Pub Date : 2023-03-01DOI: 10.1016/j.neucie.2022.11.017
Esteban Ramírez-Ferrer, Rafael Aponte-Caballero, Maria Paula Aguilera-Pena, Santiago David Mendoza-Ayús, Luis Alejandro Osorio-Bohorquez, William Mauricio Riveros-Castillo
Cerebral Arteriovenous malformations (AVMs) are presumed congenital anomalies of the blood vessels, which can increase intracranial pressure by uncertain mechanisms.
We report the rare case of a 55-year-old male patient who complained about CSF rhinorrhea. Persisting CSF leakage prompted CT, which evidenced a bone defect in the right middle cranial fossa with protruding brain tissue. The diagnosis of a sphenoidal meningoencephalocele was made. Neuroimaging evidenced an AVM Spetzler Martin V. The lesion was targeted via an endonasal approach with resection of the herniated brain tissue and closure of the bony and dural defects. The postoperative course was uneventful without recurrence of the CSF fistula.
Documentation of these cases is essential to come up with standardized therapeutical protocols and follow-up. Nevertheless, conservative management of the AVM and surgical repair of the bone defects is an appropriate approach in the first instance, depending on the morphology and characterization of the AVM.
{"title":"Sphenoidal meningoencephalocele associated with CSF fistula and arteriovenous malformation Spetzler-Martin V: A case report","authors":"Esteban Ramírez-Ferrer, Rafael Aponte-Caballero, Maria Paula Aguilera-Pena, Santiago David Mendoza-Ayús, Luis Alejandro Osorio-Bohorquez, William Mauricio Riveros-Castillo","doi":"10.1016/j.neucie.2022.11.017","DOIUrl":"10.1016/j.neucie.2022.11.017","url":null,"abstract":"<div><p>Cerebral Arteriovenous malformations<span><span> (AVMs) are presumed congenital anomalies of the blood vessels, which can increase </span>intracranial pressure by uncertain mechanisms.</span></p><p><span><span>We report the rare case of a 55-year-old male patient who complained about CSF rhinorrhea<span>. Persisting CSF leakage<span> prompted CT<span>, which evidenced a bone defect<span> in the right middle cranial fossa with protruding </span></span></span></span></span>brain tissue<span>. The diagnosis of a sphenoidal meningoencephalocele was made. Neuroimaging evidenced an </span></span>AVM<span> Spetzler Martin V. The lesion was targeted via an endonasal approach with resection of the herniated brain tissue and closure of the bony and dural defects. The postoperative course was uneventful without recurrence of the CSF fistula.</span></p><p>Documentation of these cases is essential to come up with standardized therapeutical protocols and follow-up. Nevertheless, conservative management of the AVM and surgical repair of the bone defects is an appropriate approach in the first instance, depending on the morphology and characterization of the AVM.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9488935","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 : 2023-03-01DOI: 10.1016/j.neucie.2022.01.003
Sara Iglesias , Pablo M. Munarriz , Javier Saceda , Gregorio Catalán-Uribarrena , Pablo Miranda , Juana M. Vidal , David Fustero , Jorge Giménez-Pando , Francisca Rius
Purpose
To present a descriptive analysis of pediatric craniopharyngiomas (PedCPG) treated in various Spanish hospitals, defining factors related to recurrence and performing a critical analysis of the results.
Methods
We undertook a multicenter retrospective review of PedCPG treated between 2000 and 2017. Data collected included epidemiological variables, clinical and radiological characteristics, goal of first surgery, rate of recurrence and its approach, adjuvant treatment, complications and permanent morbidity. Associations were studied between progression and number of progressions and independent variables.
Results
The study involved 69 children from 8 Spanish hospitals. Most of the tumors invaded several intracranial compartments at diagnosis, with the hypothalamus involved in 41.3% of cases. The first treatment strategy was usually gross total resection (GTR) (71%), with some patients treated with radiotherapy or intracystic chemotherapy. The progression rate after first surgery was 53% in a mean follow-up of 88.2 months (range 7–357). In the GTR group 38.8% of tumors recurred, 40% in the group of subtotal resection or biopsy and 93.3% in the cyst fenestration ± Ommaya reservoir group. Mortality was 7.2%. Follow-up period, size of the tumor and goal of first surgery were significantly related with progression.
Conclusions
Our results in terms of disease control, hormonal or visual impairment and mortality were acceptable, but there are several areas for improvement. Our short-term goals should be to create a national register of PedCPG, reach a consensus about a treatment algorithm, and improve diagnosis of hypothalamic dysfunction to avoid preventable morbidity.
