Neurocirugia (English Edition)最新文献

Intradural disk herniation (IDH) refers to the protrusion of the nucleus pulposus into the dural sac. While disk herniation is a relatively frequent condition, the intradural variant is exceptionally rare. Patients diagnosed with IDH often exhibit more pronounced clinical symptoms compared to those with extradural herniations. Establishing a definitive preoperative diagnosis remains challenging, as the pathophysiology and radiological features are not yet fully understood. Differentiating IDH from other intradural extramedullary pathologies, including schwannomas, neurofibromas, meningiomas, or metastatic lesions, can be complex. A systematic review was conducted on the diagnosis and treatment of cervical, thoracic and lumbar IDH, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and retrieving potentially relevant literature from PubMed and Embase. The search strategy included combinations of the terms "transdural" OR "intradural" AND "disc" AND "herniation". Age, sex, symptoms, herniated disk level, history of trauma, location of disk mass, imaging examination, pre- or intraoperative diagnosis and clinical outcomes were studied through the medical records. The type of surgery, the ventral dural defect management and the postoperative leakage of cerebrospinal fluid were also evaluated. One hundred and sixty-one articles involving 285 patients were selected. Cases of IDHs occurred at the lumbar (64.3%), thoracic (21.9%) and cervical (13.8%) levels. The most common level IDH was located at L4-L5 (27.6%). 49 patients exhibited cauda equina syndrome. Only 44 patients (15.4%) were diagnosed as having IDH preoperatively, while most patients were diagnosed intraoperatively. Neurological functions improved variably according to cervical, thoracic and lumbar locations (respectively 2.5%, 5.6% and 21.7%). IDH mostly involves the lumbar spine. Patients with IDH generally experience more severe symptoms than those with extradural disk herniation and have incomplete recovery of postoperative neurological functions. Diagnosing IDH remains challenging given its clinical presentations and radiographic features, and it is likely an underdiagnosed and underestimated condition.

We report the case of a 56-year-old female patient with controlled Human Immunodeficiency Virus (HIV) who presented with binocular diplopia and a known sixth cranial nerve palsy. Imaging revealed a lesion centered in the right cavernous sinus (CS) causing mass effect and displacement of adjacent structures. Progressive cranial nerve involvement led to surgical intervention. Intraoperative biopsy yielded inconclusive results, with initial suspicion pointing toward meningioma. Definitive diagnosis was only possible after paraffin-embedded histopathology confirmed a CS hemangioma. Postoperative management included pain control and corticosteroid tapering. The patient remains stable under multidisciplinary follow-up. This case underscores the diagnostic challenges of CS lesions and the limitations of intraoperative biopsy in differentiating vascular tumors from meningiomas and other CS neoplasms such as schwannomas should be taken into account.

Introduction: Traumatic brain injury (TBI) can lead to post-traumatic stress disorder (PTSD), with risk factors potentially linked to injury characteristics visible on imaging. This study examines associations between PTSD at 6 months and two imaging features: bleed location (epidural, subdural, subarachnoid, and contusions) and MRI pathology.

Methods: Using data from the TRACK-TBI Pilot Dataset, we analyzed imaging characteristics and PTSD status in 586 patients. Bleed types and MRI results were assessed in relation to PTSD rates at 6 months. We applied logistic regression for bleed locations and chi-square testing for MRI findings to determine statistical significance.

Results: Bleed location did not significantly predict PTSD at 6 months. Logistic regression analysis showed no significant association between specific bleed types (epidural, subdural, subarachnoid, or contusions) and PTSD risk (p>0.05 for all bleed types). However, MRI findings showed a statistically significant association with PTSD status (p=0.048). Patients with positive MRI findings indicating pathology had a lower PTSD prevalence (20.9%) compared to those with negative MRI findings (36.7%) or uncertain findings, where no PTSD cases were observed.

Conclusion: While bleed location is not significantly associated with PTSD risk, MRI results suggest a possible link between brain pathology and PTSD outcomes, with positive MRI findings associated with a lower prevalence of PTSD. These findings highlight the complex relationship between TBI imaging characteristics and PTSD risk, suggesting that MRI pathology may serve as a marker for differential PTSD outcomes. Future studies should explore underlying mechanisms and integrate clinical, genetic, and imaging data to refine PTSD risk assessment in TBI patients.

Background: Vertebral corpectomy is a common surgical technique for spinal decompression and fusion. This retrospective pilot study compares the neurological outcomes of corpectomy using autologous bone grafts versus expandable titanium cages.

