Pub Date : 2025-11-20DOI: 10.1016/j.neucie.2025.500726
Tong Yi, Chongxi Xu, Jinmei Li, Junpeng Ma
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.
{"title":"Rare atlantoaxial dislocation secondary to os odontoideum: A comparative study of orthotopic and dystopic variants with two representative cases.","authors":"Tong Yi, Chongxi Xu, Jinmei Li, Junpeng Ma","doi":"10.1016/j.neucie.2025.500726","DOIUrl":"10.1016/j.neucie.2025.500726","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500726"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582299","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 : 2025-11-20DOI: 10.1016/j.neucie.2025.500729
Joel Caballero-García, Justo Gonzáles Gonzáles, Guillermo Sánchez Paneque, Luis Horta Clavero
Background and objectives: The use of a digital three-dimensional (3D) exoscope system in neurosurgery is increasing as an alternative to the operative microscope due to its similar visual fidelity but superior ergonomics. However, publications on cerebral aneurysms treated with this are scarce.
Methods: Clinical information, surgical records and, imaging of patients with cerebral aneurysms undergoing surgery by a single surgeon, from December 2023 to March 2025, using the VITOM 3D as a vision/magnification method exclusively, is analyzed. Postoperative follow-up included angio-CT scan. Descriptive statistics and data relating to operative time and complications were analyzed. An extensive discussion regarding other authors' experience using 4K 3D exoscopes in microsurgical clipping of cerebral aneurysms was performed and compared with the present series.
Results: Eighty-eight patients with 107 cerebral aneurysms underwent surgery. Most patients were female (65.9%), with a mean age of 52.6 (±13.6) years. Grades I-III WFNS score was seen in 74 (84.1%) patients, with 14 (15.9%) having grade IV. Ruptured aneurysm rate was 94.3%, but up to 14.9% associated unruptured aneurysms were recorded. Complications rate was 9.1%. A favorable outcome was observed in 83.0% of patients based on modified Rankin Scale score at 30 days.
Conclusion: VITOM 3D exoscope is a valid alternative to the surgical microscope, since it offers comparable visualization but superior ergonomics, at a lower cost. Randomized comparative studies with a larger series of cases should be carried out to increase the level of evidence.
{"title":"Preliminary experience with VITOM 3D exoscope during microsurgical treatment of cerebral aneurysms.","authors":"Joel Caballero-García, Justo Gonzáles Gonzáles, Guillermo Sánchez Paneque, Luis Horta Clavero","doi":"10.1016/j.neucie.2025.500729","DOIUrl":"10.1016/j.neucie.2025.500729","url":null,"abstract":"<p><strong>Background and objectives: </strong>The use of a digital three-dimensional (3D) exoscope system in neurosurgery is increasing as an alternative to the operative microscope due to its similar visual fidelity but superior ergonomics. However, publications on cerebral aneurysms treated with this are scarce.</p><p><strong>Methods: </strong>Clinical information, surgical records and, imaging of patients with cerebral aneurysms undergoing surgery by a single surgeon, from December 2023 to March 2025, using the VITOM 3D as a vision/magnification method exclusively, is analyzed. Postoperative follow-up included angio-CT scan. Descriptive statistics and data relating to operative time and complications were analyzed. An extensive discussion regarding other authors' experience using 4K 3D exoscopes in microsurgical clipping of cerebral aneurysms was performed and compared with the present series.</p><p><strong>Results: </strong>Eighty-eight patients with 107 cerebral aneurysms underwent surgery. Most patients were female (65.9%), with a mean age of 52.6 (±13.6) years. Grades I-III WFNS score was seen in 74 (84.1%) patients, with 14 (15.9%) having grade IV. Ruptured aneurysm rate was 94.3%, but up to 14.9% associated unruptured aneurysms were recorded. Complications rate was 9.1%. A favorable outcome was observed in 83.0% of patients based on modified Rankin Scale score at 30 days.</p><p><strong>Conclusion: </strong>VITOM 3D exoscope is a valid alternative to the surgical microscope, since it offers comparable visualization but superior ergonomics, at a lower cost. Randomized comparative studies with a larger series of cases should be carried out to increase the level of evidence.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500729"},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582228","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 : 2025-11-01DOI: 10.1016/j.neucie.2025.500699
Oguz Altunyuva, Ali Imran Ozmarasali, Nur Balcin, Hanside Setenay Unal, Selcuk Yilmazlar
Introduction
Endoscopic transsphenoidal surgery (ETSS) is the preferred approach for most pituitary adenomas. However, transcranial microsurgery remains relevant for giant adenomas with complex features. This study presents long-term outcomes and complications in a single-surgeon series of patients with giant pituitary adenomas who underwent transcranial resection.
