Pub Date : 2025-09-01DOI: 10.1016/j.neucie.2025.500657
Luis Miguel Moreno-Gómez , Pablo M. Munarriz , Aurelio Hernández-Laín , Alfonso Lagares
Pituitary abscesses are rare entities that may occur in a previously healthy gland or in the setting of a pituitary tumor. Only eleven cases of abscesses associated with craniopharyngioma have been reported in the literature. The etiology is unknown and the diagnosis is difficult because there are no specific clinical or radiologic features that allow us to suspect the synchrony of both entities before surgery. Intraoperative findings and culture are the only definitive signs to confirm this association.
Here we present the first surgical video showing this unique association and highlighting the technical pearls of the procedure. In a 9-year-old boy, we performed a transphenoidal approach to resect the tumor and saw pus during surgery. Pathology revealed a papillary craniopharyngioma, with microbiology showing Staphylococcus aureus. The tumor resection resulted in ophthalmologic improvement but pituitary insufficiency. A brief review of the literature is presented.
{"title":"Craniopharyngioma and abscess: When tumor and infection co-exist","authors":"Luis Miguel Moreno-Gómez , Pablo M. Munarriz , Aurelio Hernández-Laín , Alfonso Lagares","doi":"10.1016/j.neucie.2025.500657","DOIUrl":"10.1016/j.neucie.2025.500657","url":null,"abstract":"<div><div>Pituitary abscesses are rare entities that may occur in a previously healthy gland or in the setting of a pituitary tumor<span>. Only eleven cases of abscesses associated with craniopharyngioma have been reported in the literature. The etiology is unknown and the diagnosis is difficult because there are no specific clinical or radiologic features that allow us to suspect the synchrony of both entities before surgery. Intraoperative findings and culture are the only definitive signs to confirm this association.</span></div><div>Here we present the first surgical video showing this unique association and highlighting the technical pearls of the procedure. In a 9-year-old boy, we performed a transphenoidal approach to resect the tumor and saw pus during surgery. Pathology revealed a papillary craniopharyngioma, with microbiology showing <span><em>Staphylococcus aureus</em></span><span>. The tumor resection resulted in ophthalmologic improvement but pituitary insufficiency. A brief review of the literature is presented.</span></div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 5","pages":"Article 500657"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569048","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}
Subarachnoid hemorrhage (SAH) caused by a dissecting aneurysm of the anterior inferior cerebellar artery (AICA) is rare. Partial coil embolization of the AICA may be an effective treatment. A 65-year-old woman presented at the emergency room with headache and vomiting for the past five days, after contracting coronavirus disease (COVID)-19. Computed tomography (CT) revealed SAH and intraventricular hemorrhage, and the patient was diagnosed with a dissecting aneurysm of the AICA. The patient underwent endovascular surgery, and the AICA was partially occluded using coiling, with no subsequent hearing disturbance, cranial nerve palsy, or infarction. Ventriculoperitoneal shunt surgery was performed for hydrocephalus at 7 weeks after SAH. The patient was discharged from hospital with no neurological deficit. We reported a rare case of ruptured AICA dissecting aneurysm, which was treated by partial coil embolization without neurological deficit or infarction.
{"title":"Parent artery occlusion for ruptured dissecting aneurysm of anterior inferior cerebellar artery: Case report and literature review.","authors":"Taiki Ishikawa, Hiroshi Kagami, Mami Ishikawa, Kenichi Oyama","doi":"10.1016/j.neucie.2025.500712","DOIUrl":"10.1016/j.neucie.2025.500712","url":null,"abstract":"<p><p>Subarachnoid hemorrhage (SAH) caused by a dissecting aneurysm of the anterior inferior cerebellar artery (AICA) is rare. Partial coil embolization of the AICA may be an effective treatment. A 65-year-old woman presented at the emergency room with headache and vomiting for the past five days, after contracting coronavirus disease (COVID)-19. Computed tomography (CT) revealed SAH and intraventricular hemorrhage, and the patient was diagnosed with a dissecting aneurysm of the AICA. The patient underwent endovascular surgery, and the AICA was partially occluded using coiling, with no subsequent hearing disturbance, cranial nerve palsy, or infarction. Ventriculoperitoneal shunt surgery was performed for hydrocephalus at 7 weeks after SAH. The patient was discharged from hospital with no neurological deficit. We reported a rare case of ruptured AICA dissecting aneurysm, which was treated by partial coil embolization without neurological deficit or infarction.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500712"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755298","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 : 2025-07-28DOI: 10.1016/j.neucie.2025.500714
Cláudia Fernandes, Vanessa Viegas, Alberto Artiles Medina, Carlos Martins Silva, Luis San José, Luis López-Fando Lavalle
Introduction: Pudendal nerve entrapment (PNE) is rare, and mostly affects women, with men accounting for only 1/3 of cases. The European guidelines advocate surgical decompression in select PNE cases. We aim to evaluate surgical outcomes in a group of male patients diagnosed with PNE who underwent laparoscopic decompression surgery supported by intraoperative neurophysiological monitoring (pIOM).