Methods: In this retrospective pilot study of 40 patients, we compared autologous bone grafts versus expandable cages for single- or multi-level corpectomy. We assessed pre- and postoperative mJOA (Modified Japanese Orthopedic Association) scores. To account for baseline imbalances, we performed analysis of covariance (ANCOVA) adjusting for age and preoperative mJOA, and inverse probability of treatment weighting (IPTW) based on propensity scores. Outcomes included postoperative mJOA, ΔmJOA, responder rate (≥2-point improvement), and Hirabayashi recovery rate.

Results: Both groups showed significant neurological improvement. Adjusted for preoperative mJOA, the ANCOVA model found that the titanium group presented significantly higher postoperative mJOA scores after adjustment (ANCOVA coefficient=+2.50, p=0.0007). IPTW-weighted regression showed a trend toward greater neurological improvement with titanium (coefficient=+1.75, p=0.092), with satisfactory covariate balance. Clinically meaningful recovery was observed in 100% of titanium cases versus 75% of autologous cases (p=0.064). The Hirabayashi recovery rate was also superior with titanium (mean 65.0%) compared to autologous grafts (mean 45.1%).

Conclusion: Both techniques provided similar and effective neurological outcomes after corpectomy. Our findings suggest that neurological recovery is more strongly influenced by the preoperative severity of the myelopathy than by the surgical system used. Both are viable options for corpectomy and warrant larger-scale studies.

Purpose: In the surgical management of spinal tumours, haemilaminectomy is frequently the preferred approach due to its minimal invasive nature and the ability to preserve stability. However, the repair of the dura mater defect is technically very difficult and a challenging problem for neurosurgeons because of the high incidence of complications related to postoperative cerebrospinal fluid (CSF) leakage. This study presents a novel haemoclip-assisted technique that has been developed for the purpose of providing safe and rapid dura repair in spinal tumour surgery involving haemilaminectomy.

Material and methods: In 12 patients who underwent haemilaminectomy for spinal intradural extramedullary tumours between 2023 and 2024, dura mater defects were repaired with haemoclips. The technique is to present the results of cases in which the dura edges were closed with non-penetrating haemoclips. The results were evaluated in terms of dura repair time, postoperative complications and presence of CSF leakage.

Results: The mean dural repair time was found to be significantly shorter when compared to conventional suture methods. Postoperative cerebrospinal fluid leakage and related complications were not observed in any patient. The technique significantly facilitated surgical practice, especially in the haemilaminectomy window, which provides a limited field of view. Furthermore, the absence of artefacts in magnetic resonance imaging (MRI) appears to be a significant additional criterion in patient follow-up.

Conclusion: Haemoclip-assisted dura repair is a safe, fast and practical alternative for spinal tumour surgery with haemilaminectomy. The technique has the potential to reduce complication rates by facilitating dura repair.

Background: Tarlov cysts (TCs) are commonly found sacral perineural cysts. Symptomatic TCs are rare, and there is no consensus on optimal treatment. The pathophysiological mechanism of TCs remains unclear. The aim of this study is to investigate the effects of surgical intervention on symptomatic TCs and the development mechanism of TCs.

Methods: We retrospectively analyzed the clinical data of 26 patients with symptomatic TCs who underwent surgical treatment in our department between November 2016 and June 2019. Intraoperative manometry was performed in 10 of these patients. Pain relief and clinical outcomes were evaluated statistically.

Results: Postoperative symptoms improved in 25 patients (96.2%), while one patient (3.8%) showed no improvement. No wound infections or new complications were observed. Patients were followed for 5-49 months (mean: 28.04±12.57 months). There were statistically significant decreases (p<0.05) in the M-JOA low-back pain scores from preoperative (26.32±1.75) to postoperative (14.92±5.95) values, as well as a significant improvement (p<0.05) in the NRS pain scores from preoperative (2.02±1.46) to postoperative (6.23±1.20). Preoperative intracapsular pressure ranged from 3.1 to 12.4mmHg across different positions. Postoperative sacral canal pressure ranged from 0.1 to 0.8mmHg in various positions.

Conclusion: Cyst excision and perineurium reconstruction under a microscope is an effective and safe method for treating sacral radicular cysts.

