Pub Date : 2023-10-02DOI: 10.1186/s41984-023-00233-w
Umer Iqbal, Aashish Kumar, Syed Ali Arsal, Muhammad Ashir Shafique, Shafin Bin Amin, Adarsh Raja, Rabbia Aqeel, Sameeka Waqas
Abstract Background Traumatic brain injury has a crippling impact on sufferers’ quality of life, and numerous therapy techniques are being researched to address this problem. In this study, we compared the superiority of HS against mannitol as one such element of treating TBI patients. Objective To compare the efficacy of hypertonic saline and mannitol and demonstrate superiority of one group over the other. Method Our meta-analysis included only randomized controlled trials that compared the efficacy of mannitol and hypertonic saline in the treatment of traumatic brain injury. The literature search was done using a variety of databases, like Google Scholar, PubMed, and the Cochrane Library. From each of the included RCTs, accurate data extraction, bias risk assessment, and statistical analysis were carried out. Result There are 748 patients among the 15 RCTs. Our primary outcomes are mortality and functional outcomes, and our secondary outcomes include treatment failure, osmolality, intracerebral pressure (ICP), cerebral perfusion pressure (CPP), serum sodium (Na), partial pressure of oxygen in brain tissue (PBTO2), duration of elevated ICP, mean arterial pressure, hematocrit level, and central venous pressure. The comparison showed non-significant results for mortality (RR = 0.73, 95% CI 0.49–1.08; p = 0.12) and functional outcome (RR = 1.15, 95% CI = 0.74–1.80; p = 0.53). HS is linked to higher Na levels (RR = 4.55, 95% CI 1.34–7.76, P = 0.005, I2 = 96%). Despite performing a sensitivity analysis due to the heterogeneities in our various outcomes, the findings were still unreliable. Conclusion Our study revealed inconsequential trends for HS and mannitol, and no conclusion was made. We believe the two medications to be equally effective, but there is still opportunity for improvement as more studies are carried out. Eventually, a conclusive decision can be reached in the future.
背景外伤性脑损伤对患者的生活质量有严重的影响，人们正在研究许多治疗技术来解决这个问题。在这项研究中，我们比较了HS与甘露醇作为治疗TBI患者的一种元素的优势。目的比较高渗盐水与甘露醇的治疗效果，探讨两者的优越性。方法我们的荟萃分析只包括随机对照试验，比较甘露醇和高渗盐水治疗外伤性脑损伤的疗效。文献检索是使用各种数据库完成的，如Google Scholar, PubMed和Cochrane图书馆。对每个纳入的rct进行准确的数据提取、偏倚风险评估和统计分析。结果15例随机对照试验共748例患者。我们的主要结局是死亡率和功能结局，次要结局包括治疗失败、渗透压、颅内压(ICP)、脑灌注压(CPP)、血清钠(Na)、脑组织氧分压(PBTO2)、ICP升高持续时间、平均动脉压、红细胞压积水平和中心静脉压。比较显示死亡率无显著差异(RR = 0.73, 95% CI 0.49-1.08;p = 0.12)和功能结局(RR = 1.15, 95% CI = 0.74-1.80;P = 0.53)。HS与较高的Na水平有关(RR = 4.55, 95% CI 1.34-7.76, P = 0.005, I2 = 96%)。尽管由于各种结果的异质性，我们进行了敏感性分析，但结果仍然不可靠。结论本研究揭示了HS与甘露醇的不相关趋势，未得出结论。我们相信这两种药物同样有效，但随着更多研究的开展，仍有改进的机会。最终，一个决定性的决定可以在未来达成。
{"title":"Efficacy of hypertonic saline and mannitol in patients with traumatic brain injury and cerebral edema: a systematic review and meta-analysis","authors":"Umer Iqbal, Aashish Kumar, Syed Ali Arsal, Muhammad Ashir Shafique, Shafin Bin Amin, Adarsh Raja, Rabbia Aqeel, Sameeka Waqas","doi":"10.1186/s41984-023-00233-w","DOIUrl":"https://doi.org/10.1186/s41984-023-00233-w","url":null,"abstract":"Abstract Background Traumatic brain injury has a crippling impact on sufferers’ quality of life, and numerous therapy techniques are being researched to address this problem. In this study, we compared the superiority of HS against mannitol as one such element of treating TBI patients. Objective To compare the efficacy of hypertonic saline and mannitol and demonstrate superiority of one group over the other. Method Our meta-analysis included only randomized controlled trials that compared the efficacy of mannitol and hypertonic saline in the treatment of traumatic brain injury. The literature search was done using a variety of databases, like Google Scholar, PubMed, and