Material and methods: This retrospective and multicentric study included 138 patients with suspected PNE syndrome. The diagnosis of PNE was established based on neurophysiological tests and response to pudendal nerve block. Patients who experienced symptom relief following the nerve block underwent laparoscopic pudendal nerve decompression surgery, with pIOM utilized during the procedure. Symptom progression was tracked over a 12-month follow-up period.
Results: A total of 84 (60%) were diagnosed with PNE. Of these, 20 (24%) were male, with 14 (70%) receiving pudendal nerve infiltration. Six men (46%) later underwent laparoscopic pudendal nerve decompression surgery with pIOM. At the 12-month follow-up, five patients (83%) reported significant pain reduction, while one (17%) noted no improvement. Visual Analog Scale ranged between 2 and 5. Bladder dysfunction resolved in 2 of the 3. Two patients ceased all medications by the 12-month mark. In terms of satisfaction, four patients expressed complete satisfaction, one reported partial satisfaction, and one did not provide feedback.
Conclusion: Laparoscopic PNE decompression surgery, combined with pIOM is an effective intervention for male PNE patients with significant pain relief and enhanced quality of life. Further research is needed to validate these results and refine the criteria for patient selection.
{"title":"Male pudendal nerve release assisted by laparoscopy and intraoperative neurophysiologic monitoring.","authors":"Cláudia Fernandes, Vanessa Viegas, Alberto Artiles Medina, Carlos Martins Silva, Luis San José, Luis López-Fando Lavalle","doi":"10.1016/j.neucie.2025.500714","DOIUrl":"10.1016/j.neucie.2025.500714","url":null,"abstract":"<p><strong>Introduction: </strong>Pudendal nerve entrapment (PNE) is rare, and mostly affects women, with men accounting for only 1/3 of cases. The European guidelines advocate surgical decompression in select PNE cases. We aim to evaluate surgical outcomes in a group of male patients diagnosed with PNE who underwent laparoscopic decompression surgery supported by intraoperative neurophysiological monitoring (pIOM).</p><p><strong>Material and methods: </strong>This retrospective and multicentric study included 138 patients with suspected PNE syndrome. The diagnosis of PNE was established based on neurophysiological tests and response to pudendal nerve block. Patients who experienced symptom relief following the nerve block underwent laparoscopic pudendal nerve decompression surgery, with pIOM utilized during the procedure. Symptom progression was tracked over a 12-month follow-up period.</p><p><strong>Results: </strong>A total of 84 (60%) were diagnosed with PNE. Of these, 20 (24%) were male, with 14 (70%) receiving pudendal nerve infiltration. Six men (46%) later underwent laparoscopic pudendal nerve decompression surgery with pIOM. At the 12-month follow-up, five patients (83%) reported significant pain reduction, while one (17%) noted no improvement. Visual Analog Scale ranged between 2 and 5. Bladder dysfunction resolved in 2 of the 3. Two patients ceased all medications by the 12-month mark. In terms of satisfaction, four patients expressed complete satisfaction, one reported partial satisfaction, and one did not provide feedback.</p><p><strong>Conclusion: </strong>Laparoscopic PNE decompression surgery, combined with pIOM is an effective intervention for male PNE patients with significant pain relief and enhanced quality of life. Further research is needed to validate these results and refine the criteria for patient selection.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500714"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755297","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 : 2025-07-28DOI: 10.1016/j.neucie.2025.500711
Jose Alberto Escribano Mesa, Leidy Vanessa Fajardo Güiza, Cristina Muñoz Romero, Juan Solivera Vela
Objectives: To determine the relationship between the impact of high-grade gliomas (HGG) on the population in Córdoba from 2008 to 2019 and the natural radiation background, estimated using radon maps and water origin according to the supply reservoir. Correlation of the results with other prognostic factors. The survival study based on exposure to radon.
