Pub Date : 2023-11-13DOI: 10.1186/s41984-023-00246-5
Ahmed Elsayed Sultan, Amr Elwany, Amr Madkour, Mohmed Agamy
Abstract Background The location of the cortical incision and maximum evacuations of parenchymal intracerebral hematoma are crucial points. Intraoperative ultrasonography is a real-time tool with great benefit at these points Methods A retrospective study of patients with parenchymal intracerebral hemorrhage that underwent evacuation using intraoperative ultrasound guidance was included. Preoperative clinical and radiological assessments were studied. The postoperative imaging and clinical outcome were assessed. A late follow-up after 6 months was done. Results The age of study patients ranged from 9 to 73 (mean 45.3 ± 20.4 years). There were 14 males (58.3%). The mean preoperative Glasgow Coma Scale (GCS) was 9.8 ± 2.9. The preoperative hematoma volume ranged from 32 to 135 cm 3 with a mean of 68.5 ± 30.5 cm 3 . The rate of evacuation ranged from 90 to 100%. The mean postoperative GCS was 11.7 ± 2.5. None of the patients had a recurrent hemorrhage. There was a significant rate of evacuation of the hematomas ( P value < 0.001 * ). Also, there was a marked improvement in postoperative GCS and the late modified Rankin Scale ( P value < 0.001 * ). Conclusion Ultrasonography is a useful, efficient, real-time tool for the localization and evacuation of parenchymal intracerebral hemorrhage. It maximizes evacuation and decreases parenchymal insult. It is an important aid to the neurosurgeon.
摘要背景皮质切口的位置和脑实质内血肿的最大排出量是关键。术中超声是一种实时工具，在这些方面具有很大的优势。方法回顾性分析术中超声引导下脑实质脑出血患者行引流术的病例。术前进行临床和放射学评估。评估术后影像学和临床结果。6个月后进行随访。结果患者年龄9 ~ 73岁(平均45.3±20.4岁)。男性14例(58.3%)。术前格拉斯哥昏迷评分(GCS)平均为9.8±2.9。术前血肿体积32 ~ 135 cm 3，平均68.5±30.5 cm 3。疏散率从90%到100%不等。术后平均GCS为11.7±2.5。所有患者均无复发性出血。血肿排出率显著高于对照组(P值<0.001 *)。术后GCS和晚期改良Rankin量表(P值<0.001 *)。结论超声对脑实质出血的定位和清除是一种实用、高效、实时的诊断工具。它能最大限度地疏散并减少实质损伤。它是神经外科医生的重要辅助工具。
{"title":"Intraoperative ultrasonographic-guided surgery of intracerebral hemorrhage","authors":"Ahmed Elsayed Sultan, Amr Elwany, Amr Madkour, Mohmed Agamy","doi":"10.1186/s41984-023-00246-5","DOIUrl":"https://doi.org/10.1186/s41984-023-00246-5","url":null,"abstract":"Abstract Background The location of the cortical incision and maximum evacuations of parenchymal intracerebral hematoma are crucial points. Intraoperative ultrasonography is a real-time tool with great benefit at these points Methods A retrospective study of patients with parenchymal intracerebral hemorrhage that underwent evacuation using intraoperative ultrasound guidance was included. Preoperative clinical and radiological assessments were studied. The postoperative imaging and clinical outcome were assessed. A late follow-up after 6 months was done. Results The age of study patients ranged from 9 to 73 (mean 45.3 ± 20.4 years). There were 14 males (58.3%). The mean preoperative Glasgow Coma Scale (GCS) was 9.8 ± 2.9. The preoperative hematoma volume ranged from 32 to 135 cm 3 with a mean of 68.5 ± 30.5 cm 3 . The rate of evacuation ranged from 90 to 100%. The mean postoperative GCS was 11.7 ± 2.5. None of the patients had a recurrent hemorrhage. There was a significant rate of evacuation of the hematomas ( P value < 0.001 * ). Also, there was a marked improvement in postoperative GCS and the late modified Rankin Scale ( P value < 0.001 * ). Conclusion Ultrasonography is a useful, efficient, real-time tool for the localization and evacuation of parenchymal intracerebral hemorrhage. It maximizes evacuation and decreases parenchymal insult. It is an important aid to the neurosurgeon.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"65 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":"136282473","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 : 2023-11-09DOI: 10.1186/s41984-023-00228-7
Oday Atallah, Yasser F. Almealawy, Omar Wawi, Ved Maurya, Md Moshiur Rahman, Amit Agrawal
Abstract Recurrent artery of Heubner (RAH) infarction is a potential complication following the surgical clipping of anterior communicating artery (A-comm) aneurysms. RAH plays a crucial role in supplying blood to the basal ganglia and anterior limb of the internal capsule. Understanding the pathogenesis, prognosis, and surgical result of RAH infarction is critical for providing the best care for patients. The literature study produced case reports and retrospective research on topics including the RAH infarct and A-comm aneurysm clipping. The importance of recognizing and controlling the risk of a RAH infarction in relation to A-comm aneurysm clipping is emphasized in this research. RAH infarction following clipping of an A-comm aneurysm has a complex pathophysiology, and by learning more about its causes, prognosis, and surgical results, medical personnel may better assist their patients. While further study is needed to overcome the obstacles highlighted here, the information presented here lays the groundwork for future research and adds to what is already known about the topic.
