Background: Bilateral, biventricular lesions present a challenging scenario in neurosurgery, often requiring complex surgical techniques for management. Gangliogliomas (GG), while typically indolent, can manifest as anaplastic variants (AGG), necessitating comprehensive treatment strategies. This case study explores a unique surgical approach for a patient with bilateral, intra-extraventricular lesions infiltrating the corpus callosum, highlighting the complexities of managing such cases.
Methods: A 63-year-old female presented with a progressive intraventricular lesion infiltrating the left frontal lobe, diagnosed initially as a ganglioglioma. Following resection and histological examination, the lesion was confirmed as a WHO Grade 1 ganglioglioma. Subsequently, a contralateral lesion emerged, necessitating a novel surgical approach to achieve maximal safe resection while minimising neurological deficits. The technique involved extending the surgical corridor contralaterally along the tumour route, guided by neuronavigation and fluorescence imaging.
Results: The surgical approach enabled maximal safe resection of the lesion, with postoperative imaging confirming complete resection in most sites except for a known infiltration in the right posterior lateral ventricle. Histological examination revealed AGG, prompting subsequent adjuvant radiotherapy due to its aggressive nature.
Conclusion: The management of bilateral, biventricular lesions such as AGG requires innovative surgical approaches tailored to individual patient characteristics. The case highlights the efficacy of a transtumoral approach in achieving maximal safe resection while minimising neurological sequelae. Moreover, it underscores the importance of comprehensive treatment strategies, including adjuvant therapies, in addressing aggressive histological variants of gangliogliomas.
背景:双侧双脑室病变是神经外科面临的一个挑战,通常需要复杂的外科技术进行治疗。神经节胶质瘤(Gangliogliomas,GG)是典型的懒癌,但也可表现为无弹性变异型(anaplastic variants,AGG),因此需要采取综合治疗策略。本病例研究探讨了一种治疗双侧胼胝体浸润的室外内病变患者的独特手术方法,强调了此类病例治疗的复杂性:一名63岁的女性患者因脑室内进行性病变浸润左侧额叶而就诊,初步诊断为神经节胶质瘤。经过切除和组织学检查,病变被确诊为 WHO 1 级神经节胶质瘤。随后,对侧也出现了病变,因此需要采用一种新的手术方法,以实现最大程度的安全切除,同时将神经功能缺损降至最低。该技术包括在神经导航和荧光成像的引导下,沿肿瘤路线向对侧延伸手术走廊:手术方法最大限度地安全切除了病灶,术后成像证实,除了右后外侧脑室的已知浸润外,大部分部位都完全切除。组织学检查显示病灶为AGG,由于其侵袭性强,随后进行了辅助放疗:结论:治疗双侧双心室病变(如 AGG)需要根据患者的个体特征采取创新的手术方法。该病例强调了经瘤体方法在实现最大程度安全切除的同时将神经系统后遗症降至最低的功效。此外,该病例还强调了综合治疗策略(包括辅助疗法)在应对神经节胶质瘤侵袭性组织学变异方面的重要性。
{"title":"Contralateral transcallosal transfalcine approach for bilateral intra-extraventricular anaplastic ganglioglioma <i>via</i> 'the trans-tumoral route': a technical case instruction.","authors":"Giuseppe Emmanuele Umana, Sruthi Ranganathan, Manikon Poullay Silven, Salvatore Marrone, Domenico Gerardo Iacopino, Francesco Inserra, Saveria Spadola, Matias Baldoncini, Gianluca Ferini, Gianluca Scalia","doi":"10.1080/02688697.2024.2400146","DOIUrl":"https://doi.org/10.1080/02688697.2024.2400146","url":null,"abstract":"<p><strong>Background: </strong>Bilateral, biventricular lesions present a challenging scenario in neurosurgery, often requiring complex surgical techniques for management. Gangliogliomas (GG), while typically indolent, can manifest as anaplastic variants (AGG), necessitating comprehensive treatment strategies. This case study explores a unique surgical approach for a patient with bilateral, intra-extraventricular lesions infiltrating the corpus callosum, highlighting the complexities of managing such cases.</p><p><strong>Methods: </strong>A 63-year-old female presented with a progressive intraventricular lesion infiltrating the left frontal lobe, diagnosed initially as a ganglioglioma. Following resection and histological examination, the lesion was confirmed as a WHO Grade 1 ganglioglioma. Subsequently, a contralateral lesion emerged, necessitating a novel surgical approach to achieve maximal safe resection while minimising neurological deficits. The technique involved extending the surgical corridor contralaterally along the tumour route, guided by neuronavigation and fluorescence imaging.</p><p><strong>Results: </strong>The surgical approach enabled maximal safe resection of the lesion, with postoperative imaging confirming complete resection in most sites except for a known infiltration in the right posterior lateral ventricle. Histological examination revealed AGG, prompting subsequent adjuvant radiotherapy due to its aggressive nature.</p><p><strong>Conclusion: </strong>The management of bilateral, biventricular lesions such as AGG requires innovative surgical approaches tailored to individual patient characteristics. The case highlights the efficacy of a transtumoral approach in achieving maximal safe resection while minimising neurological sequelae. Moreover, it underscores the importance of comprehensive treatment strategies, including adjuvant therapies, in addressing aggressive histological variants of gangliogliomas.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1080/02688697.2024.2389856