Material and methods
This retrospective study analyzed 29 patients with giant pituitary adenomas (≥4 cm) who underwent transcranial surgery between 2009 and 2018 at Bursa Uludağ University Faculty of Medicine. Inclusion criteria were: a minimum tumor diameter of 4 cm, histologically confirmed pituitary adenoma, tumor resection via a transcranial approach, regular postoperative follow-up, and a minimum follow-up of 60 months. Data collected included patient demographics, clinical presentation, tumor characteristics, surgical details, extent of resection, and long-term outcomes (minimum 60 months follow-up).
Results
The mean patient age was 48.17 ± 12.92 years. Vision loss was the most common presenting symptom (n = 20). Gross total resection (GTR) was achieved in 51.7% (n = 15) and subtotal resection (STR) in 48.3% (n = 14). Postoperative improvement in visual function was observed in 48.3% (n = 14), while 20.7% (n = 6) experienced deterioration. Endocrinological remission occurred in 20.7% (n = 6). Complications included diabetes insipidus (24.13%, n = 7), cerebrovascular events (10.34%, n = 3), and mortality (17.24%, n = 5).
Conclusions
Transcranial surgery for giant pituitary adenomas can achieve favorable outcomes in terms of tumor control and visual function improvement. However, it is associated with a risk of complications, including endocrinological and cerebrovascular events. Careful patient selection, meticulous surgical technique, and close postoperative monitoring are essential for optimizing outcomes. Transcranial microsurgery remains an important tool in the armamentarium of neurosurgeons managing complex giant pituitary adenomas.
{"title":"Transcranial Microsurgery as a Salvage Strategy in Giant Pituitary Adenomas: A Single-Center Experience and Long-Term Follow-up Results","authors":"Oguz Altunyuva, Ali Imran Ozmarasali, Nur Balcin, Hanside Setenay Unal, Selcuk Yilmazlar","doi":"10.1016/j.neucie.2025.500699","DOIUrl":"10.1016/j.neucie.2025.500699","url":null,"abstract":"<div><h3>Introduction</h3><div>Endoscopic transsphenoidal surgery<span> (ETSS) is the preferred approach for most pituitary adenomas<span>. However, transcranial microsurgery<span> remains relevant for giant adenomas<span> with complex features. This study presents long-term outcomes and complications in a single-surgeon series of patients with giant pituitary adenomas who underwent transcranial resection.</span></span></span></span></div></div><div><h3>Material and methods</h3><div>This retrospective study analyzed 29 patients with giant pituitary adenomas (≥4 cm) who underwent transcranial surgery between 2009 and 2018 at Bursa Uludağ University Faculty of Medicine. Inclusion criteria were: a minimum tumor diameter of 4 cm, histologically confirmed pituitary adenoma, tumor resection via a transcranial approach, regular postoperative follow-up, and a minimum follow-up of 60 months. Data collected included patient demographics, clinical presentation, tumor characteristics, surgical details, extent of resection, and long-term outcomes (minimum 60 months follow-up).</div></div><div><h3>Results</h3><div>The mean patient age was 48.17 ± 12.92 years. Vision loss<span> was the most common presenting symptom (n = 20). Gross total resection (GTR) was achieved in 51.7% (n = 15) and subtotal resection (STR) in 48.3% (n = 14). Postoperative improvement in visual function was observed in 48.3% (n = 14), while 20.7% (n = 6) experienced deterioration. Endocrinological remission occurred in 20.7% (n = 6). Complications included diabetes insipidus (24.13%, n = 7), cerebrovascular events (10.34%, n = 3), and mortality (17.24%, n = 5).</span></div></div><div><h3>Conclusions</h3><div>Transcranial surgery for giant pituitary adenomas can achieve favorable outcomes in terms of tumor control and visual function improvement. However, it is associated with a risk of complications, including endocrinological and cerebrovascular events. Careful patient selection, meticulous surgical technique, and close postoperative monitoring are essential for optimizing outcomes. Transcranial microsurgery remains an important tool in the armamentarium of neurosurgeons managing complex giant pituitary adenomas.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500699"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227792","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 : 2025-11-01DOI: 10.1016/j.neucie.2025.500660
Artem Kuptsov , Alessandra Rocca , Cristina Gómez-Revuelta , Ana Flores-Justa , J. Fernández-Villa , J.A. Nieto-Navarro
Hinged craniotomy (HC) is an alternative surgical technique that can be used in place of decompressive craniectomy (DC) to treat refractory intracranial hypertension. This procedure has the advantage of avoiding the need for a second surgery to replace the bone, while giving a good control of intracranial pressure. However, there is no consistent literature about complications of HC. In particular, there are no reported cases of contralateral subdural effusion (CSE) after HC. In this article we present a case of a 55-years-old man who developed CSE after a hinged craniotomy (HC) for intracranial hypertension, and how we handled it. Therefore, we explored literature to better understand the pathogenesis of CSE, treatments and possible prevention strategies.
