Pub Date : 2025-09-01Epub Date: 2025-03-24DOI: 10.1016/j.neucie.2025.500669
Gino A. Mendoza-Vega , Jason Riveros-Ruiz , Juan E. Basilio-Flores
Late complications of radiosurgery for brain arteriovenous malformation include cystic formation, chronic encapsulated hematoma and radiation-induced tumors. Other complications are rarely reported.
We present a case of an adult patient who received radiosurgery for treatment of an unruptured parietal arteriovenous malformation. He was followed-up for 10 years and angiographic cure was documented. Fifteen-years after radiosurgery, he complained of new-onset progressive focal seizures associated with a thrombosed venous aneurysm with persistent arteriovenous shunt angiographically occult but evidenced intraoperatively. After resection of the lesion, symptoms disappeared.
This case depicts a symptomatic thrombosed venous aneurysm presenting as a rare delayed complication of radiosurgery for the treatment of brain arteriovenous malformation, which can be associated with angiographically-occult persistent arteriovenous shunt.
{"title":"Symptomatic thrombosed venous aneurysm after stereotactic radiosurgery for brain arteriovenous malformation: Case report of a late complication mimicking radiation necrosis","authors":"Gino A. Mendoza-Vega , Jason Riveros-Ruiz , Juan E. Basilio-Flores","doi":"10.1016/j.neucie.2025.500669","DOIUrl":"10.1016/j.neucie.2025.500669","url":null,"abstract":"<div><div><span><span>Late complications of radiosurgery for brain </span>arteriovenous malformation include cystic formation, chronic encapsulated </span>hematoma and radiation-induced tumors. Other complications are rarely reported.</div><div><span>We present a case of an adult patient who received radiosurgery for treatment of an unruptured parietal arteriovenous malformation. He was followed-up for 10 years and angiographic cure was documented. Fifteen-years after radiosurgery, he complained of new-onset progressive </span>focal seizures<span><span> associated with a thrombosed venous aneurysm with persistent </span>arteriovenous shunt angiographically occult but evidenced intraoperatively. After resection of the lesion, symptoms disappeared.</span></div><div><span>This case depicts a symptomatic thrombosed venous aneurysm presenting as a rare delayed complication of radiosurgery for the treatment of </span>brain arteriovenous malformation, which can be associated with angiographically-occult persistent arteriovenous shunt.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 5","pages":"Article 500669"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733501","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 : 2025-09-01Epub Date: 2025-03-24DOI: 10.1016/j.neucie.2025.500667
Edward Emerson Susanibar Mesías , Alba León Jorba , Antoni Raventós Estellé , Christian Abel Schinder , David Rodriguez Rubio
Schwannomas of the musculocutaneous nerve (MCN) are rare benign tumors of the peripheral nerve sheath. Due to their slow growth, they are often diagnosed late. In the upper limbs, schwannomas typically affect longer peripheral nerves at a distal level, making MCN cases uncommon. Ultrasound (US) and magnetic resonance imaging (MRI) are essential tools for early detection. While most schwannomas can be surgically removed without damaging the nerve, intraoperative neurophysiological monitoring (IONM) is critical if fascicular involvement exists.
We present a 73-year-old right-handed Jehovah's Witness with a history of mild polio affecting the right arm. MRI showed a slow-growing, cystic mass in the right biceps, originating from the MCN and suggestive of schwannoma. Surgery achieved gross total resection without nerve damage. Histopathology confirmed a cystic schwannoma.
In atypical proximal upper limb tumors, MCN schwannoma should be considered, with US/MRI crucial for diagnosis. IONM-assisted removal can minimize postoperative complications.