the Cochrane Library. From each of the included RCTs, accurate data extraction, bias risk assessment, and statistical analysis were carried out. Result There are 748 patients among the 15 RCTs. Our primary outcomes are mortality and functional outcomes, and our secondary outcomes include treatment failure, osmolality, intracerebral pressure (ICP), cerebral perfusion pressure (CPP), serum sodium (Na), partial pressure of oxygen in brain tissue (PBTO2), duration of elevated ICP, mean arterial pressure, hematocrit level, and central venous pressure. The comparison showed non-significant results for mortality (RR = 0.73, 95% CI 0.49–1.08; p = 0.12) and functional outcome (RR = 1.15, 95% CI = 0.74–1.80; p = 0.53). HS is linked to higher Na levels (RR = 4.55, 95% CI 1.34–7.76, P = 0.005, I2 = 96%). Despite performing a sensitivity analysis due to the heterogeneities in our various outcomes, the findings were still unreliable. Conclusion Our study revealed inconsequential trends for HS and mannitol, and no conclusion was made. We believe the two medications to be equally effective, but there is still opportunity for improvement as more studies are carried out. Eventually, a conclusive decision can be reached in the future.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135790320","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 : 2023-10-02DOI: 10.1186/s41984-023-00221-0
Abdelrahman Magdy Elhabashy, Ahmed Abdelaziz Fayed, Islam Sorour
Abstract Background The main aim of surgical intervention for unstable sacral fractures is to obtain a solid construct across the lumbopelvic junction to allow for early mobilization. Both iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) are widely used surgical techniques used for treatment of unstable sacral fractures. Nevertheless, it is unclear whether one technique provides more favorable postoperative outcomes than the other. Objective To compare the three-year outcome of ISF versus LPF in patients with unstable sacral fractures as regard effectiveness and safety of both techniques. Methods The study included 54 patients with sacral fractures who underwent sacral fusion using either ISF or LPF at a single institution. Patients were followed up for at least 3 years. Operative and postoperative data were collected and statistically calculated. Results Thirty patients were included in the ISF group and 24 patients in the LPF group. The operative time was notably higher in the LPF group (mean 107 min compared to 33 min in the ISF group; p = 0.002). Blood loss was also higher in the LPF group (mean 320 ml compared to 96 ml in the ISF; p = 0.004). Assessment of pelvic fusion was done via Majeed and Matta scores (pelvic fusion outcome scores). The ISF and LPF groups had a comparable Majeed score at the end of the third year of follow-up (excellent rate = 53.3% vs. 58.3%, respectively; p = 0.93). Likewise, ISF and LPF groups had comparable Matta score at the end of the third year of follow-up (excellent rate = 66.7% vs. 70.8%, respectively; p = 0.27). The most commonly reported postoperative complications in the ISF group were screw malposition in 2 cases out of 30 cases (6.6%) and non-union in 2 cases out of 30 cases (6.6%). On the other hand, the most commonly reported postoperative complications in the LPF group were implant prominence in 3 cases out of 24 cases (12.5%) and infection in 2 cases out of 24 cases (8.3%). Conclusion LPF and ISF have comparable safety and efficacy in patients with sacral fractures. ISF is an excellent and safe method of fixation, especially in old age to avoid open surgery-related complications. LPF is preferred in young active patients to benefit from rapid weight bearing after surgery and in cases with ambiguous sacral anatomy as sacral dysmorphism.