{"title":"Recurrent artery of Heubner infarction: a complication after clipping of anterior communicating artery aneurysm","authors":"Oday Atallah, Yasser F. Almealawy, Omar Wawi, Ved Maurya, Md Moshiur Rahman, Amit Agrawal","doi":"10.1186/s41984-023-00228-7","DOIUrl":"https://doi.org/10.1186/s41984-023-00228-7","url":null,"abstract":"Abstract Recurrent artery of Heubner (RAH) infarction is a potential complication following the surgical clipping of anterior communicating artery (A-comm) aneurysms. RAH plays a crucial role in supplying blood to the basal ganglia and anterior limb of the internal capsule. Understanding the pathogenesis, prognosis, and surgical result of RAH infarction is critical for providing the best care for patients. The literature study produced case reports and retrospective research on topics including the RAH infarct and A-comm aneurysm clipping. The importance of recognizing and controlling the risk of a RAH infarction in relation to A-comm aneurysm clipping is emphasized in this research. RAH infarction following clipping of an A-comm aneurysm has a complex pathophysiology, and by learning more about its causes, prognosis, and surgical results, medical personnel may better assist their patients. While further study is needed to overcome the obstacles highlighted here, the information presented here lays the groundwork for future research and adds to what is already known about the topic.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":" 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135242545","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 : 2023-11-02DOI: 10.1186/s41984-023-00227-8
Misbah Kaleem, Musaddiq Kaleem, Alishba Anwar, Sarah Anis, Yumna Zafar, Muhammad Tanveer Alam
Abstract Background This study aims to access the perspective of medical students toward practicing neurosurgery after MBBS and also to identify factors responsible for low affinity among medical students in pursuing neurosurgery as a career. In this cross-sectional study, medical students were surveyed via pre-tested questionnaire, with a four-point Likert scale to determine their influence on student’s consideration of neurosurgery as a career. Data analysis was performed using SPSS software. Results The survey was completed by 185 students out of which 56.2% students considered neurosurgery as a career. Although more than 90% students acknowledged that neurosurgery training is too prolonged and it can also impede family life but huge prestige and income is attached to neurosurgery, 35.7% students shared that neurosurgery exposure and teaching is not adequate enough for them in order to have a positive influence toward neurosurgery as a career. Conclusion Additional studies are required to further explore how participation in a formal neurosurgery experience can alter medical students’ perceptions and influences their consideration of neurosurgery as career choice.
