,"abstract":"Multisegment cervical canal stenosis is one of the most common causes of spinal cord dysfunction. Cervical laminectomy affords direct relief from dorsal stenosis, but many concerns were raised regarding its effect on spinal stability and cervical sagittal alignment. Laminectomy in conjunction with lateral mass screws is aiming to prevent recurrence of stenosis and to achieve much improvement of the cervical spine range of motion and curvature. To compare the clinical and radiological outcome of laminectomy alone versus laminectomy with lateral mass screw fixation in the treatment of patients with multisegment cervical canal stenosis. A retrospective study conducted on 46 patients with multisegment cervical canal stenosis who were treated between April 2018 and April 2021. Patients were divided into two groups. The 20 cases in group (A) underwent conventional laminectomies and the 26 cases in group (B) underwent laminectomies with lateral mass screw fixation. Operative complications, visual analogue scale (VAS), neurological functional recovery and cervical curvature changes were compared between the two groups. Operative times in group A were significantly less than it was in group B (P < 0.001). The postoperative VAS scores in group B were significantly lower than those in group A (P < 0.05). No statistical differences in the modified Japanese Orthopedic Association score could be found between the two groups after surgery. Patients in group B in comparison with those in group A had good alignment of the cervical spine with maintenance of curvature index (P < 0.001). In multilevel cervical canal stenosis, internal fixation using lateral mass screws in conjunction with laminectomy can be of a considerable significance than laminectomy alone in improving the axial symptoms and ceasing further disease progression through stabilization of the cervical spine and maintaining the sagittal alignment.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138533981","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}
Pub Date : 2023-11-21DOI: 10.1186/s41984-023-00248-3
Amey P. Patankar, Shivani Chaudhary, Kashyap Patel
We retrospectively analyse and review the results of microvascular decompression performed for trigeminal neuralgia. We also discuss the surgical nuances, complication avoidance and compare our results with other reported studies. This is a retrospective study in which the data of eighty-four patients who underwent microvascular decompression for trigeminal neuralgia in the last ten years from 2013 till May 2023 at our institute (Neuron hospital and SSG Hospital, Vadodara, India) was reviewed. The preoperative pain characteristics, radiology reports and the degree and duration of post-operative pain relief and neurologic outcome was assessed. MRI was done preoperatively in all the cases to rule out a secondary cause for trigeminal neuralgia. All the cases of secondary trigeminal neuralgia were excluded from the study. A favourable outcome was defined as a post-operative Barrow Neurological Institute pain intensity score of 1. Eighty patients had excellent immediate postoperative pain relief without any need for medications. None of these patients have developed any recurrence of pain till date. Four operated patients did not experience any pain relief after surgery. Microvascular decompression for trigeminal neuralgia is a safe and effective procedure which treats the root cause of the disease and hence provides good long term pain relief.
{"title":"Microvascular decompression for trigeminal neuralgia: an experience of 84 operated cases","authors":"Amey P. Patankar, Shivani Chaudhary, Kashyap Patel","doi":"10.1186/s41984-023-00248-3","DOIUrl":"https://doi.org/10.1186/s41984-023-00248-3","url":null,"abstract":"We retrospectively analyse and review the results of microvascular decompression performed for trigeminal neuralgia. We also discuss the surgical nuances, complication avoidance and compare our results with other reported studies. This is a retrospective study in which the data of eighty-four patients who underwent microvascular decompression for trigeminal neuralgia in the last ten years from 2013 till May 2023 at our institute (Neuron hospital and SSG Hospital, Vadodara, India) was reviewed. The preoperative pain characteristics, radiology reports and the degree and duration of post-operative pain relief and neurologic outcome was assessed. MRI was done preoperatively in all the cases to rule out a secondary cause for trigeminal neuralgia. All the cases of secondary trigeminal neuralgia were excluded from the study. A favourable outcome was defined as a post-operative Barrow Neurological Institute pain intensity score of 1. Eighty patients had excellent immediate postoperative pain relief without any need for medications. None of these patients have developed any recurrence of pain till date. Four operated patients did not experience any pain relief after surgery. Microvascular decompression for trigeminal neuralgia is a safe and effective procedure which treats the root cause of the disease and hence provides good long term pain relief.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138533977","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}
