Pub Date : 2024-08-02DOI: 10.1007/s00701-024-06216-6
Michal Benes, Michal Zido, Petr Machac, Radek Kaiser, Anhelina Khadanovich, Simona Nemcova, Vojtech Kunc, David Kachlik
Background: Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach.
Methods: A total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated.
Results: The most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively.
Conclusion: Nerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine.
{"title":"Variations of the extrapsoas course of the lumbar plexus with implications for the lateral transpsoas approach to the lumbar spine: a cadaveric study.","authors":"Michal Benes, Michal Zido, Petr Machac, Radek Kaiser, Anhelina Khadanovich, Simona Nemcova, Vojtech Kunc, David Kachlik","doi":"10.1007/s00701-024-06216-6","DOIUrl":"10.1007/s00701-024-06216-6","url":null,"abstract":"<p><strong>Background: </strong>Together with an increased interest in minimally invasive lateral transpsoas approach to the lumbar spine goes a demand for detailed anatomical descriptions of the lumbar plexus. Although definitions of safe zones and essential descriptions of topographical anatomy have been presented in several studies, the existing literature expects standard appearance of the neural structures. Therefore, the aim of this study was to investigate the variability of the extrapsoas portion of the lumbar plexus in regard to the lateral transpsoas approach.</p><p><strong>Methods: </strong>A total of 260 lumbar regions from embalmed cadavers were utilized in this study. The specimens were dissected as per protocol and all nerves from the lumbar plexus were morphologically evaluated.</p><p><strong>Results: </strong>The most common variation of the iliohypogastric and ilioinguinal nerves was fusion of these two nerves (9.6%). Nearly in the half of the cases (48.1%) the genitofemoral nerve left the psoas major muscle already divided into the femoral and genital branches. The lateral femoral cutaneous nerve was the least variable one as it resembled its normal morphology in 95.0% of cases. Regarding the variant origins of the femoral nerve, there was a low formation outside the psoas major muscle in 3.8% of cases. The obturator nerve was not variable at its emergence point but frequently branched (40.4%) before entering the obturator canal. In addition to the proper femoral and obturator nerves, accessory nerves were present in 12.3% and 9.2% of cases, respectively.</p><p><strong>Conclusion: </strong>Nerves of the lumbar plexus frequently show atypical anatomy outside the psoas major muscle. The presented study provides a compendious information source of the possibly encountered neural variations during retroperitoneal access to different segments of the lumbar spine.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11297108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1007/s00701-024-06198-5
Alice Ryba, Diego Gonzalez Lopez, Roman Rotermund, Jörg Flitsch
Introduction: Prolactinoma account to the most common pituitary adenomas and current therapy regime constitutes of dopamine agonist therapy (DA) and surgery in selected cases [17]. Due to tumor fibrosis induced by previous DA therapy, surgical removal can be challenging though. Therefore, this study investigates how preoperative DA usage influences perioperative treatment and surgical outcome in prolactinoma and aims to ascertain whether a specific subgroup of prolactinoma patients could derive greater benefit from exclusive surgical intervention.
Methods: We retrospectively analyzed n = 159 surgically treated and histologically confirmed prolactinomas in the sella region from 2013-2022 in our institution. Clinical, radiological and surgical features were analyzed. Univariate and multivariate analyses were performed.
Results: Out of total of 159 prolactinoma patients, 83.6% received previous treatment with DA followed by surgery, while only 16.4% received exclusive surgery. Both groups presented similar initial tumor volumes (1.9cm3 vs. 1.5cm3, p = 0.59) and equal preoperative prolactin levels (PRL) (199.7 µg/l vs. 191.0 µg/l, p = 0.44). Surgical procedures took significantly longer when patients received prior DA treatment (79 min. vs. 70 min., p = 0.0479). Six months after surgery, pretreated patients revealed significantly higher PRL compared to non-treated (107 g/l vs. 8.64 µg/, p = 0.0009). Additionally, untreated microprolactinoma presented a remission of 100%, whereas pretreated exhibited a remission rate of 88.75%.