{"title":"Comparative study between open lumbopelvic fixation and percutaneous iliosacral fixation for management of sacral fractures","authors":"Abdelrahman Magdy Elhabashy, Ahmed Abdelaziz Fayed, Islam Sorour","doi":"10.1186/s41984-023-00221-0","DOIUrl":"https://doi.org/10.1186/s41984-023-00221-0","url":null,"abstract":"Abstract Background The main aim of surgical intervention for unstable sacral fractures is to obtain a solid construct across the lumbopelvic junction to allow for early mobilization. Both iliosacral screw fixation (ISF) and lumbopelvic fixation (LPF) are widely used surgical techniques used for treatment of unstable sacral fractures. Nevertheless, it is unclear whether one technique provides more favorable postoperative outcomes than the other. Objective To compare the three-year outcome of ISF versus LPF in patients with unstable sacral fractures as regard effectiveness and safety of both techniques. Methods The study included 54 patients with sacral fractures who underwent sacral fusion using either ISF or LPF at a single institution. Patients were followed up for at least 3 years. Operative and postoperative data were collected and statistically calculated. Results Thirty patients were included in the ISF group and 24 patients in the LPF group. The operative time was notably higher in the LPF group (mean 107 min compared to 33 min in the ISF group; p = 0.002). Blood loss was also higher in the LPF group (mean 320 ml compared to 96 ml in the ISF; p = 0.004). Assessment of pelvic fusion was done via Majeed and Matta scores (pelvic fusion outcome scores). The ISF and LPF groups had a comparable Majeed score at the end of the third year of follow-up (excellent rate = 53.3% vs. 58.3%, respectively; p = 0.93). Likewise, ISF and LPF groups had comparable Matta score at the end of the third year of follow-up (excellent rate = 66.7% vs. 70.8%, respectively; p = 0.27). The most commonly reported postoperative complications in the ISF group were screw malposition in 2 cases out of 30 cases (6.6%) and non-union in 2 cases out of 30 cases (6.6%). On the other hand, the most commonly reported postoperative complications in the LPF group were implant prominence in 3 cases out of 24 cases (12.5%) and infection in 2 cases out of 24 cases (8.3%). Conclusion LPF and ISF have comparable safety and efficacy in patients with sacral fractures. ISF is an excellent and safe method of fixation, especially in old age to avoid open surgery-related complications. LPF is preferred in young active patients to benefit from rapid weight bearing after surgery and in cases with ambiguous sacral anatomy as sacral dysmorphism.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135791384","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 The glossopharyngeal nerve is both a sensitive and motor entity that emerges from the posterior lateral sulcus of the bulb and exits the skull through the jugular foramen. Schwannomas arising from glossopharyngeal nerves are extremely rare, and the clinical and imaging features of glossopharyngeal schwannomas closely resemble that of acoustic schwannomas. Case presentation We report a case of a 65-year-old female patient with glossopharyngeal neurinoma of incidental finding on brain CT scan requested after she sustained a minor traumatic brain injury. She was taken to the operating room, and the tumor was excised endoscopically via a retrosigmoid approach and the postoperative course was simple and uneventful. Histopathology of the sample showed short spindle-shaped cells with poor atypia proliferated in fascicles, and shelf-like arrangement of nuclei was seen partially, which was in keeping with a neurinoma. Conclusions Glossopharyngeal neurinoma may not present with obvious symptoms and signs related to its compression and may also be found incidentally compared to its counterpart vestibular schwannoma.
{"title":"Glossopharyngeal neurinoma of incidental finding in a 65-year-old female patient: case report","authors":"Kantenga Dieu Merci Kabulo, Kazuhito Takeuchi, Yasuo Yamada, Afsal Sharafundeen, Kazadi Kaluile Ntenga Kalangu, Yoko Kato","doi":"10.1186/s41984-023-00226-9","DOIUrl":"https://doi.org/10.1186/s41984-023-00226-9","url":null,"abstract":"Abstract Background The glossopharyngeal nerve is both a sensitive and motor entity that emerges from the posterior lateral sulcus of the bulb and exits the skull through the jugular foramen. Schwannomas arising from glossopharyngeal nerves are extremely rare, and the clinical and imaging features of glossopharyngeal schwannomas closely resemble that of acoustic schwannomas. Case presentation We report a case of a 65-year-old female patient with glossopharyngeal neurinoma of incidental finding on brain CT scan requested after she sustained a minor traumatic brain injury. She was taken to the operating room, and the tumor was excised endoscopically via a retrosigmoid approach and the postoperative course was simple and uneventful. Histopathology of the sample showed short spindle-shaped cells with poor atypia proliferated in fascicles, and shelf-like arrangement of nuclei was seen partially, which was in keeping with a neurinoma. Conclusions Glossopharyngeal neurinoma may not present with obvious symptoms and signs related to its compression and may also be found incidentally compared to its counterpart vestibular schwannoma.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135386791","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 : 2023-09-26DOI: 10.1186/s41984-023-00234-9
Vishal Kumar, Ankit Rai, Sarvdeep Singh Dhatt
