Abstract Background BioGlue is touted as a safe and effective sealant for various surgical procedures. This article describes five cases of delayed wound healing associated with the use of BioGlue after craniectomies. Case Description Five patients of different genders and ages who had undergone craniectomy with BioGlue were presented to our medical center with wound dehiscence and purulent discharge. The first attempt to solve this problem by incision and drainage was unsuccessful. The removal of BioGlue is necessary to eliminate these problems. Discussion The presence of wound dehiscence and aseptic cystic contents may indicate a chronic inflammatory process following the application of BioGlue. This problem usually occurs within a few months after wound closure. For rapid intervention, it is recommended to perform an incision and drainage and remove the BioGlue. The main risk factor is directly applying BioGlue to the skin, subcutaneous tissue, or titanium material. Conclusion Neurosurgeons should exercise caution and be aware of a possible delayed chronic inflammatory process in surgical wounds associated with the use of BioGlue as a sealant, especially when the product is used without cranial coverage or in cases where it comes into direct contact with subcutaneous tissue or titanium material. To resolve this issue quickly, BioGlue should be completely removed at the first attempt at incision and drainage.
{"title":"Delayed Wound Healing Resulting from Inflammatory Process in Craniectomy Patients Treated with BioGlue: A Case Series with Literature Review","authors":"Methee Wongsirsiuwan","doi":"10.1055/s-0044-1787673","DOIUrl":"https://doi.org/10.1055/s-0044-1787673","url":null,"abstract":"Abstract Background BioGlue is touted as a safe and effective sealant for various surgical procedures. This article describes five cases of delayed wound healing associated with the use of BioGlue after craniectomies. Case Description Five patients of different genders and ages who had undergone craniectomy with BioGlue were presented to our medical center with wound dehiscence and purulent discharge. The first attempt to solve this problem by incision and drainage was unsuccessful. The removal of BioGlue is necessary to eliminate these problems. Discussion The presence of wound dehiscence and aseptic cystic contents may indicate a chronic inflammatory process following the application of BioGlue. This problem usually occurs within a few months after wound closure. For rapid intervention, it is recommended to perform an incision and drainage and remove the BioGlue. The main risk factor is directly applying BioGlue to the skin, subcutaneous tissue, or titanium material. Conclusion Neurosurgeons should exercise caution and be aware of a possible delayed chronic inflammatory process in surgical wounds associated with the use of BioGlue as a sealant, especially when the product is used without cranial coverage or in cases where it comes into direct contact with subcutaneous tissue or titanium material. To resolve this issue quickly, BioGlue should be completely removed at the first attempt at incision and drainage.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141371065","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}
Abstract The standard of care for treating acute large vessel occlusion is endovascular therapy. The most frequent cause of occlusion is either embolic occlusion or in situ thrombotic occlusion. However, occlusion resulting from intracranial dissection is extremely rare, especially in the middle cerebral artery. Prior to a thrombectomy or endovascular therapy, understanding and interpreting the angiographic findings is crucial for planning the appropriate treatment and preventing complications.
{"title":"Atherosclerosis-Like Spontaneous Middle Cerebral Artery Dissection","authors":"Yodkhwan Wattanasen, S. Komonchan","doi":"10.1055/s-0044-1787534","DOIUrl":"https://doi.org/10.1055/s-0044-1787534","url":null,"abstract":"Abstract The standard of care for treating acute large vessel occlusion is endovascular therapy. The most frequent cause of occlusion is either embolic occlusion or in situ thrombotic occlusion. However, occlusion resulting from intracranial dissection is extremely rare, especially in the middle cerebral artery. Prior to a thrombectomy or endovascular therapy, understanding and interpreting the angiographic findings is crucial for planning the appropriate treatment and preventing complications.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141375405","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}
Pornthida Chuthip, B. Sitthinamsuwan, Theerapol Witthiwej, Chottiwat Tansirisithikul, Inthira Khumpalikit, S. Nunta-aree
Abstract Introduction Differentiation between glioblastoma (GBM), primary central nervous system lymphoma (PCNSL), and metastasis is important in decision-making before surgery. However, these malignant brain tumors have overlapping features. This study aimed to identify predictors differentiating between GBM, PCNSL, and metastasis. Materials and Methods Patients with a solitary intracranial enhancing tumor and a histopathological diagnosis of GBM, PCNSL, or metastasis were investigated. All patients with intracranial lymphoma had PCNSL without extracranial involvement. Demographic, clinical, and radiographic data were analyzed to determine their associations with the tumor types. Results The predictors associated with GBM were functional impairment ( p = 0.001), large tumor size ( p < 0.001), irregular tumor margin ( p < 0.001), heterogeneous contrast enhancement ( p < 0.001), central necrosis ( p < 0.001), intratumoral hemorrhage ( p = 0.018), abnormal flow void ( p < 0.001), and hypodensity component on noncontrast cranial computed tomography (CT) scan ( p < 0.001). The predictors associated with PCNSL comprised functional impairment ( p = 0.005), deep-seated tumor location ( p = 0.006), homogeneous contrast enhancement ( p < 0.001), absence of cystic appearance ( p = 0.008), presence of hypointensity component on precontrast cranial T1-weighted magnetic resonance imaging (MRI; p = 0.027), and presence of isodensity component on noncontrast cranial CT ( p < 0.008). Finally, the predictors for metastasis were an infratentorial ( p < 0.001) or extra-axial tumor location ( p = 0.035), smooth tumor margin ( p < 0.001), and presence of isointensity component on cranial fluid-attenuated inversion recovery MRI ( p = 0.047). Conclusion These predictors may be used to differentiate between GBM, PCNSL, and metastasis, and they are useful in clinical management.