{"title":"Contralateral subdural effusion following decompressive hinged craniotomy: A case report and narrative review","authors":"Artem Kuptsov , Alessandra Rocca , Cristina Gómez-Revuelta , Ana Flores-Justa , J. Fernández-Villa , J.A. Nieto-Navarro","doi":"10.1016/j.neucie.2025.500660","DOIUrl":"10.1016/j.neucie.2025.500660","url":null,"abstract":"<div><div><span>Hinged craniotomy (HC) is an alternative surgical technique that can be used in place of </span>decompressive craniectomy<span><span><span> (DC) to treat refractory intracranial hypertension. This procedure has the advantage of avoiding the need for a second surgery to replace the bone, while giving a good control of </span>intracranial pressure<span>. However, there is no consistent literature about complications of HC. In particular, there are no reported cases of contralateral </span></span>subdural effusion<span> (CSE) after HC. In this article we present a case of a 55-years-old man who developed CSE after a hinged craniotomy (HC) for intracranial hypertension, and how we handled it. Therefore, we explored literature to better understand the pathogenesis of CSE, treatments and possible prevention strategies.</span></span></div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500660"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639931","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 : 2025-11-01DOI: 10.1016/j.neucie.2025.500677
Sebastián Menéndez-Girón, Antonio González-Crespo, Alberto Blanco Ibáñez de Opacua, Roser García-Armengol, Carlos J. Dominguez, Ana Rodríguez-Hernández
Background
Cerebral digital subtraction angiography (DSA) remains the gold standard for the control of aneurysmal remnants after surgical clipping. Despite being associated with minimal risks, it is an invasive procedure far from being iatrogenia free. Furthermore, it has limited availability which may prolong patient’s postoperative stay. On the other hand, the image quality of computed tomography angiography (CTA) has improved significantly over the past decades providing a valuable alternative to DSA. The objective of this study was to compare the capacity of CTA and DSA to detect clinically significant aneurysmal remnants.
Methods
From a prospective series of surgically treated aneurysms, those with postoperative CTA and DSA were retrospectively included in the study. A three-dimensional reconstruction of the CTA was performed using the Brainlab Elements software and the results were compared with those of the DSA. In addition, variables that could affect the three-dimensional reconstruction were collected, such as the number of clips per aneurysm and previous clipping or embolization. In case of an aneurysm remnant, its size was also recorded.
Results
Between January 2020 and January 2022, a total of 42 patients in whom 52 aneurysms were clipped (8 of them ruptured) were included. CTA presented a sensitivity of 50% and a specificity of 97% in the detection of aneurysmal remnants. The cases in which CTA did not detect the aneurysmal remnant were previously embolized aneurysms or complex aneurysms that required neck reconstruction with 3 or more clips. None of the remnants undetected by CTA were significant enough to warrant retreatment of the aneurysm.
Conclusions
Excluding complex aneurysms (previously embolized or requiring surgical reconstruction with 3 or more clips), three-dimensional reconstructions of CTA images showed excellent results in detecting clinically significant postoperative aneurysm remnants and may obviate the need for a the more invasive and less available DSA.
