Hiroyuki Abe, Kentaro Mori, I. Fukui, A. Tamase, Ryotaro Yamashita, Mutsuki Takeda, T. Nakano, M. Nomura, Tetsuya Yamamoto
Abstract An 85-year-old woman with a history of diabetes mellitus became aware of motor weakness of the left lower extremity. Magnetic resonance imaging showed multiple small cerebral infarctions in the right corona radiata. Angiography revealed persistent primitive trigeminal artery (PPTA) originating from the right internal carotid artery (ICA) and connecting to basilar artery, and the right ICA occluded distal to PPTA. Collateral blood circulation had developed, and sufficient collateral blood flow was expected. From these findings, the right ICA was considered to show stenosis due to atherosclerotic changes before occlusion. Conservative treatment was conducted with the transoral administration of rivaroxaban. It is important to correctly diagnose the anatomy and existence of an anomalous vessel in a stroke patient, not only when endovascular treatment is planned, but also for conservative medical treatment. Rapid and accurate radiological examinations facilitate safe and effective treatment.
{"title":"A Case of Cerebral Infarction due to Internal Carotid Artery Occlusion Accompanied by Persistent Primitive Trigeminal Artery","authors":"Hiroyuki Abe, Kentaro Mori, I. Fukui, A. Tamase, Ryotaro Yamashita, Mutsuki Takeda, T. Nakano, M. Nomura, Tetsuya Yamamoto","doi":"10.1055/s-0044-1787085","DOIUrl":"https://doi.org/10.1055/s-0044-1787085","url":null,"abstract":"Abstract An 85-year-old woman with a history of diabetes mellitus became aware of motor weakness of the left lower extremity. Magnetic resonance imaging showed multiple small cerebral infarctions in the right corona radiata. Angiography revealed persistent primitive trigeminal artery (PPTA) originating from the right internal carotid artery (ICA) and connecting to basilar artery, and the right ICA occluded distal to PPTA. Collateral blood circulation had developed, and sufficient collateral blood flow was expected. From these findings, the right ICA was considered to show stenosis due to atherosclerotic changes before occlusion. Conservative treatment was conducted with the transoral administration of rivaroxaban. It is important to correctly diagnose the anatomy and existence of an anomalous vessel in a stroke patient, not only when endovascular treatment is planned, but also for conservative medical treatment. Rapid and accurate radiological examinations facilitate safe and effective treatment.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":"59 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381596","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 In acute ischemic stroke, various endovascular approaches have been reported with high recanalization rates and good clinical outcomes. However, the best device or technique for the first attempt at mechanical thrombectomy remains a matter of debate. We report a case in which endoluminal injury from initial stent clot retrieval possibly caused repeated middle cerebral artery occlusion. A 74-year-old man presented with left-sided hemiplegia and was diagnosed with a right internal carotid artery occlusion. He underwent endovascular thrombectomy using a stent clot retriever. Although complete recanalization was achieved in the first pass, repeated middle cerebral artery occlusion occurred. Angiography revealed an irregular inner surface and thrombus formation in the superior branch of the second segment of the right middle cerebral artery. There is a risk of endoluminal injury due to stent retrieval, especially using a large sized stent against small branches. Antiplatelet therapy may be effective for preventing recurrent occlusion. Key Messages We report a case in which endoluminal injury from initial stent clot retrieval possibly caused repeated middle cerebral artery occlusion. There is a risk of endoluminal injury due to stent retrieval, especially using a large sized stent against nonvisible small branches.
