Acta Neurochirurgica最新文献

Background

A 63-year-old presented with reduced left visual acuity and V1 sensation. Imaging demonstrated left sphenoid osseous meningioma narrowing superior orbital fissure with intracranial extension to superior temporal gyrus.

Method

Endoscopic transorbital approach utilising novel lateral orbit ‘sliding coach door’ osteotomy performed. Lateral canthal incision with lateral canthal ligament division mobilises and decompresses globe infero-medially. Osteotomy performed, tethered by temporalis. Osteotomy slides postero-laterally creating working space lateral to inferior and superior orbital fissures.

Conclusion

This technique requires reduced soft tissue dissection and facilitates reconstruction. Adequate working space enabled satisfactory resection with residual dural tail requiring future surveillance. Cosmesis was satisfactory.

Background

The frontal basal interhemispheric approach (FBIA) provides wide access to the chiasmatic cistern, retrochiasmatic space, and lamina terminalis for craniopharyngioma removal.

Methods

We introduce in detail the anatomical structure related to the FBIA, the surgical techniques of craniotomy, and how to prevent the surgical complications.

Conclusion

The FBIA provides a satisfactory surgical corridor for craniopharyngioma resection.

Background

For drug-resistant mesial temporal lobe epilepsy (MTLE), surgery is recommended. There is no evidence of a seizure outcome advantage of temporal lobectomy over other strategies despite the high risks of this surgical procedure.

Methods

We describe a Temporal Resection guided by intraoperative stereo-electroencephalography (iSEEG) and the ¹⁸FluoroDeoxyGlucose PET (¹⁸FDG PET) (iSP-TR) to treat lesional MTLE. We avoided functional cortical areas using navigated Transcranial Magnetic Stimulation (nTMS).

Conclusion

iSP-TR allows for a spare brain parenchyma compared to temporal lobectomy without compromising seizure outcomes.

Purpose

The aim of this study was to explore risk factors for intraoperative events and postoperative complications of endoscopic transsphenoidal surgery (ETS) for pituitary tumors, and the role of intrasellar pressure (ISP) in relation to complications.

Methods

The study was a single-center, retrospective, consecutive, observational study, with ISP data collected prospectively. After exclusions, the study population encompassed 69 patients. All had ISP measured intraoperatively during ETS for a pituitary adenoma and underwent standardized postoperative observations and follow-up. Data on complications within 3 months after surgery and some risk factors were collected retrospectively.

Results

Decreased risk of postoperative cerebrospinal fluid leakage was seen with higher age. Large tumor volume was associated with higher risk of intraoperative events. ISP was not associated with complication frequency, but patients with ISP > 20 mmHg had increased frequency of postoperative epistaxis.

Conclusion

This study confirms earlier findings of low age as a possible risk factor for postoperative cerebrospinal fluid leakage. Tumor volume is suggested to be associated with higher complication risk. ISP does not seem to be a significant risk factor for intraoperative events or postoperative complications following ETS. Predictive risk factors for surgical complications after ETS are still not satisfactorily explained and heterogeneous definitions of complications are problematic in this context.

Purpose

Leptomeningeal metastasis (LM)-associated hydrocephalus is a rare but severe complication of non-small cell lung cancer (NSCLC). The spread of malignant cells to the leptomeninges obstructs cerebrospinal fluid flow and increases intracranial pressure (ICP). This study compared the outcomes of lumboperitoneal (LP) and ventriculoperitoneal (VP) shunt surgeries in managing LM-associated hydrocephalus, focusing on symptom-free periods (SFPs) and overall survival (OS).

Methods

A retrospective analysis was conducted on 43 NSCLC patients with LM-associated hydrocephalus who underwent shunt surgery between 2017 and 2024. Patients were classified into LP (n = 23) and VP (n = 20) groups. Clinical characteristics, surgical outcomes, and survival rates were analyzed using Kaplan–Meier survival and Cox regression analyses. Karnofsky performance status (KPS), increased intracranial pressure (IICP) symptoms, and postoperative epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatment were evaluated for prognostic significance.

Results

No significant difference was observed between VP and LP shunt surgeries regarding SFP (VP: 5.02 ± 1.29 months, LP: 7.50 ± 2.86 months, p = 0.906) or OS (VP: 8.43 ± 1.89 months, LP: 9.62 ± 3.20 months, p = 0.820). High preoperative KPS, absence of ICP symptoms, and postoperative EGFR-TKI treatment were significantly associated with improved SFP and OS (p < 0.05). LP shunt surgery had shorter anesthesia and fewer complications compared to VP shunt surgery, representing a viable option for patients unsuitable for general anesthesia.

Conclusion

LP and VP shunt surgeries are equally effective for patients with LM-associated hydrocephalus in NSCLC. LP shunt surgery under local anesthesia could be recommended for its safety and patient acceptability. Favorable prognostic factors, including high KPS, absence of ICP, and postoperative EGFR-TKI treatment, should guide individualized treatment strategies to enhance patient outcomes and quality of life.

Purpose

Cerebral bypasses are technically challenging procedures essential in the neurosurgeon’s armamentarium. Decreasing surgical indications leading to reduced caseload has resulted in less than ideal clinical outcomes, particularly in low to medium volume centres. We describe the neuroplastics approach to cerebral bypasses in the largest retrospective series to date and demonstrate how this approach has been able to smoothen the learning curve and achieve consistent outcomes approximating that of high-volume centres.

Methods

A retrospective study was conducted. All patients who received a bypass were classified into those with bypasses performed using the neuroplastics approach (NP group) and those performed by solo neurosurgeons (Solo group). Technical outcomes and clinical outcomes were compared.

