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Mortality risk factors for adult trauma patients treated with halo brace for cervical spine fracture 使用 Halo 支架治疗颈椎骨折的成年创伤患者的死亡风险因素。
Pub Date : 2025-05-01 DOI: 10.1016/j.neucie.2024.09.003
Kim Hoang , Jeffrey Santos , Areg Grigorian , Lourdes Swentek , Hansen Bow , Jeffry Nahmias

Introduction and objectives

Halo braces treat upper cervical spine fractures and serve as the most rigid form of external immobilization. Recently, halo braces have lost favor due to known complications and advances in surgical stabilization. This study aims to determine the contemporary incidence for use of halo braces and identify risk factors associated with mortality in trauma patients undergoing halo brace for cervical spine fractures.

Materials and methods

The 2017–2019 Trauma Quality Improvement Program Database was queried for patients ≥18 years-old with a cervical spine fracture undergoing halo brace. Patients sustaining penetrating trauma and severe torso injuries (abbreviated injury scale >3 for the abdomen or thorax) were excluded. Bivariate and multivariable logistic regression analyses were performed.

Results

From 144,434 patients with a cervical spine fracture, 272 (0.2%) underwent halo brace and 14 (5%) of these died. Those who died were older (73.5 vs. 53 years-old, p = 0.011) and had higher rates of hypertension (78.6% vs 33.1%, p < 0.001) and chronic kidney disease (14.3% vs. 1.2%, p < 0.001). Glasgow Coma Scale ≤8 (46.2% vs. 8.2%, p < 0.001) and cervical spinal cord injury (71.4% vs. 21.3%, p < 0.001) were more common in patients who died. In addition, those who died more often sustained respiratory complications (7.1% vs. 0.4%, p = 0.004) and sepsis (7.1% vs. 0.4%, p = 0.004). On multivariable logistic regression analysis, only Glasgow Coma Scale ≤8 (OR 19.77, 3.04–128.45, p = 0.002) was associated with increased mortality.

Conclusions

Only 5% of cervical spine fracture patients undergoing halo brace died. Respiratory complications and sepsis were more common in those who died. On multivariable analysis only Glasgow Coma Scale ≤8 remained an independent associated risk factor for mortality.
简介和目的:光环支架用于治疗上颈椎骨折,是最坚固的外固定方式。近来,由于已知的并发症和手术稳定的进步,光环支架已失去了人们的青睐。本研究旨在确定光环支架的当代使用率,并识别与接受光环支架治疗颈椎骨折的创伤患者死亡率相关的风险因素:对2017-2019年创伤质量改进计划数据库中年龄大于18岁、接受光环支架治疗的颈椎骨折患者进行查询。不包括穿透性创伤和严重躯干损伤(腹部或胸部缩写损伤量表>3)的患者。进行了二元和多变量逻辑回归分析:在144434名颈椎骨折患者中,有272人(0.2%)接受了光环支撑,其中14人(5%)死亡。死亡患者年龄较大(73.5 岁对 53 岁,P = 0.011),高血压发病率较高(78.6% 对 33.1%,P 结论:只有 5%的颈椎骨折患者接受了光环支撑治疗:接受光环支撑治疗的颈椎骨折患者中仅有5%死亡。在死亡患者中,呼吸系统并发症和败血症更为常见。在多变量分析中,只有格拉斯哥昏迷量表<8仍是死亡的独立相关风险因素。
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引用次数: 0
Moyamoya disease and moyamoya syndrome: A case series from multicentre private hospitals in Indonesia 莫亚莫亚病和莫亚莫亚综合征:印度尼西亚多中心私立医院病例系列。
Pub Date : 2025-05-01 DOI: 10.1016/j.neucie.2024.11.008
Rusli Muljadi , Koesbandono , Teodorus Alfons Pratama , Gilbert Sterling Octavius

Background

Moyamoya disease (MMD) and moyamoya syndrome (MMS) are considered rare in Indonesia, without any proper epidemiological data backing this claim. Hence, this case series aims to assess all MMD and MMS cases from the perspective of a multicentre private hospital in Indonesia.