Pub Date : 2023-11-20DOI: 10.1186/s41984-023-00241-w
Amir Rezakhah, Andrew J. Kobets, Faezeh Emami Sigaroudi, Mohammad Amin Habibi, Rahim Derakhshesh, Naghmeh Javanshir Rezaei, Seyed Ahmad Naseri Alavi
Rheumatoid arthritis (RA) is a chronic, progressive, and systemic disease that broadly affects connective tissues, especially synovial joints. The aim of this study was to investigate the prevalence of cervical spine instability in patients diagnosed with RA. Fifty patients with rheumatoid arthritis referred to Imam Khomeini Hospital in Urmia were selected by the census. After taking a history, the neck X-ray was taken from the lateral view in static, flexion, and extension. Among 50 patients, 11 were male (22%) and 39 were female (78%). The average disease duration period was 5.63 ± 5.21 years. 43 patients (86%) had normal AADI, 5 patients (10%) had abnormal dynamic AADI, and 2 patients (4%) had abnormal AADI static. Basilar invagination instability was not found in the studied patients. There was no significant difference in terms of gender between normal and abnormal cases of AADI. Among normal AADI cases, 40 cases (93%) were taking drugs and among abnormal AADI cases, 4 cases (57.1%) were taking drugs and 3 patients (42.9%) were not receiving drug treatment. There is a significant difference between normal and abnormal cases of AADI in terms of drug use. In our study, 7 cases of abnormal AADI were found among 50 patients, of which 2 had abnormal static AADI, which indicates the worsening of cervical spine instability. The study also found that those not treated with DMARDS were more likely to have cervical spine instability.
{"title":"Investigating the prevalence of cervical spine instability in patients with rheumatoid arthritis","authors":"Amir Rezakhah, Andrew J. Kobets, Faezeh Emami Sigaroudi, Mohammad Amin Habibi, Rahim Derakhshesh, Naghmeh Javanshir Rezaei, Seyed Ahmad Naseri Alavi","doi":"10.1186/s41984-023-00241-w","DOIUrl":"https://doi.org/10.1186/s41984-023-00241-w","url":null,"abstract":"Rheumatoid arthritis (RA) is a chronic, progressive, and systemic disease that broadly affects connective tissues, especially synovial joints. The aim of this study was to investigate the prevalence of cervical spine instability in patients diagnosed with RA. Fifty patients with rheumatoid arthritis referred to Imam Khomeini Hospital in Urmia were selected by the census. After taking a history, the neck X-ray was taken from the lateral view in static, flexion, and extension. Among 50 patients, 11 were male (22%) and 39 were female (78%). The average disease duration period was 5.63 ± 5.21 years. 43 patients (86%) had normal AADI, 5 patients (10%) had abnormal dynamic AADI, and 2 patients (4%) had abnormal AADI static. Basilar invagination instability was not found in the studied patients. There was no significant difference in terms of gender between normal and abnormal cases of AADI. Among normal AADI cases, 40 cases (93%) were taking drugs and among abnormal AADI cases, 4 cases (57.1%) were taking drugs and 3 patients (42.9%) were not receiving drug treatment. There is a significant difference between normal and abnormal cases of AADI in terms of drug use. In our study, 7 cases of abnormal AADI were found among 50 patients, of which 2 had abnormal static AADI, which indicates the worsening of cervical spine instability. The study also found that those not treated with DMARDS were more likely to have cervical spine instability.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138533980","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}
Pub Date : 2023-11-16DOI: 10.1186/s41984-023-00249-2
Surajudeen A. Olomo, Joseph O. Obande, Gyang M. Bot, Peter O. Binitie
Ventriculoperitoneal (VP) shunt is the mainstay of surgical management of patients with hydrocephalus. The insertion of ventriculoperitoneal shunt may be accompanied by many potentially life-threatening complications including shunt infection. Concerted efforts have been made to reduce shunt infection rates, including use of saline- antibiotic solutions containing antibiotics such as Gentamicin, mixture of Gentamicin and Vancomycin in shunt system preparation. We therefore set out to determine the infection rates following the use of intraoperative Gentamicin and Vancomycin in ventriculoperitoneal shunt system preparation and compare the infection rates. Therefore, a randomized single blind comparative study was carried out for a period of seventeen months, among 56 patients that presented to 2 tertiary health centers in Nigeria diagnosed of hydrocephalus. Patients were randomized into Vancomycin- and Gentamicin-shunt preparation groups. The outcome measure was postoperative shunt infection rates. Statistical analysis was performed using SPSS software (version) 21. Group comparisons were made using the Student's t-test for numerical variables, and chi-square test or fisher’s exact test for categorical variables. Statistical significance was inferred at p-value < 0.05. Fifty-six patients were included in the study. One patient was lost to follow-up