Material and methods: Observational, cross-sectional, retrospective 11-year study on 365 patients diagnosed with HGG at the Reina Sofía Hospital in Córdoba, exposed or not, to significant radiation, to estimate the impact that this could have on HGG.
Results: The incidence of patients diagnosed with glioblastoma multiforme (GBM) in those exposed to radon was 41.6 versus 31.4 cases/100,000 inhabitants in those not exposed (p=0.02). The global incidence of HGG was 52.8 cases in those exposed to radon compared with 45 cases/1000 inhabitants in the unexposed ones (p=0.12). It was found that 56.8/100,000 were supplied by reservoirs significant for radon, compared to 31.4 cases/100,000 inhabitants that were not (p=0.23). A Cox regression was performed, leaving IDH mutation and type of intervention in the model: survival is six times higher in positive IDH mutation (p=0.021) and three in surgically intervened (p<0.001).
Conclusions: Long-term exposure to natural radiation does seem to increase the risk factor for the appearance of GBM. However, other factors influencing such exposure must be considered, such as reliable measurements of radiation and time spent in that place.
{"title":"Relationship between the incidence of glioblastoma and natural radiation.","authors":"Jose Alberto Escribano Mesa, Leidy Vanessa Fajardo Güiza, Cristina Muñoz Romero, Juan Solivera Vela","doi":"10.1016/j.neucie.2025.500711","DOIUrl":"10.1016/j.neucie.2025.500711","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the relationship between the impact of high-grade gliomas (HGG) on the population in Córdoba from 2008 to 2019 and the natural radiation background, estimated using radon maps and water origin according to the supply reservoir. Correlation of the results with other prognostic factors. The survival study based on exposure to radon.</p><p><strong>Material and methods: </strong>Observational, cross-sectional, retrospective 11-year study on 365 patients diagnosed with HGG at the Reina Sofía Hospital in Córdoba, exposed or not, to significant radiation, to estimate the impact that this could have on HGG.</p><p><strong>Results: </strong>The incidence of patients diagnosed with glioblastoma multiforme (GBM) in those exposed to radon was 41.6 versus 31.4 cases/100,000 inhabitants in those not exposed (p=0.02). The global incidence of HGG was 52.8 cases in those exposed to radon compared with 45 cases/1000 inhabitants in the unexposed ones (p=0.12). It was found that 56.8/100,000 were supplied by reservoirs significant for radon, compared to 31.4 cases/100,000 inhabitants that were not (p=0.23). A Cox regression was performed, leaving IDH mutation and type of intervention in the model: survival is six times higher in positive IDH mutation (p=0.021) and three in surgically intervened (p<0.001).</p><p><strong>Conclusions: </strong>Long-term exposure to natural radiation does seem to increase the risk factor for the appearance of GBM. However, other factors influencing such exposure must be considered, such as reliable measurements of radiation and time spent in that place.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500711"},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755299","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}
Nervous system involvement is uncommon in granulomatosis with polyangiitis (GPA), a systemic autoimmune disease with episodes of necrotizing vasculitis. It is usually due to the compressive effect of dural or epidural masses. Spinal hemorrhagic presentation is exceptional. A 41-year-old woman diagnosed with GPA presented with three episodes of acute spinal subdural hematoma separated by eight years and ten months, respectively. The symptomatic debut was pain and paresis in all episodes. On all occasions, a lesion compatible with acute spinal subdural hematoma was diagnosed by magnetic resonance imaging (MRI). All episodes were treated conservatively with corticosteroids and immunosuppressants. The patient presented complete neurological recovery in the first two episodes. A mild residual left lower limb paresis remains after the last one. Follow-up MRI was performed after all episodes, and no focal intraspinal lesions were detected. Spinal subdural hemorrhage is a form of manifestation of GPA, either as a debut or in the course of the disease. We describe the third confirmed case of spontaneous spinal hemorrhage secondary to GPA published in the literature and the first with recurrence. Given the extraordinary response to immunosuppressive therapy, a high level of clinical suspicion is necessary to establish treatment as early as possible.