Methods

This is a descriptive analysis using data from the picture archiving and communication system (PACS) from January 2019 to December 2023. The inclusion criteria included all patients who fulfilled the radiological criteria for MMD and/or MMS, while patients who only underwent brain non-contrast computed tomography (CT) scans were excluded.

Results

There are 58,905 unique MRI scans from 2019 to 2023. The cohort comprises 8 females and 2 males, with a median age of 37 (7–65) years old. Three cases are probable MMD. with six MMD cases and one MMS case. Therefore, the prevalence rate for the four years is approximately 11.9 cases per 100,000 scans. Out of the confirmed Moya-Moya cases, the majority (4/7) are ischemic subtypes, followed by epileptic (electroencephalography shows slowing brain waves) and TIA in one case each. The most common presenting symptom is weakness in the extremity (N = 7), followed by headache (N = 5). Four patients underwent operative procedures, with three of them being superior temporal artery to middle cerebral artery (STA-MCA) bypass procedures and one of them being encephalo-duro-myo-arterio-pericraniosynangiosis (EDMAPS).

Conclusion

The paucity of confirmed cases either points towards the low prevalence of MMD and MMS in Indonesia or the underdiagnosis of these cases.
背景:在印度尼西亚,莫亚莫亚病(MMD)和莫亚莫亚综合征(MMS)被认为是罕见病,但没有任何适当的流行病学数据支持这一说法。因此,本病例系列旨在从印尼一家多中心私立医院的角度评估所有MMD和MMS病例:这是一项描述性分析,使用的数据来自 2019 年 1 月至 2023 年 12 月的图片存档和通信系统(PACS)。纳入标准包括所有符合MMD和/或MMS放射学标准的患者,而仅接受脑部非对比计算机断层扫描(CT)的患者则被排除在外:从 2019 年到 2023 年,共进行了 58905 次磁共振成像扫描。队列中有 8 名女性和 2 名男性,中位年龄为 37(7-65)岁。其中 3 例可能为 MMD,6 例为 MMD,1 例为 MMS。因此,这四年的发病率约为每 10 万次扫描中有 11.9 个病例。在确诊的莫亚-莫亚病例中,大多数(4/7)是缺血性亚型,其次是癫痫(脑电图显示脑电波减慢)和 TIA 各一例。最常见的症状是四肢无力(7 例),其次是头痛(5 例)。四名患者接受了手术治疗,其中三例为颞上动脉至大脑中动脉(STA-MCA)搭桥术,一例为脑-双侧肌动脉-颅周血管综合征(EDMAPS):结论:确诊病例较少,这表明印尼的多发性骨髓瘤和多发性硬化症发病率较低,或者这些病例诊断不足。
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引用次数: 0
Cord compression due to atypical T-cell lymphoma from paraspinal soft tissue: Report of a case 脊柱旁软组织非典型T细胞淋巴瘤导致的脊髓压迫:病例报告。
Pub Date : 2025-05-01 DOI: 10.1016/j.neucie.2024.11.004
Alejandro Augusto Ortega Rodriguez, Santiago Nicolás Valbuena Dussan, José Luís Caro Cardera, Jordi de Manuel-Rimbau Muñoz
During lymphoma’s natural history of disease, 5–10% of cases may develop Central Nervous affectation. We present the case of a 57-years-old man with less than 24 h of onset symptoms of paraparesis, lower limb hypoesthesia and sphincter dysfunction who was operated due to dorsal tumor with epidural component which caused severe cord compression. Pathological analysis concluded atypical T-cell lymphoblastic lymphoma, a rare subtype of lymphoma which accounts 1%−2% of all Non-Hodgkin Lymphomas. Our case was particularly aggressive and atypical due to its origin in paraspinal soft tissue. Despite specific treatment, the patient presented an early epidural relapse, frequent in this lymphoma subtype.
在淋巴瘤的自然病史中,5%-10%的病例可能会出现中枢神经影响。我们报告了一例 57 岁男性淋巴瘤患者的病例,他在发病不到 24 小时就出现了偏瘫、下肢麻木和括约肌功能障碍等症状,并因背侧肿瘤伴硬膜外成分导致严重脊髓压迫而接受了手术。病理分析得出的结论是非典型T细胞淋巴母细胞淋巴瘤,这是一种罕见的淋巴瘤亚型,占所有非霍奇金淋巴瘤的1%-2%。我们的病例由于起源于脊柱旁软组织,因此具有特别的侵袭性和非典型性。尽管接受了特殊治疗,患者还是出现了硬膜外早期复发,这在这种淋巴瘤亚型中很常见。
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引用次数: 0
Robotic spine surgery: Technical note and descriptive analysis of the first 40 cases 机器人脊柱手术:前40例的技术说明和描述性分析。
Pub Date : 2025-05-01 DOI: 10.1016/j.neucie.2024.12.002
Víctor Rodríguez-Domínguez, Jorge Bedia Cadelo, Javier Giner García, María Luisa Gandía González, Catalina Vivancos Sánchez, Alberto Isla Guerrero