{"title":"Repeated Middle Cerebral Artery Occlusion Possibly Caused by Endoluminal Injury Due to Stent Clot Retriever: A Case Report","authors":"Tomotaka Ohshima, Shigeru Miyachi","doi":"10.1055/s-0044-1787083","DOIUrl":"https://doi.org/10.1055/s-0044-1787083","url":null,"abstract":"Abstract In acute ischemic stroke, various endovascular approaches have been reported with high recanalization rates and good clinical outcomes. However, the best device or technique for the first attempt at mechanical thrombectomy remains a matter of debate. We report a case in which endoluminal injury from initial stent clot retrieval possibly caused repeated middle cerebral artery occlusion. A 74-year-old man presented with left-sided hemiplegia and was diagnosed with a right internal carotid artery occlusion. He underwent endovascular thrombectomy using a stent clot retriever. Although complete recanalization was achieved in the first pass, repeated middle cerebral artery occlusion occurred. Angiography revealed an irregular inner surface and thrombus formation in the superior branch of the second segment of the right middle cerebral artery. There is a risk of endoluminal injury due to stent retrieval, especially using a large sized stent against small branches. Antiplatelet therapy may be effective for preventing recurrent occlusion. Key Messages We report a case in which endoluminal injury from initial stent clot retrieval possibly caused repeated middle cerebral artery occlusion. There is a risk of endoluminal injury due to stent retrieval, especially using a large sized stent against nonvisible small branches.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141386005","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}
Gakuji Maruyama, T. Sameshima, Takashi Tsuchida, Kazuhiko Kurozumi
Abstract Pediatric cavernous sinus meningiomas are rare. Herein, we present the case of a 5-year-old boy who presented with progressive left oculomotor nerve palsy. A head magnetic resonance imaging revealed a mass lesion in the left cavernous sinus, following which tumor resection was performed. The tumor strongly adhered to the left oculomotor nerve without adherence to the walls of the cavernous sinus; however, its border with the nerve was unclear. Histopathological analysis led to the diagnosis of fibrous meningioma. To the best of our knowledge, this is the first case study to report the pediatric development of a cavernous sinus meningioma in the oculomotor nerve.
{"title":"Cavernous Sinus Meningioma of the Oculomotor Nerve in a Child: A Surgical Case Study","authors":"Gakuji Maruyama, T. Sameshima, Takashi Tsuchida, Kazuhiko Kurozumi","doi":"10.1055/s-0044-1787533","DOIUrl":"https://doi.org/10.1055/s-0044-1787533","url":null,"abstract":"Abstract Pediatric cavernous sinus meningiomas are rare. Herein, we present the case of a 5-year-old boy who presented with progressive left oculomotor nerve palsy. A head magnetic resonance imaging revealed a mass lesion in the left cavernous sinus, following which tumor resection was performed. The tumor strongly adhered to the left oculomotor nerve without adherence to the walls of the cavernous sinus; however, its border with the nerve was unclear. Histopathological analysis led to the diagnosis of fibrous meningioma. To the best of our knowledge, this is the first case study to report the pediatric development of a cavernous sinus meningioma in the oculomotor nerve.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":"29 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141382626","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}
Suppaluk Anukulsampan, Chottiwat Tansirisithikul, B. Sitthinamsuwan
Abstract Background The middle clinoid process (MCP), particularly caroticoclinoid ring (CCR) type of the MCP, is an important part of the sphenoid bone for skull base surgery. Previous studies have shown a wide range of MCP prevalence affected by various factors. However, no study has investigated the association between the MCP and the presence of sellar lesions. Objectives The main aim of this study was to evaluate the prevalence of the MCP in the Thai population and factors associated with its presence. Materials and Methods We conducted a cross-sectional study on 400 sides from 200 patients (100 with and 100 without sellar lesions) using cranial computerized tomography scans. Demographic data and MCP characteristics were collected. The association between individual variables and the presence of the MCP was determined by univariate and multivariate analysis. Results The MCP was identified in 168 of 400 sides (42%). Patients with sellar lesions had a significantly lower prevalence of the MCP compared with normal controls (29.5% versus 54.5%, p < 0.001). Of all MCP only 6% were the CCR type. Univariate and multivariate analysis showed that the absence of the sellar lesion was the only factor significantly associated with presence of the MCP (odds ratio: 2.86; 95% confidence interval: 1.90–4.32; p < 0.001). Conclusion The prevalence of the MCP was relatively high in the Thai population, while the prevalence of the CCR was relatively low compared with previous studies. The absence of sellar lesions was the only factor associated with the presence of the MCP.