{"title":"Recurrent spinal subdural hematoma in granulomatosis with polyangiitis","authors":"Teresa Kalantari , Celia Ortega-Angulo , Raquel Gutiérrez-González","doi":"10.1016/j.neucie.2025.500670","DOIUrl":"10.1016/j.neucie.2025.500670","url":null,"abstract":"<div><div>Nervous system involvement is uncommon in granulomatosis with polyangiitis (GPA), a systemic autoimmune disease with episodes of necrotizing vasculitis. It is usually due to the compressive effect of dural or epidural masses. Spinal hemorrhagic presentation is exceptional. A 41-year-old woman diagnosed with GPA presented with three episodes of acute spinal subdural hematoma separated by eight years and ten months, respectively. The symptomatic debut was pain and paresis in all episodes. On all occasions, a lesion compatible with acute spinal subdural hematoma was diagnosed by magnetic resonance imaging (MRI). All episodes were treated conservatively with corticosteroids and immunosuppressants. The patient presented complete neurological recovery in the first two episodes. A mild residual left lower limb paresis remains after the last one. Follow-up MRI was performed after all episodes, and no focal intraspinal lesions were detected. Spinal subdural hemorrhage is a form of manifestation of GPA, either as a debut or in the course of the disease. We describe the third confirmed case of spontaneous spinal hemorrhage secondary to GPA published in the literature and the first with recurrence. Given the extraordinary response to immunosuppressive therapy, a high level of clinical suspicion is necessary to establish treatment as early as possible.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 4","pages":"Article 500670"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733469","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 : 2025-07-01DOI: 10.1016/j.neucie.2025.500659
Miguel Nuñez Rodriguez, Alexis Tovar, Victoria Herrera Gunn, Pablo Kuchlewski, Guido Carlomagno, Florencia Beldi
Background
Practice in simulation models optimizes learning and manual skills necessary in neurosurgical training.
Objectives
To describe a neurosurgical simulation model for the resection of brain tumors using easily accessible materials and to evaluate the acceptance of the model through a questionnaire.
Methods
An artificial tumor based on gelatin and spongostan with infiltrative characteristics was elaborated. It was injected into a bovine brain and the latter into a dry skull. Its location was studied to later operate it using microsurgical instruments. Dural opening, corticotomy, biopsy and debulking with supramarginal resection were performed and the participants evaluated the model through a Likert-type questionnaire.
Results
In vivo simulation models, cadaveric preparations, 3D printing, virtual reality and injection of artificial lesions into animal brains ex vivo are described. In the latter, the creation of tumors based on different materials, including gelatin, is mentioned. It is important that the tumor is easy to inject and resistant to heat, so a mixture of gelatin - spongostan was created. This model describes qualities to emulate tumor surgery as well as pre-surgical planning, reconstruction of the subarachnoid space and continuous instillation of artificial blood to the surgical bed.
Conclusion
An intraaxial tumor simulation model was described as a useful tool to improve surgical techniques in oncological neurosurgery. It proved to have a good degree of acceptance in the participants.
{"title":"Neurosurgical training model in bovine brain for resection of intraaxial tumors","authors":"Miguel Nuñez Rodriguez, Alexis Tovar, Victoria Herrera Gunn, Pablo Kuchlewski, Guido Carlomagno, Florencia Beldi","doi":"10.1016/j.neucie.2025.500659","DOIUrl":"10.1016/j.neucie.2025.500659","url":null,"abstract":"<div><h3>Background</h3><div>Practice in simulation models optimizes learning and manual skills necessary in neurosurgical training.</div></div><div><h3>Objectives</h3><div>To describe a neurosurgical simulation model for the resection of brain tumors using easily accessible materials and to evaluate the acceptance of the model through a questionnaire.</div></div><div><h3>Methods</h3><div>An artificial tumor based on gelatin and spongostan with infiltrative characteristics was elaborated. It was injected into a bovine brain and the latter into a dry skull. Its location was studied to later operate it using microsurgical instruments. Dural opening, corticotomy, biopsy and debulking with supramarginal resection were performed and the participants evaluated the model through a Likert-type questionnaire.</div></div><div><h3>Results</h3><div>In vivo simulation models, cadaveric preparations, 3D printing, virtual reality and injection of artificial lesions into animal brains ex vivo are described. In the latter, the creation of tumors based on different materials, including gelatin, is mentioned. It is important that the tumor is easy to inject and resistant to heat, so a mixture of gelatin - spongostan was created. This model describes qualities to emulate tumor surgery as well as pre-surgical planning, reconstruction of the subarachnoid space and continuous instillation of artificial blood to the surgical bed.</div></div><div><h3>Conclusion</h3><div>An intraaxial tumor simulation model was described as a useful tool to improve surgical techniques in oncological neurosurgery. It proved to have a good degree of acceptance in the participants.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 4","pages":"Article 500659"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000114","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 : 2025-07-01DOI: 10.1016/j.neucie.2025.500654
Turgut Kuytu , Ahmet Karaoğlu
Introduction and objectives
In cases where adjacent segment disease (ASD) develops following lumbar fusion surgery, various surgical approaches can be employed. In such cases, removal of the instrumentation can positively impact lumbar pain syndrome. One frequently used method is short-segment fixation-decompression (SSFD). One of minimally invasive methods is microsurgical bilateral decompression via unilateral approach (MBDU). This study aims to determine which method is more effective and safe in cases that developed ASD following fusion surgery by comparing SSFD and MBDU after instrumentation removal.
