Pub Date : 2025-05-01DOI: 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.
{"title":"Trigeminal neuralgia secondary to minor size lesion, anatomical considerations and pathophysiology","authors":"Adrián Fernández García, Carlos Alberto Rodríguez Arias, Estefanía Utiel Monsálvez, Herbert Daniel Jiménez Zapata","doi":"10.1016/j.neucie.2024.11.010","DOIUrl":"10.1016/j.neucie.2024.11.010","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 3","pages":"Pages 204-207"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693826","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 : 2025-05-01DOI: 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.
{"title":"Utility of very high-pressure valves in persistent symptomatic shunt overdrainage","authors":"Iván Federico Narváez Moscoso, Bienvenido Ros López, Sara Iglesias Moroño, Julia Casado Ruiz, Raquel Simón Wolter, 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}
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。
{"title":"Association of the C-reactive protein/albumin ratio with the prognosis of Aneurysmal Subarachnoid Hemorrhage: A systematic review","authors":"Gerardo Luna-Peralta , Alvaro Lopez-Luza , Claudia Cruzalegui-Bazán , Miguel Cabanillas-Lazo","doi":"10.1016/j.neucie.2024.11.009","DOIUrl":"10.1016/j.neucie.2024.11.009","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 3","pages":"Pages 185-193"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693589","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 : 2025-03-01DOI: 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.
{"title":"Cauda equina malignant peripheral nerve sheath tumor presenting with subarachnoid hemorrhage: a case report","authors":"Rafael Aponte-Caballero , Julian Alfonso Sierra-Peña , Juan Felipe Abaunza-Camacho , William Mauricio Riveros-Castillo , Javier M. Saavedra","doi":"10.1016/j.neucie.2024.10.001","DOIUrl":"10.1016/j.neucie.2024.10.001","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 2","pages":"Pages 129-134"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482519","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 : 2025-03-01DOI: 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.
{"title":"Acute subdural hematoma from ruptured middle cerebral artery aneurysm: A rare and critical analysis of 25 cases","authors":"Cristina Romero-López , Javier Ros de San Pedro , Francisco Arteaga-Romero , Beatriz Cuartero-Pérez , Ignacio Martín-Schrader","doi":"10.1016/j.neucie.2024.11.002","DOIUrl":"10.1016/j.neucie.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>We reported 23 cases of aSDH due to ruptured MCA aneurysm from literature revision and 2 cases from our center.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 2","pages":"Pages 83-92"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649761","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 : 2025-03-01DOI: 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.
{"title":"Lateralization in visualization among neurosurgeons","authors":"Hrvoje Barić , Sara Komljenović , 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}
Pub Date : 2025-03-01DOI: 10.1016/j.neucie.2024.10.005
Ana Irigaray Echarri , M. Dolores Ollero García-Agulló , José Jorge Ortez Toro , Idoya Zazpe Cenoz
In patients with acromegaly, the pleiotropic effects of GH and IGF-1 have been associated with the development of endothelial dysfunction and vascular abnormalities.
We present the case of a 45-year-old male diagnosed with acromegaly. Magnetic resonance imaging identified a marked dilatation and medialization of both cavernous internal carotid arteries (ICA), leading to a narrow intercarotid distance, a phenomenon known as “carotid kisses”.
This vascular alteration has been described in greater proportion in patients with acromegaly. The anomalies that are also present with greater prevalence in these patients are: aneurysms of the ICA, protrusion of the ICA into the sphenoid sinus, narrow intercarotid distance, fusiform dilatation of the ICA and dehiscence of this artery in the bony canal. The presence of such alterations increases the risk of injury to the ICA.
Pre-surgical detection of such abnormalities is essential to ensure the safety of the surgical approach.