Abstract Background White cord syndrome is an unexpected and dreaded complication of decompression surgery in cervical myelopathy with an unforeseeable prognosis. Ischemic reperfusion injury has been advocated as an underlying pathophysiology. Not only must the surgeon be acquainted with this complication, but the patient should also be counseled before surgery regarding the expected outcome and worsening of neurological status after surgery in severe chronic compressive myelopathy. Case presentation A 48-year-old female presented with difficulty walking and numbness in all four limbs. The clinical and radiological assessment was suggestive of multilevel cervical cord compression. Posterior cervical decompression with C3–C7 lateral mass screw was performed. The patient developed a worsening neurological status in the immediate postoperative period. The patient was shifted to the intensive care unit and managed with high-dose dexamethasone along with monitoring and maintaining mean arterial pressure above 85 mm Hg. A partial improvement in neurology was noted during the in-hospital stay. The patient was attached to the local rehabilitation clinic. At the one-year follow-up, the patient was ambulatory with some residual numbness and weakness in the upper limbs. Conclusions White cord syndrome following spinal decompression in chronic cervical myelopathy is a rare, unfortunate complication and a diagnosis of exclusion with variable outcomes. An increase in signal hyper-intensity on T2-weighted MRI imaging in this entity is the most consistent finding. This report reviewed our current knowledge on the management of white cord syndrome based on our present experience.
{"title":"White cord syndrome—an unforeseen complication and diagnosis of exclusion: a case report and review of management","authors":"Vishal Kumar, Ankit Rai, Sarvdeep Singh Dhatt","doi":"10.1186/s41984-023-00234-9","DOIUrl":"https://doi.org/10.1186/s41984-023-00234-9","url":null,"abstract":"Abstract Background White cord syndrome is an unexpected and dreaded complication of decompression surgery in cervical myelopathy with an unforeseeable prognosis. Ischemic reperfusion injury has been advocated as an underlying pathophysiology. Not only must the surgeon be acquainted with this complication, but the patient should also be counseled before surgery regarding the expected outcome and worsening of neurological status after surgery in severe chronic compressive myelopathy. Case presentation A 48-year-old female presented with difficulty walking and numbness in all four limbs. The clinical and radiological assessment was suggestive of multilevel cervical cord compression. Posterior cervical decompression with C3–C7 lateral mass screw was performed. The patient developed a worsening neurological status in the immediate postoperative period. The patient was shifted to the intensive care unit and managed with high-dose dexamethasone along with monitoring and maintaining mean arterial pressure above 85 mm Hg. A partial improvement in neurology was noted during the in-hospital stay. The patient was attached to the local rehabilitation clinic. At the one-year follow-up, the patient was ambulatory with some residual numbness and weakness in the upper limbs. Conclusions White cord syndrome following spinal decompression in chronic cervical myelopathy is a rare, unfortunate complication and a diagnosis of exclusion with variable outcomes. An increase in signal hyper-intensity on T2-weighted MRI imaging in this entity is the most consistent finding. This report reviewed our current knowledge on the management of white cord syndrome based on our present experience.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134886013","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 : 2023-09-26DOI: 10.1186/s41984-023-00232-x
Safwat Abouhashem, Mohammed Bafaquh, Ahmed Assem, Mahmoud M. Taha, Mohammed ELSherif, Shawkat El-Atawy, Maryam Hashem, Hany Eldawoody
Abstract Background Although it is well known that performing decompressive craniectomy (DC) in cases of swollen middle cerebral artery infarction (SMCAI) improves patient outcomes, limited evidence presently exists on the likelihood of mortality and achieving functional outcome following DC. The aim of the present study was to identify the predictors of early in-hospital mortality and functional status six months after performing DC in a cohort of patients with SMCAI. Material and methods All patients that had suffered SMCAI and underwent DC were included in the study sample and their demographic information, along with clinical and radiological findings, and risk factors were recorded for further analyses, which were conducted using the commercial software STATA. Modified Rankin Scale score (mRS) served as an outcome measure at 6-month follow-up. Results DC was performed on 50 patients with SMCAI (72% of whom had left hemisphere infractions) aged 45.2 ± 10.2 years (range 24–67 years), 32 (64%) of whom were female and 18 (36%) were male. While the initial median Glasgow Coma Scale (GCS) score was 8 (range 4–13), clinical deterioration mostly occurred within the first five days, whereby DC was performed within 9 ± 7.2 h (range 2–36 h). Following surgery, 16 (32%) patients died while in hospital, whereas the remaining 34 were discharged after 135 days on average, and attended the 6-month follow-up, when the median mRS score of 3 (range 2–6) was recorded for this subsample. Conclusions Younger age, higher GCS score, presence of isochoric pupils, history of prior treatment (e.g., embolectomy or tissue plasminogen activator), and shorter interval between clinical deterioration and surgery are associated with a lower likelihood of mortality and a greater odd of a favorable functional outcome.