{"title":"Medical students’ perception toward neurosurgery as a career: a cross-sectional study","authors":"Misbah Kaleem, Musaddiq Kaleem, Alishba Anwar, Sarah Anis, Yumna Zafar, Muhammad Tanveer Alam","doi":"10.1186/s41984-023-00227-8","DOIUrl":"https://doi.org/10.1186/s41984-023-00227-8","url":null,"abstract":"Abstract Background This study aims to access the perspective of medical students toward practicing neurosurgery after MBBS and also to identify factors responsible for low affinity among medical students in pursuing neurosurgery as a career. In this cross-sectional study, medical students were surveyed via pre-tested questionnaire, with a four-point Likert scale to determine their influence on student’s consideration of neurosurgery as a career. Data analysis was performed using SPSS software. Results The survey was completed by 185 students out of which 56.2% students considered neurosurgery as a career. Although more than 90% students acknowledged that neurosurgery training is too prolonged and it can also impede family life but huge prestige and income is attached to neurosurgery, 35.7% students shared that neurosurgery exposure and teaching is not adequate enough for them in order to have a positive influence toward neurosurgery as a career. Conclusion Additional studies are required to further explore how participation in a formal neurosurgery experience can alter medical students’ perceptions and influences their consideration of neurosurgery as career choice.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135933889","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 : 2023-11-02DOI: 10.1186/s41984-023-00236-7
William A. Florez-Perdomo, Tariq Janjua, Luis Rafael Moscote-Salazar, Adesh Shrivastava, Sumit Raj, Amit Agrawal
Abstract Objective Systematically review and analyze the published literature on the safety and efficacy of Surpass flow diverter in terms of mortality, functional outcome, complication rate, and aneurysm occlusion rate. Methods The literature was searched in PubMed, MEDLINE, Embase, and Scopus using the terms Surpass for the treatment of Intracranial aneurysms, Intracranial aneurysms, Complication with no constraints applied. Two review authors independently conducted the study selection. Two review authors independently extracted study data. Data were pooled using a random effect model, results were abstracted as odds ratios and 95% CI, and heterogeneity was reported as I 2 . Results Five studies were included, which involved retrospectively and prospectively collected data on 464 patients. The use of Surpass flow diverter was associated with a rate of occlusion of 73.4% (95% confidence interval [CI] 62.48–83.077%). Low rate of thromboembolic complication was 6.6% (95% CI 3.0–10.1%), the rate of hemorrhagic complication was 2.9% (95% CI 1.6–4.6%), and low vasospasm rate was 4.38% (95% confidence interval [CI] 1.8–7.7%). The mortality rate was 4.6% (95% CI 1.4–1.4%). An overall of good outcome was 86.6% (95% CI 75.9–94.5%), and poor outcome was 7.8% (95% CI 5.0–11.2%). Conclusions Based on the studies available in the literature, Surpass flow diverter offers high aneurysm occlusion rates with adequate safety and low rate of complications.
【摘要】目的从死亡率、功能结局、并发症发生率和动脉瘤闭塞率等方面对已发表的有关transcend分流器安全性和有效性的文献进行系统回顾和分析。方法在PubMed、MEDLINE、Embase、Scopus中检索颅内动脉瘤治疗、颅内动脉瘤、并发症的相关文献，不加限制。两位综述作者独立进行了研究选择。两位综述作者独立提取研究数据。采用随机效应模型合并数据，结果抽象为优势比和95% CI，异质性报告为i2。结果纳入5项研究，回顾性和前瞻性收集了464例患者的资料。使用transcend分流器与73.4%的闭塞率相关(95%可信区间[CI] 62.48-83.077%)。低血栓栓塞并发症发生率为6.6% (95% CI 3.0 ~ 10.1%)，出血性并发症发生率为2.9% (95% CI 1.6 ~ 4.6%)，低血管痉挛发生率为4.38%(95%可信区间[CI] 1.8 ~ 7.7%)。死亡率为4.6% (95% CI 1.4-1.4%)。总体良好结局为86.6% (95% CI 75.9-94.5%)，不良结局为7.8% (95% CI 5.0-11.2%)。结论根据已有的文献研究，exceed分流器具有较高的动脉瘤闭塞率、足够的安全性和较低的并发症发生率。
{"title":"A systematic review and meta-analysis of Surpass flow diverter for the treatment of intracranial aneurysms","authors":"William A. Florez-Perdomo, Tariq Janjua, Luis Rafael Moscote-Salazar, Adesh Shrivastava, Sumit Raj, Amit Agrawal","doi":"10.1186/s41984-023-00236-7","DOIUrl":"https://doi.org/10.1186/s41984-023-00236-7","url":null,"abstract":"Abstract Objective Systematically review and analyze the published literature on the safety and efficacy of Surpass flow diverter in terms of mortality, functional outcome, complication rate, and aneurysm occlusion rate. Methods The literature was searched in PubMed, MEDLINE, Embase, and Scopus using the terms Surpass for the treatment of Intracranial aneurysms, Intracranial aneurysms, Complication with no constraints applied. Two review authors independently conducted the study selection. Two review authors independently extracted study data. Data were pooled using a random effect model, results were abstracted as odds ratios and 95% CI, and heterogeneity was reported as I 2 . Results Five studies were included, which involved retrospectively and prospectively collected data on 464 patients. The use of Surpass flow diverter was associated with a rate of occlusion of 73.4% (95% confidence interval [CI] 62.48–83.077%). Low rate of thromboembolic complication was 6.6% (95% CI 3.0–10.1%), the rate of hemorrhagic complication was 2.9% (95% CI 1.6–4.6%), and low vasospasm rate was 4.38% (95% confidence interval [CI] 1.8–7.7%). The mortality rate was 4.6% (95% CI 1.4–1.4%). An overall of good outcome was 86.6% (95% CI 75.9–94.5%), and poor outcome was 7.8% (95% CI 5.0–11.2%). Conclusions Based on the studies available in the literature, Surpass flow diverter offers high aneurysm occlusion rates with adequate safety and low rate of complications.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"25 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135934856","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 : 2023-10-30DOI: 10.1186/s41984-023-00225-w
