Asian Journal of Neurosurgery最新文献

Fronto-temporal lobectomy for refractory intracranial hypertension following an acute arterial ischemic stroke in a child is rarely performed following failed conventional measures including decompressive craniectomy. We present a case of a 10-year-old child who presented with acute ischemic stroke with intractable cerebral edema and failed conventional measures including decompressive craniectomy and had significant neurological recovery following frontotemporal lobectomy.

Malignant peripheral nerve sheath tumor (MPNST) of the scalp is rare. These lesions are associated with neurofibromatosis type 1 (NF1), but patients had been reported without NF1 also. We tried to analyze the difference between the clinical course and outcome of the patient with MPNST having stigmata of NF1 and without it. We included five patients treated over 3 years between July 2018 and July 2021 with diffuse scalp MPNST. Two of these five patients with MPNST of the scalp had neurocutaneous stigmata of NF1. Three were female and two males with an average age of 38.40 ± 18.48 years-the youngest with NF1 being a 19-year-old female. We found dull aching pain as the most typical complaint in all patients and a repeated episode of generalized seizure in one patient. In these cases, two patients with NF1 have highly vascular tumors and attained large sizes greater than 30 cm. These two cases required preoperative digital subtraction angiography (DSA) and embolization with n-butyl acrylate. Total excision of the tumor was done in all patients with radiotherapy. Metastases within 1 year were noted in two patients with NF1, and one of these two succumbed to her illness. The rest of the three patients without NF1 are under follow-up with no evidence of disease with a maximum follow-up of 2 years. Large MPNST (size > 20 cm) are rare and reported to have been associated with and without NF1. Patients with scalp MPNST with NF1 can achieve larger size with fast progression of tumor size and higher chances of recurrence and metastases.

Background  There is an increasing incidence of chronic subdural hematoma due to extended life expectancy and associated trauma and fall risk. This retrospective study evaluates the efficacy of two burr-hole craniotomy over mini-craniotomy. Methods  Sixty-five patients were recruited over 2 years, of which 56 were male and 9 were females. A patient with a chronic subdural hematoma either underwent burr-hole craniostomy or mini-craniotomy for hematoma evacuation. Glasgow coma scale (GCS) and modified Rankin score were used to assess the neurological status and interventional outcome at discharge and follow-up, respectively. A head CT scan was performed at 3 week and 3 month follow-up. Statistical Analysis  Categorical data are presented as frequency and percentage, while non-categorical data are represented as mean ± SD. Statistical significance for difference in outcome between the two groups was analyzed using the chi-square test and p -value less than 0.05 was considered statistically significant. Results  The mean age of patients was 55.6 years. Headache (35 cases), hemiparesis, and altered sensorium were seen in 20 patients, each with the main presenting symptoms. Trauma history was noted in 69.2% of patients. One (3.7%) hematoma recurrence in the burr-hole group and four (8.3%) in the mini-craniotomy group was recorded. The mean operative time was longer in the minicraniotomy group (124.2 min vs. 75.4 min; p  < 0.001). A higher incidence of recurrence was noted in the craniotomy group (8.3%) than the burr-hole group (3.7%). No statistical difference in the recurrence rate, duration of hospital stay, GCS at discharge, modified Rankin score between the two study groups at discharge was noted. Conclusion  Two burr-hole craniostomy is a safe and effective surgical option to treat chronic subdural hematoma. It is also validated in patients on anticoagulants and antiplatelet medications with adequate pre-surgical correction of coagulation parameters.

Background  Spinal-cord stimulation (SCS) for relief of chronic neuropathic pain is well established. Objective  The inherent limitations with conventional percutaneous lead SCS are lead migration, positional variations in stimulation, as well as possible nonreplication of benefits after permanent SCS implantation, which were experienced during a positive trial period. To circumvent these limitations, we analyzed five consecutive cases of chronic intractable neuropathic pain who underwent direct SCS paddle lead placement during the trial period for pain relief. In addition, during the process of placing a permanent paddle lead, the impediment created by prior epidural scarring in such chronic patients can be obviated mechanically thereby increasing the efficacy of the procedure. Material and Methods  The demographic details, diagnosis, preoperative visual analogue scale score (VAS), and follow-up VAS were recorded. Surgical procedure consisted of a standard dorsal laminotomy followed by placement of permanent paddle leads. Results  All patients reported significant improvement in their VAS scores. Mean duration of follow-up was 23.6 months (9-35 months). Mean preoperative VAS was 9.4 and 1.4 at the last follow-up. No major complications were found. Conclusion  With careful patient selection and appropriate surgical strategy, it was possible to implant permanent paddle leads during SCS trial itself in our five patients thereby replicating and sustaining the trial period pain relief. We argue that this can be a new cost-effective and reliable technique for the placement of SCS leads achieving excellent and sustained pain relief.

Background  The ABO blood type, due to its various hemostaseologic properties, has been associated with several vascular diseases, including aneurysmal subarachnoid hemorrhage (aSAH). However, the role of ABO blood type in delayed cerebral ischemia (DCI) onset and other clinical outcomes after aSAH is largely unexplored. This study aimed to investigate the association between ABO blood type and outcomes after aSAH, primarily DCI. Methods  A retrospective analysis was made on the data collected from 175 aSAH patients at a tertiary supraregional neurosurgery department over 5 years. Socio-demographic factors, clinical variables (DCI, mFG, WFNS grade, and Glasgow Outcome Scale at discharge), EVD placement, and aneurysm size were analyzed for their association with ABO blood type. Results  DCI was reported in 25% of patients with 'O' blood type and 9.6% with 'non-O' blood type. A stepwise logistic regression model showed that after adjusting for BMI, mFG, WFNS grade, and EVD placement, 'O' type blood group was an independent risk factor for DCI, greatly increasing the risk of DCI as compared to 'non-O' type groups (OR = 3.27, 95% CI: 1.21-8.82). Conclusion  This study provides evidence that individuals with 'O' blood type may have a higher risk of DCI onset after aSAH. However, further studies are essential to address the limitations of our work and confirm our findings.