{"title":"Functional outcome and mortality prediction after decompressive craniectomy in patients with malignant middle cerebral artery infarction","authors":"Safwat Abouhashem, Mohammed Bafaquh, Ahmed Assem, Mahmoud M. Taha, Mohammed ELSherif, Shawkat El-Atawy, Maryam Hashem, Hany Eldawoody","doi":"10.1186/s41984-023-00232-x","DOIUrl":"https://doi.org/10.1186/s41984-023-00232-x","url":null,"abstract":"Abstract Background Although it is well known that performing decompressive craniectomy (DC) in cases of swollen middle cerebral artery infarction (SMCAI) improves patient outcomes, limited evidence presently exists on the likelihood of mortality and achieving functional outcome following DC. The aim of the present study was to identify the predictors of early in-hospital mortality and functional status six months after performing DC in a cohort of patients with SMCAI. Material and methods All patients that had suffered SMCAI and underwent DC were included in the study sample and their demographic information, along with clinical and radiological findings, and risk factors were recorded for further analyses, which were conducted using the commercial software STATA. Modified Rankin Scale score (mRS) served as an outcome measure at 6-month follow-up. Results DC was performed on 50 patients with SMCAI (72% of whom had left hemisphere infractions) aged 45.2 ± 10.2 years (range 24–67 years), 32 (64%) of whom were female and 18 (36%) were male. While the initial median Glasgow Coma Scale (GCS) score was 8 (range 4–13), clinical deterioration mostly occurred within the first five days, whereby DC was performed within 9 ± 7.2 h (range 2–36 h). Following surgery, 16 (32%) patients died while in hospital, whereas the remaining 34 were discharged after 135 days on average, and attended the 6-month follow-up, when the median mRS score of 3 (range 2–6) was recorded for this subsample. Conclusions Younger age, higher GCS score, presence of isochoric pupils, history of prior treatment (e.g., embolectomy or tissue plasminogen activator), and shorter interval between clinical deterioration and surgery are associated with a lower likelihood of mortality and a greater odd of a favorable functional outcome.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"330 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134958759","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 Ectopic meningiomas are rare neoplasms that occur entirely outside the intracranial and intraspinal cavities and account for only 1–2% of all meningiomas. These tumors have been reported at various sites, however they are predominantly observed in the head and neck region. Here, we detail a case of an adult diagnosed with ectopic meningioma of the neck. Case presentation A 26-year-old woman underwent evaluation for a neck swelling associated with difficult in swallowing. Clinical examination revealed a firm, non-tender and non-pulsatile swelling in the right side of neck. On imaging, a soft tissue mass lesion was seen involving the right supra-hyoid neck, centered at the right carotid space/retro-styloid parapharyngeal space. She underwent maximal safe resection of the tumor and a consensus was reached regarding the diagnosis of ectopic meningioma based on the histopathological, clinical and radiological findings. Relevant literature is reviewed. Conclusions The diagnosis of ectopic meningioma may pose difficulties due to their occurrence in uncommon sites. The primary approach to treatment entails the surgical removal of the neoplasm, and a multidisciplinary strategy is pivotal for achieving the best possible clinical outcomes for patients with this rare entity.