Alhusain Nagm
Abstract Background Endoscopic third ventriculostomy (ETV) is a satisfying neuro-endoscopic journey in candidates with preoperatively predicted higher success rates. Alarming cases require extra care to avoid serious complications, predict/identify failure and offer reasonable intra-/postoperative decisions. Purpose To create easily interpretable traffic light alarming signs to increase the awareness level for neurosurgeons regarding ETV difficulty/failure. Methods A 3-year-retrospective study of postoperative ETV infants of both sexes with obstructive hydrocephalus and preoperative ETV success score ≤ 70, age ≤ 12 months, and follow-up for ≥ 6 months with a postoperative radiological evaluation of the ETV patency and cerebrospinal fluid dynamics. The ETV difficulty scale (ETV-DS) was designed as an intraoperative monitor for surgical/anatomical difficulties. And the ETV failure threshold (ETV-FT) was offered for postoperative evaluation to identify cases that are mistakenly interpreted as failure. Results Among our 159 case series, 54 infants were involved. Patients’ demographics, age: ≤ 28 days, > 28 days to 6 months, and >6 to 12 months, were 5.5%, 70.3%, and 24.2%, respectively. Postoperatively, the outcome based on ETV-FT color scale was dark green (ETV-FT=0), light green (ETV-FT=1), yellow (ETV-FT=2), orange (ETV-FT=3), red (ETV-FT=4) in 29%, 14%, 20%, 10.3%, and 26.7%, respectively. Actual failure is identified as ETV-FT=4 based on clinical/radiological data. The failure rate was significantly attributed to inadequate communication with the basal cistern due to difficult/unsafe perforation of the thick/dense Liliequist membrane (87%) ( P = 0.001). Conclusion The traffic light alarming signs (ETV-DS and ETV-FT) can warn neurosurgeons to recognize critical cases that necessitate ultra-precautions to navigate safely through landmines for worthy outcomes.
{"title":"Traffic light alarming signs are indispensable prerequisites for fruitful endoscopic third ventriculostomy","authors":"Alhusain Nagm","doi":"10.1186/s41984-023-00225-w","DOIUrl":"https://doi.org/10.1186/s41984-023-00225-w","url":null,"abstract":"Abstract Background Endoscopic third ventriculostomy (ETV) is a satisfying neuro-endoscopic journey in candidates with preoperatively predicted higher success rates. Alarming cases require extra care to avoid serious complications, predict/identify failure and offer reasonable intra-/postoperative decisions. Purpose To create easily interpretable traffic light alarming signs to increase the awareness level for neurosurgeons regarding ETV difficulty/failure. Methods A 3-year-retrospective study of postoperative ETV infants of both sexes with obstructive hydrocephalus and preoperative ETV success score ≤ 70, age ≤ 12 months, and follow-up for ≥ 6 months with a postoperative radiological evaluation of the ETV patency and cerebrospinal fluid dynamics. The ETV difficulty scale (ETV-DS) was designed as an intraoperative monitor for surgical/anatomical difficulties. And the ETV failure threshold (ETV-FT) was offered for postoperative evaluation to identify cases that are mistakenly interpreted as failure. Results Among our 159 case series, 54 infants were involved. Patients’ demographics, age: ≤ 28 days, > 28 days to 6 months, and >6 to 12 months, were 5.5%, 70.3%, and 24.2%, respectively. Postoperatively, the outcome based on ETV-FT color scale was dark green (ETV-FT=0), light green (ETV-FT=1), yellow (ETV-FT=2), orange (ETV-FT=3), red (ETV-FT=4) in 29%, 14%, 20%, 10.3%, and 26.7%, respectively. Actual failure is identified as ETV-FT=4 based on clinical/radiological data. The failure rate was significantly attributed to inadequate communication with the basal cistern due to difficult/unsafe perforation of the thick/dense Liliequist membrane (87%) ( P = 0.001). Conclusion The traffic light alarming signs (ETV-DS and ETV-FT) can warn neurosurgeons to recognize critical cases that necessitate ultra-precautions to navigate safely through landmines for worthy outcomes.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"131 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136104938","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 : 2023-10-25DOI: 10.1186/s41984-023-00239-4
Mariam S. K. Abdelwahed, Mamdouh S. Ahmed, Ahmed S. Kamel Abdelwahed, Mohamed M. Aziz