Conclusion: The current study demonstrates that prior DA treatment is associated with significantly longer surgeries, higher recurrence rates and lower rates of normalization of PRL levels after surgery, particularly in microprolactinomas and support the latest recommendations of the Pituitary Society's Consensus Statement 2023, which favors the option of surgery alone as first-line therapy for microprolactinomas.
导言:催乳素瘤是最常见的垂体腺瘤,目前的治疗方法包括多巴胺受体激动剂(DA)治疗和特定病例的手术治疗[17]。由于之前的多巴胺治疗导致肿瘤纤维化,手术切除可能具有挑战性。因此,本研究探讨了术前使用多巴胺如何影响泌乳素瘤的围手术期治疗和手术结果,并旨在确定特定亚组的泌乳素瘤患者是否能从完全的手术干预中获得更大的益处:我们回顾性分析了本院2013-2022年期间经手术治疗和组织学确诊的159例蝶鞍区泌乳素瘤。分析了临床、放射学和手术特征。进行了单变量和多变量分析:在159例泌乳素瘤患者中,83.6%的患者在接受DA治疗后接受了手术,只有16.4%的患者只接受了手术。两组患者的初始肿瘤体积相似(1.9 立方厘米对 1.5 立方厘米,P = 0.59),术前泌乳素水平(PRL)相同(199.7 微克/升对 191.0 微克/升,P = 0.44)。如果患者事先接受了 DA 治疗,手术时间会明显延长(79 分钟对 70 分钟,p = 0.0479)。手术六个月后,接受过预处理的患者显示 PRL 明显高于未接受预处理的患者(107 克/升 vs. 8.64 微克/升,p = 0.0009)。此外,未经治疗的微泌乳素瘤的缓解率为100%,而经预处理的缓解率为88.75%:目前的研究表明,DA治疗前的手术时间明显更长,复发率更高,术后PRL水平的正常化率更低,尤其是在微泌乳素瘤中,支持垂体协会《2023共识声明》的最新建议,即倾向于选择单纯手术作为微泌乳素瘤的一线疗法。
{"title":"Preoperative treatment with dopamine agonist therapy influences surgical outcome in prolactinoma: a retrospective single-center on 159 patients.","authors":"Alice Ryba, Diego Gonzalez Lopez, Roman Rotermund, Jörg Flitsch","doi":"10.1007/s00701-024-06198-5","DOIUrl":"10.1007/s00701-024-06198-5","url":null,"abstract":"<p><strong>Introduction: </strong>Prolactinoma account to the most common pituitary adenomas and current therapy regime constitutes of dopamine agonist therapy (DA) and surgery in selected cases [17]. Due to tumor fibrosis induced by previous DA therapy, surgical removal can be challenging though. Therefore, this study investigates how preoperative DA usage influences perioperative treatment and surgical outcome in prolactinoma and aims to ascertain whether a specific subgroup of prolactinoma patients could derive greater benefit from exclusive surgical intervention.</p><p><strong>Methods: </strong>We retrospectively analyzed n = 159 surgically treated and histologically confirmed prolactinomas in the sella region from 2013-2022 in our institution. Clinical, radiological and surgical features were analyzed. Univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>Out of total of 159 prolactinoma patients, 83.6% received previous treatment with DA followed by surgery, while only 16.4% received exclusive surgery. Both groups presented similar initial tumor volumes (1.9cm<sup>3</sup> vs. 1.5cm<sup>3</sup>, p = 0.59) and equal preoperative prolactin levels (PRL) (199.7 µg/l vs. 191.0 µg/l, p = 0.44). Surgical procedures took significantly longer when patients received prior DA treatment (79 min. vs. 70 min., p = 0.0479). Six months after surgery, pretreated patients revealed significantly higher PRL compared to non-treated (107 g/l vs. 8.64 µg/, p = 0.0009). Additionally, untreated microprolactinoma presented a remission of 100%, whereas pretreated exhibited a remission rate of 88.75%.</p><p><strong>Conclusion: </strong>The current study demonstrates that prior DA treatment is associated with significantly longer surgeries, higher recurrence rates and lower rates of normalization of PRL levels after surgery, particularly in microprolactinomas and support the latest recommendations of the Pituitary Society's Consensus Statement 2023, which favors the option of surgery alone as first-line therapy for microprolactinomas.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1007/s00701-024-06179-8