{"title":"Predictors for the Differentiation between Glioblastoma, Primary Central Nervous System Lymphoma, and Metastasis in Patients with a Solitary Enhancing Intracranial Mass","authors":"Pornthida Chuthip, B. Sitthinamsuwan, Theerapol Witthiwej, Chottiwat Tansirisithikul, Inthira Khumpalikit, S. Nunta-aree","doi":"10.1055/s-0044-1787051","DOIUrl":"https://doi.org/10.1055/s-0044-1787051","url":null,"abstract":"Abstract Introduction Differentiation between glioblastoma (GBM), primary central nervous system lymphoma (PCNSL), and metastasis is important in decision-making before surgery. However, these malignant brain tumors have overlapping features. This study aimed to identify predictors differentiating between GBM, PCNSL, and metastasis. Materials and Methods Patients with a solitary intracranial enhancing tumor and a histopathological diagnosis of GBM, PCNSL, or metastasis were investigated. All patients with intracranial lymphoma had PCNSL without extracranial involvement. Demographic, clinical, and radiographic data were analyzed to determine their associations with the tumor types. Results The predictors associated with GBM were functional impairment ( p = 0.001), large tumor size ( p < 0.001), irregular tumor margin ( p < 0.001), heterogeneous contrast enhancement ( p < 0.001), central necrosis ( p < 0.001), intratumoral hemorrhage ( p = 0.018), abnormal flow void ( p < 0.001), and hypodensity component on noncontrast cranial computed tomography (CT) scan ( p < 0.001). The predictors associated with PCNSL comprised functional impairment ( p = 0.005), deep-seated tumor location ( p = 0.006), homogeneous contrast enhancement ( p < 0.001), absence of cystic appearance ( p = 0.008), presence of hypointensity component on precontrast cranial T1-weighted magnetic resonance imaging (MRI; p = 0.027), and presence of isodensity component on noncontrast cranial CT ( p < 0.008). Finally, the predictors for metastasis were an infratentorial ( p < 0.001) or extra-axial tumor location ( p = 0.035), smooth tumor margin ( p < 0.001), and presence of isointensity component on cranial fluid-attenuated inversion recovery MRI ( p = 0.047). Conclusion These predictors may be used to differentiate between GBM, PCNSL, and metastasis, and they are useful in clinical management.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141377920","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}
Pankaj Totala, Vikas Janu, R. Sharma, Mohit Agrawal, M. Garg, J. Gosal, S. Bhaskar, D. Jha
Abstract Purpose There is an acute shortage of neurosurgeons and spine surgeons especially in rural areas of low- and middle-income countries including India. Patients of spine surgery need to travel long distances for follow-up at tertiary care hospitals. This study was done to evaluate role and success rate of telemedicine in follow-up after spine surgery based on patients' diagnosis and demographic features and to identify barriers to successful telemedicine consultations. Methods All patients undergoing spine surgeries including craniovertebral junction (CVJ) surgeries from January 2021 to June 2022 were included in the study. Success rate of telemedicine was calculated using a simple formula: Success rate of telemedicine = successful telemedicine consultations / total number of telemedicine consultation × 100. Success rate was evaluated with respect to demographic features and underlying disease-related factors. Results Eighty-four patients formed the study group in which a total of 181 video teleconsultations were done. Overall success rate of telemedicine was 82.87%. Higher socioeconomic and educational statuses were related to higher success rates of tele-consultations ( p < 0.05). Difficulty in assessing neurological condition using video call in follow-up cases of CVJ and issues related to Internet communication network leading to inability to video call and share image/videos were major causes of failures. Conclusion Telemedicine may prove an effective option for following up patients undergoing spine surgeries except CVJ, which is likely to improve further with improvements in Internet connectivity.