Abstract Introduction Cranioplasty is the surgical correction of a cranial defect. Three-dimensional software designs have allowed patient-specific single-step cranial reconstruction for neuroprotection and cosmesis. Ultra-high molecular weight polyethylene for partial or total bone replacement has been recently introduced as a promising material for cranioplasty. The objectives of this study are to evaluate the complications and esthetic results concerning the use of ultra-high molecular weight polyethylene patient-specific implants in craniectomy patients. Methods We report a series of nine patients with cranial defects from a previous craniectomy, or patients eligible for simultaneous craniectomy and cranioplasty via computer designed ultra-high molecular weight polyethylene patient-specific implants. We have analyzed the complications and cosmetic outcomes over a course of six months. Results None of the cases developed infection, extra/subdural hematoma, cerebrospinal fluid leak, or implant failure. Three cases had postoperative sequalae: The first patient had mild postoperative seroma which subsided after medical therapy and compression, the second showed wound breakdown due to tumor metastasis and recurrence but did not necessitate implant removal, while the third sequela was a subgaleal hematoma which was aspirated, and the patient healed uneventfully afterward. Esthetic results were highly satisfactory in 75% of the patients (good patient acceptance without touch-ups). Conclusion Ultra-high molecular weight polyethylene is in all respects suitable for primary and secondary cranioplasty, combined with computer-aided manufacturing–computer-aided design techniques, excellent esthetic and functional results were achieved. However, proper preoperative planning is important, and we recommend further prospective studies with larger number of patients followed up for longer periods for better assessment.
{"title":"Computer-guided cranioplasty using ultra-high molecular weight polyethylene patient-specific implants: a case series","authors":"Mariam S. K. Abdelwahed, Mamdouh S. Ahmed, Ahmed S. Kamel Abdelwahed, Mohamed M. Aziz","doi":"10.1186/s41984-023-00239-4","DOIUrl":"https://doi.org/10.1186/s41984-023-00239-4","url":null,"abstract":"Abstract Introduction Cranioplasty is the surgical correction of a cranial defect. Three-dimensional software designs have allowed patient-specific single-step cranial reconstruction for neuroprotection and cosmesis. Ultra-high molecular weight polyethylene for partial or total bone replacement has been recently introduced as a promising material for cranioplasty. The objectives of this study are to evaluate the complications and esthetic results concerning the use of ultra-high molecular weight polyethylene patient-specific implants in craniectomy patients. Methods We report a series of nine patients with cranial defects from a previous craniectomy, or patients eligible for simultaneous craniectomy and cranioplasty via computer designed ultra-high molecular weight polyethylene patient-specific implants. We have analyzed the complications and cosmetic outcomes over a course of six months. Results None of the cases developed infection, extra/subdural hematoma, cerebrospinal fluid leak, or implant failure. Three cases had postoperative sequalae: The first patient had mild postoperative seroma which subsided after medical therapy and compression, the second showed wound breakdown due to tumor metastasis and recurrence but did not necessitate implant removal, while the third sequela was a subgaleal hematoma which was aspirated, and the patient healed uneventfully afterward. Esthetic results were highly satisfactory in 75% of the patients (good patient acceptance without touch-ups). Conclusion Ultra-high molecular weight polyethylene is in all respects suitable for primary and secondary cranioplasty, combined with computer-aided manufacturing–computer-aided design techniques, excellent esthetic and functional results were achieved. However, proper preoperative planning is important, and we recommend further prospective studies with larger number of patients followed up for longer periods for better assessment.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"415 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135217711","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 : 2023-10-23DOI: 10.1186/s41984-023-00224-x
Fakhreddin Sabooniha, Ghasem Baghershahi
Abstract Background Arachnoid cysts (ACs) account for about 1% of all intracranial mass lesions. The Sylvian fissure is the most common site of ACs which are usually asymptomatic. Traumatic rupture of arachnoid cysts complicated with subdural hygroma is a relatively rare entity in adults especially in females. There is no consensus on their management and each case could add to previous experiences leading to more uniform therapeutic measurements. This case encompasses a combination of watchful strategy, limited surgery and ultimately successful cyst fenestration which highlights a good outcome without complications by adopting a stepwise procedure. Case presentation Here, the case of a 51-year-old Persian woman being presented with a 2-month history of a localized headache which had begun 4 days after a minor head trauma. Early brain computed tomography (CT) obtained in another center at 4th day of post-injury which misinterpreted as an old infarct. Repeated CT in our center revealed a large AC of Sylvian fissure complicated with subdural hygroma. Initially a conservative management pursued but due to worsening of the symptoms, a burr-hole craniotomy performed for hygroma evacuation that subsequently followed by cyst fenestration about 1-month later. Conclusion Previous awareness about radiographic characteristics of ACs as well as employing appropriate imaging modality are necessary for correct and timely diagnosis of symptomatic patients after minor head trauma because incidentally found ACs might be the underpinning causes of symptoms. Also, following a multistage therapeutic process along with the involvement of patients in decision-making are of paramount importance.