{"title":"Ectopic meningioma presenting as a neck mass: case report and review of literature","authors":"Balu Vijayan, Asha Arjunan, Priya Balakrishnan, Anitha Mathews, Jiji Valsalamony, Neelima Radhakrishnan, Nijo Jose","doi":"10.1186/s41984-023-00230-z","DOIUrl":"https://doi.org/10.1186/s41984-023-00230-z","url":null,"abstract":"Abstract Background Ectopic meningiomas are rare neoplasms that occur entirely outside the intracranial and intraspinal cavities and account for only 1–2% of all meningiomas. These tumors have been reported at various sites, however they are predominantly observed in the head and neck region. Here, we detail a case of an adult diagnosed with ectopic meningioma of the neck. Case presentation A 26-year-old woman underwent evaluation for a neck swelling associated with difficult in swallowing. Clinical examination revealed a firm, non-tender and non-pulsatile swelling in the right side of neck. On imaging, a soft tissue mass lesion was seen involving the right supra-hyoid neck, centered at the right carotid space/retro-styloid parapharyngeal space. She underwent maximal safe resection of the tumor and a consensus was reached regarding the diagnosis of ectopic meningioma based on the histopathological, clinical and radiological findings. Relevant literature is reviewed. Conclusions The diagnosis of ectopic meningioma may pose difficulties due to their occurrence in uncommon sites. The primary approach to treatment entails the surgical removal of the neoplasm, and a multidisciplinary strategy is pivotal for achieving the best possible clinical outcomes for patients with this rare entity.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135814641","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 Surgical management is one of the mainstay management options for cerebrovascular diseases, which is not only curative but also preventive. However, there's a gap between the surgical management of cerebrovascular disease in Africa when compared to the developed parts of the world. Methods A literature search was done on the state of Cerebrovascular surgery in Africa from databases such as Pubmed, Embase, and Google Scholar, articles we fetched and meticulously reviewed. Results We found gaps in the surgical management of cerebrovascular diseases such as stroke in African countries when compared to developed countries. The challenges facing the surgical management of cerebrovascular disease in Africa include a low number of neurosurgeons and vascular surgeons trained in the surgical management of these diseases, a lack of adequate facilities for surgical management, and others. The burden of cerebrovascular diseases in Africa is great, and this warrants an improvement in the surgical management of the conditions, which includes primary prevention of such diseases through public health education on risk factors, improvement of health facilities to accommodate recent advances in the cerebrovascular surgeries, establishments of several neurosurgery training centers. Conclusion The practice of surgical management of cerebrovascular disease in Africa needs to be optimized for it to be at the global standard and for better outcomes and management of patients.
{"title":"Surgical management of cerebrovascular disease in Africa: a systematic review of state","authors":"Kehinde Alare, Joshua Opanike, Temidayo Adebayo, AbdulSalam Owonikoko, Mariam Edun, Qudus Tajudeen","doi":"10.1186/s41984-023-00229-6","DOIUrl":"https://doi.org/10.1186/s41984-023-00229-6","url":null,"abstract":"Abstract Background Surgical management is one of the mainstay management options for cerebrovascular diseases, which is not only curative but also preventive. However, there's a gap between the surgical management of cerebrovascular disease in Africa when compared to the developed parts of the world. Methods A literature search was done on the state of Cerebrovascular surgery in Africa from databases such as Pubmed, Embase, and Google Scholar, articles we fetched and meticulously reviewed. Results We found gaps in the surgical management of cerebrovascular diseases such as stroke in African countries when compared to developed countries. The challenges facing the surgical management of cerebrovascular disease in Africa include a low number of neurosurgeons and vascular surgeons trained in the surgical management of these diseases, a lack of adequate facilities for surgical management, and others. The burden of cerebrovascular diseases in Africa is great, and this warrants an improvement in the surgical management of the conditions, which includes primary prevention of such diseases through public health education on risk factors, improvement of health facilities to accommodate recent advances in the cerebrovascular surgeries, establishments of several neurosurgery training centers. Conclusion The practice of surgical management of cerebrovascular disease in Africa needs to be optimized for it to be at the global standard and for better outcomes and management of patients.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135814638","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 Discal cyst, a rare disease with unclear pathogenesis, exhibits symptoms similar to lumbar disk herniation. Currently, there is no consensus on the optimal treatment for this condition. Case presentation This report presents the clinical efficacy of the percutaneous endoscopic interlaminar approach surgery technique in patients diagnosed with lumbar 4–5 discal cyst. The patient exhibited sub-acute radiculopathy in the left leg accompanied by weakness of the extensor hallucis longus. Magnetic resonance imaging of the lumbar spine confirmed the presence of lumbar discal cysts, which exerted compression on the traversing nerve root. Surgical treatment involved performing percutaneous endoscopic interlaminar approach surgery without additional discectomy under general anesthesia. The symptoms were immediately alleviated following the removal of the discal cysts, and the weakness in the toe improved the day after the surgery. No recurrent symptoms or complications were observed during the 6-month follow-up period. Conclusion Based on our findings, we posit that percutaneous interlaminar endoscopic surgery represents a safe, minimally invasive, and appropriate approach for treating discal cysts.