{"title":"Removal of a giant musculocutaneous nerve schwannoma under intraoperative neurophysiological monitoring: Case report video and review of the literature","authors":"Edward Emerson Susanibar Mesías , Alba León Jorba , Antoni Raventós Estellé , Christian Abel Schinder , David Rodriguez Rubio","doi":"10.1016/j.neucie.2025.500667","DOIUrl":"10.1016/j.neucie.2025.500667","url":null,"abstract":"<div><div><span>Schwannomas of the </span>musculocutaneous nerve<span> (MCN) are rare benign tumors<span><span> of the peripheral nerve sheath. Due to their slow growth, they are often diagnosed late. In the upper limbs, schwannomas typically affect longer peripheral nerves at a distal level, making MCN cases uncommon. Ultrasound (US) and magnetic resonance imaging (MRI) are essential tools for early detection. While most schwannomas can be surgically removed without damaging the nerve, </span>intraoperative neurophysiological monitoring (IONM) is critical if fascicular involvement exists.</span></span></div><div><span>We present a 73-year-old right-handed Jehovah's Witness with a history of mild polio affecting the right arm. MRI showed a slow-growing, cystic mass in the right biceps, originating from the MCN and suggestive of schwannoma. Surgery achieved gross total resection without nerve damage. </span>Histopathology confirmed a cystic schwannoma.</div><div>In atypical proximal upper limb tumors, MCN schwannoma should be considered, with US/MRI crucial for diagnosis. IONM-assisted removal can minimize postoperative complications.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 5","pages":"Article 500667"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733470","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 : 2025-09-01Epub Date: 2025-05-17DOI: 10.1016/j.neucie.2025.500666
Matilde Lissarrague , Franklin Miranda Solís , Fernando Martínez Benia
Introduction
Peripheral nerves can present anastomoses at different levels, with intraspinal anastomoses being relatively common, but little studied.
Objective
To study the presence and number of intradural anastomoses of the cervical spinal nerves in the Latin population.
Materials and methods
14 adult corpses of both sexes were dissected, fixed in formaldehyde solution. Sex of the corpse, existence of anastomosis, side, height of the anastomoses and sensory/motor origin were recorded.
Results
of the 14 corpses, 8 were male and 6 were female. Eleven cases presented anastomoses (79%), 8 of them bilaterally. In the total number of corpses, 52 anastomoses were found, 43 were between sensory roots (83%) and 9 between motor roots (17%). The levels where anastomoses were found most frequently were C1-C2 and C2-C3 (63% of the total).
Discussion and conclusions
intraspinal anastomoses between motor or sensory nerves can vary the clinical presentation of spinal cord injuries, radicular or medullar compressions, brachial plexus lesions or nerve root tumors, because the sensory or motor information of a given spinal cord level may be exiting the neuraxis with the adjacent spinal nerve.
{"title":"Intradural anastomoses between the cervical spinal nerves: Anatomical study","authors":"Matilde Lissarrague , Franklin Miranda Solís , Fernando Martínez Benia","doi":"10.1016/j.neucie.2025.500666","DOIUrl":"10.1016/j.neucie.2025.500666","url":null,"abstract":"<div><h3>Introduction</h3><div>Peripheral nerves can present anastomoses at different levels, with intraspinal anastomoses being relatively common, but little studied.</div></div><div><h3>Objective</h3><div>To study the presence and number of intradural anastomoses of the cervical spinal nerves in the Latin population.</div></div><div><h3>Materials and methods</h3><div>14 adult corpses of both sexes were dissected, fixed in formaldehyde solution. Sex of the corpse, existence of anastomosis, side, height of the anastomoses and sensory/motor origin were recorded.</div></div><div><h3>Results</h3><div>of the 14 corpses, 8 were male and 6 were female. Eleven cases presented anastomoses (79%), 8 of them bilaterally. In the total number of corpses, 52 anastomoses were found, 43 were between sensory roots (83%) and 9 between motor roots (17%). The levels where anastomoses were found most frequently were C1-C2 and C2-C3 (63% of the total).</div></div><div><h3>Discussion and conclusions</h3><div>intraspinal anastomoses between motor or sensory nerves can vary the clinical presentation of spinal cord injuries, radicular or medullar compressions, brachial plexus lesions or nerve root tumors, because the sensory or motor information of a given spinal cord level may be exiting the neuraxis with the adjacent spinal nerve.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 5","pages":"Article 500666"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103302","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 : 2025-09-01Epub Date: 2025-03-03DOI: 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}
Pub Date : 2025-07-01Epub Date: 2025-04-24DOI: 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}
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 : 2025-07-01Epub Date: 2025-03-03DOI: 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 : 2025-07-01Epub Date: 2025-03-05DOI: 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 : 2025-07-01Epub Date: 2025-02-27DOI: 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 : 2025-07-01Epub Date: 2025-03-03DOI: 10.1016/j.neucie.2025.500656
Roser Garcia-Armengol , Sebastian Andres Menéndez-Girón , Cristina Hostalot , Ana Cristina Pérez-Balaguero , Carlos Javier Dominguez , Ana Rodriguez-Hernandez
Objective
This study aimed to identify and analyze the 100 most-cited articles in neurosurgical journals over the past 20 years.