{"title":"Image control after aneurysm clipping: Is 3D computed tomogram angiography enough?","authors":"Sebastián Menéndez-Girón, Antonio González-Crespo, Alberto Blanco Ibáñez de Opacua, Roser García-Armengol, Carlos J. Dominguez, Ana Rodríguez-Hernández","doi":"10.1016/j.neucie.2025.500677","DOIUrl":"10.1016/j.neucie.2025.500677","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral digital subtraction angiography<span> (DSA) remains the gold standard for the control of aneurysmal remnants after surgical clipping. Despite being associated with minimal risks, it is an invasive procedure far from being iatrogenia free. Furthermore, it has limited availability which may prolong patient’s postoperative stay. On the other hand, the image quality of computed tomography angiography (CTA) has improved significantly over the past decades providing a valuable alternative to DSA. The objective of this study was to compare the capacity of CTA and DSA to detect clinically significant aneurysmal remnants.</span></div></div><div><h3>Methods</h3><div>From a prospective series of surgically treated aneurysms, those with postoperative CTA and DSA were retrospectively included in the study. A three-dimensional reconstruction of the CTA was performed using the Brainlab Elements software and the results were compared with those of the DSA. In addition, variables that could affect the three-dimensional reconstruction were collected, such as the number of clips per aneurysm and previous clipping or embolization. In case of an aneurysm remnant, its size was also recorded.</div></div><div><h3>Results</h3><div>Between January 2020 and January 2022, a total of 42 patients in whom 52 aneurysms were clipped (8 of them ruptured) were included. CTA presented a sensitivity of 50% and a specificity of 97% in the detection of aneurysmal remnants. The cases in which CTA did not detect the aneurysmal remnant were previously embolized aneurysms or complex aneurysms that required neck reconstruction with 3 or more clips. None of the remnants undetected by CTA were significant enough to warrant retreatment of the aneurysm.</div></div><div><h3>Conclusions</h3><div>Excluding complex aneurysms (previously embolized or requiring surgical reconstruction with 3 or more clips), three-dimensional reconstructions of CTA images showed excellent results in detecting clinically significant postoperative aneurysm remnants and may obviate the need for a the more invasive and less available DSA.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500677"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082609","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 : 2025-11-01DOI: 10.1016/j.neucie.2025.500673
Giancarlo Mattos Piaggio, Esteban Quevedo Orrego, Emilio González Martínez, Javier Ibañez Plágaro, José García-Cosamalón
The study of degenerative pathology of the intervertebral disc (IVD) with magnetic resonance imaging (MRI) has generated such an extensive and ambiguous terminology that it causes confusion. The loss of the nucleus pulposus signal intensity (ISNP) in the T2 sequence of MRI, secondary to the early decrease in water content, is generally described as “black disc”, a term spread as a synonym for degenerative disc disease. On the other hand, to designate a supposedly symptomatic dehydrated disc, the following names have been introduced: “painful black disc”, “black disc syndrome” and “black disc disease”. In this way, the physiological dehydration of the NP present in the entire population from the third decade on, is arbitrarily considered a presumed radiological marker of discogenic back pain, with the consequent risk of being the target of unnecessary interventions. Dehydrated discs suspected of being a source of pain present, in addition to the decrease in ISNP, other radiological signs such as a high intensity zone (HIZ) in the posterior part of the annulus fibrosus (AF), protrusion, loss of height or Modic changes.