{"title":"Multicentric and collaborative study of Spanish neurosurgical management of pediatric craniopharyngiomas: S-PedCPG.co","authors":"Sara Iglesias , Pablo M. Munarriz , Javier Saceda , Gregorio Catalán-Uribarrena , Pablo Miranda , Juana M. Vidal , David Fustero , Jorge Giménez-Pando , Francisca Rius","doi":"10.1016/j.neucie.2022.01.003","DOIUrl":"10.1016/j.neucie.2022.01.003","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To present a descriptive analysis of pediatric </span>craniopharyngiomas (PedCPG) treated in various Spanish hospitals, defining factors related to recurrence and performing a critical analysis of the results.</p></div><div><h3>Methods</h3><p>We undertook a multicenter retrospective review of PedCPG treated between 2000 and 2017. Data collected included epidemiological variables, clinical and radiological characteristics, goal of first surgery, rate of recurrence and its approach, adjuvant treatment, complications and permanent morbidity. Associations were studied between progression and number of progressions and independent variables.</p></div><div><h3>Results</h3><p><span>The study involved 69 children from 8 Spanish hospitals. Most of the tumors invaded several intracranial compartments at diagnosis, with the hypothalamus<span> involved in 41.3% of cases. The first treatment strategy was usually gross total resection (GTR) (71%), with some patients treated with radiotherapy or intracystic chemotherapy. The progression rate after first surgery was 53% in a mean follow-up of 88.2 months (range 7–357). In the GTR group 38.8% of tumors recurred, 40% in the group of subtotal resection or biopsy and 93.3% in the cyst fenestration</span></span> <!-->±<!--> <span>Ommaya reservoir group. Mortality was 7.2%. Follow-up period, size of the tumor and goal of first surgery were significantly related with progression.</span></p></div><div><h3>Conclusions</h3><p>Our results in terms of disease control, hormonal or visual impairment<span> and mortality were acceptable, but there are several areas for improvement. Our short-term goals should be to create a national register of PedCPG, reach a consensus about a treatment algorithm, and improve diagnosis of hypothalamic dysfunction to avoid preventable morbidity.</span></p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117493","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 : 2023-03-01DOI: 10.1016/j.neucie.2022.11.012
Roberto M. Soriano , Juan M. Revuelta Barbero , Gustavo Pradilla , Oswaldo A. Henriquez
Transpatial skull base lesions involving the infratemporal fossa (ITF) are challenging due to the complex neurovascular structures of the region. Open approaches have traditionally been utilized to access these spaces. We present a 55-year-old woman presented with a mesenchymal mass involving the left ITF and masticator space. A combined endoscopic endonasal transpterygoid approach was performed followed by an endoscopic transoral-transmandibular corridor to access and resect the tumor. The post-operative course was unremarkable with no recurrence during her follow-up. Combined endoscopic approaches for transpatial tumor resection offered sufficient exposure to access safely each space.
{"title":"Combined endoscopic endonasal & transoral approach to transpatial lesion involving the infratemporal fossa and masticator space: A case study and literature review","authors":"Roberto M. Soriano , Juan M. Revuelta Barbero , Gustavo Pradilla , Oswaldo A. Henriquez","doi":"10.1016/j.neucie.2022.11.012","DOIUrl":"10.1016/j.neucie.2022.11.012","url":null,"abstract":"<div><p>Transpatial skull base lesions involving the infratemporal fossa (ITF) are challenging due to the complex neurovascular structures of the region. Open approaches have traditionally been utilized to access these spaces. We present a 55-year-old woman presented with a mesenchymal mass involving the left ITF and masticator space. A combined endoscopic endonasal transpterygoid approach was performed followed by an endoscopic transoral-transmandibular corridor to access and resect the tumor. The post-operative course was unremarkable with no recurrence during her follow-up. Combined endoscopic approaches for transpatial tumor resection offered sufficient exposure to access safely each space.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117495","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}
To investigate the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) with different stimulation frequencies on static balance.
Materials and methods
Twenty patients (15 males and 5 females), aged between 43 and 81 (mean: 60.05 ± 7.4) years, who had been diagnosed with idiopathic Parkinson's disease (PD) and undergone STN-DBS surgery were included in the study. Static balance was assessed with TecnoBody Rehabilitation System at four different frequencies: 230, 130, 90 and 60 Hz and off-stimulation. Static balance tests were ‘stabilometric test, stabilometric compared bipedal closed/opened eye, stabilometric compared mono pedal (right/left foot)’. These tests reported the centre of pressure data ‘ellipse area, perimeter, front/back and mediolateral standard deviations’.