Introduction

The global incidence of spinal pathology is increasing due to the progressive aging of the population and increased life expectancy. Vertebral fixation with transpedicular screws is the most commonly used technique in unstable or potentially unstable pathologies. There are different implantation methods, the most recently developed being implantation guided by robotic navigation.

Materials and methods

We describe the technical aspects and the different workflows available with the ExcelsiusGPS® robotic navigation system (GlobusMedical, Inc, Audubon, PA, USA), as well as the results of the first 40 patients operated on at the Hospital Universitario la Paz between July 2023 and February 2024.

Results

A total of 250 screws were implanted at the thoracic and lumbar levels. 12 patients underwent minimally invasive surgery (MIS) (30%) and 28 patients underwent open surgery (70%). The median number of screws implanted per patient was 6.00 (4.00–6.00). The intraoperative malpositioning rate was 2.5% (1 case). The median duration of surgery was 143.00 minutes (113.00–165.50). The median hospital stay was 4.00 days (3.00–5.50). The median intraoperative radiation delivered was 899 mGy/cm2 (523.25–1595.00). The median blood loss was 150.00 ml (100.00–300.00) and the blood transfusion rate was 0%.

Discussion

Compared to conventional techniques, Robotic spine surgery increases accuracy to 96–100% and reduces the radiation dose received by the patient and surgical team. In addition, it allows the implantation of larger screws, which has been associated with increased biomechanical strength and reduced risk of loosening. Initially, it may involve an increase in total surgical time, but this is reduced once the learning curve is reached, around 40 cases.