{"title":"The Prevalence of the Middle Clinoid Process: A Cross-Sectional Comparative Study in Patients with and without Pathology of the Sella Turcica","authors":"Suppaluk Anukulsampan, Chottiwat Tansirisithikul, B. Sitthinamsuwan","doi":"10.1055/s-0044-1787054","DOIUrl":"https://doi.org/10.1055/s-0044-1787054","url":null,"abstract":"Abstract Background The middle clinoid process (MCP), particularly caroticoclinoid ring (CCR) type of the MCP, is an important part of the sphenoid bone for skull base surgery. Previous studies have shown a wide range of MCP prevalence affected by various factors. However, no study has investigated the association between the MCP and the presence of sellar lesions. Objectives The main aim of this study was to evaluate the prevalence of the MCP in the Thai population and factors associated with its presence. Materials and Methods We conducted a cross-sectional study on 400 sides from 200 patients (100 with and 100 without sellar lesions) using cranial computerized tomography scans. Demographic data and MCP characteristics were collected. The association between individual variables and the presence of the MCP was determined by univariate and multivariate analysis. Results The MCP was identified in 168 of 400 sides (42%). Patients with sellar lesions had a significantly lower prevalence of the MCP compared with normal controls (29.5% versus 54.5%, p < 0.001). Of all MCP only 6% were the CCR type. Univariate and multivariate analysis showed that the absence of the sellar lesion was the only factor significantly associated with presence of the MCP (odds ratio: 2.86; 95% confidence interval: 1.90–4.32; p < 0.001). Conclusion The prevalence of the MCP was relatively high in the Thai population, while the prevalence of the CCR was relatively low compared with previous studies. The absence of sellar lesions was the only factor associated with the presence of the MCP.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":"56 47","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141384163","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}
Hari K. Garachetla, Kiyoshi Takagi, Ryosuke Takagi, Yoko Kato
Abstract Vascular dementia (VaD) is the second most common cause of dementia after Alzheimer's disease. While new therapeutic modalities have been available for Alzheimer's disease, there is currently no effective treatment for VaD. We encountered two cases with VaD who recovered their cognitive function to normal levels after ventriculoatrial shunt (VA shunt). Both cases complained cognitive impairment shortly after cerebral infarctions. Their brain images showed ventricular dilatation without the findings of disproportionately enlarged subarachnoid space hydrocephalus, which is regarded as characteristic for idiopathic normal pressure hydrocephalus (iNPH). Both cases were initially diagnosed as VaD by board neurosurgeons. However, since they showed positive response to lumbar tap test, VA shunts were performed. Both cases recovered their cognitive function to normal level. Their excellent cognitive outcomes after VA shunts indicate that many iNPH patients with lacunar infarcts may possibly be misdiagnosed as VaD.
摘要 血管性痴呆（VaD）是仅次于阿尔茨海默病的第二大痴呆病因。虽然阿尔茨海默病已经有了新的治疗方法，但血管性痴呆目前还没有有效的治疗方法。我们遇到过两例认知功能障碍患者，他们在接受脑室-心房分流术（VA 分流术）后认知功能恢复到了正常水平。两例患者均在脑梗塞后不久出现认知功能障碍。他们的大脑图像显示脑室扩张，但没有发现蛛网膜下腔不成比例扩大的脑积水，而这被认为是特发性正常压力脑积水（iNPH）的特征。这两个病例最初都被神经外科医生诊断为 VaD。然而，由于他们对腰椎拍击试验呈阳性反应，因此进行了 VA 分流。两个病例的认知功能都恢复到了正常水平。VA分流术后，他们的认知功能得到了很好的恢复，这表明许多患有腔隙性脑梗塞的iNPH患者可能被误诊为VaD。
{"title":"Does Vascular Dementia Exist? Report of Two Cases Previously Diagnosed with Vascular Dementia Treated by Means of Ventriculoatrial Shunts","authors":"Hari K. Garachetla, Kiyoshi Takagi, Ryosuke Takagi, Yoko Kato","doi":"10.1055/s-0044-1787053","DOIUrl":"https://doi.org/10.1055/s-0044-1787053","url":null,"abstract":"Abstract Vascular dementia (VaD) is the second most common cause of dementia after Alzheimer's disease. While new therapeutic modalities have been available for Alzheimer's disease, there is currently no effective treatment for VaD. We encountered two cases with VaD who recovered their cognitive function to normal levels after ventriculoatrial shunt (VA shunt). Both cases complained cognitive impairment shortly after cerebral infarctions. Their brain images showed ventricular dilatation without the findings of disproportionately enlarged subarachnoid space hydrocephalus, which is regarded as characteristic for idiopathic normal pressure hydrocephalus (iNPH). Both cases were initially diagnosed as VaD by board neurosurgeons. However, since they showed positive response to lumbar tap test, VA shunts were performed. Both cases recovered their cognitive function to normal level. Their excellent cognitive outcomes after VA shunts indicate that many iNPH patients with lacunar infarcts may possibly be misdiagnosed as VaD.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":"40 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141384430","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 Spinal intramedullary epidermoids are rare intramedullary lesions of the spinal cord. They may be congenital or acquired with the congenital type often associated with spinal dysraphism and other spinal anomalies. The clinical presentation depends on the level of the involvement of the spinal cord. Management of these lesions is surgical excision. We report a case of intramedullary spinal epidermoid who presented with spastic paraparesis.
