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Bilateral hypothalamotomy plus dominant amygdalotomy with Gamma Knife radiosurgery. A non-invasive alternative when everything has failed in the management of aggressive behavior disorder. 双侧下丘脑切开术加显性杏仁核切开术加伽玛刀放射治疗。这是一种非侵入性的治疗方法当治疗攻击性行为障碍的方法都失败时。
Pub Date : 2024-12-20 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_860_2024
Oscar I Molina Romero, Juan Carlos Diez-Palma, Andrés Fonnegra-Caballero, Andrés Segura-Hernández, Roberto Matinez-Alvarez, Edgar Yamhure, Julian Felipe Camargo, Julio Roberto Fonnegra-Pardo

Background: Impulsive aggression is the core symptom of intermittent explosive disorder, which can be a feature of several psychiatric disorders. There is a subset of individuals who do not respond adequately to medical treatment; they are treatment refractory. The objective of this report is to describe a case of a patient with a background of schizophrenia and concomitant refractory aggressiveness disorder, treated with two-stage bilateral hypothalamotomy and unilateral amygdalotomy with Gamma Knife radiosurgery (GKR).

Case description: A 36-year-old male presented with a background of paranoid schizophrenia. Episodes of self- and hetero-aggressiveness were present at the initial diagnosis. High dosages of psychotropic medication were taken, and 70 sessions of electroconvulsive therapy were performed; however, no adequate response was obtained. Bilateral hypothalamotomy plus left amygdalotomy through GKR was performed. After 25 months of follow-up, a marked decrease in the frequency, degree, severity of aggressiveness and the requirement for psychotropic medications was observed.

Conclusion: Hypothalamotomy plus amygdalotomy with Gamma Knife may be an effective ablative technique for the management of refractory aggressive disorder in patients with mental illness.

背景:冲动攻击是间歇性爆发障碍的核心症状,可能是多种精神障碍的特征。有一小部分人对医疗没有充分的反应;它们是处理难熔的。本报告的目的是描述一个病例患者的精神分裂症和伴随的难治性攻击障碍的背景下,治疗两期双侧下丘脑切开术和单侧杏仁核切开术伽玛刀放射手术(GKR)。病例描述:一名36岁男性,以偏执型精神分裂症为背景。在最初的诊断中有自我攻击和异性攻击的发作。大剂量精神药物治疗,电休克治疗70次;然而,没有得到充分的回应。经GKR行双侧下丘脑切开术加左侧杏仁核切开术。经过25个月的随访,观察到攻击性的频率,程度,严重程度和精神药物的需求显着降低。结论:下丘脑切开术加伽玛刀杏仁核切开术可能是治疗精神疾病患者难治性侵袭性障碍的有效方法。
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引用次数: 0
Differences in tumor size, clinical, demographic, and socioeconomic profiles of central nervous system tumors among a racially diverse cohort: A retrospective case-control study. 不同种族人群中中枢神经系统肿瘤的肿瘤大小、临床、人口统计学和社会经济特征的差异:一项回顾性病例对照研究。
Pub Date : 2024-12-13 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_190_2024
Kyung Moo Kim, Rachel Jane Lew, Tate Justin Higashihara, Shaina Yamashita, Michelle Pang, Michelle Stafford, Connor Goo, Kimberly Bergenholtz Teehera, Kayti Luu, Richard Ho, Enrique Carrazana, Jason Viereck, Kore Kai Liow, Arash Ghaffari-Rafi

Background: One avenue to improve outcomes among brain tumor patients involves the mitigation of healthcare disparities. Investigating clinical differences among brain tumors across socioeconomic and demographic strata, such can aid in healthcare disparity identification and, by extension, outcome improvement.

Methods: Utilizing a racially diverse population from Hawaii, 323 cases of brain tumors (meningiomas, gliomas, schwannomas, pituitary adenomas, and metastases) were matched by age, sex, and race to 651 controls to investigate the associations between tumor type and various demographic, socioeconomic, and medical comorbidities. Tumor size at the time of diagnosis was also compared across demographic groups.