{"title":"Is there such a thing as black disc disease?","authors":"Giancarlo Mattos Piaggio, Esteban Quevedo Orrego, Emilio González Martínez, Javier Ibañez Plágaro, José García-Cosamalón","doi":"10.1016/j.neucie.2025.500673","DOIUrl":"10.1016/j.neucie.2025.500673","url":null,"abstract":"<div><div>The study of degenerative pathology of the intervertebral disc (IVD) with magnetic resonance imaging (MRI) has generated such an extensive and ambiguous terminology that it causes confusion. The loss of the nucleus pulposus signal intensity (ISNP) in the T2 sequence of MRI, secondary to the early decrease in water content, is generally described as “black disc”, a term spread as a synonym for degenerative disc disease. On the other hand, to designate a supposedly symptomatic dehydrated disc, the following names have been introduced: “painful black disc”, “black disc syndrome” and “black disc disease”. In this way, the physiological dehydration of the NP present in the entire population from the third decade on, is arbitrarily considered a presumed radiological marker of discogenic back pain, with the consequent risk of being the target of unnecessary interventions. Dehydrated discs suspected of being a source of pain present, in addition to the decrease in ISNP, other radiological signs such as a high intensity zone (HIZ) in the posterior part of the annulus fibrosus (AF), protrusion, loss of height or Modic changes.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500673"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562217","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 : 2025-11-01DOI: 10.1016/j.neucie.2025.500675
Pedro Miguel González-Vargas , Jorge Caramés , Antonio Riveiro , José Luis Thenier-Villa , Cesáreo Conde , Juan Pou
Background
Fractures of the odontoid, prevalent among the elderly but affecting diverse demographics, pose significant risks ranging from mild discomfort to severe disability or fatality. These fractures, often stemming from trauma, are particularly frequent in the cervical spine. While commonly attributed to high-impact events like traffic accidents in adults, even low-energy incidents such as falls can precipitate these fractures in the elderly.
Previous studies have explored loading conditions and treatment effects; however, a comprehensive investigation into the influence of the magnitude and direction of the force involved in the trauma, and the influence of the sex and age of the patient remains scarce so we want to delve deeper into this topic.
Methods
This study uses a finite element (FE) model to analyze the response of 3D models of the second cervical vertebra (extracted from computed tomography images) exposed to different loads of magnitude and force. 52 patients were analyzed in this study.
The patients were divided into 4 groups: male <70, female <70, male >70, female >70) under different force conditions.
Von Mises stress values were obtained when loads of 200 N and 1500 N were applied to the anterior surface of the odontoid with different angles of incidence in the sagittal and axial plane.
Results
Odontoid fractures in subjects over 70 years of age are more frequent in female, the maximum stresses produced in the odontoid are 181 MPa and are considerably higher compared to male, which is 131 MPa. In young subjects (<70 years), the differences between sex are less marked, 113 MPa for female and 114 MPa for male.
Conclusions
Load direction is one of the main factors affecting odontoid fracture, especially in subjects >70 years of age; by understanding this, the mechanisms that cause different types of fractures can be understood and better strategies can be proposed to apply different treatment approaches to them, both from a medical and surgical point of view.
{"title":"Influence of the magnitude and orientation of forces on the odontoid fracture: A finite element model analyses","authors":"Pedro Miguel González-Vargas , Jorge Caramés , Antonio Riveiro , José Luis Thenier-Villa , Cesáreo Conde , Juan Pou","doi":"10.1016/j.neucie.2025.500675","DOIUrl":"10.1016/j.neucie.2025.500675","url":null,"abstract":"<div><h3>Background</h3><div>Fractures of the odontoid, prevalent among the elderly but affecting diverse demographics, pose significant risks ranging from mild discomfort to severe disability or fatality. These fractures, often stemming from trauma<span><span>, are particularly frequent in the cervical spine. While commonly attributed to high-impact events like </span>traffic accidents in adults, even low-energy incidents such as falls can precipitate these fractures in the elderly.</span></div><div>Previous studies have explored loading conditions and treatment effects; however, a comprehensive investigation into the influence of the magnitude and direction of the force involved in the trauma, and the influence of the sex and age of the patient remains scarce so we want to delve deeper into this topic.</div></div><div><h3>Methods</h3><div><span>This study uses a finite element (FE) model to analyze the response of 3D models of the second cervical vertebra (extracted from </span>computed tomography images) exposed to different loads of magnitude and force. 52 patients were analyzed in this study.</div><div>The patients were divided into 4 groups: male <70, female <70, male >70, female >70) under different force conditions.</div><div><span>Von Mises stress values were obtained when loads of 200 N and 1500 N were applied to the anterior surface of the odontoid with different angles of incidence in the sagittal and </span>axial plane.</div></div><div><h3>Results</h3><div>Odontoid fractures in subjects over 70 years of age are more frequent in female, the maximum stresses produced in the odontoid are 181 MPa and are considerably higher compared to male, which is 131 MPa. In young subjects (<70 years), the differences between sex are less marked, 113 MPa for female and 114 MPa for male.</div></div><div><h3>Conclusions</h3><div>Load direction is one of the main factors affecting odontoid fracture, especially in subjects >70 years of age; by understanding this, the mechanisms that cause different types of fractures can be understood and better strategies can be proposed to apply different treatment approaches to them, both from a medical and surgical point of view.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500675"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082611","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 : 2025-11-01DOI: 10.1016/j.neucie.2025.500676
Claudio Sebastián Iglesias Vargas , Tomas Quinzacara Aravena , Ingrid Trujillo Ramos , Sebastián Vigueras Alvares
This case presents an unusual case of Langerhans cell histiocytosis with invasion into the brain parenchyma, a rare phenomenon documented in few cases worldwide. The relevance of this case lies in the contribution to the knowledge of this pathology in the paediatric neuro-oncologic context.