Results
There were no statically differences between the static balance test results at any frequency (p > 0.05), but results were found better at 90 Hz. Stabilometric compared bipedal opened eye forward–backward standard deviation result was significant between off-stimulation and 130 Hz (p = 0.04). Different frequency stimulation affected the static balance categories percentage with no statistical significance between off-stimulation and others (all p > 0.05).
Conclusion
This study showed that STN-DBS did not affect the static balance negatively. Low-frequency (LF) stimulation improved the static equilibrium. Posturography systems will give more precise and quantitative results in similar studies with wide frequency ranges.
{"title":"Does subthalamic nucleus deep brain stimulation affect the static balance at different frequencies?","authors":"Fatma Oz , Bircan Yucekeya , Irem Huzmeli , Atilla Yilmaz","doi":"10.1016/j.neucie.2022.11.014","DOIUrl":"10.1016/j.neucie.2022.11.014","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) with different stimulation frequencies on static balance.</p></div><div><h3>Materials and methods</h3><p>Twenty patients (15 males and 5 females), aged between 43 and 81 (mean: 60.05<!--> <!-->±<!--> <!-->7.4) years, who had been diagnosed with idiopathic Parkinson's disease (PD) and undergone STN-DBS surgery were included in the study. Static balance was assessed with TecnoBody Rehabilitation System at four different frequencies: 230, 130, 90 and 60<!--> <!-->Hz and off-stimulation. Static balance tests were ‘stabilometric test, stabilometric compared bipedal closed/opened eye, stabilometric compared mono pedal (right/left foot)’. These tests reported the centre of pressure data ‘ellipse area, perimeter, front/back and mediolateral standard deviations’.</p></div><div><h3>Results</h3><p>There were no statically differences between the static balance test results at any frequency (<em>p</em> <!-->><!--> <!-->0.05), but results were found better at 90<!--> <!-->Hz. Stabilometric compared bipedal opened eye forward–backward standard deviation result was significant between off-stimulation and 130<!--> <!-->Hz (<em>p</em> <!-->=<!--> <!-->0.04). Different frequency stimulation affected the static balance categories percentage with no statistical significance between off-stimulation and others (all <em>p</em> <!-->><!--> <!-->0.05).</p></div><div><h3>Conclusion</h3><p>This study showed that STN-DBS did not affect the static balance negatively. Low-frequency (LF) stimulation improved the static equilibrium. Posturography systems will give more precise and quantitative results in similar studies with wide frequency ranges.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117496","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 : 2023-03-01DOI: 10.1016/j.neucie.2022.11.015
Dimitri Laurent, Brandon Lucke-Wold, Kevin Pierre, Olgert Bardhi, Sijia Yue, Meghan Brennan, W. Christopher Fox, Nohra Chalouhi, Matthew J. Koch, Brian Hoh, Jamie S. Dow, Gregory J.A. Murad, Adam Polifka
Introduction
National and international trends continue to show greater emphasis on endovascular techniques for the treatment of cerebrovascular disease. The cerebrovascular neurosurgeon however must be adequately equipped to treat these patients via both open and endovascular techniques.
Methods
The decline in open cerebrovascular cases for aneurysm clipping has forced many trainees to pursue open cerebrovascular fellowships to increase case volume. An alternative strategy has been employed at our institution, which is early identification of subspecialty focus with resident driven self-selection of open cerebrovascular cases.
Results
This has allowed recent graduates to obtain enfolded endovascular training and a significant number of open cerebrovascular cases in order to obtain competence and exposure.
Discussion
We advocate for further self-selection paradigms supplemented with simulation training in order to obviate the need for extended post-residency fellowships.