Leon Slade, Paul Leach, Milan Makwana, Chirag Patel, Anthony Jesurasa
Objective: This study aimed to evaluate the demographics and outcomes of major paediatric head trauma managed in our Paediatric Intensive Care Unit (PICU) in South Wales and comparison is made with the existing published literature.
Design and setting: A retrospective review of medical records and imaging of patients identified from the paediatric neurosurgical trauma database at University Hospital Wales (UHW) from March 2013 to July 2021. We assessed the GCS at admission, mechanism of injury, CT scan, type of surgery required and GOS after 12 months.
Patients: A total of 46 children (<16 years old) who were admitted to intensive care secondary to a traumatic brain injury were identified. Mean age was 7.6 years (range 0 days-15.7 years).
Results: Road traffic accidents (RTA) were the predominant mechanism of injury (56.5%), followed by falls (32.6%). Neurosurgical intervention, including stand-alone ICP monitoring was required in 69.6% of patients. Post discharge outcome was defined using the Glasgow Outcome Score (GOS), with a good functional outcome (GOS ≥4) accounting for 86.4% at 12 months follow-up. Survival rate was 93.4%.
Conclusion: Demographics in South Wales are similar to the published literature, except falls had a higher mortality than RTA in our cohort. Head injury mechanisms, surgical interventions and outcomes show variation between patients from the pre-covid and lockdown periods. Outcomes are good for surgically and conservatively treated patients and very comparable to the published literature.
{"title":"Outcomes of head trauma in children admitted to a tertiary paediatric intensive care unit in South Wales.","authors":"Leon Slade, Paul Leach, Milan Makwana, Chirag Patel, Anthony Jesurasa","doi":"10.1080/02688697.2024.2389856","DOIUrl":"https://doi.org/10.1080/02688697.2024.2389856","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the demographics and outcomes of major paediatric head trauma managed in our Paediatric Intensive Care Unit (PICU) in South Wales and comparison is made with the existing published literature.</p><p><strong>Design and setting: </strong>A retrospective review of medical records and imaging of patients identified from the paediatric neurosurgical trauma database at University Hospital Wales (UHW) from March 2013 to July 2021. We assessed the GCS at admission, mechanism of injury, CT scan, type of surgery required and GOS after 12 months.</p><p><strong>Patients: </strong>A total of 46 children (<16 years old) who were admitted to intensive care secondary to a traumatic brain injury were identified. Mean age was 7.6 years (range 0 days-15.7 years).</p><p><strong>Results: </strong>Road traffic accidents (RTA) were the predominant mechanism of injury (56.5%), followed by falls (32.6%). Neurosurgical intervention, including stand-alone ICP monitoring was required in 69.6% of patients. Post discharge outcome was defined using the Glasgow Outcome Score (GOS), with a good functional outcome (GOS ≥4) accounting for 86.4% at 12 months follow-up. Survival rate was 93.4%.</p><p><strong>Conclusion: </strong>Demographics in South Wales are similar to the published literature, except falls had a higher mortality than RTA in our cohort. Head injury mechanisms, surgical interventions and outcomes show variation between patients from the pre-covid and lockdown periods. Outcomes are good for surgically and conservatively treated patients and very comparable to the published literature.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.1080/02688697.2024.2395373
Jeremy Khong, Amal Abou-Hamden, Barbara Koszyca, Daniel Roos, Ramkumar Govindaraj
Background: Cardiac myxoma is a rare, benign tumour that commonly originates in the left atrium and may lead to embolic events. Parenchymal brain metastases represent a rare neurological manifestation. While surgical intervention is commonly used, there is limited information on long-term outcomes after radiotherapy treatment. This report describes a case of successful treatment of haemorrhagic brain metastases with radiotherapy and offers a literature review of long-term results after radiotherapy treatment.