{"title":"Telemedicine in Follow-up after Spine Surgery: Need of the Hour","authors":"Pankaj Totala, Vikas Janu, R. Sharma, Mohit Agrawal, M. Garg, J. Gosal, S. Bhaskar, D. Jha","doi":"10.1055/s-0044-1787082","DOIUrl":"https://doi.org/10.1055/s-0044-1787082","url":null,"abstract":"Abstract Purpose There is an acute shortage of neurosurgeons and spine surgeons especially in rural areas of low- and middle-income countries including India. Patients of spine surgery need to travel long distances for follow-up at tertiary care hospitals. This study was done to evaluate role and success rate of telemedicine in follow-up after spine surgery based on patients' diagnosis and demographic features and to identify barriers to successful telemedicine consultations. Methods All patients undergoing spine surgeries including craniovertebral junction (CVJ) surgeries from January 2021 to June 2022 were included in the study. Success rate of telemedicine was calculated using a simple formula: Success rate of telemedicine = successful telemedicine consultations / total number of telemedicine consultation × 100. Success rate was evaluated with respect to demographic features and underlying disease-related factors. Results Eighty-four patients formed the study group in which a total of 181 video teleconsultations were done. Overall success rate of telemedicine was 82.87%. Higher socioeconomic and educational statuses were related to higher success rates of tele-consultations ( p < 0.05). Difficulty in assessing neurological condition using video call in follow-up cases of CVJ and issues related to Internet communication network leading to inability to video call and share image/videos were major causes of failures. Conclusion Telemedicine may prove an effective option for following up patients undergoing spine surgeries except CVJ, which is likely to improve further with improvements in Internet connectivity.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141376569","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}
Eric Plitman, L. Venkatraghavan, Sanket Agrawal, Vishvak Raghavan, Tumul Chowdhury, O. Sobczyk, E. Sayin, J. Poublanc, James Duffin, David D. Mikulis, J. Fisher
Abstract Introduction Controlling the partial pressure of carbon dioxide (PaCO 2 ) is an important consideration in patients with intracranial steno-occlusive disease to avoid reductions in critical perfusion from vasoconstriction due to hypocapnia, or reductions in blood flow due to steal physiology during hypercapnia. However, the normal range for resting PCO 2 in this patient population is not known. Therefore, we investigated the variability in resting end-tidal PCO 2 (P ET CO 2 ) in patients with intracranial steno-occlusive disease and the impact of revascularization on resting P ET CO 2 in these patients. Setting and Design Tertiary care center, retrospective chart review Materials and Methods We collected resting P ET CO 2 values in adult patients with intracranial steno-occlusive disease who presented to our institution between January 2010 and June 2021. We also explored postrevascularization changes in resting P ET CO 2 in a subset of patients. Results Two hundred and twenty-seven patients were included [moyamoya vasculopathy ( n = 98) and intracranial atherosclerotic disease ( n = 129)]. In the whole cohort, mean ± standard deviation resting P ET CO 2 was 37.8 ± 3.9 mm Hg (range: 26–47). In patients with moyamoya vasculopathy and intracranial atherosclerotic disease, resting P ET CO 2 was 38.4 ± 3.6 mm Hg (range: 28–47) and 37.4 ± 4.1 mm Hg (range: 26–46), respectively. A trend was identified suggesting increasing resting P ET CO 2 after revascularization in patients with low preoperative resting P ET CO 2 (<38 mm Hg) and decreasing resting P ET CO 2 after revascularization in patients with high preoperative resting P ET CO 2 (>38 mm Hg). Conclusions This study demonstrates that resting P ET CO 2 in patients with intracranial steno-occlusive disease is highly variable. In some patients, there was a change in resting P ET CO 2 after a revascularization procedure.