Methods
A retrospective analysis was conducted on 47 cases treated with SSFD and 29 cases treated with MBDU. The groups were analyzed for gender, age, preoperative symptom duration, duration of hospitalization, and Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores during the preoperative and postoperative intermittent follow-up periods.
Results
Duration of hospitalization was higher in the SSFD group compared to the MBDU group (p = <0.001 CI = 56,42–76,24 and 22,04–25,13 respectively), mean transverse canal diameter ratio in the decompressed segment was lower in the SSFD group (p = 0,03 IC = 0,24–0,31 for SSFD y 0,40–0,47 for MBDU), and ODI indices were higher in the SSFD group in all follow-ups (p = <0.001). During the follow-up period, symptomatic ASD was observed in 3 of 47 patients in the SSFD group, whereas no symptomatic ASD was observed in the MBDU group.
Conclusion
In selected patients who develop ASD after fusion surgery MBDU after instrumentation removal can be considered as a minimally invasive option that does not exacerbate postoperative lumbar pain syndrome or lead to the development of new ASD. To the best of our knowledge, this is the first comparison of these two techniques in literature after removal of spinal fixators in lumbar ASD cases.
{"title":"“Short-segment lumbar fusion” vs.“microsurgical bilateral decompression via unilateral approach” after removal of the spinal fixators in patients with adjacent segment disease: Clinical retrospective study","authors":"Turgut Kuytu , Ahmet Karaoğlu","doi":"10.1016/j.neucie.2025.500654","DOIUrl":"10.1016/j.neucie.2025.500654","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>In cases where adjacent segment disease (ASD) develops following lumbar fusion surgery, various surgical approaches can be employed. In such cases, removal of the instrumentation can positively impact lumbar pain syndrome. One frequently used method is short-segment fixation-decompression (SSFD). One of minimally invasive methods is microsurgical bilateral decompression via unilateral approach (MBDU). This study aims to determine which method is more effective and safe in cases that developed ASD following fusion surgery by comparing SSFD and MBDU after instrumentation removal.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 47 cases treated with SSFD and 29 cases treated with MBDU. The groups were analyzed for gender, age, preoperative symptom duration, duration of hospitalization, and Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores during the preoperative and postoperative intermittent follow-up periods.</div></div><div><h3>Results</h3><div>Duration of hospitalization was higher in the SSFD group compared to the MBDU group (p = <0.001 CI = 56,42–76,24 and 22,04–25,13 respectively), mean transverse canal diameter ratio in the decompressed segment was lower in the SSFD group (p = 0,03 IC = 0,24–0,31 for SSFD y 0,40–0,47 for MBDU), and ODI indices were higher in the SSFD group in all follow-ups (p = <0.001). During the follow-up period, symptomatic ASD was observed in 3 of 47 patients in the SSFD group, whereas no symptomatic ASD was observed in the MBDU group.</div></div><div><h3>Conclusion</h3><div>In selected patients who develop ASD after fusion surgery MBDU after instrumentation removal can be considered as a minimally invasive option that does not exacerbate postoperative lumbar pain syndrome or lead to the development of new ASD. To the best of our knowledge, this is the first comparison of these two techniques in literature after removal of spinal fixators in lumbar ASD cases.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 4","pages":"Article 500654"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569043","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 : 2025-07-01DOI: 10.1016/j.neucie.2025.500664
Ali Rıza Güvercin, Mehmet Aktoklu, Mehmet Orbay Bıyık, Uğur Yazar
Retroclival subdural haematomas (RSH) are a rare occurrence, accounting for 0.3% of acute extra-axial haematomas. Although typically associated with trauma, non-traumatic causes include coagulopathy, pituitary apoplexy and vascular anomalies.The presence of cases due to non-traumatic causes can present significant diagnostic challenges. This article aims to shed light on the intricacies of non-traumatic RSH by conducting a review of the literature and presenting a case study of a 74-year-old woman on anticoagulants. The primary objective is to enhance our understanding of the diagnosis and treatment of this condition, emphasising the significance of bleeding in a location that often goes unnoticed, particularly in Computed Tomography (CT) scans, with the exception of trauma. A comprehensive review of the literature revealed 28 cases of non-traumatic RSH in adults. A detailed analysis was conducted on the demographic characteristics, causes, presentations and outcomes of these cases.The mean patient age was found to be 59 years, with a slight male predominance of 57.57%. The primary causes were identified as pituitary apoplexy (39.28%) and anticoagulants (21.42%), while 25% of cases had an unknown aetiology. Spinal canal extension occurred in 10.71% of cases, which increased morbidity.The recovery rate was 92.85% and the mortality rate was 3.57%.Non-traumatic RSH is under-recognised and often missed on standard imaging.Conservative treatment is effective without spinal cord compression.Awareness is very important, especially for diagnosis and treatment.