{"title":"Intramedullary Spinal Epidermoid Cyst—A Rare Cause of Spastic Paraparesis","authors":"Debajyoti Datta, Debarshi Chatterjee, Mona Tiwari, Soutrik Das, Anindya Basu","doi":"10.1055/s-0044-1787049","DOIUrl":"https://doi.org/10.1055/s-0044-1787049","url":null,"abstract":"Abstract Spinal intramedullary epidermoids are rare intramedullary lesions of the spinal cord. They may be congenital or acquired with the congenital type often associated with spinal dysraphism and other spinal anomalies. The clinical presentation depends on the level of the involvement of the spinal cord. Management of these lesions is surgical excision. We report a case of intramedullary spinal epidermoid who presented with spastic paraparesis.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":"18 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141387979","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}
G. Rao, Mohammed Imran, Reddycherla Naga Raju, Pittala Sandeep, Kotha Arjun Reddy
Introduction Chronic subdural hematoma (SDH) is one of the most common conditions encountered in the neurosurgical practice. Surgical modalities like twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy are practiced in the management of chronic SDH. Mini-craniotomy without excision of membranes may help to achieve best results with decreased complication rate. Materials and Methods Patients with chronic SDH operated from September 2013 to September 2022 were included in the study. Mini-craniotomy (40–60 mm) was done and cruciate incision was given over the dura. Dura was left wide open by reflecting and suturing the cut edges of the dural leaflets to the craniotomy edge allowing to evacuate subdural space under vision during surgery and to allow any residual collection to drain out freely in the postoperative period. A drain was placed between the inner membrane and the bone flap. Preoperative and postoperative clinical and radiological parameters were recorded. Complications, recurrence, and residual collections were noted. Results Seventy-seven patients were included in the study. Mean age was 57.32 years. Median Glasgow Coma Scale (GCS) at presentation was 13 while median GCS at discharge was 15. Two patients with preexisting comorbidities expired after surgery due to medical causes. No recurrences were noted. Fourteen patients had residual collections which resolved by 6 weeks. Two patients had wound infection. One of these patients later needed a bone flap removal due to osteomyelitis. Conclusion Mini-craniotomy without membranectomy is a good option for complete evacuation of chronic SDH under vision mainly avoiding the complication of membranectomy. It is not associated with increased complications rate. It needs fewer follow-ups as brain expansion can be established radiologically in a short period.