Alistair Weld, Luke Dixon, Giulio Anichini, Neekhil Patel, Amr Nimer, Michael Dyck, Kevin O'Neill, Adrian Lim, Stamatia Giannarou, Sophie Camp
Objective - Addressing the challenges that come with identifying and delineating brain tumours in intraoperative ultrasound. Our goal is to both qualitatively and quantitatively assess the interobserver variation, amongst experienced neuro-oncological intraoperative ultrasound users (neurosurgeons and neuroradiologists), in detecting and segmenting brain tumours on ultrasound. We then propose that, due to the inherent challenges of this task, annotation by localisation of the entire tumour mass with a bounding box could serve as an ancillary solution to segmentation for clinical training, encompassing margin uncertainty and the curation of large datasets. Methods - 30 ultrasound images of brain lesions in 30 patients were annotated by 4 annotators - 1 neuroradiologist and 3 neurosurgeons. The annotation variation of the 3 neurosurgeons was first measured, and then the annotations of each neurosurgeon were individually compared to the neuroradiologist's, which served as a reference standard as their segmentations were further refined by cross-reference to the preoperative magnetic resonance imaging (MRI). The following statistical metrics were used: Intersection Over Union (IoU), Sørensen-Dice Similarity Coefficient (DSC) and Hausdorff Distance (HD). These annotations were then converted into bounding boxes for the same evaluation. Results - There was a moderate level of interobserver variance between the neurosurgeons and a larger level of variance when compared against the MRI-informed reference standard annotations by the neuroradiologist, mean across annotators . After converting the segments to bounding boxes, all metrics improve, most significantly, the interquartile range drops by . Conclusion - This study highlights the current challenges with detecting and defining tumour boundaries in neuro-oncological intraoperative brain ultrasound. We then show that bounding box annotation could serve as a useful complementary approach for both clinical and technical reasons.
目标 - 解决术中超声波识别和划分脑肿瘤所面临的挑战。我们的目标是定性和定量评估经验丰富的神经肿瘤术中超声用户(神经外科医生和神经放射科医生)在超声检测和分割脑肿瘤时观察者之间的差异。然后,我们提出,由于这项任务本身具有挑战性,通过用边界框定位整个肿瘤块来进行标注,可作为临床培训中分割的辅助解决方案,包括边缘不确定性和大型数据集的整理。方法--30 位患者的 30 幅脑部病变超声图像由 4 位标注者(1 位神经放射科医生和 3 位神经外科医生)进行标注。首先测量 3 位神经外科医生的注释差异,然后将每位神经外科医生的注释分别与神经放射科医生的注释进行比较,神经放射科医生的注释作为参考标准,他们的分割通过与术前核磁共振成像(MRI)的交叉参考进一步完善。使用了以下统计指标:交集大于联合(IoU)、索伦森-骰子相似系数(DSC)和豪斯多夫距离(HD)。然后将这些注释转换成边界框,进行同样的评估。结果 - 神经外科医生之间存在中等程度的观察者间差异[I o U : 0.789 , D S C : 0.876 , H D : 103.227],而与神经放射科医生的 MRI 信息参考标准注释相比,不同注释者之间的平均差异更大[I o U : 0.723 , D S C : 0.813 , H D : 115.675]。将节段转换为边界框后,所有指标都有所改善,最明显的是四分位数间距下降了 [ I o U : 37 % , D S C : 41 % , H D : 54 % ] 。结论--本研究强调了目前在神经肿瘤术中脑超声中检测和定义肿瘤边界所面临的挑战。然后我们表明,出于临床和技术原因,边界框注释可作为一种有用的补充方法。