Results

There were 19 patients in the NP group and 50 patients in the Solo group. There were 17 patients in the NP group with double-barrel bypasses and 2 with single-barrel bypasses (total of 36 direct anastomoses) and 45 patients of the Solo group with single-barrel bypasses and 5 patients with conversion to indirect bypasses. Patients in the Solo group were more likely to experience a postoperative stroke in the bypassed territory (Solo, 17.8%; NP, 0%; p = 0.008). Although not statistically significant, there was a difference in the proportion of patients with conversion to indirect bypass (Solo, 10.0%; NP, 0%), postoperative anastomotic bleed (Solo, 8.9%; NP, 0%), and long-term patency (Solo, 93.9%; NP, 100%). Patients in the NP group had a shorter median length of stay (NP, 3 [2 – 7] days; Solo, 6 [5 – 9] days; p = 0.005) and 1-year modified Rankin scale approached significance (NP, 0 [0 – 0]; Solo, 0 [0 – 2]).

Conclusion

Our experience supports the adoption of a neuroplastics approach to the training and execution of cerebrovascular bypasses in small to medium volume centres. This collaboration allowed us to deliver cerebral bypasses to indicated patients with excellent outcomes.

Background

Traumatic brain injury (TBI) in people falling from trees is a condition rarely reported in the literature and is often observed in rural areas of developing countries such as Senegal. Ziguinchor, a heavily forested and agricultural region, experiences seasonal fruit harvesting activities that expose populations to the risk of falling from trees. The aim of our study was to highlight the epidemiological, diagnostic, therapeutic, evolutionary, and prognostic aspects of this pathology in Ziguinchor over a period of 3 years and 8 months, with the goal of identifying preventive measures.

Materials and methods

This was a cross-sectional retrospective, descriptive, and analytical study conducted from April 1, 2019, to December 31, 2022. The study included complete records of patients admitted for TBI due to falling from trees at the neurosurgery unit of Ziguinchor Regional Hospital. Morbidity refers to all the subsequent effects of trauma, often described as functional sequelae.

Results

Among 83 patients, 72 were male, with an average age of 17.7 ± 13.1 years. There was a statistically significant correlation between season (quarter) and the type of tree involved (P = 0.012). The average fall height was 4 ± 2.9 m. Most patients (77.6%) had a Glasgow Coma Scale (GCS) Score ≥ 13. There was a significant relationship between fall height and the presence of scalp wounds (P = 0.023). The average hospital stay was 7.5 ± 6.3 days (range: 1–30 days). The mortality rate was 8.4%, and the morbidity rate was 12%.

Conclusion

Climbing trees remains a hazardous activity, as it can lead to falls, causing injuries such as traumatic brain injuries. Educational programs should focus on safe practices for fruit and leaf harvesting to prevent injuries associated with these activities.

Background

Brain Dural Arteriovenous Fistulae (DAVF) are acquired abnormal connections between dural arteries and cerebral veins or venous sinuses. Disconnection of the pathological shunt is recommended for high-grade fistulae and cases with intolerable symptoms or previous bleedings. Surgical disconnection remains the preferred method for anterior fossa DAVF.

Method

Microsurgical disconnection of anterior fossa DAVF is performed with the assistance of a robotic exoscope. Intraoperative aniography is implemented to confirm the exclusion of DAVF.

Conclusion

The exoscope provides excellent lighting and magnification in challenging surgical fields improving surgeon's ergonomics and enabling tailored, minimally invasive approaches without compromising procedural safety or effectiveness.

Background

Two surgical microvascular decompression techniques to treat primary hemifacial spasm (HFS) are described in literature. The “interposition” uses different materials as “spacers” while the “transposition” consists in suturing the offending vessel to the petrous bone dura mater. In the literature is described a transposition surgery adopting self-adhesive materials reporting promising results.

Method

We describe a combination of these two techniques using autologous muscle and Tachosil^®. The step-by-step surgical principles are described in the article and clarified in a video.

Conclusion

This procedure is effective to cure the HFS especially in case of large arteries when interposition only is insufficient.

Background

Although the use of vasopressors is recommended after aneurysmal subarachnoid hemorrhage (aSAH) to maintain adequate cerebral perfusion pressure, data on potential adverse effects on delayed cerebral ischemia (DCI) are lacking. The aim of this study was to evaluate the effects of early high-dose vasopressor therapy with norepinephrine alone or additional vasopressin on the subsequent occurrence of DCI, DCI-related infarction and functional outcomes.

Methods

Retrospective evaluation of aSAH patients admitted between January 2010 and December 2022. Demographic, clinical and outcome data as well as daily norepinephrine equivalent (NEE) scores were collected. Potential risk factors for DCI, DCI-related infarction and functional outcome 3 months after discharge were assessed by logistic regression analyses.

Results

A total of 288 patients were included. 208 patients (72%) received vasopressor therapy during the first 14 postictal days with a mean NEE score of 3.8 µg/kgBW/h. The highest NEE scores were observed in the acute phase after hemorrhage and mainly in poor-grade patients. The mean NEE score during the postictal days 1–4 was significantly higher in patients who developed DCI or DCI-related infarction and who had an unfavorable functional outcome. Multivariable logistic regression analysis identified a high NEE score on postictal days 1–4 as an independent predictor of DCI and unfavorable functional outcome.

Conclusions

Vasopressor use is common in aSAH patients in the acute phase after hemorrhage. Our results suggest that high NEE scores during the first 4 days after ictus represent an independent prognostic factor and might aggravate the complex cerebral sequelae associated with the disease.