Conclusions

ExcelsiusGPS® is the most recent robot model on the market and different studies have demonstrated its effectiveness in different techniques and indications. Unlike other robotic systems used exclusively in dorsolumbar spine pathology, it can be used in the pathology of the entire spinal axis (from C1 to the sacrum) and brain pathology (deep electrode implantation, brain biopsy, SEEG, among others).
导言:由于人口逐渐老龄化和预期寿命延长,全球脊柱病变的发病率不断上升。使用经椎螺钉进行椎体固定是治疗不稳定或潜在不稳定病症的最常用技术。有多种不同的植入方法,最近开发的是机器人导航引导下的植入方法:我们介绍了ExcelsiusGPS®机器人导航系统(GlobusMedical, Inc, Audubon, PA, USA)的技术方面和不同的工作流程,以及2023年7月至2024年2月期间在帕斯大学医院对首批40名患者进行手术的结果:胸椎和腰椎共植入了250枚螺钉。12名患者接受了微创手术(MIS)(30%),28名患者接受了开放手术(70%)。每位患者植入螺钉数量的中位数为 6.00(4.00-6.00)。术中定位不良率为 2.5%(1 例)。手术时间中位数为 143.00 分钟(113.00-165.50 分钟)。住院时间中位数为 4.00 天(3.00-5.50 天)。术中放射量中位数为 899 mGy/cm²(523.25-1595.00)。中位失血量为150.00毫升(100.00-300.00),输血率为0%:与传统技术相比,机器人脊柱手术将准确率提高到 96%-100%,并减少了患者和手术团队接受的辐射剂量。此外,机器人脊柱手术允许植入更大的螺钉,这与增加生物力学强度和降低松动风险有关。起初,它可能会增加手术总时间,但一旦达到学习曲线(约 40 个病例),时间就会缩短:ExcelsiusGPS®是市场上最新的机器人型号,不同的研究证明了它在不同技术和适应症中的有效性。与其他专门用于背腰椎病变的机器人系统不同,它可用于整个脊柱轴(从C1到骶骨)的病变和脑部病变(深部电极植入、脑活检、SEEG等)。
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引用次数: 0
Trigeminal neuralgia secondary to minor size lesion, anatomical considerations and pathophysiology 继发于小面积病变的三叉神经痛、解剖学考虑因素和病理生理学。
Pub Date : 2025-05-01 DOI: 10.1016/j.neucie.2024.11.010
Adrián Fernández García, Carlos Alberto Rodríguez Arias, Estefanía Utiel Monsálvez, Herbert Daniel Jiménez Zapata
Trigeminal neuralgia is a well-characterized disorder of high prevalence among the current population. It may be caused, among many other causes, by a tumor which contacts with the trigeminal nerve, often of large volume. We present the case of a middle-aged woman without any remarkable medical background who suffered a trigeminal neuralgia caused by a subcentimeter tumor which appeared to be a meningioma. Some small tumors like this one may be symptomatic whereas larger ones will not. We discuss the pathogenesis and characterization of the trigeminal neuralgia in such cases proposing some mechanisms that could be involved in the development of a secondary neuralgia.
三叉神经痛是一种特征明显的疾病,在当前人群中发病率很高。除其他原因外,三叉神经痛还可能由与三叉神经相接触的肿瘤引起,这种肿瘤通常体积较大。我们现在介绍的病例是一名没有任何特殊医学背景的中年女性,她的三叉神经痛是由一个亚厘米肿瘤引起的,该肿瘤看起来像是脑膜瘤。一些像这样的小肿瘤可能会出现症状,而较大的肿瘤则不会。我们将讨论此类病例中三叉神经痛的发病机制和特征,并提出一些可能与继发性神经痛的发生有关的机制。
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引用次数: 0
Utility of very high-pressure valves in persistent symptomatic shunt overdrainage 超高压瓣膜对持续性症状性分流过度引流的作用。
Pub Date : 2025-05-01 DOI: 10.1016/j.neucie.2024.11.011
Iván Federico Narváez Moscoso, Bienvenido Ros López, Sara Iglesias Moroño, Julia Casado Ruiz, Raquel Simón Wolter, Miguel Ángel Arráez Sánchez

Introduction

Shunt overdrainage is one of the long-term complications associated with ventriculoperitoneal shunts. Treatment of refractory cases may require further upgrading of both the valve opening pressure and antisiphon device. The aim of this paper is to describe the results of this combination in a selected group of patients.

Methods

Retrospective cohort study that included 18 pediatric patients between 2003–2022. Previous shunts were exchanged for the combination of a SOPHYSA Polaris® SPVA-300 valve and upgraded fixed or adjustable antigravitatory devices. The following variables were collected: etiology of the hydrocephalus, age at first shunt and type of valve, number of shunt revisions, other surgical procedures, age at inclusion, clinical and radiological outcomes, and follow-up time. A descriptive analysis was done with means, medians and ranges for quantitative variables; percentages and frequencies for the analysis of qualitative data.

Results

The median age at first shunt was two months (0–67). The mean number of shunt revisions before inclusion was three. Shunt removal was attempted in seven patients without success; temporary success was observed in two patients who underwent ETV. Two patients had previous cranial expansions. The mean age at inclusion was 9.1 years (2.7–15.2). After the shunt system was exchanged and upgraded, clinical improvement was observed in 94.4% (17/18) of patients, and radiological improvement was observed in 83.3% (15/18) of patients. The median follow-up was 21 months.