{"title":"Challenges with segmenting intraoperative ultrasound for brain tumours.","authors":"Alistair Weld, Luke Dixon, Giulio Anichini, Neekhil Patel, Amr Nimer, Michael Dyck, Kevin O'Neill, Adrian Lim, Stamatia Giannarou, Sophie Camp","doi":"10.1007/s00701-024-06179-8","DOIUrl":"10.1007/s00701-024-06179-8","url":null,"abstract":"<p><p>Objective - Addressing the challenges that come with identifying and delineating brain tumours in intraoperative ultrasound. Our goal is to both qualitatively and quantitatively assess the interobserver variation, amongst experienced neuro-oncological intraoperative ultrasound users (neurosurgeons and neuroradiologists), in detecting and segmenting brain tumours on ultrasound. We then propose that, due to the inherent challenges of this task, annotation by localisation of the entire tumour mass with a bounding box could serve as an ancillary solution to segmentation for clinical training, encompassing margin uncertainty and the curation of large datasets. Methods - 30 ultrasound images of brain lesions in 30 patients were annotated by 4 annotators - 1 neuroradiologist and 3 neurosurgeons. The annotation variation of the 3 neurosurgeons was first measured, and then the annotations of each neurosurgeon were individually compared to the neuroradiologist's, which served as a reference standard as their segmentations were further refined by cross-reference to the preoperative magnetic resonance imaging (MRI). The following statistical metrics were used: Intersection Over Union (IoU), Sørensen-Dice Similarity Coefficient (DSC) and Hausdorff Distance (HD). These annotations were then converted into bounding boxes for the same evaluation. Results - There was a moderate level of interobserver variance between the neurosurgeons <math><mrow><mo>[</mo> <mi>I</mi> <mi>o</mi> <mi>U</mi> <mo>:</mo> <mn>0.789</mn> <mo>,</mo> <mspace></mspace> <mi>D</mi> <mi>S</mi> <mi>C</mi> <mo>:</mo> <mn>0.876</mn> <mo>,</mo> <mspace></mspace> <mi>H</mi> <mi>D</mi> <mo>:</mo> <mn>103.227</mn> <mo>]</mo></mrow> </math> and a larger level of variance when compared against the MRI-informed reference standard annotations by the neuroradiologist, mean across annotators <math><mrow><mo>[</mo> <mi>I</mi> <mi>o</mi> <mi>U</mi> <mo>:</mo> <mn>0.723</mn> <mo>,</mo> <mspace></mspace> <mi>D</mi> <mi>S</mi> <mi>C</mi> <mo>:</mo> <mn>0.813</mn> <mo>,</mo> <mspace></mspace> <mi>H</mi> <mi>D</mi> <mo>:</mo> <mn>115.675</mn> <mo>]</mo></mrow> </math> . After converting the segments to bounding boxes, all metrics improve, most significantly, the interquartile range drops by <math><mrow><mo>[</mo> <mi>I</mi> <mi>o</mi> <mi>U</mi> <mo>:</mo> <mn>37</mn> <mo>%</mo> <mo>,</mo> <mspace></mspace> <mi>D</mi> <mi>S</mi> <mi>C</mi> <mo>:</mo> <mn>41</mn> <mo>%</mo> <mo>,</mo> <mspace></mspace> <mi>H</mi> <mi>D</mi> <mo>:</mo> <mn>54</mn> <mo>%</mo> <mo>]</mo></mrow> </math> . Conclusion - This study highlights the current challenges with detecting and defining tumour boundaries in neuro-oncological intraoperative brain ultrasound. We then show that bounding box annotation could serve as a useful complementary approach for both clinical and technical reasons.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11294268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1007/s00701-024-06213-9
Lukas Andereggen, Angelo Tortora, Gerrit A Schubert, Christian Musahl, Janine Frey, Andrea Stieger, Béatrice Kobel, Markus M Luedi, Michel Roethlisberger, Luigi Mariani, Jürgen Beck, Emanuel Christ
Purpose: Erectile dysfunction (ED) is frequently underreported in men suffering from prolactinomas and can be challenging to manage. Both dopamine agonists (DAs) and transsphenoidal surgery (TSS) correct hyperprolactinemia and restore gonadal function. However, there is scarce data regarding their effectiveness in correcting ED over the long term.