Myxoid glioneuronal tumor represents a newly recognized entity in the 2021 World Health Organization classification of central nervous system tumors. As one of the 14 defined neuronal and glioneuronal tumors, it is molecularly characterized by PDGFRA p.K385 mutation. In this paper, we illustrate computed tomography, conventional and functional magnetic resonance imaging, and positron emission tomography-computed tomography imaging features of two myxoid glioneuronal tumor cases, introducing novel imaging characteristics.

Purpose: Aneurysmal subarachnoid hemorrhage is an urgent manner in which blood accumulates in the subarachnoid region. Presence of chronic kidney disease (CKD) is often a predictor of adverse outcomes perioperatively. Patients with CKD may have different perioperative outcomes during surgery for aneurysmal subarachnoid hemorrhage compared to patients without CKD, and we sought to retrospectively examine the effect of CKD on perioperative outcomes in aSAH patients receiving surgery.

Methods: Patients undergoing craniotomy for aneurysmal subarachnoid hemorrhage were analyzed using the ACS-NSQIP database from 2005 to 2021. Patients with CKD were defined based on estimated glomerular filtration rate (eGFR) <60mL/min. 30-Day postoperative outcomes were compared between the two groups and included death, cardiac complications, renal complications, sepsis, pulmonary complications, return to the operating room (OR), and operation time greater than 4h, among other variables.

Results: There were 122 CKD patients and 1456 non-CKD aSAH patients who underwent craniotomy identified. Compared to non-CKD patients, CKD patients had increased risk of mortality (30.33% vs. 12.84%, aOR 1.862, p=0.0097), renal complications (4.92% vs. 0.82%, aOR 3.911, p=0.0208), and bleeding perioperatively (31.97% vs. 14.56%, aOR 2.369, p<0.0001).

Conclusion: This study demonstrated that CKD patients with aneurysmal subarachnoid hemorrhage receiving craniotomy have increased risk of death, renal complications, and bleeding perioperatively.

Introduction: The semisitting position offers surgical advantages for posterior fossa and pineal region procedures but remains controversial due to potential complications such as venous air embolism (VAE) and tension pneumocephalus. This study reviews a 20-year single-center experience to assess its safety, complication profile, and clinical outcomes under a standardized monitoring protocol.

Materials and methods: This retrospective cohort study included all consecutive patients undergoing neurosurgical procedures in the semisitting position at our tertiary center from January 2004 to December 2024. Patients were monitored using a standardized protocol including precordial Doppler ultrasonography, end-tidal CO₂ monitoring, and central venous catheter placement. Patient demographics, surgical details, perioperative complications, and clinical outcomes were systematically analyzed. Venous air embolism (VAE) and other significant adverse events were specifically documented. Statistical analyses included univariate and multivariate logistic regression analyses to identify potential risk factors for complications.

Results: A total of 244 patients underwent surgery in the semisitting position, with a mean age of 43.8±18.4 years. The most common surgical localizations were the parietal and occipital regions, followed by the posterior fossa. The incidence of VAE was 4.5% (n=11), including one fatal cerebral infarction. Other complications occurred in 3.6% of cases, including tension pneumocephalus (1.6%), neurological deficit, cerebrospinal fluid leakage, postoperative seizure, myocardial infarction, and ischemic infarction (each 0.4%). Multivariate analysis did not identify significant predictors of complications.

Conclusions: The semisitting position remains a safe and effective neurosurgical approach when executed with rigorous protocols and vigilant monitoring. With careful management, these risks can be effectively mitigated, underscoring their continued utility in suitable cases, particularly for surgeries involving the posterior fossa and pineal region.

Atlantoaxial dislocation often results in upper cervical spinal cord compression, which may lead to significant neurological impairment. Among these, os odontoideum (OO) is a rare anomaly where the odontoid is replaced by a separate ossicle. Case one describes a 36-year-old male with dystopic OO presented a 4-month history of progressive incomplete quadriparesis. Radiological evaluation confirmed the presence of atlantoaxial dislocation associated with basilar invagination and OO, demonstrating an ossified structure with functional fusion between the free odontoid segment and the basion. Case two involves a 56-year-old female with orthotopic OO manifesting as cervical pain and arm weakness. Imaging studies revealed OO with anterior atlantoaxial dislocation. Dynamic radiographs demonstrated synchronous movement of the free odontoid ossicle with the anterior arch of C1 during flexion-extension. This study compares the clinical manifestations, radiographic features, treatment approaches, and outcomes between orthotopic and dystopic OO variants in patients, providing clinically relevant insights for management decisions.