摘要 引言 控制二氧化碳分压（PaCO 2）是颅内狭窄性闭塞症患者的一个重要考虑因素，以避免因低碳酸血症导致血管收缩而导致临界灌注量减少，或因高碳酸血症期间的盗血生理现象而导致血流量减少。然而，这类患者静息 PCO 2 的正常范围尚不清楚。因此，我们研究了颅内狭窄闭塞症患者静息潮气末 PCO 2（P ET CO 2）的变异性，以及血管再通术对这些患者静息 P ET CO 2 的影响。材料和方法 我们收集了 2010 年 1 月至 2021 年 6 月期间在我院就诊的颅内狭窄闭塞症成年患者的静息 P ET CO 2 值。我们还研究了一部分患者血管重建后静息 P ET CO 2 的变化。结果 共纳入 227 名患者[莫亚莫亚血管病（98 人）和颅内动脉粥样硬化性疾病（129 人）]。在所有患者中，静息 P ET CO 2 的平均值（± 标准差）为 37.8 ± 3.9 mm Hg（范围：26-47）。在患有莫亚莫亚血管病和颅内动脉粥样硬化疾病的患者中，静息 P ET CO 2 分别为 38.4 ± 3.6 mm Hg（范围：28-47）和 37.4 ± 4.1 mm Hg（范围：26-46）。研究发现，术前静息 P ET CO 2 较低（38 毫米汞柱）的患者在血管再通后静息 P ET CO 2 呈上升趋势。结论 本研究表明，颅内狭窄闭塞症患者的静息 P ET CO 2 变化很大。在一些患者中，血管重建术后静息 P ET CO 2 发生了变化。
{"title":"Variability of Resting Carbon Dioxide Tension in Patients with Intracranial Steno-occlusive Disease","authors":"Eric Plitman, L. Venkatraghavan, Sanket Agrawal, Vishvak Raghavan, Tumul Chowdhury, O. Sobczyk, E. Sayin, J. Poublanc, James Duffin, David D. Mikulis, J. Fisher","doi":"10.1055/s-0044-1786699","DOIUrl":"https://doi.org/10.1055/s-0044-1786699","url":null,"abstract":"Abstract Introduction Controlling the partial pressure of carbon dioxide (PaCO 2 ) is an important consideration in patients with intracranial steno-occlusive disease to avoid reductions in critical perfusion from vasoconstriction due to hypocapnia, or reductions in blood flow due to steal physiology during hypercapnia. However, the normal range for resting PCO 2 in this patient population is not known. Therefore, we investigated the variability in resting end-tidal PCO 2 (P ET CO 2 ) in patients with intracranial steno-occlusive disease and the impact of revascularization on resting P ET CO 2 in these patients. Setting and Design Tertiary care center, retrospective chart review Materials and Methods We collected resting P ET CO 2 values in adult patients with intracranial steno-occlusive disease who presented to our institution between January 2010 and June 2021. We also explored postrevascularization changes in resting P ET CO 2 in a subset of patients. Results Two hundred and twenty-seven patients were included [moyamoya vasculopathy ( n = 98) and intracranial atherosclerotic disease ( n = 129)]. In the whole cohort, mean ± standard deviation resting P ET CO 2 was 37.8 ± 3.9 mm Hg (range: 26–47). In patients with moyamoya vasculopathy and intracranial atherosclerotic disease, resting P ET CO 2 was 38.4 ± 3.6 mm Hg (range: 28–47) and 37.4 ± 4.1 mm Hg (range: 26–46), respectively. A trend was identified suggesting increasing resting P ET CO 2 after revascularization in patients with low preoperative resting P ET CO 2 (<38 mm Hg) and decreasing resting P ET CO 2 after revascularization in patients with high preoperative resting P ET CO 2 (>38 mm Hg). Conclusions This study demonstrates that resting P ET CO 2 in patients with intracranial steno-occlusive disease is highly variable. In some patients, there was a change in resting P ET CO 2 after a revascularization procedure.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380966","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}
Lucca B. Palavani, Atharva Bapat, Sávio Batista, João Pedro Mendes, L. Oliveira, Raphael Bertani
Abstract Extramedullary plasmacytoma (EMP) is an uncommon disorder characterized by the development of abnormal plasma cell tumors outside the bone marrow. These tumors are typically observed in various locations, including the upper respiratory tract, gastrointestinal tract, and other soft tissues. Among the less explored manifestations of EMP is intracranial EMP, which remains poorly understood due to the limited literature available on the subject. The objective was to comprehend the population characteristics, localization, type, treatment, and outcomes of intracranial EMP. A systematic review of the literature for EMPs was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The strategy “extramedullary plasmacytoma AND multiple myeloma” was used for the search. The search terms were queried using PubMed, Embase, Scopus, Cochrane, and Web of Science databases. We included only those studies that presented clinical studies with patients diagnosed with intracranial plasmacytomas. In this study, a total of 84 patients from 25 studies were analyzed. The average age of diagnosis was 57.25 years, with a slightly higher proportion of females (57%) compared to male patients (43%). The most common locations of intracranial plasmacytomas were the clivus (29.7%), frontal lobe (18.9%), parietal lobe (8.1%), occipital lobe (6.7%), temporal lobe (6.7%), and sphenoid (4%). Chordoma and meningioma were the most common differential diagnoses encountered during clinical investigations. Treatment modalities included radiotherapy (RT), chemotherapy (QT), surgical resection (SR), and conservative approaches. The most frequent treatment combinations were SR + RT (19%) and RT only (17.8%). Mortality was reported in 48% of the cases, with complete resolution observed in 10 cases and partial resolution in 3 cases. The average follow-up duration was 37.5 months. The clivus is the most frequently reported site of extramedullary intracranial plasmacytoma (EMIP) occurrence, representing 29.7% of cases. Chordomas were commonly observed alongside EMIPs and emerged as the primary differential diagnosis. RT was the predominant treatment modality, with SR considered when feasible. RT alone demonstrated the highest effectiveness in managing EMIPs (30%), while QT as a sole intervention showed lower efficacy. However, a combination of dexamethasone, lenalidomide, and targeted RT displayed promising results, offering improved tumor response and increased safety.