Conclusions

Before considering more invasive therapeutic measures, shunt system optimization by the combination of very high-pressure valves and upgraded in-line antisiphon devices is a valid and safe strategy for refractory symptomatic shunt overdrainage.
简介分流过度引流是脑室腹腔分流术的长期并发症之一。治疗难治性病例可能需要进一步提高瓣膜开放压力和反虹吸装置。本文旨在描述这一组合在部分患者中的效果:方法:回顾性队列研究,包括 2003-2022 年间的 18 名儿科患者。这些患者之前使用的分流管被替换为 SOPHYSA Polaris® SPVA-300 瓣膜和升级的固定或可调式反重力装置的组合。研究人员收集了以下变量:脑积水病因、首次分流术的年龄和瓣膜类型、分流术翻修次数、其他外科手术、纳入时的年龄、临床和放射学结果以及随访时间。对定量变量采用均值、中位数和范围进行描述性分析,对定性数据采用百分比和频率进行分析:首次分流的中位年龄为两个月(0-67)。纳入前分流手术的平均次数为三次。有七名患者尝试过移除分流器,但未获成功;有两名患者接受了 ETV,并取得了暂时的成功。两名患者曾进行过颅骨扩张手术。患者入院时的平均年龄为 9.1 岁(2.7-15.2 岁)。更换和升级分流系统后,94.4%(17/18)的患者临床症状得到改善,83.3%(15/18)的患者放射学症状得到改善。中位随访时间为 21 个月:结论:在考虑采取更具侵入性的治疗措施之前,通过结合使用超高压阀门和升级后的在线反虹吸装置来优化分流系统,是治疗难治性症状性分流过度引流的有效且安全的策略。
{"title":"Utility of very high-pressure valves in persistent symptomatic shunt overdrainage","authors":"Iván Federico Narváez Moscoso,&nbsp;Bienvenido Ros López,&nbsp;Sara Iglesias Moroño,&nbsp;Julia Casado Ruiz,&nbsp;Raquel Simón Wolter,&nbsp;Miguel Ángel Arráez Sánchez","doi":"10.1016/j.neucie.2024.11.011","DOIUrl":"10.1016/j.neucie.2024.11.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Shunt overdrainage is one of the long-term complications associated with ventriculoperitoneal shunts. Treatment of refractory cases may require further upgrading of both the valve opening pressure and antisiphon device. The aim of this paper is to describe the results of this combination in a selected group of patients.</div></div><div><h3>Methods</h3><div>Retrospective cohort study that included 18 pediatric patients between 2003–2022. Previous shunts were exchanged for the combination of a SOPHYSA Polaris® SPVA-300 valve and upgraded fixed or adjustable antigravitatory devices. The following variables were collected: etiology of the hydrocephalus, age at first shunt and type of valve, number of shunt revisions, other surgical procedures, age at inclusion, clinical and radiological outcomes, and follow-up time. A descriptive analysis was done with means, medians and ranges for quantitative variables; percentages and frequencies for the analysis of qualitative data.</div></div><div><h3>Results</h3><div>The median age at first shunt was two months (0–67). The mean number of shunt revisions before inclusion was three. Shunt removal was attempted in seven patients without success; temporary success was observed in two patients who underwent ETV. Two patients had previous cranial expansions. The mean age at inclusion was 9.1 years (2.7–15.2). After the shunt system was exchanged and upgraded, clinical improvement was observed in 94.4% (17/18) of patients, and radiological improvement was observed in 83.3% (15/18) of patients. The median follow-up was 21 months.</div></div><div><h3>Conclusions</h3><div>Before considering more invasive therapeutic measures, shunt system optimization by the combination of very high-pressure valves and upgraded in-line antisiphon devices is a valid and safe strategy for refractory symptomatic shunt overdrainage.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 3","pages":"Pages 161-168"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693827","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}
引用次数: 0
Association of the C-reactive protein/albumin ratio with the prognosis of Aneurysmal Subarachnoid Hemorrhage: A systematic review C 反应蛋白/白蛋白比值与动脉瘤性蛛网膜下腔出血预后的关系:系统综述。
Pub Date : 2025-05-01 DOI: 10.1016/j.neucie.2024.11.009
Gerardo Luna-Peralta , Alvaro Lopez-Luza , Claudia Cruzalegui-Bazán , Miguel Cabanillas-Lazo