Case report: A 49-year-old woman presented with multiple haemorrhagic brain lesions and a cardiac mass. Surgical removal of the cardiac mass and the symptomatic brain lesion confirmed metastatic cardiac myxoma. Post-surgery, she experienced fatigued and neurocognitive impairment and was closely monitored. However, the metastases progressed. She subsequently received whole-brain radiotherapy, resulting in complete response. Seven years later, she remains in remission, although with enduring neurocognitive impairment.
Conclusions: Whole-brain radiotherapy can provide long-term control of haemorrhagic brain metastases arising from cardiac myxoma. Radiotherapy dose and treatment volume need careful consideration to reduce toxicity.
{"title":"Long-term control of haemorrhagic brain metastases from atrial myxoma after radiotherapy.","authors":"Jeremy Khong, Amal Abou-Hamden, Barbara Koszyca, Daniel Roos, Ramkumar Govindaraj","doi":"10.1080/02688697.2024.2395373","DOIUrl":"https://doi.org/10.1080/02688697.2024.2395373","url":null,"abstract":"<p><strong>Background: </strong>Cardiac myxoma is a rare, benign tumour that commonly originates in the left atrium and may lead to embolic events. Parenchymal brain metastases represent a rare neurological manifestation. While surgical intervention is commonly used, there is limited information on long-term outcomes after radiotherapy treatment. This report describes a case of successful treatment of haemorrhagic brain metastases with radiotherapy and offers a literature review of long-term results after radiotherapy treatment.</p><p><strong>Case report: </strong>A 49-year-old woman presented with multiple haemorrhagic brain lesions and a cardiac mass. Surgical removal of the cardiac mass and the symptomatic brain lesion confirmed metastatic cardiac myxoma. Post-surgery, she experienced fatigued and neurocognitive impairment and was closely monitored. However, the metastases progressed. She subsequently received whole-brain radiotherapy, resulting in complete response. Seven years later, she remains in remission, although with enduring neurocognitive impairment.</p><p><strong>Conclusions: </strong>Whole-brain radiotherapy can provide long-term control of haemorrhagic brain metastases arising from cardiac myxoma. Radiotherapy dose and treatment volume need careful consideration to reduce toxicity.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.1080/02688697.2024.2396948
Michelle Angus, Calvin Heal, Rebecca Mcdonough, Vicki Currie, Andrew Mcdonough, Irfan Siddique, Daniel Horner
Background: The guidance for clinicians on who requires further investigation when suspecting cauda equina syndrome has become clearer in England following the publication of the national recommendations. This does not have specific advice for those patients who have had recent imaging with no compression, returning to a healthcare provider with a change in symptoms. These cases can cause difficulty for clinicians with limited access to imaging who can often be reassured by previous imaging.
Method: This study presents a retrospective review of the case notes of 45 patients presenting on two occasions to the same Emergency Department who underwent magnetic resonance imaging due to the clinical diagnosis of cauda equina syndrome. Those with compression of the cauda equina on the second visit were compared to those without a compressive cause for their symptoms.
Results: Patients presenting with an increased number of clinical symptoms associated with cauda equina syndrome on their return visit were more likely to have compression of the cauda equina on imaging.
Conclusion: The small numbers in this study would suggest caution, however, if patients present with an increasing number of symptoms further imaging should be considered, even with previous reassuring scans.