{"title":"An arachnoid cyst rupture complicated with subdural hygroma in a middle-aged woman: a case report and review of the literature","authors":"Fakhreddin Sabooniha, Ghasem Baghershahi","doi":"10.1186/s41984-023-00224-x","DOIUrl":"https://doi.org/10.1186/s41984-023-00224-x","url":null,"abstract":"Abstract Background Arachnoid cysts (ACs) account for about 1% of all intracranial mass lesions. The Sylvian fissure is the most common site of ACs which are usually asymptomatic. Traumatic rupture of arachnoid cysts complicated with subdural hygroma is a relatively rare entity in adults especially in females. There is no consensus on their management and each case could add to previous experiences leading to more uniform therapeutic measurements. This case encompasses a combination of watchful strategy, limited surgery and ultimately successful cyst fenestration which highlights a good outcome without complications by adopting a stepwise procedure. Case presentation Here, the case of a 51-year-old Persian woman being presented with a 2-month history of a localized headache which had begun 4 days after a minor head trauma. Early brain computed tomography (CT) obtained in another center at 4th day of post-injury which misinterpreted as an old infarct. Repeated CT in our center revealed a large AC of Sylvian fissure complicated with subdural hygroma. Initially a conservative management pursued but due to worsening of the symptoms, a burr-hole craniotomy performed for hygroma evacuation that subsequently followed by cyst fenestration about 1-month later. Conclusion Previous awareness about radiographic characteristics of ACs as well as employing appropriate imaging modality are necessary for correct and timely diagnosis of symptomatic patients after minor head trauma because incidentally found ACs might be the underpinning causes of symptoms. Also, following a multistage therapeutic process along with the involvement of patients in decision-making are of paramount importance.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"2010 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135366146","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 : 2023-10-16DOI: 10.1186/s41984-023-00223-y
Hosam Eldin Abdel Azim Habib, Sameh Fathy Abdo, Ahmed Gabry El Nagar
Abstract Background Lumbar radicular pain (LRP) is one of the most encountered complaints in neurosurgical practice that pose a challenge in its management as adequate pain control, which is not always achieved. Objective The aim of this study was to evaluate the role of pulsed radiofrequency as a minimally invasive tool in the management of lumbar radicular pain of lumbar discogenic origin. Methods This is a prospective study that included 20 patients with lumbar radicular pain with radiological evidence of lumbar disc prolapse, who have been subjected to pulsed radiofrequency. Results The mean preoperative visual analogue score was 71 ± 14.38 dropped to a mean of 43.5 ± 21.47 at six-month follow-up. Seventy percentage of the study population had a satisfactory outcome, which did not correlate with the age, sex, or body mass index of the patients. Conclusions Pulsed radiofrequency is a safe and useful tool that may be used in the management of lumbar radicular pain.