{"title":"Removal of discal cyst using percutaneous full endoscopic via interlaminar route: a case report","authors":"Pawin Kasempipatchai, Withawin Kesornsak, Verapan Kuansongtham","doi":"10.1186/s41984-023-00231-y","DOIUrl":"https://doi.org/10.1186/s41984-023-00231-y","url":null,"abstract":"Abstract Background Discal cyst, a rare disease with unclear pathogenesis, exhibits symptoms similar to lumbar disk herniation. Currently, there is no consensus on the optimal treatment for this condition. Case presentation This report presents the clinical efficacy of the percutaneous endoscopic interlaminar approach surgery technique in patients diagnosed with lumbar 4–5 discal cyst. The patient exhibited sub-acute radiculopathy in the left leg accompanied by weakness of the extensor hallucis longus. Magnetic resonance imaging of the lumbar spine confirmed the presence of lumbar discal cysts, which exerted compression on the traversing nerve root. Surgical treatment involved performing percutaneous endoscopic interlaminar approach surgery without additional discectomy under general anesthesia. The symptoms were immediately alleviated following the removal of the discal cysts, and the weakness in the toe improved the day after the surgery. No recurrent symptoms or complications were observed during the 6-month follow-up period. Conclusion Based on our findings, we posit that percutaneous interlaminar endoscopic surgery represents a safe, minimally invasive, and appropriate approach for treating discal cysts.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"186 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135814640","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 : 2023-09-25DOI: 10.1186/s41984-023-00235-8
Ahmed M. Elsabaa, Hany Eldawoody, Mariam S. K. Abdelwahed, Mohamed M. Aziz
Abstract Introduction Traumatic brain injuries (TBIs) are among the leading causes of death and disability in younger age groups. Current guidelines to prevent infection in compound depressed fractures of the skull recommend fragment removal and debridement, and the cranial defect usually is left for a secondary cranioplasty. However, recent studies demonstrated no difference in infection rates between primary and secondary reconstruction. Herein we point out our preliminary experience using a single-staged approach to surgical management of open depressed skull fractures. Methods This study included 72 patients between Egypt and Saudi Arabia with compound depressed fractures of the skull that underwent primary cranioplasty either by elevation or by titanium reconstruction within the first 72 h post-traumatic brain injuries. We report surgery-specific characteristics and overall complications over a 12-month follow-up period. Results Fifty-nine (82%) immediate primary cranioplasty patients were without complications. Twelve complications were seen in twelve patients. Infection accounted for only 2.8%, while the rest consisted of convulsions (6.9%), CSF rhinorrhea (4.2%), CSF leak, seroma, and re-operation (1.4%) each. One patient died after 20 postoperative days due to pulmonary embolism. Conclusion Neurosurgical expertise and readily available medical facilities within the civilian populations have significantly changed the traditional approach in calvarial CDF patients within the first 72 h post-trauma, where primary cranioplasty has proven to be a valid procedure with minimal morbidities compared to the traditional two-stage protocol.