in Vancomycin group. Another patient died in Gentamicin group of sudden death without the patient exhibiting symptoms of shunt infection leaving a total of 54 for analysis. All the patients included in the study were followed up for six months. Their mean ages were between 1688.5 ± 665.3 (days) for Vancomycin group and 10,222 ± 6635.8 (days) for Gentamicin group. There was male preponderance of 55.6% as against female of 44.4%. Majority of the hydrocephalus were of congenital cause accounting for 64.8%. There was one shunt infection in the Gentamicin group giving rise to an infection rate of 1.9% which was not statistically significant (P –value—0.313). The organism isolated was Pseudomonas species. Ventriculoperitoneal shunt infection rates can be reduced to the barest minimum if standard concentration of antibiotics is used to prepare the shunt hardware employing a standard surgical technique.
{"title":"Randomized trial of shunt infection rates comparing intraoperative Vancomycin versus Gentamicin in ventriculoperitoneal shunt system preparation","authors":"Surajudeen A. Olomo, Joseph O. Obande, Gyang M. Bot, Peter O. Binitie","doi":"10.1186/s41984-023-00249-2","DOIUrl":"https://doi.org/10.1186/s41984-023-00249-2","url":null,"abstract":"Ventriculoperitoneal (VP) shunt is the mainstay of surgical management of patients with hydrocephalus. The insertion of ventriculoperitoneal shunt may be accompanied by many potentially life-threatening complications including shunt infection. Concerted efforts have been made to reduce shunt infection rates, including use of saline- antibiotic solutions containing antibiotics such as Gentamicin, mixture of Gentamicin and Vancomycin in shunt system preparation. We therefore set out to determine the infection rates following the use of intraoperative Gentamicin and Vancomycin in ventriculoperitoneal shunt system preparation and compare the infection rates. Therefore, a randomized single blind comparative study was carried out for a period of seventeen months, among 56 patients that presented to 2 tertiary health centers in Nigeria diagnosed of hydrocephalus. Patients were randomized into Vancomycin- and Gentamicin-shunt preparation groups. The outcome measure was postoperative shunt infection rates. Statistical analysis was performed using SPSS software (version) 21. Group comparisons were made using the Student's t-test for numerical variables, and chi-square test or fisher’s exact test for categorical variables. Statistical significance was inferred at p-value < 0.05. Fifty-six patients were included in the study. One patient was lost to follow-up in Vancomycin group. Another patient died in Gentamicin group of sudden death without the patient exhibiting symptoms of shunt infection leaving a total of 54 for analysis. All the patients included in the study were followed up for six months. Their mean ages were between 1688.5 ± 665.3 (days) for Vancomycin group and 10,222 ± 6635.8 (days) for Gentamicin group. There was male preponderance of 55.6% as against female of 44.4%. Majority of the hydrocephalus were of congenital cause accounting for 64.8%. There was one shunt infection in the Gentamicin group giving rise to an infection rate of 1.9% which was not statistically significant (P –value—0.313). The organism isolated was Pseudomonas species. Ventriculoperitoneal shunt infection rates can be reduced to the barest minimum if standard concentration of antibiotics is used to prepare the shunt hardware employing a standard surgical technique.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138533979","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}
Pub Date : 2023-11-16DOI: 10.1186/s41984-023-00254-5
Toyin Ayofe Oyemolade, Amos Olufemi Adeleye, Inwonoabasi Nicholas Ekanem
Spinal cord damage (SCD) is rare in children, hence the paucity of literature on the subject, particularly in developing countries. This study aims to define the clinical epidemiology of paediatric SCD in a Nigerian tertiary health facility. A retrospective review of a 42-month long prospectively collected clinical data on paediatric SCD in a rural neurosurgery unit. There were 37 children (20 males) accounting for about 12% of the paediatric neurosurgical patients we managed during the study period. The mean age was 6.9 years (peak = 0–4 years, 43.2%). Traumatic spinal cord injury (SCI) was the cause of SCD in 54.1% (20/37) of the cases, spinal bifida in 37.8%, spinal cord tumour in 5.4%, and spinal tuberculosis in 2.7%. The mean age of patients with traumatic SCI was 11.5 years, while the median age for spinal bifida was 3 days. Traumatic SCI was caused by road traffic accident in 70% (14/20), and falls in 25%. The cervical spinal cord was the location of the spinal cord damage in 51.4% of all the cases in this study, lumbosacral in 24.3%, and sacral in 10.8%. Traumatic SCI was predominantly located in the cervical region in (90%, 18/20) while spinal bifida was most commonly lumbosacral (64.3%, 9/14). Spinal cord damage accounted for more than a tenth (12.1%) of our paediatric neurosurgical workload in this rural neurosurgery, and are mostly due to traumatic SCI and spinal bifida.