{"title":"Patients returning to the emergency department with symptoms of cauda equina syndrome: do the symptoms differ with radiological cauda equina compression?","authors":"Michelle Angus, Calvin Heal, Rebecca Mcdonough, Vicki Currie, Andrew Mcdonough, Irfan Siddique, Daniel Horner","doi":"10.1080/02688697.2024.2396948","DOIUrl":"https://doi.org/10.1080/02688697.2024.2396948","url":null,"abstract":"<p><strong>Background: </strong>The guidance for clinicians on who requires further investigation when suspecting cauda equina syndrome has become clearer in England following the publication of the national recommendations. This does not have specific advice for those patients who have had recent imaging with no compression, returning to a healthcare provider with a change in symptoms. These cases can cause difficulty for clinicians with limited access to imaging who can often be reassured by previous imaging.</p><p><strong>Method: </strong>This study presents a retrospective review of the case notes of 45 patients presenting on two occasions to the same Emergency Department who underwent magnetic resonance imaging due to the clinical diagnosis of cauda equina syndrome. Those with compression of the cauda equina on the second visit were compared to those without a compressive cause for their symptoms.</p><p><strong>Results: </strong>Patients presenting with an increased number of clinical symptoms associated with cauda equina syndrome on their return visit were more likely to have compression of the cauda equina on imaging.</p><p><strong>Conclusion: </strong>The small numbers in this study would suggest caution, however, if patients present with an increasing number of symptoms further imaging should be considered, even with previous reassuring scans.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1080/02688697.2024.2391867
Iris-Elena Feodor, Ronak Ved, Anthony Jesurasa, Chirag Patel, Paul Leach
Purpose: We present our analysis of the existing Paediatric High Dependency Unit (HDU) admission policy at our institution and discuss our thoughts for its revision in the context of paediatric supratentorial tumour surgery.
Materials and methods: We screened our prospectively maintained database of all children undergoing supratentorial craniotomy for resection of paediatric brain tumours over a fifteen-year period. The post-operative course of each patient was reviewed, assessing the number of patients who had true HDU needs in the immediate post-operative period, and the relative depth of input from paediatric HDU specialists that each patient received.
Results: Forty-three patients underwent craniotomy for supratentorial tumour resections during the study period. The median age of the children was 8 years old. Forty-two patients in the study cohort did not require any HDU-level monitoring or treatment post-operatively; all these patients were able to be discharged from HDU to a standard ward bed very rapidly post-operatively. Only one patient (2%) from the study cohort had any tangible HDU needs in the acute post-operative period, comprising of invasive cardiovascular monitoring and repeated blood transfusions. This child's tumour was known to be large, highly vascular, and invasive pre-operatively.
Conclusions: We would advocate a rational and nuanced approach with regards to predicting which children are most likely need paediatric HDU care following supratentorial craniotomy for resection of a brain tumour. This rationalisation could improve resource availability and reduce financial burdens upon paediatric neurosurgical units.
{"title":"Is postoperative high dependency care really needed for children undergoing supratentorial brain tumour surgery?","authors":"Iris-Elena Feodor, Ronak Ved, Anthony Jesurasa, Chirag Patel, Paul Leach","doi":"10.1080/02688697.2024.2391867","DOIUrl":"https://doi.org/10.1080/02688697.2024.2391867","url":null,"abstract":"<p><strong>Purpose: </strong>We present our analysis of the existing Paediatric High Dependency Unit (HDU) admission policy at our institution and discuss our thoughts for its revision in the context of paediatric supratentorial tumour surgery.</p><p><strong>Materials and methods: </strong>We screened our prospectively maintained database of all children undergoing supratentorial craniotomy for resection of paediatric brain tumours over a fifteen-year period. The post-operative course of each patient was reviewed, assessing the number of patients who had true HDU needs in the immediate post-operative period, and the relative depth of input from paediatric HDU specialists that each patient received.</p><p><strong>Results: </strong>Forty-three patients underwent craniotomy for supratentorial tumour resections during the study period. The median age of the children was 8 years old. Forty-two patients in the study cohort did not require any HDU-level monitoring or treatment post-operatively; all these patients were able to be discharged from HDU to a standard ward bed very rapidly post-operatively. Only one patient (2%) from the study cohort had any tangible HDU needs in the acute post-operative period, comprising of invasive cardiovascular monitoring and repeated blood transfusions. This child's tumour was known to be large, highly vascular, and invasive pre-operatively.</p><p><strong>Conclusions: </strong>We would advocate a rational and nuanced approach with regards to predicting which children are most likely need paediatric HDU care following supratentorial craniotomy for resection of a brain tumour. This rationalisation could improve resource availability and reduce financial burdens upon paediatric neurosurgical units.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1080/02688697.2024.2393886
Shazia Syeda Nusky, Peter Alwyn Bodkin, Kim Ah-See, Michaela Matejova, Asha Venkatesh, Arnab K Rana
Aim: A case of Eustachian tube dysfunction following percutaneous balloon compression (PBC) of the trigeminal ganglion led us to investigate aural complications of PBC and similar procedures. We aimed to clarify both the physiological effects of compression of the trigeminal ganglion on aural function and the possibility of puncture of the Eustachian tube during placement of the needle.