{"title":"Extramedullary Intracranial Plasmacytomas: A Systematic Review of Literature","authors":"Lucca B. Palavani, Atharva Bapat, Sávio Batista, João Pedro Mendes, L. Oliveira, Raphael Bertani","doi":"10.1055/s-0044-1787535","DOIUrl":"https://doi.org/10.1055/s-0044-1787535","url":null,"abstract":"Abstract Extramedullary plasmacytoma (EMP) is an uncommon disorder characterized by the development of abnormal plasma cell tumors outside the bone marrow. These tumors are typically observed in various locations, including the upper respiratory tract, gastrointestinal tract, and other soft tissues. Among the less explored manifestations of EMP is intracranial EMP, which remains poorly understood due to the limited literature available on the subject. The objective was to comprehend the population characteristics, localization, type, treatment, and outcomes of intracranial EMP. A systematic review of the literature for EMPs was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The strategy “extramedullary plasmacytoma AND multiple myeloma” was used for the search. The search terms were queried using PubMed, Embase, Scopus, Cochrane, and Web of Science databases. We included only those studies that presented clinical studies with patients diagnosed with intracranial plasmacytomas. In this study, a total of 84 patients from 25 studies were analyzed. The average age of diagnosis was 57.25 years, with a slightly higher proportion of females (57%) compared to male patients (43%). The most common locations of intracranial plasmacytomas were the clivus (29.7%), frontal lobe (18.9%), parietal lobe (8.1%), occipital lobe (6.7%), temporal lobe (6.7%), and sphenoid (4%). Chordoma and meningioma were the most common differential diagnoses encountered during clinical investigations. Treatment modalities included radiotherapy (RT), chemotherapy (QT), surgical resection (SR), and conservative approaches. The most frequent treatment combinations were SR + RT (19%) and RT only (17.8%). Mortality was reported in 48% of the cases, with complete resolution observed in 10 cases and partial resolution in 3 cases. The average follow-up duration was 37.5 months. The clivus is the most frequently reported site of extramedullary intracranial plasmacytoma (EMIP) occurrence, representing 29.7% of cases. Chordomas were commonly observed alongside EMIPs and emerged as the primary differential diagnosis. RT was the predominant treatment modality, with SR considered when feasible. RT alone demonstrated the highest effectiveness in managing EMIPs (30%), while QT as a sole intervention showed lower efficacy. However, a combination of dexamethasone, lenalidomide, and targeted RT displayed promising results, offering improved tumor response and increased safety.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380551","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}
L. Venkatraghavan, Evan Shao, K. Nijs, M. Dinsmore, Tumul Chowdhury
Abstract Introduction Postcraniotomy headaches are often underestimated and undertreaded. This study aimed to identify if postoperative administration of sumatriptan after minimally invasive craniotomy for clipping an unruptured aneurysm could reduce postcraniotomy headache and improve the quality of postoperative recovery. Settings and Design Tertiary care center, single-center randomized double-blind placebo-controlled trial. Materials and Methods Patients who complained of postoperative headaches after minimally invasive craniotomy for clipping of unruptured aneurysms were randomized to receive subcutaneous sumatriptan (6 mg) or placebo. The primary outcome was the quality of recovery measured 24 hours after surgery. Secondary outcomes were total opioid use and headache score at 24 hours after surgery. Data were analyzed using a Student's t -test or the chi-square test. Results Forty patients were randomized to receive sumatriptan ( n = 19) or placebo ( n = 21). Both groups had similar demographics, comorbidities, and anesthesia management. The Quality of Recovery 40 score was higher for patients receiving sumatriptan compared to placebo, however, not statistically significant (173 [156–196] vs. 148 [139–181], p = 0.055). Postoperative opioid use between sumatriptan and placebo was lower, but not significant (5.4 vs. 5.6 mg morphine equivalent, p = 0.71). The severity of headache was also not statistically different between the two groups (5 [4–5] vs. 4 [2–5], p = 0.155). Conclusion In patients undergoing minimally invasive craniotomies for aneurysm clipping, sumatriptan given postoperatively has a nonsignificant trend for a higher quality of recovery. Similarly, there was a nonsignificant trend toward lower postcraniotomy headache scores and opioid scores for the patient given sumatriptan.
