Surgical neurology international最新文献

Background: Although tuberculosis (TB) of the central nervous system is quite common, tuberculous pyogenic ventriculitis is not only rare; it is a devastating disease in an immunocompetent patient if left untreated.

Case description: We present the case of a 43-year-old man who underwent successful treatment for tuberculous pyogenic ventriculitis that presented with meningeal syndrome and loss of consciousness.

Conclusion: Tuberculous pyogenic ventriculitis is a rare manifestation of intracranial tuberculous infection. Despite advances in imaging techniques, the diagnosis of intraventricular TB is essentially biological.

Background: Abnormal electrocardiogram (ECG) findings can be seen in traumatic brain injury (TBI) patients. ECG may be an inexpensive tool to identify patients at high risk for developing cardiac dysfunction after TBI. This study aimed to examine abnormal ECG findings after isolated TBI and their association with true cardiac dysfunction based on echocardiogram.

Methods: This prospective observational study examined the data from adult patients with isolated and non-operated TBI between 2020 and 2021. Patients aged <18 years and >65 years with and presence of extracranial injuries including orthopedic, chest, cardiac, abdominal, and pelvis, pre-existing cardiac disease, patients who have undergone cardiothoracic surgery, with inotrope drugs, acute hemorrhage, and brain death were excluded from the study.

Results: We examined data from 100 patients with isolated TBI who underwent ECG and echocardiographic evaluation. ECG changes among 53% of mild cases showed a heart rate of 60-100/min, and 2% of cases showed more than 100/min. Prolonged pulse rate (PR) interval was observed in 8%, 11%, and 16% of mild, moderate, and severe cases, while no changes in PR interval were observed in 65% of cases. A prolonged QRS pattern was observed in 5%, 7%, and 15% of mild, moderate, and severe cases. A normal QRS complex was observed in 71% of cases. Prolonged QTc was observed in 3%, 10%, and 15% of cases in mild, moderate, and severe cases, respectively.

Conclusion: Repolarization abnormalities, but not ischemic-like ECG changes, are associated with cardiac dysfunction after isolated TBI. 12-lead ECG may be an inexpensive screening tool to evaluate isolated TBI patients for cardiac dysfunction.

Background: Advancements in minimally invasive spinal surgery have led to an expansion of targeted pathologies as well as improvements in surgical outcomes compared to their conventional counterparts through open laminectomy; however, this technique is rarely mentioned in the literature for intrinsic cord lesions. The authors present a novel minimally invasive, dorsolateral, and expandable tubular approach for the resection of an intradural, intramedullary thoracic cavernous malformation (CM).

Case descriptions: A 52-year-old male patient presented with rapidly progressive myelopathy and loss of ambulatory capabilities, with which magnetic resonance imaging revealed a hemorrhagic CM within the thoracic spinal cord. The CM was successfully resected through a minimally invasive tubular approach utilizing a dorsal root entry zone myelotomy. Postoperative imaging confirmed gross resection. His motor examination rapidly recovered, and he remains ambulatory with the use of a cane at a 2-year follow-up.

Conclusion: This novel minimally invasive approach is a promising technique for well-selected cases of symptomatic spinal CMs. Further exploration and potentially randomized studies are necessary to fully affirm the tubular approach's suitability for the treatment of intradural intramedullary CMs compared to conventional techniques.

Background: We evaluated how and whether the pedicular morphometry of the C7 and T1 vertebrae might impact C7/T1 spinal fusions for patients from Argentina.

Methods: Using computed tomography (CT) scans, we evaluated the pedicular morphology at the C7 and T1 levels.

Results: Among 102 male and female CT studies, we observed significant differences in the height, width, length, and morphometry of the C7 and T1 pedicles.

Conclusion: This study of C7/T1 CT scans revealed significant sex-based morphometric differences, particularly in pedicle height, width, and length at C7 and T1. Given the notable variability in vertebral characteristics observed in our study sample, we recommend preoperative planning with CT scans for C7/T1 fusion.

Background: Terson syndrome (TS) is a neuro-ophthalmologic disease arising due to subarachnoid hemorrhage (SAH), resulting in the formation of subhyaloid hemorrhagic spots. These spots can affect the ability to see due to the alteration of the optic cameras. Although it often affects both eyes, the symptoms and the eye involvement can be asymmetrical in rare cases.

Case description: We described the case of a 52-year-old female patient who developed Terson disease following the rupture of a right middle cerebral artery aneurysm occurring during coitus with SAH (Fisher grade III). The aneurysm was treated by endovascular coiling. Interestingly, despite the major involvement of the right eye, the patient primarily manifested symptoms of visual changes in the left eye.

Conclusion: TS is a frequent ocular complication of SAH, with symptoms typically affecting both eyes. Characterized by hemorrhagic spots in both subhyaloid layers, the syndrome's symptomatology is generally bilateral. However, in the case described, the manifestation is deemed atypical, primarily appearing contralateral to the hemisphere exhibiting a greater pattern of SAH.