{"title":"Focused selection of open cerebrovascular cases for residents interested in cerebrovascular neurosurgery","authors":"Dimitri Laurent, Brandon Lucke-Wold, Kevin Pierre, Olgert Bardhi, Sijia Yue, Meghan Brennan, W. Christopher Fox, Nohra Chalouhi, Matthew J. Koch, Brian Hoh, Jamie S. Dow, Gregory J.A. Murad, Adam Polifka","doi":"10.1016/j.neucie.2022.11.015","DOIUrl":"10.1016/j.neucie.2022.11.015","url":null,"abstract":"<div><h3>Introduction</h3><p><span>National and international trends continue to show greater emphasis on endovascular techniques for the treatment of </span>cerebrovascular disease. The cerebrovascular neurosurgeon however must be adequately equipped to treat these patients via both open and endovascular techniques.</p></div><div><h3>Methods</h3><p>The decline in open cerebrovascular cases for aneurysm clipping has forced many trainees to pursue open cerebrovascular fellowships to increase case volume. An alternative strategy has been employed at our institution, which is early identification of subspecialty focus with resident driven self-selection of open cerebrovascular cases.</p></div><div><h3>Results</h3><p>This has allowed recent graduates to obtain enfolded endovascular training and a significant number of open cerebrovascular cases in order to obtain competence and exposure.</p></div><div><h3>Discussion</h3><p>We advocate for further self-selection paradigms supplemented with simulation training in order to obviate the need for extended post-residency fellowships.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9994638/pdf/nihms-1796168.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9488936","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 : 2023-03-01DOI: 10.1016/j.neucie.2022.11.013
Ignacio Arrese, Santiago Cepeda, Sergio García-García, Rosario Sarabia
Introduction
Carotid endarterectomy (CEA) is usually performed using the anterior cervical triangle as a surgical corridor but, when needed, the retromandibular space makes dissection of higher structures difficult in some cases. The posterior cervical triangle (PCT) can be useful in these demanding cases.
Methods
We retrospectively reviewed cases from July 2013 to November 2019 in which PCT was used as an approach for CEA. The surgical technique used was explained, and the complications and evolution of the patients were analysed.
Results
We found 7 CEAs performed through this approach, of which 2 presented transient trapezius paresis. There were no cases of severe complications in this series.
Conclusion
The PCT approach for performing CEA represents a useful and easy technique that avoids the need for mandibular mobilisation or osteotomies for lesions located in anatomically high carotid bifurcations.
{"title":"Posterior cervical triangle approach for carotid endarterectomy: Technical note and results","authors":"Ignacio Arrese, Santiago Cepeda, Sergio García-García, Rosario Sarabia","doi":"10.1016/j.neucie.2022.11.013","DOIUrl":"10.1016/j.neucie.2022.11.013","url":null,"abstract":"<div><h3>Introduction</h3><p>Carotid endarterectomy (CEA) is usually performed using the anterior cervical triangle as a surgical corridor but, when needed, the retromandibular space makes dissection of higher structures difficult in some cases. The posterior cervical triangle (PCT) can be useful in these demanding cases.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed cases from July 2013 to November 2019 in which PCT was used as an approach for CEA. The surgical technique used was explained, and the complications and evolution of the patients were analysed.</p></div><div><h3>Results</h3><p>We found 7 CEAs performed through this approach, of which 2 presented transient trapezius paresis. There were no cases of severe complications in this series.</p></div><div><h3>Conclusion</h3><p>The PCT approach for performing CEA represents a useful and easy technique that avoids the need for mandibular mobilisation or osteotomies for lesions located in anatomically high carotid bifurcations.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9488931","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 : 2023-01-01DOI: 10.1016/j.neucie.2022.11.005
Pedro Plou , Luis Boccalatte , Fernando Padilla-Lichtenberger , Marcelo Figari , Pablo Ajler , Juan Larrañaga
Introduction
Resection of malignant tumors located in the anterior and middle fossae of the skull base requires thorough anatomical knowledge, as well as experience regarding the possible reconstructive options to resolve the resulting defects. The anatomical and functional relevance of the region, the complexity of the defects requiring reconstruction and the potential complications that can occur, represent a true challenge for the surgical team. The goal of this study is to describe the microsurgical reconstructive techniques available, their usefulness and postoperative complications, in patients with malignant tumors involving the skull base.
Materials and method
This observational, retrospective study, included all patients who underwent surgery for malignant craniofacial tumors from January 1st, 2009 to January 1st, 2019 at a University Hospital in Argentina. Only patients who required reconstruction of the resulting defect with a free flap were included.
Results
Twenty-four patients required reconstruction with FF; 14 were male (58.3%) and mean age was 54.9 years. Sarcoma was the most frequent tumor histology. Free flaps used were the following: anterolateral thigh, rectus abdominis, radial, latissimus dorsi, iliac crest and fibular. Complications occurred in 6 cases and no deaths were reported in the study group.
Conclusion
Free flaps are considered one of the preferable choices of treatment for large skull base defects. In spite of the complexity of the technique and the learning curve required, free flaps have shown to be safe, with a low rate of serious complications. For these patients, the surgical resolution should be performed by a multidisciplinary team.