{"title":"Clinical profile of paediatric spinal cord damage in a developing country’s rural-area tertiary hospital neurosurgery","authors":"Toyin Ayofe Oyemolade, Amos Olufemi Adeleye, Inwonoabasi Nicholas Ekanem","doi":"10.1186/s41984-023-00254-5","DOIUrl":"https://doi.org/10.1186/s41984-023-00254-5","url":null,"abstract":"Spinal cord damage (SCD) is rare in children, hence the paucity of literature on the subject, particularly in developing countries. This study aims to define the clinical epidemiology of paediatric SCD in a Nigerian tertiary health facility. A retrospective review of a 42-month long prospectively collected clinical data on paediatric SCD in a rural neurosurgery unit. There were 37 children (20 males) accounting for about 12% of the paediatric neurosurgical patients we managed during the study period. The mean age was 6.9 years (peak = 0–4 years, 43.2%). Traumatic spinal cord injury (SCI) was the cause of SCD in 54.1% (20/37) of the cases, spinal bifida in 37.8%, spinal cord tumour in 5.4%, and spinal tuberculosis in 2.7%. The mean age of patients with traumatic SCI was 11.5 years, while the median age for spinal bifida was 3 days. Traumatic SCI was caused by road traffic accident in 70% (14/20), and falls in 25%. The cervical spinal cord was the location of the spinal cord damage in 51.4% of all the cases in this study, lumbosacral in 24.3%, and sacral in 10.8%. Traumatic SCI was predominantly located in the cervical region in (90%, 18/20) while spinal bifida was most commonly lumbosacral (64.3%, 9/14). Spinal cord damage accounted for more than a tenth (12.1%) of our paediatric neurosurgical workload in this rural neurosurgery, and are mostly due to traumatic SCI and spinal bifida.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138533982","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}
Pub Date : 2023-11-14DOI: 10.1186/s41984-023-00245-6
Mohamed Mohsen Amen, Mohamed Badran, Ahmed Zaher, Amr Farid Khalil, Ibrahim Abdelaal, Mahmoud Saad
Abstract Objectives Post-infection hydrocephalus with multiple intraventricular septations is a complex issue in neurosurgery, with multiple treatment options available. The authors reviewed the results of neuroendoscopic cyst wall fenestration for managing this disease. Materials and Methods Medical records of 76 patients with post-infection hydrocephalus and multiple intraventricular septations who underwent endoscopic treatment were collected and analyzed. Results The patient group consisted of 40 males (52.6%) and 36 females (47.4%), with a mean age of 22.36 months (range: 4–132 months). Bacterial meningitis was the most common cause of hydrocephalus with multiple intraventricular septations in 37 patients (48.6%), while 24 patients had post-shunt infection (31.6%) that was complicated with multiloculated hydrocephalus. After confirming clearance of CSF infection, all patients underwent ventriculoscopic cyst fenestration and insertion of a ventriculoperitoneal shunt to create a single communicating system drained by one ventricular catheter. Fifty-five patients underwent De novo shunt implantation, while 20 patients required shunt revision. Endoscopy reduced the shunt revision rate from 3.4 per year before fenestration to 0.4 per year after fenestration. During the mean follow-up period of 7.7 months (range: 1–20 months), complications were reported in 13 patients (17.1%), including CSF leakage in eight (10.5%), VPS malfunction in five (6.5%), and two deaths (2.6%). Conclusion The authors concluded that neuroendoscopic fenestration with the aid of CSF drainage by intraventricular catheter is an effective treatment for managing multiloculated post-infection hydrocephalus with much lower rates of morbidity and mortality than traditional procedures.