Methods: This study is a retrospective single-center comparative cohort study analyzing men diagnosed with prolactinomas, both with and without confirmed erectile dysfunction (ED) at diagnosis. Independent risk factors for persistent ED over the long term were examined using multivariate logistic regression.
Results: Among the 39 men with lactotroph adenomas, ED was one of the presenting symptoms in 22 (56%). The mean age at diagnosis was 45 ± 12 years. Surgery was the primary treatment in 6 (27%) ED patients and 8 (47%) non-ED patients. After a mean follow-up of 74 ± 48 months, remission from hyperprolactinemia was achieved in the majority (76%) of men: 71% in the non-ED cohort and 81% in the ED group (p = 0.70), regardless of the primary treatment strategy (surgical 84% versus medical 72%, p = 0.46). Long-term remission of ED was noted in 16 (73%) patients. Interestingly, high baseline BMI levels emerged as potential risk factors for persistent ED over the long term (OR 1.4, 95%CI 1.0-1.9; p = 0.04), while neither the initial adenoma size nor the primary treatment strategy (i.e., TSS vs. DAs) reached statistical significance.
Conclusions: Correcting hyperprolactinemia and its associated hypogonadism significantly improves ED in the majority of men with prolactinomas over the long term, regardless of the primary treatment strategy employed. In addition to addressing endocrine deficiencies, the early initiation of weight control programs may be considered for men with lactotroph adenomas and ED. Although our study suggests an association between BMI and the risk of persistent ED, further research is needed to establish any causal relationships.
{"title":"Characteristics and outcomes of men with erectile dysfunction as the presenting symptom due to a lactotroph adenoma.","authors":"Lukas Andereggen, Angelo Tortora, Gerrit A Schubert, Christian Musahl, Janine Frey, Andrea Stieger, Béatrice Kobel, Markus M Luedi, Michel Roethlisberger, Luigi Mariani, Jürgen Beck, Emanuel Christ","doi":"10.1007/s00701-024-06213-9","DOIUrl":"10.1007/s00701-024-06213-9","url":null,"abstract":"<p><strong>Purpose: </strong>Erectile dysfunction (ED) is frequently underreported in men suffering from prolactinomas and can be challenging to manage. Both dopamine agonists (DAs) and transsphenoidal surgery (TSS) correct hyperprolactinemia and restore gonadal function. However, there is scarce data regarding their effectiveness in correcting ED over the long term.</p><p><strong>Methods: </strong>This study is a retrospective single-center comparative cohort study analyzing men diagnosed with prolactinomas, both with and without confirmed erectile dysfunction (ED) at diagnosis. Independent risk factors for persistent ED over the long term were examined using multivariate logistic regression.</p><p><strong>Results: </strong>Among the 39 men with lactotroph adenomas, ED was one of the presenting symptoms in 22 (56%). The mean age at diagnosis was 45 ± 12 years. Surgery was the primary treatment in 6 (27%) ED patients and 8 (47%) non-ED patients. After a mean follow-up of 74 ± 48 months, remission from hyperprolactinemia was achieved in the majority (76%) of men: 71% in the non-ED cohort and 81% in the ED group (p = 0.70), regardless of the primary treatment strategy (surgical 84% versus medical 72%, p = 0.46). Long-term remission of ED was noted in 16 (73%) patients. Interestingly, high baseline BMI levels emerged as potential risk factors for persistent ED over the long term (OR 1.4, 95%CI 1.0-1.9; p = 0.04), while neither the initial adenoma size nor the primary treatment strategy (i.e., TSS vs. DAs) reached statistical significance.</p><p><strong>Conclusions: </strong>Correcting hyperprolactinemia and its associated hypogonadism significantly improves ED in the majority of men with prolactinomas over the long term, regardless of the primary treatment strategy employed. In addition to addressing endocrine deficiencies, the early initiation of weight control programs may be considered for men with lactotroph adenomas and ED. Although our study suggests an association between BMI and the risk of persistent ED, further research is needed to establish any causal relationships.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1007/s00701-024-06201-z
Paola Maria Francesca Cristaldi, Chiara Benedetta Rui, Lorenzo Piergallini, Andrea Di Cristofori, Mirko Patassini, Paolo Remida, Carlo Giorgio Giussani, Giorgio Giovanni Carrabba
Middle meningeal artery embolization (MMAE) has emerged as a safe and efficacious alternative to surgery for the treatment of new or recurrent chronic subdural hematoma (CSDH). Several complications such as facial palsy may suddenly occur even in the absence of evident dangerous anastomoses in the angiogram. We herein present a case-report of left facial nerve palsy after MMAE.