The C-Reactive Protein/Albumin Ratio (CAR) is being studied as a potential predictor of severe outcomes in various diseases. Our study aimed to review current evidence on the prognostic value of CAR in patients with aneurysmal subarachnoid hemorrhage (aSAH). We conducted a systematic search in PubMed, Embase, Scopus, Web of Science, and Google Scholar up to April 2023 and assessed the risk of bias using the NewCastle-Ottawa tool. A narrative synthesis was performed, and the GRADE system was used to evaluate the certainty of the evidence. Out of 534 articles, 4 were selected. We found that a higher CAR level is moderately associated with a lower score on the Glasgow Outcome Scale at 3 months and a higher incidence of in-hospital mortality. However, no significant association was found with the modified Rankin scale or delayed cerebral ischemia. Although the evidence is limited, CAR could be a useful tool for predicting poor prognosis in aSAH patients, but more prospective studies are needed to determine optimal cut-off points and include CAR in long-term prognostic models.
C-反应蛋白/白蛋白比值(CAR)是预测各种疾病严重后果的潜在指标,目前正在对其进行研究。我们的研究旨在回顾CAR对动脉瘤性蛛网膜下腔出血(aSAH)患者预后价值的现有证据。我们在PubMed、Embase、Scopus、Web of Science和Google Scholar上进行了系统性检索(截至2023年4月),并使用NewCastle-Ottawa工具评估了偏倚风险。进行了叙述性综合,并使用 GRADE 系统评估证据的确定性。从 534 篇文章中筛选出 4 篇。我们发现,CAR 水平越高,3 个月后格拉斯哥结果量表的评分越低,院内死亡率越高,两者之间存在中度相关性。但是,我们没有发现 CAR 与改良兰金量表或延迟性脑缺血有明显关系。虽然证据有限,但CAR可能是预测急性脑缺血患者不良预后的有用工具,但还需要更多的前瞻性研究来确定最佳临界点,并将CAR纳入长期预后模型中。
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引用次数: 0
Cauda equina malignant peripheral nerve sheath tumor presenting with subarachnoid hemorrhage: a case report 马尾恶性周围神经鞘瘤伴蛛网膜下腔出血:病例报告。
Pub Date : 2025-03-01 DOI: 10.1016/j.neucie.2024.10.001
Rafael Aponte-Caballero , Julian Alfonso Sierra-Peña , Juan Felipe Abaunza-Camacho , William Mauricio Riveros-Castillo , Javier M. Saavedra
Malignant peripheral nerve sheath tumors (MPNST) are uncommon aggressive neoplasms, frequently associated with type I neurofibromatosis. This is the first case of intradural lumbar spine MPNST with intraoperative findings of associated subarachnoid hemorrhage (SAH). A 72-year-old man presented to the emergency department with severe acute low back pain. Neurological examination was unremarkable. Gadolinium-enhanced MRI of the lumbar spine showed an irregularly shaped intradural lesion extending from L3 to L5. The lesion exhibited a medium signal both on T1 and T2-weighted imaging with peripheral enhancement. Through an L3-L5 laminectomy, a diffuse SAH, and a tumor tightly adherent to cauda equina nerve roots were found. Specimen examination revealed a fusocelular tumor with pleomorphic and hyperchromatic nuclei, positive for S100, and SOX10. On an 8-month follow-up, he had no neurological deficit, with a Karnofsky performance score of 90 points. Surgical evidence of SAH in lumbar spine intradural MPNST is a novel finding.
恶性周围神经鞘瘤(MPNST)是一种不常见的侵袭性肿瘤,常与 I 型神经纤维瘤病有关。这是首例腰椎硬膜内 MPNST,术中发现伴有蛛网膜下腔出血(SAH)。一名72岁的男子因严重急性腰背痛到急诊科就诊。神经系统检查无异常。腰椎钆增强磁共振成像显示,硬膜内病变呈不规则形状,从L3延伸至L5。病灶在T1和T2加权成像中均呈中等信号,周围增强。通过 L3-L5 椎板切除术,发现了弥漫性 SAH 和与马尾神经根紧密粘连的肿瘤。标本检查显示肿瘤呈纺锤形,核多形、高色素,S100 和 SOX10 阳性。随访8个月后,他没有出现神经功能障碍,Karnofsky表现评分为90分。腰椎硬膜内 MPNST 中出现 SAH 的手术证据是一项新发现。
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引用次数: 0
Acute subdural hematoma from ruptured middle cerebral artery aneurysm: A rare and critical analysis of 25 cases 大脑中动脉瘤破裂引起的急性硬膜下血肿:25 例罕见病例的批判性分析。
Pub Date : 2025-03-01 DOI: 10.1016/j.neucie.2024.11.002
Cristina Romero-López , Javier Ros de San Pedro , Francisco Arteaga-Romero , Beatriz Cuartero-Pérez , Ignacio Martín-Schrader