An 11-year-old boy presented with increased volume in the left frontal region, without neurological deficit or systemic symptoms. CT and MRI revealed an aggressive osteolytic lesion with perilesional oedema and intracranial extension.
Complete excision of the lesion was performed, confirming Langerhans cell histiocytosis by immunohistochemistry. Chemotherapy was started with good tolerance and no complications so far.
This case highlights the need for timely diagnosis and treatment in cases of Langerhans cell histiocytosis with brain involvement, given its potential impact on prognosis and the scarcity of specific guidelines for this type of manifestations.
{"title":"Langerhans cells histiocytosis with invasion into the brain parenchyma: A rare presentation","authors":"Claudio Sebastián Iglesias Vargas , Tomas Quinzacara Aravena , Ingrid Trujillo Ramos , Sebastián Vigueras Alvares","doi":"10.1016/j.neucie.2025.500676","DOIUrl":"10.1016/j.neucie.2025.500676","url":null,"abstract":"<div><div>This case presents an unusual case of Langerhans cell histiocytosis with invasion into the brain parenchyma, a rare phenomenon documented in few cases worldwide. The relevance of this case lies in the contribution to the knowledge of this pathology in the paediatric neuro-oncologic context.</div><div>An 11-year-old boy presented with increased volume in the left frontal region, without neurological deficit or systemic symptoms. CT and MRI revealed an aggressive osteolytic lesion with perilesional oedema and intracranial extension.</div><div>Complete excision of the lesion was performed, confirming Langerhans cell histiocytosis by immunohistochemistry. Chemotherapy was started with good tolerance and no complications so far.</div><div>This case highlights the need for timely diagnosis and treatment in cases of Langerhans cell histiocytosis with brain involvement, given its potential impact on prognosis and the scarcity of specific guidelines for this type of manifestations.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500676"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786138","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 : 2025-11-01DOI: 10.1016/j.neucie.2025.500700
Dixit Varma, Avinash A. Gutte, Snehal Kose, Abin Jose
Solitary fibrous tumors (SFTs) are rare intracranial neoplasms that are highly vascular, making surgical resection challenging due to significant intraoperative blood loss. Preoperative embolization is commonly performed via the transarterial route; however, this approach has limitations, including difficulty in accessing multiple feeders, prolonged procedural time, and the risk of embolic material reflux into the intracranial circulation.
Here, we report the case of a 19-year-old male with a large intracranial SFT, initially treated with transarterial embolization using polyvinyl alcohol (PVA) particles, which failed to achieve proper devascularization of the tumor. Consequently, direct puncture embolization using the SQUID 12 agent was performed. Following successful embolization, complete tumor resection was achieved with significantly reduced intraoperative blood loss and no postoperative neurological deficits.
This case highlights the effectiveness of direct puncture embolization as a viable alternative to traditional transarterial approaches for managing highly vascular intracranial tumors.
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Pub Date : 2025-11-01DOI: 10.1016/j.neucie.2025.500674
Cezmi Çağrı Türk , Umut Ogün Mutlucan , Orhan Günay , Fatma Genç , Meltem Korucuk , Gültekin Kutluk
Background
The use of monopolar electrocautery in vagal nerve stimulator (VNS) revision surgeries has been debated due to concerns about device interference. Thus, herein, we aimed to evaluate the safety and efficacy of monopolar electrocautery during VNS generator replacement surgeries, particularly its impact on seizure control and battery performance.