{"title":"Primary cranioplasty for calvarial compound depressed fractures; 2 centers experience","authors":"Ahmed M. Elsabaa, Hany Eldawoody, Mariam S. K. Abdelwahed, Mohamed M. Aziz","doi":"10.1186/s41984-023-00235-8","DOIUrl":"https://doi.org/10.1186/s41984-023-00235-8","url":null,"abstract":"Abstract Introduction Traumatic brain injuries (TBIs) are among the leading causes of death and disability in younger age groups. Current guidelines to prevent infection in compound depressed fractures of the skull recommend fragment removal and debridement, and the cranial defect usually is left for a secondary cranioplasty. However, recent studies demonstrated no difference in infection rates between primary and secondary reconstruction. Herein we point out our preliminary experience using a single-staged approach to surgical management of open depressed skull fractures. Methods This study included 72 patients between Egypt and Saudi Arabia with compound depressed fractures of the skull that underwent primary cranioplasty either by elevation or by titanium reconstruction within the first 72 h post-traumatic brain injuries. We report surgery-specific characteristics and overall complications over a 12-month follow-up period. Results Fifty-nine (82%) immediate primary cranioplasty patients were without complications. Twelve complications were seen in twelve patients. Infection accounted for only 2.8%, while the rest consisted of convulsions (6.9%), CSF rhinorrhea (4.2%), CSF leak, seroma, and re-operation (1.4%) each. One patient died after 20 postoperative days due to pulmonary embolism. Conclusion Neurosurgical expertise and readily available medical facilities within the civilian populations have significantly changed the traditional approach in calvarial CDF patients within the first 72 h post-trauma, where primary cranioplasty has proven to be a valid procedure with minimal morbidities compared to the traditional two-stage protocol.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135814635","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 : 2023-09-18DOI: 10.1186/s41984-023-00219-8
Wael Abd Elrahman Ali Elmesallamy, Hesham Yakout, Sami Hassanen, Magdy Elshekh
Abstract Background The spinal intradural mass lesions represent a challenge in microsurgical practices. The intraoperative precise localization and characterization of these lesions must be achieved to avoid excessive exposure and neural tissue damage. This study aims to evaluate the role of intraoperative ultrasound during surgical dealing with spinal intradural mass lesions starting before bony work exposure. Results This prospective study had been done during the period from January 2022 to January 2023 with follow-up at least 6 months on 36 patients, suffered intradural spinal mass lesions and underwent microsurgical interventions aided with intraoperative ultrasound. MRI spine and Klekamp score were used as preoperative and postoperative parameters for assessment of the patients. Intraoperative ultrasound features were analyzed to evaluate its values. All lesions were visualized and characterized by intraoperative ultrasound beside spinal anatomical identification. Laminoplasty, laminectomy, durotomy and myelotomy were determined by IOUS. Gross total eradication was achieved in 28/36 (78%). Intraoperative ultrasonography definition of cystic component, well-defined borders and smooth shape of the masses were associated with significant Klekamp outcome improvement. Conclusion Intraoperative ultrasound can be used safely to detect the spinal intradural mass lesions even before bony work for exposure with anatomical and pathological definition and has the ability to predict the outcome.
{"title":"The role of intraoperative ultrasound in management of spinal intradural mass lesions and outcome","authors":"Wael Abd Elrahman Ali Elmesallamy, Hesham Yakout, Sami Hassanen, Magdy Elshekh","doi":"10.1186/s41984-023-00219-8","DOIUrl":"https://doi.org/10.1186/s41984-023-00219-8","url":null,"abstract":"Abstract Background The spinal intradural mass lesions represent a challenge in microsurgical practices. The intraoperative precise localization and characterization of these lesions must be achieved to avoid excessive exposure and neural tissue damage. This study aims to evaluate the role of intraoperative ultrasound during surgical dealing with spinal intradural mass lesions starting before bony work exposure. Results This prospective study had been done during the period from January 2022 to January 2023 with follow-up at least 6 months on 36 patients, suffered intradural spinal mass lesions and underwent microsurgical interventions aided with intraoperative ultrasound. MRI spine and Klekamp score were used as preoperative and postoperative parameters for assessment of the patients. Intraoperative ultrasound features were analyzed to evaluate its values. All lesions were visualized and characterized by intraoperative ultrasound beside spinal anatomical identification. Laminoplasty, laminectomy, durotomy and myelotomy were determined by IOUS. Gross total eradication was achieved in 28/36 (78%). Intraoperative ultrasonography definition of cystic component, well-defined borders and smooth shape of the masses were associated with significant Klekamp outcome improvement. Conclusion Intraoperative ultrasound can be used safely to detect the spinal intradural mass lesions even before bony work for exposure with anatomical and pathological definition and has the ability to predict the outcome.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135110878","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：