Methods: We reviewed the anatomy of the Eustachian tube in relation to the foramen ovale and the aural structures supplied by the trigeminal nerve through cadaveric study. Following CT scanning, neuronavigation was used to guide a needle into Meckel's cave of a cadaver. Dissection was subsequently carried out with the needle in-situ to assess the proximity of the needle to the Eustachian tube and other structures. A literature review of aural complications of foramen ovale procedures using Ovid Medline, PubMed, and Google Scholar databases was undertaken.
Results: Our literature review summarises the relationship of the Eustachian tube to the foramen ovale, the nerve supply of aural structures from the trigeminal nerve and examines previously reported post-operative aural complications. From our anatomical study, at its closest point, the needle was 7 mm from the Eustachian tube.
Conclusion: The trigeminal nerve supplies both the tensor tympani and tensor veli palatini muscles and percutaneous procedures may, therefore, lead to aural symptoms. Also, the path of the needle is close to the Eustachian tube and can be punctured during these procedures. The authors recommend discussing aural complications during consent for these procedures.
{"title":"Aural complications of foramen ovale procedures for trigeminal neuralgia: anatomical study and literature review.","authors":"Shazia Syeda Nusky, Peter Alwyn Bodkin, Kim Ah-See, Michaela Matejova, Asha Venkatesh, Arnab K Rana","doi":"10.1080/02688697.2024.2393886","DOIUrl":"https://doi.org/10.1080/02688697.2024.2393886","url":null,"abstract":"<p><strong>Aim: </strong>A case of Eustachian tube dysfunction following percutaneous balloon compression (PBC) of the trigeminal ganglion led us to investigate aural complications of PBC and similar procedures. We aimed to clarify both the physiological effects of compression of the trigeminal ganglion on aural function and the possibility of puncture of the Eustachian tube during placement of the needle.</p><p><strong>Methods: </strong>We reviewed the anatomy of the Eustachian tube in relation to the foramen ovale and the aural structures supplied by the trigeminal nerve through cadaveric study. Following CT scanning, neuronavigation was used to guide a needle into Meckel's cave of a cadaver. Dissection was subsequently carried out with the needle in-situ to assess the proximity of the needle to the Eustachian tube and other structures. A literature review of aural complications of foramen ovale procedures using Ovid Medline, PubMed, and Google Scholar databases was undertaken.</p><p><strong>Results: </strong>Our literature review summarises the relationship of the Eustachian tube to the foramen ovale, the nerve supply of aural structures from the trigeminal nerve and examines previously reported post-operative aural complications. From our anatomical study, at its closest point, the needle was 7 mm from the Eustachian tube.</p><p><strong>Conclusion: </strong>The trigeminal nerve supplies both the tensor tympani and tensor veli palatini muscles and percutaneous procedures may, therefore, lead to aural symptoms. Also, the path of the needle is close to the Eustachian tube and can be punctured during these procedures. The authors recommend discussing aural complications during consent for these procedures.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1080/02688697.2024.2395369
Jean Filo, Maryann Zhao, Eduardo Orrego-Gonzalez, Steven N Schwartz, Bartholomew White, Hemant Varma, Rafael A Vega
Background: Primary pituitary lymphoma (PPL) is a rare finding in immunocompetent patients, with only 54 patients reported to date (including ours). It presents most often with headache and hypopituitarism, with MRI findings comparable to more common pituitary tumours, making the diagnosis challenging. There is no consensus on the ideal management for these lesions with the role of surgical resection not clearly established.
Case report: We present here a 49-year-old female who presented with acute vision loss and was found to have PPL of diffuse large B-cell lymphoma, non-germinal centre type. The radiologic findings were distinct from prior cases with haemorrhagic components and perilesional edoema in the bilobed sellar mass. Surgical resection was halted when a diagnosis of lymphoma was suspected. This decision was based on the guidelines for the treatment of primary CNS lymphoma (PCNSL) and the lack of evidence to support surgical resection of PPL specifically. Our patient lacked mutations commonly associated with a poor prognosis in DLBCL, such as TP53 and BCL6. She remains in remission with normal vision nearly two years after treatment with minimal resection, MR-CHOP, and consolidation radiotherapy.