{"title":"Pulsed radiofrequency in the management of lumbar radicular pain: initial experience","authors":"Hosam Eldin Abdel Azim Habib, Sameh Fathy Abdo, Ahmed Gabry El Nagar","doi":"10.1186/s41984-023-00223-y","DOIUrl":"https://doi.org/10.1186/s41984-023-00223-y","url":null,"abstract":"Abstract Background Lumbar radicular pain (LRP) is one of the most encountered complaints in neurosurgical practice that pose a challenge in its management as adequate pain control, which is not always achieved. Objective The aim of this study was to evaluate the role of pulsed radiofrequency as a minimally invasive tool in the management of lumbar radicular pain of lumbar discogenic origin. Methods This is a prospective study that included 20 patients with lumbar radicular pain with radiological evidence of lumbar disc prolapse, who have been subjected to pulsed radiofrequency. Results The mean preoperative visual analogue score was 71 ± 14.38 dropped to a mean of 43.5 ± 21.47 at six-month follow-up. Seventy percentage of the study population had a satisfactory outcome, which did not correlate with the age, sex, or body mass index of the patients. Conclusions Pulsed radiofrequency is a safe and useful tool that may be used in the management of lumbar radicular pain.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"14 9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136077788","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 : 2023-10-16DOI: 10.1186/s41984-023-00240-x
Usman Daibu, Aliyu Muhammad Koko, Babagana Usman
Abstract Background Myelomeningocele is the most common neural tube defect in our environment. Initial surgical management involves untethering and water-tight dural closure. Single-continuous dural repair is more straightforward and faster than the double-breasted repair, even though the latter offers more strength to the reconstructed dura as the repair is in two layers. Preference was given to single-continuous repair even though the two techniques were not compared in terms of post-operative cerebrospinal fluid leak. The aim of this study was to compare the frequency of cerebrospinal fluid (CSF) leak following single-continuous versus double-breasted dural repair of myelomeningocele. Patients and methods This was a randomized prospective study that reviewed all patients that presented to Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria, with myelomeningocele who met the inclusion criteria. Fifty-four patients were enrolled into the study randomized into two groups of 27 patients each. Group 1 had single-continuous repair, while group 2 had double-breasted technique. Post-operatively, patients were assessed for post-operative cerebrospinal fluid leak and pseudomeningocele. Data collected were analysed using the statistical package for social sciences version 22.0. The value for significance was set at 0.05. Results The median age at presentation for both groups was 5 months. Both groups showed female preponderance with a female-to-male ratio of 1.3:1 and 1.7:1. Post-operative CSF leak occurred in 2(7.4%) patients in the single-continuous group compared to 3(11.1%) patients in the double-breasted group. Only 1(3.7%) patient in the single-continuous group developed pseudomeningocele and none in the double-breasted. Conclusion Dural repair technique of myelomeningocele does not influence the occurrence of post-operative cerebrospinal fluid leak.
{"title":"Post-operative cerebrospinal fluid leak: single-continuous versus double-breasted dural repair of myelomeningocele","authors":"Usman Daibu, Aliyu Muhammad Koko, Babagana Usman","doi":"10.1186/s41984-023-00240-x","DOIUrl":"https://doi.org/10.1186/s41984-023-00240-x","url":null,"abstract":"Abstract Background Myelomeningocele is the most common neural tube defect in our environment. Initial surgical management involves untethering and water-tight dural closure. Single-continuous dural repair is more straightforward and faster than the double-breasted repair, even though the latter offers more strength to the reconstructed dura as the repair is in two layers. Preference was given to single-continuous repair even though the two techniques were not compared in terms of post-operative cerebrospinal fluid leak. The aim of this study was to compare the frequency of cerebrospinal fluid (CSF) leak following single-continuous versus double-breasted dural repair of myelomeningocele. Patients and methods This was a randomized prospective study that reviewed all patients that presented to Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria, with myelomeningocele who met the inclusion criteria. Fifty-four patients were enrolled into the study randomized into two groups of 27 patients each. Group 1 had single-continuous repair, while group 2 had double-breasted technique. Post-operatively, patients were assessed for post-operative cerebrospinal fluid leak and pseudomeningocele. Data collected were analysed using the statistical package for social sciences version 22.0. The value for significance was set at 0.05. Results The median age at presentation for both groups was 5 months. Both groups showed female preponderance with a female-to-male ratio of 1.3:1 and 1.7:1. Post-operative CSF leak occurred in 2(7.4%) patients in the single-continuous group compared to 3(11.1%) patients in the double-breasted group. Only 1(3.7%) patient in the single-continuous group developed pseudomeningocele and none in the double-breasted. Conclusion Dural repair technique of myelomeningocele does not influence the occurrence of post-operative cerebrospinal fluid leak.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136114218","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 Pilocytic astrocytoma (PA) is a central nervous system (CNS) World Health Organization (WHO) grade 1 glial tumor that is highly prevalent in children and young adults. The main aim of the study was to assess the frequency, clinicopathological features, and treatment of PAs along with their immunohistochemical and molecular analyses in patients from Northeast India. About 144 glial tumors were diagnosed in patients from 3 to 75 yrs of age from January 2015 to March 2022. Nine pediatric PA patients were identified and their clinical data were analyzed. Immunohistochemistry (IHC), fluorescence in-situ hybridization (FISH), and molecular analysis using the real-time polymerase chain reaction (RT-PCR) were performed. Data analysis was performed using the SPSS software. Results The mean age of the glioma patients was 41.7 yrs ± 18.2 with a male/female ratio of 1.3:1. The most common form of the glial tumor was found to be astrocytoma CNS WHO grade 2 (31.9%). The frequency of PA CNS WHO grade 1 was 6.9%. The pediatric PA cohort had a mean age of 9.2 yrs ± 4.9 with a male/female ratio of 2:1. Glial fibrillary acidic protein (GFAP) positive immunostaining and retention of transcriptional regulator alpha-thalassemia mental retardation X-linked protein (ATRX) expression was seen in all the tested PAs. The KIAA1459-BRAF fusion was detected in four PAs. Surgical intervention with total or radical tumor excision was performed for the PA patients. Eight PA patients exhibited improved condition post-surgery. Conclusion With the advent of healthcare and newer diagnostic facilities there is an increased incidence of glial tumors in developing countries. A combination of histological, immunohistochemical, and molecular analysis is very important for the diagnosis, accurate treatment, and prognosis of PA patients.