Methods
A retrospective observational study was conducted on 30 patients who underwent VNS generator revision at a tertiary care center. Patients were divided into two groups: those in whom monopolar electrocautery was used (n = 18) and those in whom it was not used (n= = 12). Pre- and postoperative data were collected, including seizure frequency, VNS settings, and operative time. The McHugh Outcome Classification was used to assess seizure control.
Results
The surgeries were significantly shorter in the electrocautery group than in the nonelectrocautery group (20.06 ± 2.29 vs. 51.83 ± 12.76 min, p < 0.001). Furthermore, there was no significant difference in seizure control between the two groups (p > 0.05). In two patients, a decline in seizure control classification was noted. However, this did not reach statistical significance. No lead damage or major complications developed in either group.
Conclusion
Monopolar electrocautery significantly reduces the operative time during VNS generator revisions without compromising seizure control or increasing the risk of complications. Thus, monopolar electrocautery can be safely used in VNS revision surgeries, potentially streamlining the procedure and improving patient outcomes. However, further studies with larger populations are needed to confirm these findings.
背景：单极电刺激在迷走神经刺激器（VNS）翻修手术中的使用一直存在争议，因为担心设备干扰。因此，在此，我们旨在评估单极电灼在VNS发生器更换手术中的安全性和有效性，特别是其对癫痫发作控制和电池性能的影响。方法：对30例在某三级保健中心行VNS发生器翻修术的患者进行回顾性观察研究。将患者分为两组：使用单极电炙组（n= 18）和未使用单极电炙组（n= = 12）。收集术前和术后数据，包括癫痫发作频率、VNS设置和手术时间。McHugh结局分类用于评估癫痫控制情况。结果：电灼组手术时间明显短于非电灼组（20.06±2.29 min vs. 51.83±12.76 min, p < 0.05）。在两名患者中，癫痫控制分类有所下降。然而，这并没有达到统计学意义。两组均未出现铅损伤或主要并发症。结论：单极电灼术显著缩短了VNS发生器翻修术的手术时间，且不影响癫痫的控制或增加并发症的风险。因此，单极电灼可以安全地用于VNS翻修手术，有可能简化手术程序并改善患者的预后。然而，需要对更大的人群进行进一步的研究来证实这些发现。
{"title":"Is monopolar electrocautery use in vagus nerve stimulator revision surgery a risk to avoid or a safe surgical option?","authors":"Cezmi Çağrı Türk , Umut Ogün Mutlucan , Orhan Günay , Fatma Genç , Meltem Korucuk , Gültekin Kutluk","doi":"10.1016/j.neucie.2025.500674","DOIUrl":"10.1016/j.neucie.2025.500674","url":null,"abstract":"<div><h3>Background</h3><div>The use of monopolar electrocautery<span> in vagal nerve stimulator (VNS) revision surgeries has been debated due to concerns about device interference. Thus, herein, we aimed to evaluate the safety and efficacy of monopolar electrocautery during VNS generator replacement surgeries, particularly its impact on seizure control and battery performance.</span></div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted on 30 patients who underwent VNS generator revision at a tertiary care center. Patients were divided into two groups: those in whom monopolar electrocautery was used (n = 18) and those in whom it was not used (n= = 12). Pre- and postoperative data were collected, including seizure frequency, VNS settings, and operative time. The McHugh Outcome Classification was used to assess seizure control.</div></div><div><h3>Results</h3><div>The surgeries were significantly shorter in the electrocautery group than in the nonelectrocautery group (20.06 ± 2.29 vs. 51.83 ± 12.76 min, p < 0.001). Furthermore, there was no significant difference in seizure control between the two groups (p > 0.05). In two patients, a decline in seizure control classification was noted. However, this did not reach statistical significance. No lead damage or major complications developed in either group.</div></div><div><h3>Conclusion</h3><div>Monopolar electrocautery significantly reduces the operative time during VNS generator revisions without compromising seizure control or increasing the risk of complications. Thus, monopolar electrocautery can be safely used in VNS revision surgeries, potentially streamlining the procedure and improving patient outcomes. However, further studies with larger populations are needed to confirm these findings.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 6","pages":"Article 500674"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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