Conclusion: We highlight here the clinical and diagnostic features of PPL to guide clinicians to early recognition and diagnosis. Surgical resection should be limited to what is necessary to obtain a diagnosis and critical decompression; otherwise, these lesions respond excellently to steroids and typical chemoradiation regimens.
{"title":"Rethinking the role of surgical resection in the management of primary pituitary lymphoma.","authors":"Jean Filo, Maryann Zhao, Eduardo Orrego-Gonzalez, Steven N Schwartz, Bartholomew White, Hemant Varma, Rafael A Vega","doi":"10.1080/02688697.2024.2395369","DOIUrl":"https://doi.org/10.1080/02688697.2024.2395369","url":null,"abstract":"<p><strong>Background: </strong>Primary pituitary lymphoma (PPL) is a rare finding in immunocompetent patients, with only 54 patients reported to date (including ours). It presents most often with headache and hypopituitarism, with MRI findings comparable to more common pituitary tumours, making the diagnosis challenging. There is no consensus on the ideal management for these lesions with the role of surgical resection not clearly established.</p><p><strong>Case report: </strong>We present here a 49-year-old female who presented with acute vision loss and was found to have PPL of diffuse large B-cell lymphoma, non-germinal centre type. The radiologic findings were distinct from prior cases with haemorrhagic components and perilesional edoema in the bilobed sellar mass. Surgical resection was halted when a diagnosis of lymphoma was suspected. This decision was based on the guidelines for the treatment of primary CNS lymphoma (PCNSL) and the lack of evidence to support surgical resection of PPL specifically. Our patient lacked mutations commonly associated with a poor prognosis in DLBCL, such as TP53 and BCL6. She remains in remission with normal vision nearly two years after treatment with minimal resection, MR-CHOP, and consolidation radiotherapy.</p><p><strong>Conclusion: </strong>We highlight here the clinical and diagnostic features of PPL to guide clinicians to early recognition and diagnosis. Surgical resection should be limited to what is necessary to obtain a diagnosis and critical decompression; otherwise, these lesions respond excellently to steroids and typical chemoradiation regimens.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-18DOI: 10.1080/02688697.2024.2391858
Adam F Roche, Thomas Redmond, Gulam Zilani, Vincent Healy, Claire M Condron
Background: Trigeminal neuralgia is a very painful condition that may require a surgical approach as treatment, which is typically retrosigmoid craniotomy followed by microvascular decompression. Due to the limited margin for error when operating in the small triangular window of the cerebellopontine angle and the infrequency of this condition, the operating room can present a difficult learning environment for surgical trainees. Our aim is to create a synthetic, low-cost, high-fidelity, and largely reusable simulation model that will enable neurosurgical trainees to practice these procedural steps in a safe learning environment.
Materials and methods: Design-based research was employed to develop the model through iterative micro-cycles, with expert evaluation from an educational and clinical team. The model was made from easy to source materials without advanced technology where sustainability, reproduction at scale and cost where significant considerations.
Results: Our model effectively simulates a retrosigmoid craniotomy and microvascular decompression of the trigeminal nerve. The model consists of two distinct parts that are made of synthetic materials. Part A is a single-use, moulded portion of the skull, while part B depicts the cerebellopontine angle and some of its internal anatomical and pathological structures crucial to carrying out all the steps to this procedure. Part A sits ergonomically flush on top of Part B, with both parts subsequently clamped to the table.
Conclusions: As a proof of concept, we report the development and utilisation of a novel, low-cost, replicable retrosigmoid craniotomy and microvascular decompression of the trigeminal nerve simulation model.