{"title":"Endothelial dysfunction and vascular abnormalities in acromegaly. A case report","authors":"Ana Irigaray Echarri , M. Dolores Ollero García-Agulló , José Jorge Ortez Toro , Idoya Zazpe Cenoz","doi":"10.1016/j.neucie.2024.10.005","DOIUrl":"10.1016/j.neucie.2024.10.005","url":null,"abstract":"<div><div>In patients with acromegaly, the pleiotropic effects of GH and IGF-1 have been associated with the development of endothelial dysfunction and vascular abnormalities.</div><div>We present the case of a 45-year-old male diagnosed with acromegaly. Magnetic resonance imaging identified a marked dilatation and medialization of both cavernous internal carotid arteries (ICA), leading to a narrow intercarotid distance, a phenomenon known as “carotid kisses”.</div><div>This vascular alteration has been described in greater proportion in patients with acromegaly. The anomalies that are also present with greater prevalence in these patients are: aneurysms of the ICA, protrusion of the ICA into the sphenoid sinus, narrow intercarotid distance, fusiform dilatation of the ICA and dehiscence of this artery in the bony canal. The presence of such alterations increases the risk of injury to the ICA.</div><div>Pre-surgical detection of such abnormalities is essential to ensure the safety of the surgical approach.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 2","pages":"Pages 135-138"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549398","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 : 2025-03-01DOI: 10.1016/j.neucie.2024.11.006
Andrey Grin, Vasily Karanadze, Ivan Lvov , Aleksandr Talypov, Anton Kordonskiy, Rinat Abdrafiev
<div><h3>Objectives</h3><div>To conduct a systematic review and single-arm meta-analysis to evaluate and compare radiological indicators, as well as short-term and long-term outcomes, in patients with neurologically intact thoracolumbar burst fractures (TLBF) who underwent anterior fusion, combined anterior-posterior procedure, or short-segment pedicle screw fixation (PSF).</div></div><div><h3>Methods</h3><div>A systematic review following PRISMA guidelines was conducted. Inclusion criteria comprised articles published between 2004 and 2023, full-text availability in English, burst fractures without spinal cord or nerve root injuries at admission, short-segment PSF without fusion, anterior or combined fusion methods, patients aged 18 or older, and a minimum 12-month follow-up.</div><div>Meta-analysis was carried out using Comprehensive Meta-Analysis software. Using a single-arm meta-analysis method, pooled indicators of short- and long-term outcomes for each studied group were determined. The obtained data were then compared using simple comparison.</div></div><div><h3>Results</h3><div>The pooled mean Cobb angle at admission for the anterior, combined, and PSF groups was 18.2° (95% CI, 14.6−21.8), 11.7° (95% CI, 9.7−13.5), and 17.1° (95% CI, 15.1–19.1), respectively. Anterior fusion achieved a greater degree of kyphosis correction across all groups, but only the combined group showed a nonsignificant loss of correction after discharge (SMD = 0.809 [95% CI, 0.270, 1.348]). The anterior vertebral body compression rate at admission was 55.2% (95% CI, 46.3−64.0) in the combined group and 37.8% (95% CI, 33.7−41.9) in the PSF group.</div><div>Operative time, blood loss, and hospitalization duration were lowest in the percutaneous PSF group, with means of 96.5 min (95% CI, 82.4–110.6), 83.8 ml (95% CI, 71.7–95.9), and 6.6 days (95% CI, 4.7–8.5), respectively. All techniques demonstrated a similar incidence of deep wound infections and implant-related complications.</div><div>The pooled Oswestry Disability Index (ODI) scores were 17.2 (95% CI, 10.4−23.9) for the anterior group, 15.4 (95% CI, 11.5–19.3) for the combined group, and 13.4 (95% CI, 10.4–16.3) for the PSF group.</div></div><div><h3>Conclusions</h3><div>For patients with neurologically intact thoracolumbar burst fractures, with a kyphotic angle of less than 19.1° and an anterior vertebral body compression rate of less than 41.9%, short-segment pedicle screw fixation without fusion may be preferable option due to reduced intraoperative blood loss, shorter operation duration, shorter hospital stay, and better ODI scores at final follow-up. Routine anterior fusion has demonstrated high potential for kyphosis correction. The loss of the Cobb angle from surgery to final follow-up was nonsignificant only in patients who underwent combined surgery. When determining the surgical approach, surgeons should carefully weigh the advantages of anterior and combined fusion against the significantly higher sur