{"title":"The outcome of surgical management of post-infectious hydrocephalus with multiple intraventricular septations","authors":"Mohamed Mohsen Amen, Mohamed Badran, Ahmed Zaher, Amr Farid Khalil, Ibrahim Abdelaal, Mahmoud Saad","doi":"10.1186/s41984-023-00245-6","DOIUrl":"https://doi.org/10.1186/s41984-023-00245-6","url":null,"abstract":"Abstract Objectives Post-infection hydrocephalus with multiple intraventricular septations is a complex issue in neurosurgery, with multiple treatment options available. The authors reviewed the results of neuroendoscopic cyst wall fenestration for managing this disease. Materials and Methods Medical records of 76 patients with post-infection hydrocephalus and multiple intraventricular septations who underwent endoscopic treatment were collected and analyzed. Results The patient group consisted of 40 males (52.6%) and 36 females (47.4%), with a mean age of 22.36 months (range: 4–132 months). Bacterial meningitis was the most common cause of hydrocephalus with multiple intraventricular septations in 37 patients (48.6%), while 24 patients had post-shunt infection (31.6%) that was complicated with multiloculated hydrocephalus. After confirming clearance of CSF infection, all patients underwent ventriculoscopic cyst fenestration and insertion of a ventriculoperitoneal shunt to create a single communicating system drained by one ventricular catheter. Fifty-five patients underwent De novo shunt implantation, while 20 patients required shunt revision. Endoscopy reduced the shunt revision rate from 3.4 per year before fenestration to 0.4 per year after fenestration. During the mean follow-up period of 7.7 months (range: 1–20 months), complications were reported in 13 patients (17.1%), including CSF leakage in eight (10.5%), VPS malfunction in five (6.5%), and two deaths (2.6%). Conclusion The authors concluded that neuroendoscopic fenestration with the aid of CSF drainage by intraventricular catheter is an effective treatment for managing multiloculated post-infection hydrocephalus with much lower rates of morbidity and mortality than traditional procedures.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"47 44","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134902142","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}
Pub Date : 2023-11-14DOI: 10.1186/s41984-023-00258-1
Azad Malikov, Zeynep Daglar, Kaan Aygun, Denizhan Divanlioglu
Abstract Background Pituitary apoplexy (PA) is a rare but potentially life-threatening condition. While it is uncommon, it can present with findings that are clinically indistinguishable from acute bacterial meningitis. We report an unusual case of simultaneous coexistence of bacterial meningoencephalitis and pituitary apoplexy following transsphenoidal surgery (TSS) for pituitary macroadenoma, emphasizing the possibility of coexistence of the two entities. Case presentation A 62-year-old man was admitted with a moderate headache, gait disturbance, and progressively decreasing vision. Sellar magnetic resonance imaging showed a giant pituitary tumor of 4 × 5 cm with invasion of the cavernous sinus bilaterally, and a mass effect on the optic chiasm. The patient underwent a TSS and partial resection of a giant pituitary tumor. On postoperative day 11, he presented with an acute, severe headache and altered sensorium. An urgent computed tomography (CT) scan revealed hemorrhagic swelling of the residual. A complete analysis of the anterior pituitary hormones revealed panhypopituitarism. Administering steroid ameliorated the clinical features, but after decreasing the dose, the patient continued to deteriorate in his neurological status, a high fever, and marked stiffness were noted on postoperative day 14. Given the neck stiffness, leukocytosis, and high C-reactive protein level, acute meningitis was suspected, and the cerebrospinal fluid (CSF) was tested, which was consistent with acute bacterial meningitis. In the results of the bacterial cultures of the CSF, E. coli was identified and switched to ceftriaxone. The patient's neurological status and body temperature improved gradually. CSF test results returned to normal levels, and ceftriaxone was discontinued on day 10. Conclusions This is a report on a case of a giant pituitary tumor that developed late postoperative PA after having undergone a partial tumor resection. A postoperative CT scan showed hemorrhagic expansion of the residual tumor mass. Further, the patient exhibited typical symptoms of acute meningoencephalitis, the result of the cultures of the CSF was positive, and the patient's general condition deteriorated. In addition, laboratory findings indicated leukocytosis, an elevated C-reactive protein level, and neutrophilic pleocytosis. We highlighted diagnostic challenges and therapeutic delays arising as a result of rare concomitance.