Background: Common carotid artery occlusion (CCAO) sometimes requires vascular reconstruction. Ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unsuitable due to insufficient blood flow to the external carotid artery. The bonnet bypass, one treatment option for CCAO, requires a long coronal incision and bone groove to prevent malposition and collapse of an interposition graft. However, this long incision might lead to skin complications and reduced collateral blood flow.

Methods: A 60-year-old man who experienced recurrent ischemic stroke presented with the right internal carotid artery occlusion and left CCAO. The left STA was unavailable; however, both branches of his right STA were well-developed. Minimizing skin invasion was a priority because the patient had diabetes mellitus. We performed a right STA parietal branch - right MCA anastomosis, followed by a right STA frontal branch - left radial artery graft (RAG) - left MCA bonnet bypass using small intermittent skin incisions.

Results: We drilled a bone groove extending across the entire length of the interposition graft through the small intermittent skin incisions. Furthermore, we applied a right STA-RAG end-to-side anastomosis instead of an endto-end anastomosis to preserve collateral skin anastomosis. Postoperatively, the bypass remained patent, and the patient was discharged without complications.

Conclusion: The bonnet bypass is a potential treatment for CCAO, but the procedure is invasive. Our modified bonnet bypass method enables less invasive management, preventing collapse and malposition of the interposition graft and minimizing skin complications.

Background: Coexisting intracranial pathologies of distinct etiology which require intervention are rare. Only a handful of cases have been reported in the literature. The effects of each treatment option on both pathologies need to be considered during management. We describe the first report of the management of a patient with concurrent symptomatic tuberculum sellae meningioma (TSM) and idiopathic intracranial hypertension (IIH).

Case description: A 58-year-old male presented with 2 weeks of vision loss and 3 months of headaches. He was found to have an inferior hemi-field deficit in the left eye and bilateral papilledema. Imaging studies revealed bilateral transverse sinus stenosis and a TSM abutting the left optic nerve. The opening pressure was 40 cmH2O. An expanded-endoscopic endonasal approach was performed for mass resection. Intraoperatively, a lumbar drain was placed to aid skull base repair integrity before definitive treatment was obtained. On postoperative day 9, a right transverse-sigmoid sinus stent was placed for IIH treatment. The patient was discharged the following day.

Conclusion: Our management of this patient targeted the etiologies of each symptomatic pathology. Stenting provided treatment for the IIH and mass resection for the vision loss. Both the order and approaches to treatment were felt to maximize patient benefit while minimizing harm.

Background: In this study, we examined the impact and degree of lumbar stenosis on cerebrospinal fluid (CSF) protein concentration.

Methods: In this retrospective study, we analyzed protein concentrations in CSF samples of 61 patients with lumbar spinal stenosis (LSS) obtained during pre-operative myelography. Patients were divided into two groups: those showing no block to contrast (Group A) versus those showing medium block to contrast below the lumbar puncture level (Group B).

Results: The CSF protein concentration in Group B (104.3 ± 59 g/dL) patients with medium block was significantly greater than that in Group A (65.1 ± 33 g/dL) patients without medium block.

Conclusion: A higher average CSF protein concentration was seen in Group B patients with significant lumbar stenosis versus Group A patients without significant lumbar stenosis. Theoretically, damage to the cauda equina in patients with LSS may cause these elevated CSF protein levels.

Background: Spinal cavernomas (SCs) account for about 5% of all spinal vascular malformations. Intradural SCs occur in just 3% of cases and are typically intramedullary.

Case description: A 58-year-old female presented with progressive left occipital neuralgia, left cervicobrachial neuralgia, and paresthesia of all four extremities. The magnetic resonance imaging (MRI) revealed an intradural extramedullary C2-C4 lesion causing significant spinal cord compression. Gross total tumor excision was accomplished through a midline laminectomy pathologically; the lesion proved to be a cavernoma. The postoperative follow-up MRI obtained 4 months postoperatively showed complete tumor resection.

Conclusion: A 58-year-old female successfully underwent gross total excision of a C2-C4 intradural extramedullary SC.

Background: Chronic subdural hematoma (CSDH) is a collection of blood, blood degradation products, and fluid that accumulate on the surface of the brain between its arachnoid and dural coverings. This study is to evaluate the efficacy of subgaleal drain (SGD) versus subgaleal dissection without drainage as adjuncts to burr-hole evacuation of CSDH.

Methods: A retrospective study was conducted utilizing the data of 60 patients operated for symptomatic CSDH. Patients were divided into two groups, each thirty consecutive patients: Group I, in which a SGD was inserted after CSDH evacuation through a burr-hole; and Group II, the hematoma was evacuated as in the Group I, but with no SGD insertion but instead a subgaleal pocket was created for drainage.

Results: The neurological improvement at 24 h, discharge, 2 weeks, and 6 months after surgery was comparable in both groups. The overall recurrence was 4 cases (4/60, 6.7%). The rate of recurrence and surgical infection rate were comparable in both groups. Both groups showed similar incidences of postoperative seizures, bleeding, rates of medical complications, and neurological deficits. The overall postoperative mortality was five cases (5/60, 8.3%) with no significant difference between groups.

Conclusion: Blunt dissection to open the subgaleal space and closure without a drain is a safe and efficient alternative to the insertion of a drain after the burr-hole evacuation of CSDH.