{"title":"Is anterior fusion still necessary in patients with neurologically intact thoracolumbar burst fractures? A systematic review and meta-analysis","authors":"Andrey Grin, Vasily Karanadze, Ivan Lvov , Aleksandr Talypov, Anton Kordonskiy, Rinat Abdrafiev","doi":"10.1016/j.neucie.2024.11.006","DOIUrl":"10.1016/j.neucie.2024.11.006","url":null,"abstract":"<div><h3>Objectives</h3><div>To conduct a systematic review and single-arm meta-analysis to evaluate and compare radiological indicators, as well as short-term and long-term outcomes, in patients with neurologically intact thoracolumbar burst fractures (TLBF) who underwent anterior fusion, combined anterior-posterior procedure, or short-segment pedicle screw fixation (PSF).</div></div><div><h3>Methods</h3><div>A systematic review following PRISMA guidelines was conducted. Inclusion criteria comprised articles published between 2004 and 2023, full-text availability in English, burst fractures without spinal cord or nerve root injuries at admission, short-segment PSF without fusion, anterior or combined fusion methods, patients aged 18 or older, and a minimum 12-month follow-up.</div><div>Meta-analysis was carried out using Comprehensive Meta-Analysis software. Using a single-arm meta-analysis method, pooled indicators of short- and long-term outcomes for each studied group were determined. The obtained data were then compared using simple comparison.</div></div><div><h3>Results</h3><div>The pooled mean Cobb angle at admission for the anterior, combined, and PSF groups was 18.2° (95% CI, 14.6−21.8), 11.7° (95% CI, 9.7−13.5), and 17.1° (95% CI, 15.1–19.1), respectively. Anterior fusion achieved a greater degree of kyphosis correction across all groups, but only the combined group showed a nonsignificant loss of correction after discharge (SMD = 0.809 [95% CI, 0.270, 1.348]). The anterior vertebral body compression rate at admission was 55.2% (95% CI, 46.3−64.0) in the combined group and 37.8% (95% CI, 33.7−41.9) in the PSF group.</div><div>Operative time, blood loss, and hospitalization duration were lowest in the percutaneous PSF group, with means of 96.5 min (95% CI, 82.4–110.6), 83.8 ml (95% CI, 71.7–95.9), and 6.6 days (95% CI, 4.7–8.5), respectively. All techniques demonstrated a similar incidence of deep wound infections and implant-related complications.</div><div>The pooled Oswestry Disability Index (ODI) scores were 17.2 (95% CI, 10.4−23.9) for the anterior group, 15.4 (95% CI, 11.5–19.3) for the combined group, and 13.4 (95% CI, 10.4–16.3) for the PSF group.</div></div><div><h3>Conclusions</h3><div>For patients with neurologically intact thoracolumbar burst fractures, with a kyphotic angle of less than 19.1° and an anterior vertebral body compression rate of less than 41.9%, short-segment pedicle screw fixation without fusion may be preferable option due to reduced intraoperative blood loss, shorter operation duration, shorter hospital stay, and better ODI scores at final follow-up. Routine anterior fusion has demonstrated high potential for kyphosis correction. The loss of the Cobb angle from surgery to final follow-up was nonsignificant only in patients who underwent combined surgery. When determining the surgical approach, surgeons should carefully weigh the advantages of anterior and combined fusion against the significantly higher sur","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 2","pages":"Pages 112-128"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689891","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}
Chronic subdural hematoma is a frequent neurosurgical illness, and current treatment options mostly include subdural trepanation and drainage alone, as well as middle meningeal artery embolization in conjunction with subdural trepanation and drainage. However, there is currently a lack of extensive study and data support for comparing the clinical results of the two surgical treatment techniques.
Objective
The goal of this study is to compare the clinical effects of middle meningeal artery embolization combined with subdural trepanation and drainage versus simple subdural trepanation and drainage in the treatment of chronic subdural hematoma, in order to provide a reliable foundation for clinical selection of appropriate surgical treatment methods.
Methods
This study included 71 patients with chronic subdural hematoma, who were divided into two groups according to the procedure: observation group (n = 25) and control group (n = 46). The control group received only basic subdural drilling and drainage.
Conclusions
This study found that MMA embolization combined with subdural trepanation and drainage provides a greater therapeutic benefit in the treatment of chronic subdural hematoma. The observation group outperformed the control group in terms of postoperative CT results, Barthel index, and clinical effect, as well as operating time. Furthermore, the observation group's complications and recurrence rate were much lower than the control group’s.