{"title":"Pituitary apoplexy associated with gram-negative meningitis following transsphenoidal surgery","authors":"Azad Malikov, Zeynep Daglar, Kaan Aygun, Denizhan Divanlioglu","doi":"10.1186/s41984-023-00258-1","DOIUrl":"https://doi.org/10.1186/s41984-023-00258-1","url":null,"abstract":"Abstract Background Pituitary apoplexy (PA) is a rare but potentially life-threatening condition. While it is uncommon, it can present with findings that are clinically indistinguishable from acute bacterial meningitis. We report an unusual case of simultaneous coexistence of bacterial meningoencephalitis and pituitary apoplexy following transsphenoidal surgery (TSS) for pituitary macroadenoma, emphasizing the possibility of coexistence of the two entities. Case presentation A 62-year-old man was admitted with a moderate headache, gait disturbance, and progressively decreasing vision. Sellar magnetic resonance imaging showed a giant pituitary tumor of 4 × 5 cm with invasion of the cavernous sinus bilaterally, and a mass effect on the optic chiasm. The patient underwent a TSS and partial resection of a giant pituitary tumor. On postoperative day 11, he presented with an acute, severe headache and altered sensorium. An urgent computed tomography (CT) scan revealed hemorrhagic swelling of the residual. A complete analysis of the anterior pituitary hormones revealed panhypopituitarism. Administering steroid ameliorated the clinical features, but after decreasing the dose, the patient continued to deteriorate in his neurological status, a high fever, and marked stiffness were noted on postoperative day 14. Given the neck stiffness, leukocytosis, and high C-reactive protein level, acute meningitis was suspected, and the cerebrospinal fluid (CSF) was tested, which was consistent with acute bacterial meningitis. In the results of the bacterial cultures of the CSF, E. coli was identified and switched to ceftriaxone. The patient's neurological status and body temperature improved gradually. CSF test results returned to normal levels, and ceftriaxone was discontinued on day 10. Conclusions This is a report on a case of a giant pituitary tumor that developed late postoperative PA after having undergone a partial tumor resection. A postoperative CT scan showed hemorrhagic expansion of the residual tumor mass. Further, the patient exhibited typical symptoms of acute meningoencephalitis, the result of the cultures of the CSF was positive, and the patient's general condition deteriorated. In addition, laboratory findings indicated leukocytosis, an elevated C-reactive protein level, and neutrophilic pleocytosis. We highlighted diagnostic challenges and therapeutic delays arising as a result of rare concomitance.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"33 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134954632","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}
Abstract Background This review explores how diffuse intrinsic pontine glioma (DIPG) diagnosis and treatment have evolved and are improving. Main body Authors used various sources from 2000 to present time to compile information on diffuse intrinsic pontine glioma in the pediatric population. The following topics were included: diagnosis procedure, molecular analysis, stereotactic biopsy, radiation therapy and other treatments. Historically, diffuse intrinsic pontine glioma’s anatomical proximity to crucial brain stem structures prevented biopsy thus limiting diagnostic and molecular analysis. However, with the optimistic rise of the stereotactic biopsy technique, identifying genetic and other biological markers for targeted treatments is more feasible. Previous investigations have identified a histone mutation that appears in 80% of DIPG cases and there is plenty of exploration into how to unravel the effects of the resulting chromatin modification. For example, new pharmaceuticals like Panobinostat and ONC201 show promise. Conclusion Advances in stereotactic biopsy technology have resulted in more accurate diagnosis opening more avenues for molecular analysis and thus, targeted treatments. DIPG requires more exploration to improve outcomes for patients.