{"title":"Missed diagnosis; non-traumatic retroclival haematoma in adults, brief case report with review and evaluation of similar cases in the literature","authors":"Ali Rıza Güvercin, Mehmet Aktoklu, Mehmet Orbay Bıyık, Uğur Yazar","doi":"10.1016/j.neucie.2025.500664","DOIUrl":"10.1016/j.neucie.2025.500664","url":null,"abstract":"<div><div>Retroclival subdural haematomas (RSH) are a rare occurrence, accounting for 0.3% of acute extra-axial haematomas. Although typically associated with trauma, non-traumatic causes include coagulopathy, pituitary apoplexy and vascular anomalies.The presence of cases due to non-traumatic causes can present significant diagnostic challenges. This article aims to shed light on the intricacies of non-traumatic RSH by conducting a review of the literature and presenting a case study of a 74-year-old woman on anticoagulants. The primary objective is to enhance our understanding of the diagnosis and treatment of this condition, emphasising the significance of bleeding in a location that often goes unnoticed, particularly in Computed Tomography (CT) scans, with the exception of trauma. A comprehensive review of the literature revealed 28 cases of non-traumatic RSH in adults. A detailed analysis was conducted on the demographic characteristics, causes, presentations and outcomes of these cases.The mean patient age was found to be 59 years, with a slight male predominance of 57.57%. The primary causes were identified as pituitary apoplexy (39.28%) and anticoagulants (21.42%), while 25% of cases had an unknown aetiology. Spinal canal extension occurred in 10.71% of cases, which increased morbidity.The recovery rate was 92.85% and the mortality rate was 3.57%.Non-traumatic RSH is under-recognised and often missed on standard imaging.Conservative treatment is effective without spinal cord compression.Awareness is very important, especially for diagnosis and treatment.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 4","pages":"Article 500664"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588470","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 : 2025-07-01DOI: 10.1016/j.neucie.2025.500653
Pilar Teixidor-Rodríguez , Ferran Brugada-Bellsolà , Maria Luisa Pérez , Sebastián Menéndez-Girón , Jordi Busquets-Bonet , Carlos Javier Domínguez-Alonso
Purpose
Although there may be benefits to adult patients who have had Chiari surgery when duroplasty is indicated, there are also more risks involved. The complications derived from a non-hermetic dural closure in the posterior fossa can be significant, mainly cerebrospinal fluid (CSF) leakage, meningitis and pseudomeningocele. We explored the option of utilizing a different duroplasty that we typically utilized in order to reduce these risks. The aim of this study is to assess the safety and efficacy of two duraplasties used for Chiari malformation (ChM) surgery: Tutopatch®, and a human acellular dermal matrix (hADM). Tutopatch®, a well-known collagen membrane commonly used by our senior surgeon, and hADM, prepared by the tissue establishment and with potential properties for use as duraplasty.
Methods
A unicentric prospective study was designed with one group of patients treated with hADM and another group that retrospectively acquired surgical treatment with Tutopatch®. There were nineteen patients in each group. The patients in both groups were diagnosed with same pathology and were operated on by the same senior surgeon. This study was approved by the same hospital’s Medical Ethics Committee. Demographics, clinical risk factors, clinical syndrome and pre/postoperative and postoperative events after surgery were analysed. All serious adverse events (SAEs) and adverse events (AEs) after surgery were recorded.
Results
No differences were found between the two groups related to sex, clinical risk factors, clinical syndrome and clinical outcomes. Seven patients presented with complications, seven the Tutopatch® group (two of them requiring a new reoperation) and none in the hADM group.
Conclusion
This pilot study shows that hADM is a safe and effective alternative to Tutopatch® duraplasty, as although the two materials performed equally well in the surgical repair of Chiari malformation, the former showed better clinical outcomes. Future studies are needed to confirm these outcomes in larger cohorts.