Background

An acute subdural hematoma (aSDH) is a rare presentation of a ruptured intracranial aneurysm with pathophysiology and prognosis poorly defined. According to literature, prognosis might be improved with prompt diagnosis, hematoma evacuation and aneurysm treatment. The objective is to specify pathophysiology, prognostic factors and management of this pathology.

Methods

We reported 23 cases of aSDH due to ruptured MCA aneurysm from literature revision and 2 cases from our center.

Results

Median age was 51 years and 48% (12/25) were females. At their arrival, 76% (19/25) presented decreased level of consciousness and 55.55% (10/18) neurological deficits. Aneurysmal location was left MCA in 57.14% (8/14) and MCA segments were M4 in 76.92% (10/13) and bifurcation in 23.07% (3/13), median aneurysmal size was 6 mm, median hematoma size was 10 mm, median midline shift was 9 mm, aneurysmal projection and MCA concavity were anterior in 100% (3/3), subarachnoid hemorrhage (SAH) was present in 52.17% (12/23). The treatment was surgery in 84% (21/25), endovascular in 12% (3/25) and in 20% (5/25) decompressive craniectomy (DC) was necessary. Glasgow Outcome Scale (GOS) was >3/favorable in 66.66% (16/24) and death in 16.66% (4/2).

Conclusions

Anterior MCA concavity and aneurysmal projection might be related with aSDH presentation in proximal MCA aneurysms. We should suspect aneurysm origin when there is no history or stigma of trauma, and CT shows disproportionately massive aSDH. Hematoma evacuation solves the compressive mechanism which is the main cause of neurological deterioration in pure aSDH cases, because of that, immediate hematoma evacuation could justify better outcome in these patients.
背景:急性硬膜下血肿(aSDH)是颅内动脉瘤破裂的一种罕见表现,其病理生理学和预后尚不明确。根据文献,及时诊断、清除血肿和治疗动脉瘤可改善预后。本文旨在明确该病理的病理生理学、预后因素和治疗方法:方法:我们报告了 23 例因 MCA 动脉瘤破裂导致的 aSDH 病例,这些病例来自文献修订本和本中心的 2 例病例:中位年龄为51岁,48%(12/25)为女性。患者入院时,76%(19/25)出现意识障碍,55.55%(10/18)出现神经功能缺损。动脉瘤位置为左侧 MCA 的占 57.14%(8/14),MCA 节段为 M4 的占 76.92%(10/13),分叉的占 23.07%(3/13)。中位动脉瘤大小为 6 mm,中位血肿大小为 10 mm,中线移位为 9 mm,100%(3/3)的动脉瘤投影和 MCA 凹陷为前方,52.17%(12/23)的患者出现蛛网膜下腔出血(SAH)。84%(21/25)的患者接受了手术治疗,12%(3/25)的患者接受了血管内治疗,20%(5/25)的患者需要进行减压开颅手术(DC)。66.66%(16/24)的患者格拉斯哥结果量表(GOS)>3/良好,16.66%(4/2)的患者死亡:结论:MCA 前端凹陷和动脉瘤突出可能与近端 MCA 动脉瘤的 aSDH 表现有关。如果没有外伤史或外伤烙印,CT 又显示出不成比例的巨大 aSDH,我们就应该怀疑动脉瘤的来源。血肿排空解决了压迫机制问题,而压迫机制是纯粹的 aSDH 病例中神经功能恶化的主要原因,因此,立即进行血肿排空可使这些患者获得更好的预后。
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引用次数: 0
Lateralization in visualization among neurosurgeons 神经外科医生视觉的侧向性。
Pub Date : 2025-03-01 DOI: 10.1016/j.neucie.2024.11.003
Hrvoje Barić , Sara Komljenović , Helena Ljulj

Background

Handedness is an epiphenomenon of brain lateralization which has been researched in the context of surgical performance, yet the same does not hold true for lateralization at a more fundamental level. We aimed to investigate whether neurosurgeons are biased in visualizing and depicting anatomy and pathology.