{"title":"Diffuse intrinsic pontine gliomas in pediatric patients: management updates","authors":"Caroline Davidson, Samuel Woodford, Daisy Valle, Grace Parker, Ann-Marie Derias, Carina Copley, Brandon Lucke-Wold","doi":"10.1186/s41984-023-00242-9","DOIUrl":"https://doi.org/10.1186/s41984-023-00242-9","url":null,"abstract":"Abstract Background This review explores how diffuse intrinsic pontine glioma (DIPG) diagnosis and treatment have evolved and are improving. Main body Authors used various sources from 2000 to present time to compile information on diffuse intrinsic pontine glioma in the pediatric population. The following topics were included: diagnosis procedure, molecular analysis, stereotactic biopsy, radiation therapy and other treatments. Historically, diffuse intrinsic pontine glioma’s anatomical proximity to crucial brain stem structures prevented biopsy thus limiting diagnostic and molecular analysis. However, with the optimistic rise of the stereotactic biopsy technique, identifying genetic and other biological markers for targeted treatments is more feasible. Previous investigations have identified a histone mutation that appears in 80% of DIPG cases and there is plenty of exploration into how to unravel the effects of the resulting chromatin modification. For example, new pharmaceuticals like Panobinostat and ONC201 show promise. Conclusion Advances in stereotactic biopsy technology have resulted in more accurate diagnosis opening more avenues for molecular analysis and thus, targeted treatments. DIPG requires more exploration to improve outcomes for patients.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"33 17","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134954629","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}
Abstract Aim The incidence of spinal cord tumors (SCTs) in a population considering sex, age, histopathology, and emplacement position of tumors is different between various regions. Therefore, the present study aimed to evaluate the frequency of various SCTs in surgically treated patients in a reference spinal surgery center in Shiraz, Iran. Method Documented information related to 109 SCT patients surgically treated was collected from the archive of Shahid Chamran Hospital (the reference center of spinal cord surgery in the south of Iran) in Shiraz from 2012 to 2022. This information includes demographics, medical history, histology, and position of SCTs within the spinal cord. Result The population of patients included 65 men and 44 women, with a mean age of 44.7 years old. Most patients (26 cases) were in the age group of 50–59 years. Neurological function in most patients (51 cases) was equivalent to level D of the ASIA impairment scale (AIS), and the most common complaints of patients (83 cases) were related to pain. Finally, anatomic and histologic evaluations indicated that intradural and schwannoma tumors were the most common types of tumors, with 64 and 25 cases, respectively. Conclusions In the present study, most of the findings are consistent with the previous reports. Schwannoma and ependymoma tumors were the most common types of SCTs and the most common types of intramedullary tumors, respectively. The sixth decade of life was the most common age of incidence. Neurological function in most patients with SCT was equivalent to levels of D and E of AIS. However, regarding the factor of gender, our results are similar to those of the Asian population. More comprehensive studies in the future likely reveal the probable role of environmental, genetic, and hormonal factors in the etiology of SCTs.