背景:三叉神经痛是一种非常痛苦的疾病,可能需要采用手术方法进行治疗,通常是进行后枕骨开颅手术,然后进行微血管减压术。由于在小脑角的小三角窗进行手术时误差范围有限,而且这种病症并不常见,因此手术室可能会给外科受训人员带来困难的学习环境。我们的目标是创建一个合成的、低成本的、高保真的、基本可重复使用的模拟模型,使神经外科学员能在安全的学习环境中练习这些手术步骤:材料和方法:采用基于设计的研究方法,通过迭代微循环开发模型,并由教育和临床团队进行专家评估。该模型由易于获取的材料制成,无需先进技术,因此可持续发展、规模复制和成本都是重要的考虑因素:结果:我们的模型有效地模拟了三叉神经的逆行开颅术和微血管减压术。模型由合成材料制成的两个不同部分组成。A 部分是颅骨的一次性模制部分,而 B 部分则描绘了小脑角及其内部的一些解剖和病理结构,这些结构对实施该手术的所有步骤至关重要。A 部分与 B 部分齐平,符合人体工程学原理,两部分随后都夹在手术台上:作为概念验证,我们报告了新型、低成本、可复制的三叉神经开颅和微血管减压模拟模型的开发和使用情况。
{"title":"Developing a high fidelity, low cost simulation model for retrosigmoid craniotomy and microvascular decompression of the trigeminal nerve.","authors":"Adam F Roche, Thomas Redmond, Gulam Zilani, Vincent Healy, Claire M Condron","doi":"10.1080/02688697.2024.2391858","DOIUrl":"https://doi.org/10.1080/02688697.2024.2391858","url":null,"abstract":"<p><strong>Background: </strong>Trigeminal neuralgia is a very painful condition that may require a surgical approach as treatment, which is typically retrosigmoid craniotomy followed by microvascular decompression. Due to the limited margin for error when operating in the small triangular window of the cerebellopontine angle and the infrequency of this condition, the operating room can present a difficult learning environment for surgical trainees. Our aim is to create a synthetic, low-cost, high-fidelity, and largely reusable simulation model that will enable neurosurgical trainees to practice these procedural steps in a safe learning environment.</p><p><strong>Materials and methods: </strong>Design-based research was employed to develop the model through iterative micro-cycles, with expert evaluation from an educational and clinical team. The model was made from easy to source materials without advanced technology where sustainability, reproduction at scale and cost where significant considerations.</p><p><strong>Results: </strong>Our model effectively simulates a retrosigmoid craniotomy and microvascular decompression of the trigeminal nerve. The model consists of two distinct parts that are made of synthetic materials. Part A is a single-use, moulded portion of the skull, while part B depicts the cerebellopontine angle and some of its internal anatomical and pathological structures crucial to carrying out all the steps to this procedure. Part A sits ergonomically flush on top of Part B, with both parts subsequently clamped to the table.</p><p><strong>Conclusions: </strong>As a proof of concept, we report the development and utilisation of a novel, low-cost, replicable retrosigmoid craniotomy and microvascular decompression of the trigeminal nerve simulation model.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-15DOI: 10.1080/02688697.2024.2389836
Alex Smedley, James Meacock, Ashraf Mahmood, Nick Phillips, Paul Nix
Objectives: To evaluate a technique of multi-layered CSF repair following endonasal anterior skull base surgery using medpor graft.
Design: Retrospective review of consecutive case series from a single centre.
Subjects: 68 cases of repair of CSF leaks utilising medpor identified from a larger prospectively maintained database of endonasal endoscopic procedures at our centre.
Methods: Retrospective review of a database of consecutive anterior skull base cases from 2016-2022, and further data collection from electronic hospital records.
Results: During follow up there were 7 cases of post-op CSF leak (10.3%). There were no radiological complications, and no cases of medpor removal or extrusion. Rates of infection were low, there were 3 (4.4%) cases of confirmed bacterial meningitis within our cohort. The mean length of stay was 4.7 days (median 3 days), with 16 cases discharged on the first post-operative day.
Conclusions: Our experience of using medpor in anterior skull base reconstruction demonstrates that medpor is a readily available, easily handled, and reliable graft option with relatively low rates of infection and post-op CSF leak. Its use reduces the use of autologous graft materials and the associated donor site morbidity. Our long term follow up data further demonstrates the safety and efficacy of this technique.