{"title":"Comparison of clinical efficacy of MMA embolization combined with subdural perforation drainage and subdural perforation drainage in the treatment of CSDH","authors":"Wen Cheng, Quanlong Yang, Xiaodong Yuan, Jiangbin Wu","doi":"10.1016/j.neucie.2024.11.001","DOIUrl":"10.1016/j.neucie.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Chronic subdural hematoma is a frequent neurosurgical illness, and current treatment options mostly include subdural trepanation and drainage alone, as well as middle meningeal artery embolization in conjunction with subdural trepanation and drainage. However, there is currently a lack of extensive study and data support for comparing the clinical results of the two surgical treatment techniques.</div></div><div><h3>Objective</h3><div>The goal of this study is to compare the clinical effects of middle meningeal artery embolization combined with subdural trepanation and drainage versus simple subdural trepanation and drainage in the treatment of chronic subdural hematoma, in order to provide a reliable foundation for clinical selection of appropriate surgical treatment methods.</div></div><div><h3>Methods</h3><div>This study included 71 patients with chronic subdural hematoma, who were divided into two groups according to the procedure: observation group (n = 25) and control group (n = 46). The control group received only basic subdural drilling and drainage.</div></div><div><h3>Conclusions</h3><div>This study found that MMA embolization combined with subdural trepanation and drainage provides a greater therapeutic benefit in the treatment of chronic subdural hematoma. The observation group outperformed the control group in terms of postoperative CT results, Barthel index, and clinical effect, as well as operating time. Furthermore, the observation group's complications and recurrence rate were much lower than the control group’s.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 2","pages":"Pages 75-82"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649765","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}
Pub Date : 2025-03-01DOI: 10.1016/j.neucie.2024.10.007
Juan Sebastián Solis-Mata , Fernando Castro-Soto , José Alfonso Alvarez-Castro , Sonia Iliana Mejía-Pérez
Dandy–Walker malformation (DWM) and pilocytic astrocytoma are entities that manifest themselves at an early age. DWM is a cerebella type associated with several anatomical changes. Very few cases of concomitant occurrence of DWM and pilocytic astrocytoma have been reported on the literature. Male 20 years old, clinical history of 6 months of evolution with nausea, dizziness, headache, photophobia, phonofobia, vomiting, walking laterality, diplopia, tonic–clonic seizures, nystagmus, dysmetria, and dysdiadochokinesia. Cranial tomography was performed, reporting hydrocephaly data with significant dilation of the IV ventricle and the presence of a tumor lesion in the posterior fossa of the right cerebellar hemisphere. Pediatric tumors that manifest in adulthood are rare, with signs such as intracranial hypertension and compress the cranial nerves. The prognosis will be determined by the accompanying abnormalities as well as the effectiveness of the appropriate treatment.
{"title":"A case report on a late diagnosis of pilocytic astrocytoma in a Dandy–Walker complex","authors":"Juan Sebastián Solis-Mata , Fernando Castro-Soto , José Alfonso Alvarez-Castro , Sonia Iliana Mejía-Pérez","doi":"10.1016/j.neucie.2024.10.007","DOIUrl":"10.1016/j.neucie.2024.10.007","url":null,"abstract":"<div><div>Dandy–Walker malformation (DWM) and pilocytic astrocytoma are entities that manifest themselves at an early age. DWM is a cerebella type associated with several anatomical changes. Very few cases of concomitant occurrence of DWM and pilocytic astrocytoma have been reported on the literature. Male 20 years old, clinical history of 6 months of evolution with nausea, dizziness, headache, photophobia, phonofobia, vomiting, walking laterality, diplopia, tonic–clonic seizures, nystagmus, dysmetria, and dysdiadochokinesia. Cranial tomography was performed, reporting hydrocephaly data with significant dilation of the IV ventricle and the presence of a tumor lesion in the posterior fossa of the right cerebellar hemisphere. Pediatric tumors that manifest in adulthood are rare, with signs such as intracranial hypertension and compress the cranial nerves. The prognosis will be determined by the accompanying abnormalities as well as the effectiveness of the appropriate treatment.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"36 2","pages":"Pages 139-143"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527548","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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