{"title":"Mini-Craniotomy for Chronic Subdural Hematoma: A Reliable Surgical Option","authors":"G. Rao, Mohammed Imran, Reddycherla Naga Raju, Pittala Sandeep, Kotha Arjun Reddy","doi":"10.1055/s-0044-1786703","DOIUrl":"https://doi.org/10.1055/s-0044-1786703","url":null,"abstract":"\u0000 Introduction Chronic subdural hematoma (SDH) is one of the most common conditions encountered in the neurosurgical practice. Surgical modalities like twist drill craniostomy, burr hole evacuation, mini-craniotomy, and craniotomy are practiced in the management of chronic SDH. Mini-craniotomy without excision of membranes may help to achieve best results with decreased complication rate.\u0000 Materials and Methods Patients with chronic SDH operated from September 2013 to September 2022 were included in the study. Mini-craniotomy (40–60 mm) was done and cruciate incision was given over the dura. Dura was left wide open by reflecting and suturing the cut edges of the dural leaflets to the craniotomy edge allowing to evacuate subdural space under vision during surgery and to allow any residual collection to drain out freely in the postoperative period. A drain was placed between the inner membrane and the bone flap. Preoperative and postoperative clinical and radiological parameters were recorded. Complications, recurrence, and residual collections were noted.\u0000 Results Seventy-seven patients were included in the study. Mean age was 57.32 years. Median Glasgow Coma Scale (GCS) at presentation was 13 while median GCS at discharge was 15. Two patients with preexisting comorbidities expired after surgery due to medical causes. No recurrences were noted. Fourteen patients had residual collections which resolved by 6 weeks. Two patients had wound infection. One of these patients later needed a bone flap removal due to osteomyelitis.\u0000 Conclusion Mini-craniotomy without membranectomy is a good option for complete evacuation of chronic SDH under vision mainly avoiding the complication of membranectomy. It is not associated with increased complications rate. It needs fewer follow-ups as brain expansion can be established radiologically in a short period.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":"34 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140983936","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}
Rajasekhar Narayanan, Renjith T. Venugopal, Suresh Kumar K. L., Jose P. B., Anjana Bahuleyan, Reshmi C. P., Thomas Varghese, Marthanda A Pillai
Intracranial chondrosarcomas are rare malignant lesions. Both skull base and dural-based extraosseous chondrosarcomas have been reported to occur intracranially. Dural-based chondrosarcomas arising from the falx cerebri are rare lesions with only 19 cases reported till date. Although conventional, mesenchymal, and myxoid variants of chondrosarcomas have been reported intracranially, myxoid variant are the rarest with only 17 cases reported till date, among which only 2 were falcine. We are reporting the third case of falcine myxoid chondrosarcoma in a 32-year-old man who presented with seizures and subtle lower limb weakness. Radiological findings were suggestive of an atypical meningioma in the falcine region. Macroscopically total resection of the tumor was done. Histopathological examination confirmed myxoid chondrosarcoma, grade 1. Postoperative period was uneventful, and the patient remains asymptomatic 34 months after the surgery without the application of any adjuvant therapy. Falcine myxoid chondrosarcomas are extremely rare lesions with variable aggressiveness as suggested by the three cases reported till now including the present case.
{"title":"Primary Extraskeletal Falcine Myxoid Chondrosarcoma—A Case Report and Review of Literature","authors":"Rajasekhar Narayanan, Renjith T. Venugopal, Suresh Kumar K. L., Jose P. B., Anjana Bahuleyan, Reshmi C. P., Thomas Varghese, Marthanda A Pillai","doi":"10.1055/s-0043-1772764","DOIUrl":"https://doi.org/10.1055/s-0043-1772764","url":null,"abstract":"Intracranial chondrosarcomas are rare malignant lesions. Both skull base and dural-based extraosseous chondrosarcomas have been reported to occur intracranially. Dural-based chondrosarcomas arising from the falx cerebri are rare lesions with only 19 cases reported till date. Although conventional, mesenchymal, and myxoid variants of chondrosarcomas have been reported intracranially, myxoid variant are the rarest with only 17 cases reported till date, among which only 2 were falcine. We are reporting the third case of falcine myxoid chondrosarcoma in a 32-year-old man who presented with seizures and subtle lower limb weakness. Radiological findings were suggestive of an atypical meningioma in the falcine region. Macroscopically total resection of the tumor was done. Histopathological examination confirmed myxoid chondrosarcoma, grade 1. Postoperative period was uneventful, and the patient remains asymptomatic 34 months after the surgery without the application of any adjuvant therapy. Falcine myxoid chondrosarcomas are extremely rare lesions with variable aggressiveness as suggested by the three cases reported till now including the present case.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":"91 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140984573","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}
Combined deficit of the four lower cranial nerves (CN IX, X, XI, and XII) was originally described by French physicians Collet (1915) and Sicard (1917) during World War I. To date though, this rare neurological clinical picture lacks systematic evidence regarding its epidemiology, clinical presentation, treatment strategies, and outcome. We conducted a systematic review and meta-analysis concerning Collet-Sicard syndrome (CSS) on Medline database in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research yielded 84 articles among which 73 individual case reports were eventually retained. Mean age was 53.7 (± 16) years old and the male-to-female ratio was 1.8/1. CSS was firstly caused by tumors (38.4%), following by vascular etiologies (28.8%), trauma (16.4%), and infection (6.8%), among others. Temporary enteral nutrition was required for 17 patients (23.3%). The four CN presented significant chances of complete or partial recovery: 52.1% for CN IX (p < 0.001), 46.6% for CN X and CN XII (p < 0.001), and 39.7% for CN XI (p = 0.002). Tumoral causes presented significantly lower chances of favorable CN recovery (7.1%) compared to infection (60%), vascular (52.4%), and trauma (41.7%) (p < 0.001). Older age (> 53 years old) was not associated with a dismal CN prognostic (p = 0.763). Most patients (71.2%) presented a favorable outcome (Glasgow Outcome Scale score ≥ 4). All the patients who died (6.8%) suffered from skull base tumors. CSS is a rare condition requiring prompt clinical and radiologic diagnostic and multidisciplinary management. Vascular or infectious-related CSS seem to present a rather good prognostic, closely followed by trauma, whereas tumoral-related CSS seem to suffer from a more dismal prognostic.