{"title":"Sumatriptan for Postcraniotomy Headache after Minimally Invasive Craniotomy for Clipping of Aneurysms: A Prospective Randomized Controlled Trial","authors":"L. Venkatraghavan, Evan Shao, K. Nijs, M. Dinsmore, Tumul Chowdhury","doi":"10.1055/s-0044-1786702","DOIUrl":"https://doi.org/10.1055/s-0044-1786702","url":null,"abstract":"Abstract Introduction Postcraniotomy headaches are often underestimated and undertreaded. This study aimed to identify if postoperative administration of sumatriptan after minimally invasive craniotomy for clipping an unruptured aneurysm could reduce postcraniotomy headache and improve the quality of postoperative recovery. Settings and Design Tertiary care center, single-center randomized double-blind placebo-controlled trial. Materials and Methods Patients who complained of postoperative headaches after minimally invasive craniotomy for clipping of unruptured aneurysms were randomized to receive subcutaneous sumatriptan (6 mg) or placebo. The primary outcome was the quality of recovery measured 24 hours after surgery. Secondary outcomes were total opioid use and headache score at 24 hours after surgery. Data were analyzed using a Student's t -test or the chi-square test. Results Forty patients were randomized to receive sumatriptan ( n = 19) or placebo ( n = 21). Both groups had similar demographics, comorbidities, and anesthesia management. The Quality of Recovery 40 score was higher for patients receiving sumatriptan compared to placebo, however, not statistically significant (173 [156–196] vs. 148 [139–181], p = 0.055). Postoperative opioid use between sumatriptan and placebo was lower, but not significant (5.4 vs. 5.6 mg morphine equivalent, p = 0.71). The severity of headache was also not statistically different between the two groups (5 [4–5] vs. 4 [2–5], p = 0.155). Conclusion In patients undergoing minimally invasive craniotomies for aneurysm clipping, sumatriptan given postoperatively has a nonsignificant trend for a higher quality of recovery. Similarly, there was a nonsignificant trend toward lower postcraniotomy headache scores and opioid scores for the patient given sumatriptan.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141379402","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}
M. S. Staroverov, Vladimir Victorovich Krylov, V. A. Lukyanchikov, Egor Andreevich Orlov, Alexey Alexandrovich Veselkov, Sergey Segreevich Dydykin, Vladislav Dmitrievich Shatdler
Abstract Introduction The aim of this article was to assess the flow capacity of end-to-side arterial anastomosis depending on the method of its implementation. Materials and Methods The study was conducted on 30 live Wistar rats in vivo, which were randomly divided into three groups. In each group of animals, an end-to-side microanastamosis was performed using three methods of donor artery preparation: 45 degrees (group A), 90 degrees (group B), and arteriotomy according to the “fish mouth” type (group C). The determination of flow capacity of anastomosis by measuring the blood volume flow with transonic flowmeter was performed. Results The obtained average values after the anastomosis were, respectively, 7.335 mL/s (standard deviation [SD]: 2.0771; min: 4.05; max: 10.85), 7.36 mL/s (SD: 0.836 mi: 6.15; max: 8.75), and 6.37 mL/s (SD: 1.247; min: 5.05; max: 9.05). No statistically significant difference in the blood volume flow velocity between all types of anastomoses was obtained ( p = 0.251). Conclusion The flow capacity of end-to-side arterial anastomosis does not depend on the chosen method of anastomosis.