{"title":"Long term results with medpor<sup>®</sup> reconstruction of the anterior skull base at a single institute.","authors":"Alex Smedley, James Meacock, Ashraf Mahmood, Nick Phillips, Paul Nix","doi":"10.1080/02688697.2024.2389836","DOIUrl":"https://doi.org/10.1080/02688697.2024.2389836","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate a technique of multi-layered CSF repair following endonasal anterior skull base surgery using medpor graft.</p><p><strong>Design: </strong>Retrospective review of consecutive case series from a single centre.</p><p><strong>Subjects: </strong>68 cases of repair of CSF leaks utilising medpor identified from a larger prospectively maintained database of endonasal endoscopic procedures at our centre.</p><p><strong>Methods: </strong>Retrospective review of a database of consecutive anterior skull base cases from 2016-2022, and further data collection from electronic hospital records.</p><p><strong>Results: </strong>During follow up there were 7 cases of post-op CSF leak (10.3%). There were no radiological complications, and no cases of medpor removal or extrusion. Rates of infection were low, there were 3 (4.4%) cases of confirmed bacterial meningitis within our cohort. The mean length of stay was 4.7 days (median 3 days), with 16 cases discharged on the first post-operative day.</p><p><strong>Conclusions: </strong>Our experience of using medpor in anterior skull base reconstruction demonstrates that medpor is a readily available, easily handled, and reliable graft option with relatively low rates of infection and post-op CSF leak. Its use reduces the use of autologous graft materials and the associated donor site morbidity. Our long term follow up data further demonstrates the safety and efficacy of this technique.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1080/02688697.2024.2389839
Stylianos Kapetanakis, Nikolaos Gkantsinikoudis
Purpose: The aim of this study is to investigate the clinical outcomes of transforaminal lumbar endoscopic discectomy (TLED) in patients with L5-S1 lumbar disc herniation (LDH).
Materials and methods: Seventy-five consecutive individuals with diagnosed foraminal/extraforaminal L5-S1 LDH were included in this study. All patients underwent TLED, being subsequently evaluated in a 2-year follow-up period. Assessment was performed preoperatively and at 6 weeks and 3, 6, 12 and 24 months postoperatively. Visual Analogue Scale (distinctly applied for lower limb - VAS-LP and low back - VAS-BP pain) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire were implemented to assess pain and health-related quality of life (HRQoL) of enrolled individuals, respectively.
Results: No major perioperative complications were observed. Recorded values of all studied indices were demonstrated to feature a clinically and statistically significant amelioration at 6 weeks, presenting lesser improvement at 3 months with subsequent stabilisation. VAS-LP and VAS-BP values were displayed to reach a plateau in 6 months postoperatively, whereas all parameters of SF-36 continued to present a statistically significant improvement until the end of follow-up at 2 years.
Conclusions: TLED represent a safe and efficient technique in terms of diminishing perceived pain and improving HRQoL in patients with L5-S1 LDHs. However, specific patient- and technique-related circumstances on the ground of low surgical experience may limit its effectiveness in these patients.
{"title":"Transforaminal lumbar endoscopic discectomy: should we abandon it for L5-S1 foraminal and extraforaminal lumbar disc herniations? A prospective non-randomised study and literature review.","authors":"Stylianos Kapetanakis, Nikolaos Gkantsinikoudis","doi":"10.1080/02688697.2024.2389839","DOIUrl":"https://doi.org/10.1080/02688697.2024.2389839","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study is to investigate the clinical outcomes of transforaminal lumbar endoscopic discectomy (TLED) in patients with L5-S1 lumbar disc herniation (LDH).</p><p><strong>Materials and methods: </strong>Seventy-five consecutive individuals with diagnosed foraminal/extraforaminal L5-S1 LDH were included in this study. All patients underwent TLED, being subsequently evaluated in a 2-year follow-up period. Assessment was performed preoperatively and at 6 weeks and 3, 6, 12 and 24 months postoperatively. Visual Analogue Scale (distinctly applied for lower limb - VAS-LP and low back - VAS-BP pain) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire were implemented to assess pain and health-related quality of life (HRQoL) of enrolled individuals, respectively.</p><p><strong>Results: </strong>No major perioperative complications were observed. Recorded values of all studied indices were demonstrated to feature a clinically and statistically significant amelioration at 6 weeks, presenting lesser improvement at 3 months with subsequent stabilisation. VAS-LP and VAS-BP values were displayed to reach a plateau in 6 months postoperatively, whereas all parameters of SF-36 continued to present a statistically significant improvement until the end of follow-up at 2 years.</p><p><strong>Conclusions: </strong>TLED represent a safe and efficient technique in terms of diminishing perceived pain and improving HRQoL in patients with L5-S1 LDHs. However, specific patient- and technique-related circumstances on the ground of low surgical experience may limit its effectiveness in these patients.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}