Methods

This was a two part study consisting of an online survey and image analysis. An online questionnaire was used to collect basic sociodemographic data and prompt subjects to visualize surgical approaches and pathological entities and report on the side of the visualized topics. Prominent neurosurgical literature was screened for depictions of the same entities and approaches and the depicted side was noted.

Results

There were 49 responses, most from Croatia (n = 26), men (n = 38), right-handed (n = 42), of average age 37 years, and with 9 years of neurosurgical experience. Ambidexterity was more prevalent than in the general population. The respondents imagined the right side more commonly in all cranial-related questions, and the left side in spine-related questions. Images in neurosurgical literature showed correspondingly biased laterality.

Conclusion

There is a significant bias among neurosurgeons in laterality in processing topographical information on anatomy and pathology. Research is warranted to investigate the causes and real life implications of this phenomenon.
背景:手 偏向性是大脑侧向化的一种表象,已在外科手术表现的背景下对其进行了研究,但在更基本的层面上,侧向化却并非如此。我们的目的是调查神经外科医生在可视化和描述解剖学和病理学时是否存在偏差:这是一项由在线调查和图像分析两部分组成的研究。在线调查问卷用于收集基本社会人口学数据,提示受试者将手术方法和病理实体可视化,并报告可视化主题的侧面。对著名的神经外科文献进行了筛选,以寻找相同实体和方法的描述,并注明描述的侧面:共收到 49 份回复,大部分来自克罗地亚(26 份),男性(38 份),右撇子(42 份),平均年龄 37 岁,有 9 年神经外科经验。与普通人相比,他们的双手更灵活。在所有与颅脑相关的问题中,受访者更常想象右侧,而在与脊柱相关的问题中,受访者更常想象左侧。神经外科文献中的图像也显示出相应的偏侧:结论:神经外科医生在处理解剖学和病理学的地形信息时存在明显的侧位偏差。结论:神经外科医生在处理解剖学和病理学的地形信息时存在明显的侧向偏差,有必要对这一现象的原因和对现实生活的影响进行研究。
{"title":"Lateralization in visualization among neurosurgeons","authors":"Hrvoje Barić ,&nbsp;Sara Komljenović ,&nbsp;Helena Ljulj","doi":"10.1016/j.neucie.2024.11.003","DOIUrl":"10.1016/j.neucie.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Handedness is an epiphenomenon of brain lateralization which has been researched in the context of surgical performance, yet the same does not hold true for lateralization at a more fundamental level. We aimed to investigate whether neurosurgeons are biased in visualizing and depicting anatomy and pathology.</div></div><div><h3>Methods</h3><div>This was a two part study consisting of an online survey and image analysis. An online questionnaire was used to collect basic sociodemographic data and prompt subjects to visualize surgical approaches and pathological entities and report on the side of the visualized topics. Prominent neurosurgical literature was screened for depictions of the same entities and approaches and the depicted side was noted.</div></div><div><h3>Results</h3><div>There were 49 responses, most from Croatia (n = 26), men (n = 38), right-handed (n = 42), of average age 37 years, and with 9 years of neurosurgical experience. Ambidexterity was more prevalent than in the general population. The respondents imagined the right side more commonly in all cranial-related questions, and the left side in spine-related questions. Images in neurosurgical literature showed correspondingly biased laterality.</div></div><div><h3>Conclusion</h3><div>There is a significant bias among neurosurgeons in laterality in processing topographical information on anatomy and pathology. Research is warranted to investigate the causes and real life implications of this phenomenon.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 2","pages":"Pages 93-97"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Neurocirugia (English Edition)
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