{"title":"Blood Flow Capacity Assessment of End-to-Side Arterial Anastomosis In Vivo in Rats","authors":"M. S. Staroverov, Vladimir Victorovich Krylov, V. A. Lukyanchikov, Egor Andreevich Orlov, Alexey Alexandrovich Veselkov, Sergey Segreevich Dydykin, Vladislav Dmitrievich Shatdler","doi":"10.1055/s-0044-1786689","DOIUrl":"https://doi.org/10.1055/s-0044-1786689","url":null,"abstract":"Abstract Introduction The aim of this article was to assess the flow capacity of end-to-side arterial anastomosis depending on the method of its implementation. Materials and Methods The study was conducted on 30 live Wistar rats in vivo, which were randomly divided into three groups. In each group of animals, an end-to-side microanastamosis was performed using three methods of donor artery preparation: 45 degrees (group A), 90 degrees (group B), and arteriotomy according to the “fish mouth” type (group C). The determination of flow capacity of anastomosis by measuring the blood volume flow with transonic flowmeter was performed. Results The obtained average values after the anastomosis were, respectively, 7.335 mL/s (standard deviation [SD]: 2.0771; min: 4.05; max: 10.85), 7.36 mL/s (SD: 0.836 mi: 6.15; max: 8.75), and 6.37 mL/s (SD: 1.247; min: 5.05; max: 9.05). No statistically significant difference in the blood volume flow velocity between all types of anastomoses was obtained ( p = 0.251). Conclusion The flow capacity of end-to-side arterial anastomosis does not depend on the chosen method of anastomosis.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380957","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}
M. K. Mishra, N. Pandey, Hanjabam Barun Sharma, R. Prasad, Anurag Sahu, Ravi Shekhar Pradhan, Vikrant Yadav
Abstract Objectives Intraoperative neuromonitoring (IONM) is an acknowledged tool for real-time neuraxis assessment during surgery. Somatosensory evoked potential (SSEP) and transcranial motor evoked potential (MEP) are commonest deployed modalities of IONM. Role of SSEP and MEP in intradural extramedullary spinal cord tumor (IDEMSCT) surgery is not well established. The aim of this study was to evaluate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and transcranial MEP, in detection of intraoperative neurological injury in IDEMSCT patients as well as their postoperative limb-specific neurological improvement assessment at fixed intervals till 30 days. Materials and Methods Symptomatic patients with IDEMSCTs were selected according to the inclusion criteria of study protocol. On modified McCormick (mMC) scale, their sensory-motor deficit was assessed both preoperatively and postoperatively. Surgery was done under SSEP and MEP (transcranial) monitoring using appropriate anesthetic agents. Gross total/subtotal resection of tumor was achieved as per IONM warning alarms. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP were calculated considering postoperative neurological changes as “reference standard.” Patients were followed up at postoperative day (POD) 0, 1, 7, and 30 for convalescence. Statistical Analysis With appropriate tests of significance, statistical analysis was carried out. Receiver-operating characteristic curve was used to find cutoff point of mMC for SSEP being recordable in patients with higher neurological deficit along with calculation of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP for prediction of intraoperative neurological injury. Results Study included 32 patients. Baseline mean mMC value was 2.59. Under neuromonitoring, gross total resection of IDEMSCT was achieved in 87.5% patients. SSEP was recordable in subset of patients with mMC value less than or equal to 2 with diagnostic accuracy of 100%. MEP was recordable in all patients and it had 96.88% diagnostic accuracy. Statistically significant neurological improvement was noted at POD-7 and POD-30 follow-up. Conclusion SSEP and MEP individually carry high diagnostic accuracy in detection of intraoperative neurological injuries in patients undergoing IDEMSCT surgery. MEP continues to monitor the neuraxis, even in those subsets of patients where SSEP fails to record.