{"title":"Combined Deficit of the Four Lower Cranial Nerves also Known as the Syndrome of Collet-Sicard: A Systematic Review and Meta-analysis","authors":"N. Beucler","doi":"10.1055/s-0044-1787050","DOIUrl":"https://doi.org/10.1055/s-0044-1787050","url":null,"abstract":"Combined deficit of the four lower cranial nerves (CN IX, X, XI, and XII) was originally described by French physicians Collet (1915) and Sicard (1917) during World War I. To date though, this rare neurological clinical picture lacks systematic evidence regarding its epidemiology, clinical presentation, treatment strategies, and outcome. We conducted a systematic review and meta-analysis concerning Collet-Sicard syndrome (CSS) on Medline database in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research yielded 84 articles among which 73 individual case reports were eventually retained. Mean age was 53.7 (± 16) years old and the male-to-female ratio was 1.8/1. CSS was firstly caused by tumors (38.4%), following by vascular etiologies (28.8%), trauma (16.4%), and infection (6.8%), among others. Temporary enteral nutrition was required for 17 patients (23.3%). The four CN presented significant chances of complete or partial recovery: 52.1% for CN IX (p < 0.001), 46.6% for CN X and CN XII (p < 0.001), and 39.7% for CN XI (p = 0.002). Tumoral causes presented significantly lower chances of favorable CN recovery (7.1%) compared to infection (60%), vascular (52.4%), and trauma (41.7%) (p < 0.001). Older age (> 53 years old) was not associated with a dismal CN prognostic (p = 0.763). Most patients (71.2%) presented a favorable outcome (Glasgow Outcome Scale score ≥ 4). All the patients who died (6.8%) suffered from skull base tumors. CSS is a rare condition requiring prompt clinical and radiologic diagnostic and multidisciplinary management. Vascular or infectious-related CSS seem to present a rather good prognostic, closely followed by trauma, whereas tumoral-related CSS seem to suffer from a more dismal prognostic.","PeriodicalId":8521,"journal":{"name":"Asian Journal of Neurosurgery","volume":"65 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140983416","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}
Muhammad Shakir, A. Altaf, Hammad Atif Irshad, Muhammad Ali Akbar Khan, S. Enam
Background Pakistan has a significant proportion of medical graduates who intend to leave the country for better opportunities abroad, leading to a brain drain. However, the push and pull factors within neurosurgery remain unexplored, emphasizing the need for evaluation to enact policy changes. Materials and Methods We conducted a nationwide survey across 22 College of Physicians and Surgeons of Pakistan accredited neurosurgery training centers in all provinces of Pakistan. SPSS version 26 and STATA 15 were used for data analysis. Results We collected responses from 120 neurosurgery trainees across Pakistan. Trainees were categorized into two groups: those intending to leave (64%) and those intending to stay (36%) in Pakistan. A significant association was observed between the availability of fellowship training in the residents' hospital and the decision to leave or remain in Pakistan (p = 0.034). About 67.5% of our respondents did not have any publication, and among the intention to leave group, a greater percentage had academic involvement, when compared with the stay group. A significant association (p = 0.012) was also observed between the decision to leave or remain in Pakistan and the number of publications in nonindexed journals. Conclusion There remains a need for improvement in the standard of training provided by neurosurgery programs across the country. Our study found that disparities in research and academic exposure, as well as the lack of fellowship opportunities, may serve as stimuli for residents to leave Pakistan.
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