毛细胞星形细胞瘤(PA)是一种中枢神经系统(CNS)的世界卫生组织(WHO) 1级神经胶质肿瘤，在儿童和年轻人中高度流行。本研究的主要目的是评估印度东北部患者PAs的频率、临床病理特征和治疗方法，以及免疫组织化学和分子分析。2015年1月至2022年3月，在3至75岁的患者中诊断出约144例胶质肿瘤。对9例小儿PA患者进行临床资料分析。采用免疫组织化学(IHC)、荧光原位杂交(FISH)和实时聚合酶链反应(RT-PCR)进行分子分析。采用SPSS软件进行数据分析。结果胶质瘤患者平均年龄为41.7岁±18.2岁，男女比例为1.3:1。神经胶质肿瘤最常见的形式是星形细胞瘤CNS WHO 2级(31.9%)。PA CNS WHO 1级发生率为6.9%。儿童PA队列的平均年龄为9.2岁±4.9岁，男女比例为2:1。神经胶质原纤维酸性蛋白(GFAP)免疫染色阳性，转录调节因子α -地中海贫血智力迟钝x -连锁蛋白(ATRX)表达保留。在4个PAs中检测到KIAA1459-BRAF融合。对PA患者进行手术干预，包括全部或根治性肿瘤切除。8例PA患者术后病情改善。结论:随着医疗保健和新诊断设施的出现，发展中国家胶质肿瘤的发病率有所增加。结合组织学、免疫组织化学和分子分析对PA患者的诊断、准确治疗和预后非常重要。
{"title":"Clinical profile, histopathological, immunohistochemical, and molecular analyses and treatment of pilocytic astrocytoma: an eight year study from a tertiary health care centre in North East India","authors":"Shabnam Akhtar Ahmed, Navanil Barua, Nabajyoti Borah, Inamul Haque, Ananya Barman, Iman Dandapath","doi":"10.1186/s41984-023-00222-z","DOIUrl":"https://doi.org/10.1186/s41984-023-00222-z","url":null,"abstract":"Abstract Background Pilocytic astrocytoma (PA) is a central nervous system (CNS) World Health Organization (WHO) grade 1 glial tumor that is highly prevalent in children and young adults. The main aim of the study was to assess the frequency, clinicopathological features, and treatment of PAs along with their immunohistochemical and molecular analyses in patients from Northeast India. About 144 glial tumors were diagnosed in patients from 3 to 75 yrs of age from January 2015 to March 2022. Nine pediatric PA patients were identified and their clinical data were analyzed. Immunohistochemistry (IHC), fluorescence in-situ hybridization (FISH), and molecular analysis using the real-time polymerase chain reaction (RT-PCR) were performed. Data analysis was performed using the SPSS software. Results The mean age of the glioma patients was 41.7 yrs ± 18.2 with a male/female ratio of 1.3:1. The most common form of the glial tumor was found to be astrocytoma CNS WHO grade 2 (31.9%). The frequency of PA CNS WHO grade 1 was 6.9%. The pediatric PA cohort had a mean age of 9.2 yrs ± 4.9 with a male/female ratio of 2:1. Glial fibrillary acidic protein (GFAP) positive immunostaining and retention of transcriptional regulator alpha-thalassemia mental retardation X-linked protein (ATRX) expression was seen in all the tested PAs. The KIAA1459-BRAF fusion was detected in four PAs. Surgical intervention with total or radical tumor excision was performed for the PA patients. Eight PA patients exhibited improved condition post-surgery. Conclusion With the advent of healthcare and newer diagnostic facilities there is an increased incidence of glial tumors in developing countries. A combination of histological, immunohistochemical, and molecular analysis is very important for the diagnosis, accurate treatment, and prognosis of PA patients.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095311","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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