{"title":"The frequency of various spinal cord tumors (SCTs) in surgically treated patients at Shiraz Shahid Chamran Hospital from 2012 to 2022","authors":"Farideh Iravanpour, Majid Reza Farrokhi, Seyed Reza Mousavi, Ahmad Soltani, Mahshid Hosseini","doi":"10.1186/s41984-023-00244-7","DOIUrl":"https://doi.org/10.1186/s41984-023-00244-7","url":null,"abstract":"Abstract Aim The incidence of spinal cord tumors (SCTs) in a population considering sex, age, histopathology, and emplacement position of tumors is different between various regions. Therefore, the present study aimed to evaluate the frequency of various SCTs in surgically treated patients in a reference spinal surgery center in Shiraz, Iran. Method Documented information related to 109 SCT patients surgically treated was collected from the archive of Shahid Chamran Hospital (the reference center of spinal cord surgery in the south of Iran) in Shiraz from 2012 to 2022. This information includes demographics, medical history, histology, and position of SCTs within the spinal cord. Result The population of patients included 65 men and 44 women, with a mean age of 44.7 years old. Most patients (26 cases) were in the age group of 50–59 years. Neurological function in most patients (51 cases) was equivalent to level D of the ASIA impairment scale (AIS), and the most common complaints of patients (83 cases) were related to pain. Finally, anatomic and histologic evaluations indicated that intradural and schwannoma tumors were the most common types of tumors, with 64 and 25 cases, respectively. Conclusions In the present study, most of the findings are consistent with the previous reports. Schwannoma and ependymoma tumors were the most common types of SCTs and the most common types of intramedullary tumors, respectively. The sixth decade of life was the most common age of incidence. Neurological function in most patients with SCT was equivalent to levels of D and E of AIS. However, regarding the factor of gender, our results are similar to those of the Asian population. More comprehensive studies in the future likely reveal the probable role of environmental, genetic, and hormonal factors in the etiology of SCTs.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"63 47","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136282157","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}
Pub Date : 2023-11-13DOI: 10.1186/s41984-023-00255-4
Loraine Quintana-Pajaro, Huber S. Padilla-Zambrano, Yancarlos Ramos-Villegas, Daniela Lopez-Cepeda, Andrea Andrade-Lopez, Samer Hoz, Luis Rafael Moscote-Salazar, Andrei F. Joaquim, William A. Florez Perdomo, Tariq Janjua
Abstract Objective To review the influence of metabolic dysfunction of glucose after traumatic brain injury on patient mortality. Materials and methods We searched PubMed, Scopus, EBSCOhost, Medline, and Embase electronic databases, involving publications from 1980 to August 2017 in English and Spanish. Results The glucose metabolism in brain involved in brain signal conduction, neurotransmission, synaptic plasticity, and cognitive function. Insulin levels traverse the blood–brain barrier by utilizing an insulin receptor protein as a carrier, playing a pivotal role in various cognitive functions while also regulating energy metabolism. TBI causes elevated blood glucose levels. Hyperglycemia is attributed to an acute sympatho-adrenomedullary response, resulting in elevated catecholamines, increased levels of cortisol, and IL-6. Moreover, there is a potential association with hypothalamic involvement. Additionally, hyperglycemia is linked to lactic acidosis at the tissue level, ultimately contributing to higher mortality rates. Conclusions The monitoring and control of glucose should be an important part of multimodal monitoring in patients with moderate to severe traumatic brain injury managed in neurocritical care units. A management protocol should ensure normoglycemia and early detection and correction of glucose abnormalities since it improves patients' clinical outcomes.
{"title":"Cerebral traumatic injury and glucose metabolism: a scoping review","authors":"Loraine Quintana-Pajaro, Huber S. Padilla-Zambrano, Yancarlos Ramos-Villegas, Daniela Lopez-Cepeda, Andrea Andrade-Lopez, Samer Hoz, Luis Rafael Moscote-Salazar, Andrei F. Joaquim, William A. Florez Perdomo, Tariq Janjua","doi":"10.1186/s41984-023-00255-4","DOIUrl":"https://doi.org/10.1186/s41984-023-00255-4","url":null,"abstract":"Abstract Objective To review the influence of metabolic dysfunction of glucose after traumatic brain injury on patient mortality. Materials and methods We searched PubMed, Scopus, EBSCOhost, Medline, and Embase electronic databases, involving publications from 1980 to August 2017 in English and Spanish. Results The glucose metabolism in brain involved in brain signal conduction, neurotransmission, synaptic plasticity, and cognitive function. Insulin levels traverse the blood–brain barrier by utilizing an insulin receptor protein as a carrier, playing a pivotal role in various cognitive functions while also regulating energy metabolism. TBI causes elevated blood glucose levels. Hyperglycemia is attributed to an acute sympatho-adrenomedullary response, resulting in elevated catecholamines, increased levels of cortisol, and IL-6. Moreover, there is a potential association with hypothalamic involvement. Additionally, hyperglycemia is linked to lactic acidosis at the tissue level, ultimately contributing to higher mortality rates. Conclusions The monitoring and control of glucose should be an important part of multimodal monitoring in patients with moderate to severe traumatic brain injury managed in neurocritical care units. A management protocol should ensure normoglycemia and early detection and correction of glucose abnormalities since it improves patients' clinical outcomes.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"64 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136282310","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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