{"title":"Facial nerve palsy after middle meningeal artery embolization for chronic subdural hematoma: a case report.","authors":"Paola Maria Francesca Cristaldi, Chiara Benedetta Rui, Lorenzo Piergallini, Andrea Di Cristofori, Mirko Patassini, Paolo Remida, Carlo Giorgio Giussani, Giorgio Giovanni Carrabba","doi":"10.1007/s00701-024-06201-z","DOIUrl":"https://doi.org/10.1007/s00701-024-06201-z","url":null,"abstract":"<p><p>Middle meningeal artery embolization (MMAE) has emerged as a safe and efficacious alternative to surgery for the treatment of new or recurrent chronic subdural hematoma (CSDH). Several complications such as facial palsy may suddenly occur even in the absence of evident dangerous anastomoses in the angiogram. We herein present a case-report of left facial nerve palsy after MMAE.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1007/s00701-024-06208-6
Maximilian Olivier, Luisa Mona Kraus, Leonard Simon Brandenburg, Lukas Andereggen, Christian Fung, Jürgen Beck, Oliver Schnell, Debora Cipriani
Background: Recently, there is increasing evidence that the proportion of odontogenic brain abscesses is greater than previously known. In this study, we aim to differentiate the oral infections as triggers more precisely and to classify them in the clinical setting.
Methods: For analysis, we conducted a retrospective single center study. We reviewed patients with brain abscesses who have undergone treatment in the University Hospital of Freiburg, Germany in the period between 2000-2021. Inclusion required two main criteria: 1. The brain abscess must not have an other focus than odontogenic. 2. The microbial spectrum identified in the brain abscess must be consistent with an odontogenic origin.
Results: Of 217 brain abscess patients, 26 met the inclusion criteria. 42% (11 patients) suffered from immunosuppressive conditions. Odontogenic foci were diagnosed in 18 cases (69%). Neurologic deficits included vigilance reduction and hemiparesis. Pathogens of the Streptococcus anginosus group were the most frequent causative agent (21 cases, 81%). Metronidazole (54%) and ceftriaxone (42%) were part of the targeted antibiotic therapy. All brain abscesses were surgically treated. Teeth were extracted in 14 of 17 cases for focus control. 18 cases (72%) showed complete or partial resolution of neurologic symptoms and 3 cases were fatal.
Conclusion: Apparently silent or chronic oral infections are sufficient to cause bacterial colonization of the brain, especially in immunocompromised patients. Therefore, special care should be taken to maintain good oral health. An interdisciplinary management should become a standard to prevent and treat the occurrence of brain abscesses.