Results: At the time of diagnosis for benign meningiomas, Native Hawaiians and Pacific Islanders (NHPI; P < 0.05), Asians, and Hispanics exhibited nearly two-fold larger tumor volumes than Whites. For gliomas, NHPI similarly presented with larger tumor volumes relative to Whites (P = 0.04) and Asians (P = 0.02), while for vestibular schwannomas, NHPI had larger tumor sizes compared to Asians (P < 0.05). Benign meningiomas demonstrated greater odds of diagnosis (P < 0.05) among Native American or Alaskan Natives, patients comorbid with obesity class I, hypertension, or with a positive Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Malignant meningiomas demonstrated greater odds (P < 0.05) among patients from higher median household income and urban geography. Gliomas overall exhibited increased odds (P < 0.05) of diagnosis among Whites and reduced odds among Asians, with greater comorbidity with obesity class III; for glioblastoma specifically, there were reduced odds of asthma diagnosis. Patients with vestibular schwannomas were at increased odds (P < 0.05) of being from the highest income quartile and having a positive AUDIT-C, yet reduced odds of psychiatric disorders. Pituitary adenomas exhibited reduced odds of diagnosis among Whites, yet greater odds among NHPI, military personnel, obesity class I, and psychiatric disorders. Intracranial metastases were more common in patients with pre-obesity, asthma, a positive AUDIT-C, and living in more affluent regions. Benign meningiomas are most often presented with seizures, while malignant meningiomas have the addition of cognitive difficulty. Gliomas often present with seizures, cognitive difficulty, dizziness/nausea/vomiting (DNV), vestibular schwannomas with DNV, and metastases with seizures.

Conclusion: Brain tumors exhibit unique sociodemographic disparities and clinical comorbidities, which may have implications for diagnosis, treatment, and healthcare policy.

背景:改善脑肿瘤患者预后的途径之一是减轻医疗保健差异。调查不同社会经济和人口阶层脑肿瘤的临床差异,有助于确定医疗保健差异,并进一步改善结果。方法:利用来自夏威夷的不同种族人群,将323例脑肿瘤(脑膜瘤、胶质瘤、神经鞘瘤、垂体腺瘤和转移瘤)按年龄、性别和种族与651例对照进行匹配,以调查肿瘤类型与各种人口统计学、社会经济和医学合并症之间的关系。诊断时的肿瘤大小也在人口统计学组间进行了比较。结果:在诊断良性脑膜瘤时,夏威夷原住民和太平洋岛民(NHPI;P < 0.05),亚洲人和西班牙人的肿瘤体积几乎是白人的两倍。对于神经胶质瘤,NHPI的肿瘤体积同样比白人(P = 0.04)和亚洲人(P = 0.02)大,而对于前庭神经鞘瘤,NHPI的肿瘤体积比亚洲人大(P < 0.05)。良性脑膜瘤在美洲原住民或阿拉斯加原住民、伴有I级肥胖、高血压或酒精使用障碍识别测试-消费(AUDIT-C)阳性的患者中显示出更高的诊断几率(P < 0.05)。恶性脑膜瘤在家庭收入中位数较高和城市地理位置较高的患者中表现出更高的发病率(P < 0.05)。总的来说,胶质瘤在白人中的诊断率增加(P < 0.05),在亚洲人中的诊断率降低,与肥胖的合并症较多;特别是对于胶质母细胞瘤,哮喘诊断的几率降低。前庭神经鞘瘤患者来自最高收入四分位数和审计- c阳性的几率增加(P < 0.05),但精神疾病的几率降低。垂体腺瘤在白人中的诊断率较低,但在NHPI、军人、I级肥胖和精神疾病中的诊断率较高。颅内转移在肥胖、哮喘、审计- c阳性和生活在较富裕地区的患者中更为常见。良性脑膜瘤通常表现为癫痫发作,而恶性脑膜瘤则伴有认知困难。胶质瘤通常表现为癫痫发作,认知困难,头晕/恶心/呕吐(DNV),前庭神经鞘瘤伴DNV,转移伴癫痫发作。结论:脑肿瘤表现出独特的社会人口统计学差异和临床合并症,这可能对诊断、治疗和医疗保健政策有影响。
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引用次数: 0
An overview of intramedullary spinal cord metastases accompanied by a 2D intraoperative video. 伴二维术中影像的髓内脊髓转移的综述。
Pub Date : 2024-12-13 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_821_2024
Nehemiah Stewart, Brandon Lee, George Bourdages, Michael Galgano

Background: Metastatic intramedullary spinal cord metastases (IMSCMs) constitute <2% of spinal cord tumors. IMSCM is a late-stage manifestation of cancer with a highly variable presentation and poor survival rate. Here, we present an operative video involving gross total resection of an IMSCM (i.e., non-small-cell lung cancer [NSCLC]) in a 74-year-old male.