{"title":"Pilot study to assess the safety and efficacy of human acellular dermal matrix for Chiari surgery","authors":"Pilar Teixidor-Rodríguez , Ferran Brugada-Bellsolà , Maria Luisa Pérez , Sebastián Menéndez-Girón , Jordi Busquets-Bonet , Carlos Javier Domínguez-Alonso","doi":"10.1016/j.neucie.2025.500653","DOIUrl":"10.1016/j.neucie.2025.500653","url":null,"abstract":"<div><h3>Purpose</h3><div>Although there may be benefits to adult patients who have had Chiari surgery when duroplasty is indicated, there are also more risks involved. The complications derived from a non-hermetic dural closure in the posterior fossa can be significant, mainly cerebrospinal fluid (CSF) leakage, meningitis and pseudomeningocele. We explored the option of utilizing a different duroplasty that we typically utilized in order to reduce these risks. The aim of this study is to assess the safety and efficacy of two duraplasties used for Chiari malformation (ChM) surgery: Tutopatch®, and a human acellular dermal matrix (hADM). Tutopatch®, a well-known collagen membrane commonly used by our senior surgeon, and hADM, prepared by the tissue establishment and with potential properties for use as duraplasty.</div></div><div><h3>Methods</h3><div>A unicentric prospective study was designed with one group of patients treated with hADM and another group that retrospectively acquired surgical treatment with Tutopatch®. There were nineteen patients in each group. The patients in both groups were diagnosed with same pathology and were operated on by the same senior surgeon. This study was approved by the same hospital’s Medical Ethics Committee. Demographics, clinical risk factors, clinical syndrome and pre/postoperative and postoperative events after surgery were analysed. All serious adverse events (SAEs) and adverse events (AEs) after surgery were recorded.</div></div><div><h3>Results</h3><div>No differences were found between the two groups related to sex, clinical risk factors, clinical syndrome and clinical outcomes. Seven patients presented with complications, seven the Tutopatch® group (two of them requiring a new reoperation) and none in the hADM group.</div></div><div><h3>Conclusion</h3><div>This pilot study shows that hADM is a safe and effective alternative to Tutopatch® duraplasty, as although the two materials performed equally well in the surgical repair of Chiari malformation, the former showed better clinical outcomes. Future studies are needed to confirm these outcomes in larger cohorts.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 4","pages":"Article 500653"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538191","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 : 2025-07-01DOI: 10.1016/j.neucie.2025.500655
Mónica Maldonado-Luna , Ana María Castaño-León , Andrea Emanuela Baciu , Luis Alzamora-Llull , Elvira Vallés-Núñez , Alfonso Lagares
Antecedents and objective
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Traditional factors strongly associated with poor outcome are neurological condition and the amount of bleeding. Inflammation is considered a relevant mechanism of brain injury after aSAH. This study aims to investigate the potential role of new laboratory indexes related to inflammation for predicting the prognosis of aSAH patients, complementing established prognostic models.
Materials and methods
We conducted a retrospective observational study including adults admitted for aSAH at a single neurosurgery center from 2002 to 2023. Demographic data, clinical parameters, and blood test results at admission were collected. The main outcome variable was Glasgow Outcome Scale (GOS) six month post-bleeding. A second outcome variable was in-hospital mortality. Univariable analyses were performed to identify new laboratory predictors of poor prognosis. The independent association with outcome was evaluated after adjustment of traditional risk factors by logistic regression analysis. The additional value of new laboratory predictors was determined by comparison of the area under the receiver operating curve (AUROC).
Results
Among 542 patients with aSAH, 417 met inclusion criteria (age >18 years old and complete laboratory test available upon admission with aSAH confirmed by CT angiography (CTA) or digital subtraction angiography (DSA)). Elevated glucose/potassium ratio (GKR) in the first blood test at admission was significantly associated with unfavorable outcome and in-hospital mortality according to univariate analysis. The GKR was significantly associated with a worse final prognosis (OR 1.033, 95% CI 1.008–1.040) adjusted for age, WFNS and Fisher scales, history of diabetes mellitus and kidney disease, and prior use of diuretics, oral antidiabetic medications and insulin. Additionally, the inclusion of the GKR improved the predictive accuracy of a prognostic model compared to a model including only clinical and radiological data. The neutrophil-lymphocyte ratio (NLR) was not significantly different between subgroups of patients regarding their outcome.