{"title":"Undetected permanent dental inflammation as a possible trigger for brain abscesses? A retrospective analysis over the last 2 decades.","authors":"Maximilian Olivier, Luisa Mona Kraus, Leonard Simon Brandenburg, Lukas Andereggen, Christian Fung, Jürgen Beck, Oliver Schnell, Debora Cipriani","doi":"10.1007/s00701-024-06208-6","DOIUrl":"10.1007/s00701-024-06208-6","url":null,"abstract":"<p><strong>Background: </strong>Recently, there is increasing evidence that the proportion of odontogenic brain abscesses is greater than previously known. In this study, we aim to differentiate the oral infections as triggers more precisely and to classify them in the clinical setting.</p><p><strong>Methods: </strong>For analysis, we conducted a retrospective single center study. We reviewed patients with brain abscesses who have undergone treatment in the University Hospital of Freiburg, Germany in the period between 2000-2021. Inclusion required two main criteria: 1. The brain abscess must not have an other focus than odontogenic. 2. The microbial spectrum identified in the brain abscess must be consistent with an odontogenic origin.</p><p><strong>Results: </strong>Of 217 brain abscess patients, 26 met the inclusion criteria. 42% (11 patients) suffered from immunosuppressive conditions. Odontogenic foci were diagnosed in 18 cases (69%). Neurologic deficits included vigilance reduction and hemiparesis. Pathogens of the Streptococcus anginosus group were the most frequent causative agent (21 cases, 81%). Metronidazole (54%) and ceftriaxone (42%) were part of the targeted antibiotic therapy. All brain abscesses were surgically treated. Teeth were extracted in 14 of 17 cases for focus control. 18 cases (72%) showed complete or partial resolution of neurologic symptoms and 3 cases were fatal.</p><p><strong>Conclusion: </strong>Apparently silent or chronic oral infections are sufficient to cause bacterial colonization of the brain, especially in immunocompromised patients. Therefore, special care should be taken to maintain good oral health. An interdisciplinary management should become a standard to prevent and treat the occurrence of brain abscesses.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1007/s00701-024-06203-x
P Rochat, J B Springborg, P Birkeland, N Agerlin
Background: Surgical treatment for trigeminal neuralgia includes percutaneous techniques, including balloon compression, first described in 1983 by Mullan and Lichtor (J Neurosurg 59(6):1007-1012, 6).
Method: Here we present a safe and simple navigation-assisted percutaneous technique for balloon compression, which can also be used for glycerol injection.
Conclusion: The navigation-assisted percutaneous technique for balloon compression for trigeminal neuralgia is a quick and safe treatment for patients not candidates for microvascular decompression.
{"title":"Neuronavigation assisted percutaneous balloon compression of the gasserian ganglion for trigeminal neuralgia. How I do it.","authors":"P Rochat, J B Springborg, P Birkeland, N Agerlin","doi":"10.1007/s00701-024-06203-x","DOIUrl":"10.1007/s00701-024-06203-x","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment for trigeminal neuralgia includes percutaneous techniques, including balloon compression, first described in 1983 by Mullan and Lichtor (J Neurosurg 59(6):1007-1012, 6).</p><p><strong>Method: </strong>Here we present a safe and simple navigation-assisted percutaneous technique for balloon compression, which can also be used for glycerol injection.</p><p><strong>Conclusion: </strong>The navigation-assisted percutaneous technique for balloon compression for trigeminal neuralgia is a quick and safe treatment for patients not candidates for microvascular decompression.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1007/s00701-024-06202-y
Toshiaki Inomo, Kenichiro Iwami, Tadashi Watanabe, Koji Osuka
Background: For a minimally invasive treatment approach to the anteromedial part of the anterior cranial fossa (ACF), a small incision and craniotomy of the posterolateral part of the ACF are preferable.
Method: We described the concept and technique of suprapterional keyhole approach (SPKA), which uses an exoscope and endoscope to treat ACF lesions.
Conclusion: The SPKA enables ACF observation from the lateral direction; the endoscope's extended viewing angles enable the observation of the anteromedial part of the ACF, including the bilateral olfactory groove. Facial skin and large scalp incisions are avoided, making this approach efficient for ACF lesions.
{"title":"Suprapterional keyhole approach for anteromedial skull base lesions: How I do it.","authors":"Toshiaki Inomo, Kenichiro Iwami, Tadashi Watanabe, Koji Osuka","doi":"10.1007/s00701-024-06202-y","DOIUrl":"10.1007/s00701-024-06202-y","url":null,"abstract":"<p><strong>Background: </strong>For a minimally invasive treatment approach to the anteromedial part of the anterior cranial fossa (ACF), a small incision and craniotomy of the posterolateral part of the ACF are preferable.</p><p><strong>Method: </strong>We described the concept and technique of suprapterional keyhole approach (SPKA), which uses an exoscope and endoscope to treat ACF lesions.</p><p><strong>Conclusion: </strong>The SPKA enables ACF observation from the lateral direction; the endoscope's extended viewing angles enable the observation of the anteromedial part of the ACF, including the bilateral olfactory groove. Facial skin and large scalp incisions are avoided, making this approach efficient for ACF lesions.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11291570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Awake surgery is now a common approach for the resection of glioma. One of the surgical complications is mini-stroke which take the form of periresectional small areas of brain ischemic lesions. The main objective of this study is to evaluate the association between factors related to anesthetic management and the risk of mini-stroke, in awake surgery for glioma resection.