Methods
The Thomson Reuters Web of Science citation index was used to analyze articles from high-impact neurosurgical journals identified via Journal Citation Reports. Data extracted included citations, citations per year, title, authors, year, country, institution, journal, study type, and thematic area. Citation analysis identified the most impactful articles. A bibliometric analysis compared trends between 2012–2022 and 2001–2011. Descriptive statistics and Pearson correlation were applied to examine the relationship between publication year and citation count. Stata V14.2 was used for statistical analysis.
Results
Citations for the top 100 articles ranged from 194 to 1,501. “Journal of Neurosurgery” and “Neurosurgery” published the most-cited articles, with peak productivity in 2012 and 2013. The USA was the leading country in article contributions. Neuro-oncology, especially tumor studies, was the dominant thematic field.
Conclusions
The bibliometric analysis highlighted a strong centralization in neurosurgical research, with most highly cited articles coming from two major journals, largely from the United States. This reveals the significant influence of a few key contributors in global neurosurgery.
目的：对近20年来神经外科期刊上被引频次最高的100篇文章进行分类分析。方法：使用Thomson Reuters Web of Science引文索引分析通过Journal citation Reports检索到的高影响力神经外科期刊的文章。提取的数据包括引文、每年引文、标题、作者、年份、国家、机构、期刊、研究类型和专题领域。引用分析确定了最具影响力的文章。文献计量分析比较了2012-2022年和2001-2011年的趋势。运用描述性统计和Pearson相关检验出版年份与被引次数之间的关系。使用Stata V14.2进行统计分析。结果：前100篇文章的引用数从194到1,501不等。《Journal of Neurosurgery》和《Neurosurgery》发表的文章被引用次数最多，在2012年和2013年达到高峰。美国是文章贡献最多的国家。神经肿瘤学，特别是肿瘤研究，是主要的主题领域。结论：文献计量学分析强调了神经外科研究的高度集中，大多数高被引文章来自两大期刊，主要来自美国。这揭示了全球神经外科的几个关键贡献者的重大影响。
{"title":"Global trends in neurosurgical research: Insights from the top 100 most-cited articles","authors":"Roser Garcia-Armengol , Sebastian Andres Menéndez-Girón , Cristina Hostalot , Ana Cristina Pérez-Balaguero , Carlos Javier Dominguez , Ana Rodriguez-Hernandez","doi":"10.1016/j.neucie.2025.500656","DOIUrl":"10.1016/j.neucie.2025.500656","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to identify and analyze the 100 most-cited articles in neurosurgical journals over the past 20 years.</div></div><div><h3>Methods</h3><div>The Thomson Reuters Web of Science citation index was used to analyze articles from high-impact neurosurgical journals identified via Journal Citation Reports. Data extracted included citations, citations per year, title, authors, year, country, institution, journal, study type, and thematic area. Citation analysis identified the most impactful articles. A bibliometric analysis compared trends between 2012–2022 and 2001–2011. Descriptive statistics and Pearson correlation were applied to examine the relationship between publication year and citation count. Stata V14.2 was used for statistical analysis.</div></div><div><h3>Results</h3><div>Citations for the top 100 articles ranged from 194 to 1,501. “Journal of Neurosurgery” and “Neurosurgery” published the most-cited articles, with peak productivity in 2012 and 2013. The USA was the leading country in article contributions. Neuro-oncology, especially tumor studies, was the dominant thematic field.</div></div><div><h3>Conclusions</h3><div>The bibliometric analysis highlighted a strong centralization in neurosurgical research, with most highly cited articles coming from two major journals, largely from the United States. This reveals the significant influence of a few key contributors in global neurosurgery.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 4","pages":"Article 500656"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569053","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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