{"title":"Diagnostic Accuracy of Somatosensory Evoked Potential and Transcranial Motor Evoked Potential in Detection of Neurological Injury in Intradural Extramedullary Spinal Cord Tumor Surgeries: A Short-Term Follow-Up Prospective Interventional Study Experience from Tertiary Care Center of India","authors":"M. K. Mishra, N. Pandey, Hanjabam Barun Sharma, R. Prasad, Anurag Sahu, Ravi Shekhar Pradhan, Vikrant Yadav","doi":"10.1055/s-0044-1787052","DOIUrl":"https://doi.org/10.1055/s-0044-1787052","url":null,"abstract":"Abstract Objectives Intraoperative neuromonitoring (IONM) is an acknowledged tool for real-time neuraxis assessment during surgery. Somatosensory evoked potential (SSEP) and transcranial motor evoked potential (MEP) are commonest deployed modalities of IONM. Role of SSEP and MEP in intradural extramedullary spinal cord tumor (IDEMSCT) surgery is not well established. The aim of this study was to evaluate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and transcranial MEP, in detection of intraoperative neurological injury in IDEMSCT patients as well as their postoperative limb-specific neurological improvement assessment at fixed intervals till 30 days. Materials and Methods Symptomatic patients with IDEMSCTs were selected according to the inclusion criteria of study protocol. On modified McCormick (mMC) scale, their sensory-motor deficit was assessed both preoperatively and postoperatively. Surgery was done under SSEP and MEP (transcranial) monitoring using appropriate anesthetic agents. Gross total/subtotal resection of tumor was achieved as per IONM warning alarms. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP were calculated considering postoperative neurological changes as “reference standard.” Patients were followed up at postoperative day (POD) 0, 1, 7, and 30 for convalescence. Statistical Analysis With appropriate tests of significance, statistical analysis was carried out. Receiver-operating characteristic curve was used to find cutoff point of mMC for SSEP being recordable in patients with higher neurological deficit along with calculation of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of SSEP and MEP for prediction of intraoperative neurological injury. Results Study included 32 patients. Baseline mean mMC value was 2.59. Under neuromonitoring, gross total resection of IDEMSCT was achieved in 87.5% patients. SSEP was recordable in subset of patients with mMC value less than or equal to 2 with diagnostic accuracy of 100%. MEP was recordable in all patients and it had 96.88% diagnostic accuracy. Statistically significant neurological improvement was noted at POD-7 and POD-30 follow-up. Conclusion SSEP and MEP individually carry high diagnostic accuracy in detection of intraoperative neurological injuries in patients undergoing IDEMSCT surgery. MEP continues to monitor the neuraxis, even in those subsets of patients where SSEP fails to record.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141382983","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}
Sushant K. Sahoo, Murali K. Bethanbhatla, S. Dhandapani
Abstract Background Large pituitary adenoma often pushes the diaphragma sella and extends to the suprasellar compartment. The thinned out diaphragma may get opened during endonasal endoscopic surgery and pose high risk for cerebrospinal fluid (CSF) leak. Such larger defects are difficult to plug with fat graft that tends to slip in to the subarachnoid space. Here, we describe a unique technique of closure of diaphragma sella that augment repair of the skull base in such cases. Method The free edge of diaphragma sella was sutured with the anterior tuberculum sella dura in five cases of large pituitary adenoma that needed extra arachnoidal resection. Suturing was done with 6-0 prolene using endoscopic needle holder that converted a large diaphragm defect in to a smaller arachnoid rent and was easily plugged with fat graft. Result None of these patients had postoperative CSF leak. Conclusion Though technically difficult, direct repair of the diaphragma sella is possible. This augments the skull base reconstruct and effectively reduces the chances of postoperative CSF leak.
{"title":"Suturing and Closure of Diaphragma Sella to Augment Sellar Floor Repair after Endonasal Endoscopic Resection of Large Pituitary Adenoma","authors":"Sushant K. Sahoo, Murali K. Bethanbhatla, S. Dhandapani","doi":"10.1055/s-0044-1787088","DOIUrl":"https://doi.org/10.1055/s-0044-1787088","url":null,"abstract":"Abstract Background Large pituitary adenoma often pushes the diaphragma sella and extends to the suprasellar compartment. The thinned out diaphragma may get opened during endonasal endoscopic surgery and pose high risk for cerebrospinal fluid (CSF) leak. Such larger defects are difficult to plug with fat graft that tends to slip in to the subarachnoid space. Here, we describe a unique technique of closure of diaphragma sella that augment repair of the skull base in such cases. Method The free edge of diaphragma sella was sutured with the anterior tuberculum sella dura in five cases of large pituitary adenoma that needed extra arachnoidal resection. Suturing was done with 6-0 prolene using endoscopic needle holder that converted a large diaphragm defect in to a smaller arachnoid rent and was easily plugged with fat graft. Result None of these patients had postoperative CSF leak. Conclusion Though technically difficult, direct repair of the diaphragma sella is possible. This augments the skull base reconstruct and effectively reduces the chances of postoperative CSF leak.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141385732","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：