Objective  Fourth ventricular and juxta fourth ventricular arachnoid cysts (ACs) are rare clinical entities. Conventionally, ACs are managed with either micro-surgical excision or cerebrospinal fluid (CSF) diversionary procedures such as a shunt. Effective treatment modality still remains controversial. Advances in neuroendoscopy have helped in the effective management of this benign condition in a minimally invasive method. Description of a subset of patients with fourth ventricular and juxta fourth ventricular ACs and hydrocephalus who underwent transaqueductal cysto-ventriculostomy with a flexible neuroendoscope was the objective of this study. Methods  This study included the data of patients with fourth ventricular and juxta fourth ventricular ACs and hydrocephalus operated between 2008 and 2019. Of 350 intraventricular neuroendoscopic procedures done during the last 11 years, 8 had obstructive hydrocephalus due to fourth ventricular and juxta ventricular arachnoid cyst. Endoscopic transaqueductal cystoventriculostomy and transaqueductal shunt placement was done in all using a flexible neuro-endoscope. Results  Patients were aged 20 days to 15 months; in the neonate, the diagnosis was established during routine antenatal screening. Surgical procedure was done using a flexible neuro-endoscope. All improved symptomatically, radiologically and are on regular follow-up to date. One patient had postoperative meningitis, which gradually improved with antimicrobial therapy. None required alternative form of treatment such as shunt or craniotomy and microsurgical excision. Conclusion  Endoscopic transaqueductal cysto-ventriculostomy is a safe, effective and minimal invasive modality in the hands of an experienced neurosurgeon for the management of fourth ventricular and juxta ventricular arachnoid cysts.

The common imaging features surgeons use to distinguish spinal meningiomas from spinal nerve sheath tumors on magnetic resonance (MR) scans include the presence of the "dural tail sign" on contrast-enhanced MR images, hypointensity of the lesion on T2 sequences, presence of calcifications, lack of extraspinal dumbbell extension, and the lack of cystic changes in the lesion. We highlight the rarely described finding-the "Gingko-Leaf" sign that is caused by the stretched denticulate ligament as it extends laterally, through the tumor, from the compressed spinal cord.

Objective  Endovascular therapy has become the mainstay of treatment of acute ischemic stroke (AIS) due to large vessel occlusion. A direct aspiration first-pass technique (ADAPT) using large bore aspiration catheters has been introduced as a rapid, simple method for achieving good revascularization and good clinical outcomes. The aim of this study was to assess the safety and efficacy of ADAPT in the treatment of AIS due to large-vessel occlusion in the Nepali patient population. Materials and Methods  Retrospective data were collected for all consecutive patients treated for AIS with ADAPT from March 2019 through January 2021 at two hospitals. Outcomes were successful revascularization (modified thrombolysis in cerebral infarction score of 2b-3), time to revascularization, procedural complications, and good clinical outcome (modified Rankin Scale score of 0 to 2) and mortality at 90 days. Statistical Analysis  Retrospective data were collected and descriptive statistics were calculated. Results  Sixty-eight patients treated for AIS with ADAPT were included. The median National Institutes of Health Stroke Scale score at presentation was 13 (IQR 10-13.25). The median time from arterial puncture to revascularization was 40 minutes (IQR 30-45). Successful revascularization was achieved in 54 patients (79.4%). No cases of symptomatic intracranial hemorrhage occurred. At 90-day follow-up, good clinical outcome was achieved in 57 patients (83.8%), and 4 patients died (5.9%). Conclusion  A direct aspiration first pass technique appears to be a fast, simple, safe, and effective method for the management of AIS in the Nepali patient population.

The objective of this study is to determine the accuracy and safety of trans-pedicular screws' insertion in the thoracolumbar spine using a fluoroscopy-assisted surgical technique. We retrospectively evaluated all patients who underwent a postoperative computed tomography scan to assess the location of the pedicular screws following thoracolumbar spinal surgery, at the Mohammed Vth Military Training Hospital-Rabat, from January 2020 to April 2022. We used Gertzbein's classification to grade pedicular cortex breaches. A screw penetration greater than 4 mm (grades D-E) was considered critical and one less than 4 mm was classified as noncritical (grades A-C). A total of 122 screws inserted in the T1 to L5 vertebrae were included from 25 patients. The average age was 46 years old. Pathologies included degenerative disorders (5 patients), tumors (8 patients), and trauma (12 patients). All screws were inserted using lateral and anteroposterior fluoroscopic guidance. A total of 11 transpedicular screws breaches were identified. The breaches incidence was significantly higher in thoracic pedicles (8 screws) than in lumbar pedicles (3 screws). Of these, three critical cases occurred in two patients and one of them required reintervention. The remaining eight exceedances were not critical and were closely monitored and followed up. Transpedicular screws fluoroscopy-assisted surgical fixation can be performed for the stabilization of the thoracolumbar spine with satisfactory safety and precision.