{"title":"Microsurgical free flaps for skull base reconstruction following tumor resection: Available techniques and complications","authors":"Pedro Plou , Luis Boccalatte , Fernando Padilla-Lichtenberger , Marcelo Figari , Pablo Ajler , Juan Larrañaga","doi":"10.1016/j.neucie.2022.11.005","DOIUrl":"10.1016/j.neucie.2022.11.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Resection of malignant tumors located in the anterior and middle fossae of the skull base requires thorough anatomical knowledge, as well as experience regarding the possible reconstructive options to resolve the resulting defects. The anatomical and functional relevance of the region, the complexity of the defects requiring reconstruction and the potential complications that can occur, represent a true challenge for the surgical team. The goal of this study is to describe the microsurgical reconstructive techniques available, their usefulness and postoperative complications, in patients with malignant tumors involving the skull base.</p></div><div><h3>Materials and method</h3><p>This observational, retrospective study, included all patients who underwent surgery for malignant craniofacial tumors from January 1st, 2009 to January 1st, 2019 at a University Hospital in Argentina. Only patients who required reconstruction of the resulting defect with a free flap were included.</p></div><div><h3>Results</h3><p>Twenty-four patients required reconstruction with FF; 14 were male (58.3%) and mean age was 54.9 years. Sarcoma was the most frequent tumor histology. Free flaps used were the following: anterolateral thigh, rectus abdominis, radial, latissimus dorsi, iliac crest and fibular. Complications occurred in 6 cases and no deaths were reported in the study group.</p></div><div><h3>Conclusion</h3><p>Free flaps are considered one of the preferable choices of treatment for large skull base defects. In spite of the complexity of the technique and the learning curve required, free flaps have shown to be safe, with a low rate of serious complications. For these patients, the surgical resolution should be performed by a multidisciplinary team.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635962","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}
A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients.
{"title":"Minimally invasive retrieval of a bullet settling into the thoracic spinal canal in a pediatric patient: A case report","authors":"Rami Darwazeh , Mazhar Darwazeh , Mohammed Awad Elzain , Rasha Al-Kanash","doi":"10.1016/j.neucie.2022.11.016","DOIUrl":"10.1016/j.neucie.2022.11.016","url":null,"abstract":"<div><p>A 10-year-old boy presented to neurosurgery<span> department after a gunshot wound to the upper thoracic spine<span>. The bullet entered through the right deltoid muscle<span> and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter<span> tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients.</span></span></span></span></p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635960","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 : 2023-01-01DOI: 10.1016/j.neucie.2022.02.009
David Camilo Gómez Cristancho , Gabriela Jovel Trujillo , Iván Felipe Manrique , Juan Carlos Pérez Rodríguez , Roberto Carlos Díaz Orduz , Miguel Enrique Berbeo Calderón
The literature that explains the neurological mechanisms underlying the development or compensation of idiopathic scoliosis is limited. The objective of the article is to describe and integrate the mechanisms and nerve pathways through which idiopathic scoliosis is compensated and/or developed. A narrative systematic review in different databases of the studies published between January 1, 1967 and April 1, 2021 was performed, using the following terms: “scoliosis”, “vision”, “eye”, “vestibule”, “labyrinth” “posture”, “balance”, “eye movements”, “cerebellum”, “proprioception”, and “physiological adaptation”. In the search, 1112 references were identified, of which 50 were finally included: 46 observational analytical clinical studies-descriptive (between cohorts, report and series of cases) and 4 experimental studies. In the neurological response to idiopathic scoliosis, the sensory-cortical integration of the afferences in the visual-oculomotor-vestibular-proprioceptive systems, allows modifications at the postural level in order to achieve an initial compensation on the sagittal balance and the centre of body mass; however, over time these compensation mechanisms may be exhausted causing progression of the initial deformity.