Methods: In this single-center retrospective study, all patients who were operated on, between 2011 and 2022, in awake conditions for a glioma resection, were retrospectively included. The studied anesthetic parameters included hemodynamic variables, fluid intake and urinary output. The primary endpoint was the presence of mini-stroke on a magnetic resonance imaging performed within the first 48 h postoperatively.
Results: A total of 176 surgeries were included. Mini-stroke was present in 120/171 surgeries (70%), with a median volume of 1.2 interquartile range [0.4-2.2] cubic centimeters (cc). In a multivariable analysis, only the per operative urinary output was significantly associated with the incidence of postoperative mini-strokes (adjusted odd-ratio 0.65, 95% confidence interval 0.45-0.94, p = 0.02). No variables related to the anesthetic management were associated with the volume of postoperative mini-strokes. In particular, the time spent below 90% of the baseline systolic blood pressure was not associated with either the risk or the volume of mini-strokes.
Conclusion: During awake surgery for glioma resection, among several anesthesia related factors, only the per operative urinary output was associated with the incidence of postoperative mini-stroke.
{"title":"Mini-strokes after awake surgery for glioma resection: are there anesthesia related factors?","authors":"Thaïs Walter, Grégoire Foray, Nawel Mohammed-Brahim, Charlotte Levé, Emmanuel Mandonnet, Etienne Gayat","doi":"10.1007/s00701-024-06195-8","DOIUrl":"https://doi.org/10.1007/s00701-024-06195-8","url":null,"abstract":"<p><strong>Introduction: </strong>Awake surgery is now a common approach for the resection of glioma. One of the surgical complications is mini-stroke which take the form of periresectional small areas of brain ischemic lesions. The main objective of this study is to evaluate the association between factors related to anesthetic management and the risk of mini-stroke, in awake surgery for glioma resection.</p><p><strong>Methods: </strong>In this single-center retrospective study, all patients who were operated on, between 2011 and 2022, in awake conditions for a glioma resection, were retrospectively included. The studied anesthetic parameters included hemodynamic variables, fluid intake and urinary output. The primary endpoint was the presence of mini-stroke on a magnetic resonance imaging performed within the first 48 h postoperatively.</p><p><strong>Results: </strong>A total of 176 surgeries were included. Mini-stroke was present in 120/171 surgeries (70%), with a median volume of 1.2 interquartile range [0.4-2.2] cubic centimeters (cc). In a multivariable analysis, only the per operative urinary output was significantly associated with the incidence of postoperative mini-strokes (adjusted odd-ratio 0.65, 95% confidence interval 0.45-0.94, p = 0.02). No variables related to the anesthetic management were associated with the volume of postoperative mini-strokes. In particular, the time spent below 90% of the baseline systolic blood pressure was not associated with either the risk or the volume of mini-strokes.</p><p><strong>Conclusion: </strong>During awake surgery for glioma resection, among several anesthesia related factors, only the per operative urinary output was associated with the incidence of postoperative mini-stroke.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-30DOI: 10.1007/s00701-024-06187-8
Ziyad Makoshi, Monica Islam, Jennifer McKinney, Jeffrey Leonard
Background: Cerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP.
Methods: The current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution.
Results: There was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels.
Conclusions: SDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.
{"title":"Postoperative outcomes and stimulation responses for sectioned nerve roots during selective dorsal rhizotomy in cerebral palsy.","authors":"Ziyad Makoshi, Monica Islam, Jennifer McKinney, Jeffrey Leonard","doi":"10.1007/s00701-024-06187-8","DOIUrl":"10.1007/s00701-024-06187-8","url":null,"abstract":"<p><strong>Background: </strong>Cerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP.</p><p><strong>Methods: </strong>The current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution.</p><p><strong>Results: </strong>There was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels.</p><p><strong>Conclusions: </strong>SDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11289343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}