Conclusion
GKR measured in the first 24 h after aSAH may improve the discrimination of patients with higher risk of experiencing poor outcome at six month after the bleeding.
背景和目的：动脉瘤性蛛网膜下腔出血（aSAH）具有较高的发病率和死亡率。与预后不良密切相关的传统因素是神经系统状况和出血量。炎症被认为是aSAH后脑损伤的相关机制。本研究旨在探讨与炎症相关的新的实验室指标在预测aSAH患者预后方面的潜在作用，补充现有的预后模型。材料和方法：我们进行了一项回顾性观察研究，包括2002年至2023年在单一神经外科中心因aSAH入院的成年人。收集入院时的人口学资料、临床参数和血液检查结果。主要结局变量为出血后6个月格拉斯哥结局量表（GOS）。第二个结果变量是住院死亡率。进行单变量分析以确定新的预后不良的实验室预测因子。在调整传统危险因素后，通过logistic回归分析评估与预后的独立相关性。通过比较受试者工作曲线下面积（AUROC）来确定新的实验室预测指标的附加价值。结果：在542例aSAH患者中，417例符合纳入标准（年龄0 ~ 18岁，入院时可完成实验室检查，经CT血管造影（CTA）或数字减影血管造影（DSA）证实aSAH）。单因素分析显示，入院时首次血液检查中葡萄糖/钾比值（GKR）升高与不良结局和住院死亡率显著相关。GKR与较差的最终预后显著相关（OR 1.033, 95% CI 1.008-1.040），经年龄、WFNS和Fisher量表、糖尿病和肾脏疾病史、既往使用利尿剂、口服降糖药和胰岛素等因素校正后，GKR与较差的最终预后显著相关。此外，与仅包含临床和放射学数据的模型相比，纳入GKR提高了预后模型的预测准确性。中性粒细胞-淋巴细胞比率（NLR）在亚组患者的预后方面无显著差异。结论：在aSAH后24小时测量GKR可以提高对出血后6个月预后不良风险较高患者的鉴别。
{"title":"The role of Glucose/Potassium Ratio and Neutrophil/Lymphocyte Ratio in the prognosis of patients with aneurysmal subarachnoid hemorrhage","authors":"Mónica Maldonado-Luna , Ana María Castaño-León , Andrea Emanuela Baciu , Luis Alzamora-Llull , Elvira Vallés-Núñez , Alfonso Lagares","doi":"10.1016/j.neucie.2025.500655","DOIUrl":"10.1016/j.neucie.2025.500655","url":null,"abstract":"<div><h3>Antecedents and objective</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Traditional factors strongly associated with poor outcome are neurological condition and the amount of bleeding. Inflammation is considered a relevant mechanism of brain injury after aSAH. This study aims to investigate the potential role of new laboratory indexes related to inflammation for predicting the prognosis of aSAH patients, complementing established prognostic models.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective observational study including adults admitted for aSAH at a single neurosurgery center from 2002 to 2023. Demographic data, clinical parameters, and blood test results at admission were collected. The main outcome variable was Glasgow Outcome Scale (GOS) six month post-bleeding. A second outcome variable was in-hospital mortality. Univariable analyses were performed to identify new laboratory predictors of poor prognosis. The independent association with outcome was evaluated after adjustment of traditional risk factors by logistic regression analysis. The additional value of new laboratory predictors was determined by comparison of the area under the receiver operating curve (AUROC).</div></div><div><h3>Results</h3><div>Among 542 patients with aSAH, 417 met inclusion criteria (age >18 years old and complete laboratory test available upon admission with aSAH confirmed by CT angiography (CTA) or digital subtraction angiography (DSA)). Elevated glucose/potassium ratio (GKR) in the first blood test at admission was significantly associated with unfavorable outcome and in-hospital mortality according to univariate analysis. The GKR was significantly associated with a worse final prognosis (OR 1.033, 95% CI 1.008–1.040) adjusted for age, WFNS and Fisher scales, history of diabetes mellitus and kidney disease, and prior use of diuretics, oral antidiabetic medications and insulin. Additionally, the inclusion of the GKR improved the predictive accuracy of a prognostic model compared to a model including only clinical and radiological data. The neutrophil-lymphocyte ratio (NLR) was not significantly different between subgroups of patients regarding their outcome.</div></div><div><h3>Conclusion</h3><div>GKR measured in the first 24 h after aSAH may improve the discrimination of patients with higher risk of experiencing poor outcome at six month after the bleeding.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 4","pages":"Article 500655"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568960","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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