{"title":"Neurological mechanisms involved in idiopathic scoliosis. Systematic review of the literature","authors":"David Camilo Gómez Cristancho , Gabriela Jovel Trujillo , Iván Felipe Manrique , Juan Carlos Pérez Rodríguez , Roberto Carlos Díaz Orduz , Miguel Enrique Berbeo Calderón","doi":"10.1016/j.neucie.2022.02.009","DOIUrl":"10.1016/j.neucie.2022.02.009","url":null,"abstract":"<div><p>The literature that explains the neurological mechanisms underlying the development or compensation of idiopathic scoliosis<span><span> is limited. The objective of the article is to describe and integrate the mechanisms and nerve pathways through which idiopathic scoliosis is compensated and/or developed. A narrative </span>systematic review in different databases of the studies published between January 1, 1967 and April 1, 2021 was performed, using the following terms: “scoliosis”, “vision”, “eye”, “vestibule”, “labyrinth” “posture”, “balance”, “eye movements”, “cerebellum”, “proprioception”, and “physiological adaptation”. In the search, 1112 references were identified, of which 50 were finally included: 46 observational analytical clinical studies-descriptive (between cohorts, report and series of cases) and 4 experimental studies. In the neurological response to idiopathic scoliosis, the sensory-cortical integration of the afferences in the visual-oculomotor-vestibular-proprioceptive systems, allows modifications at the postural level in order to achieve an initial compensation on the sagittal balance and the centre of body mass; however, over time these compensation mechanisms may be exhausted causing progression of the initial deformity.</span></p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10265461","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 : 2023-01-01DOI: 10.1016/j.neucie.2022.11.001
Antonio Selfa, Cinta Arráez, Ángela Ros, Jorge Linares, Laura Cerro, Miguel Ángel Arráez
Craniopharyngiomas are benign epithelial tumors which may very occasionally recur in ectopic locations. We present two cases of ectopic recurrence, both in the posterior fossa, and provide a review of the literature with basic statistics. Two patients admitted to our institution with posterior fossa lesions underwent gross total resection. Pathological studies showed adamantinomatous craniopharyngiomas (ACP). Both patients had a prior history of suprasellar tumor surgery. We also reviewed the related data and undertook a basic statistical analysis. We found 67 cases of ectopic recurrent craniopharyngioma (including the present cases): 51 cases were adamantinomatous (76%), 6 papillary (9%) and 10 unknown (15%). 18 cases occurred in the posterior fossa, all of them diagnosed as the ACP subtype. The intervals until recurrence were 15.15 years for posterior fossa recurrences and 5.75 years for supratentorial cases. Student t test showed significant differences in time to recurrence (p 0.002). Gross total resection was performed in 53 cases (79%), subtotal resection + radiotherapy in 3 (5%) and 11 (16%) cases were treated with other options. Ectopic recurrence is a rare but possible event. Those in the posterior fossa may appear later than in the supratentorial space. ACP is likely to be the most common subtype in these cases, possibly due to its more aggressive behavior compared to the papillary subtype. Long term follow-up should be performed to detect ectopic recurrences. Ectopic recurrences are often surgically accessible and gross total resection should be achieved.
{"title":"Ectopic recurrence of craniopharyngioma in the posterior fossa: Case report and review of the literature","authors":"Antonio Selfa, Cinta Arráez, Ángela Ros, Jorge Linares, Laura Cerro, Miguel Ángel Arráez","doi":"10.1016/j.neucie.2022.11.001","DOIUrl":"10.1016/j.neucie.2022.11.001","url":null,"abstract":"<div><p><span><span>Craniopharyngiomas<span> are benign epithelial tumors which may very occasionally recur in ectopic locations. We present two cases of ectopic recurrence, both in the </span></span>posterior fossa, and provide a review of the literature with basic statistics. Two patients admitted to our institution with posterior fossa lesions underwent gross total resection. Pathological studies showed adamantinomatous craniopharyngiomas (ACP). Both patients had a prior history of suprasellar tumor surgery. We also reviewed the related data and undertook a basic statistical analysis. We found 67 cases of ectopic recurrent craniopharyngioma (including the present cases): 51 cases were adamantinomatous (76%), 6 papillary (9%) and 10 unknown (15%). 18 cases occurred in the posterior fossa, all of them diagnosed as the ACP subtype. The intervals until recurrence were 15.15 years for posterior fossa recurrences and 5.75 years for supratentorial cases. Student </span><em>t</em> test showed significant differences in time to recurrence (<em>p</em> 0.002). Gross total resection was performed in 53 cases (79%), subtotal resection<!--> <!-->+<!--> <!-->radiotherapy in 3 (5%) and 11 (16%) cases were treated with other options. Ectopic recurrence is a rare but possible event. Those in the posterior fossa may appear later than in the supratentorial space. ACP is likely to be the most common subtype in these cases, possibly due to its more aggressive behavior compared to the papillary subtype. Long term follow-up should be performed to detect ectopic recurrences. Ectopic recurrences are often surgically accessible and gross total resection should be achieved.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10643629","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}