Case description: A functionally independent 74-year-old male with a history of renal cell carcinoma (i.e., prior nephrectomy) and NSCLC presented with progressive right-sided hemiparesis/hemisensory loss. The patient's magnetic resonance imaging showed a right-eccentric metastatic lesion extending from the inferior of C3 to the superior of C5. The patient underwent a laminectomy with C2-C6 instrumentation for focal en bloc resection of the tumor (i.e., pathologically proven to be NSCLC). During surgery, dorsal column mapping defined the electrophysiological midline before proceeding with the midline myelotomy. Five months postoperatively, the patient's right-sided motor function continued to improve, and he was able to continue adjunctive therapies for his NSCLC.

Conclusion: This study documents the efficacy/utility of gross total en bloc resection in preserving/improving the neurological function of IMSCM lesions in elderly patients.

背景:转移性髓内脊髓转移(IMSCMs)构成病例描述:一名功能独立的74岁男性,有肾细胞癌(即既往肾切除术)和非小细胞肺癌病史,表现为进行性右侧偏瘫/半感觉丧失。患者的磁共振成像显示右偏心转移灶从C3的下方延伸到C5的上方。患者接受了C2-C6器械椎板切除术,以局灶整块切除肿瘤(即病理证实为非小细胞肺癌)。在手术中,在进行中线髓切开术之前,背柱测绘确定电生理中线。术后5个月,患者的右侧运动功能继续改善,他能够继续对他的NSCLC进行辅助治疗。结论:本研究证明了大体全切除在保留/改善老年IMSCM病变神经功能方面的有效性/实用性。
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引用次数: 0
Safety of emergency endoscopic endonasal surgery in COVID-positive patients with hemorrhagic complications of pituitary region tumors: A case report and review of the literature. 急诊内镜下鼻手术治疗新冠病毒阳性垂体区肿瘤出血性并发症的安全性:1例报告及文献复习
Pub Date : 2024-12-13 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_663_2024
Sabrina L Zeller, Michael G Kim, Fawaz Al-Mufti, Simon J Hanft, Matthew Kim, Jared M Pisapia

Background: Pituitary apoplexy (PA) is a rare, life-threatening clinical syndrome that occurs in response to acute ischemic infarction or hemorrhage of a pituitary adenoma. We report two cases of sudden neurologic and visual decline in patients with pituitary region masses in coronavirus disease (COVID)-positive patients with a focus on potential pathophysiological mechanisms and a safe approach to treatment.

Case description: Case one is a 58-year-old male presenting with sudden-onset headache and visual disturbance. He was febrile and tested positive for COVID-19. Magnetic resonance imaging (MRI) revealed a large sellarsuprasellar mass with intratumoral hemorrhagic components. He underwent endoscopic endonasal resection with subsequent improvement in vision and oculomotor function. Pathology was consistent with hemorrhagic pituitary adenoma. Case two is a 15-year-old male presenting with sudden-onset severe headache and acute visual loss. He also tested positive for COVID-19. MRI revealed a sellar-suprasellar mass with a regional mass effect. He underwent endoscopic endonasal resection with improvement in vision over time. Pathology was consistent with craniopharyngioma. There was no evidence of intraoperative COVID-19 transmission among members of the surgical team, who were monitored for 2 weeks after surgery.

Conclusion: PA in the setting of severe acute respiratory syndrome coronavirus 2 infection should be considered in the differential diagnosis of a COVID-positive patient presenting with acute severe headache, visual loss, and/or ophthalmoplegia; we discuss proposed mechanisms related to inflammation, coagulability, and hypoxia. The absence of intraoperative COVID-19 transmission during transsphenoidal resection performed in an emergency setting suggests that the risk of exposure may be attenuated with safety precautions.

背景:垂体卒中(PA)是一种罕见的危及生命的临床综合征,发生于急性缺血性梗死或垂体腺瘤出血。我们报告了两例冠状病毒病(COVID)阳性患者垂体区肿块的突然神经和视力下降,重点是潜在的病理生理机制和安全的治疗方法。病例描述:病例一为58岁男性,表现为突发性头痛和视觉障碍。他发烧,COVID-19检测呈阳性。磁共振成像(MRI)显示一个大鞍上肿块伴瘤内出血成分。他接受了内窥镜鼻内切除术,随后视力和动眼肌功能有所改善。病理符合出血性垂体腺瘤。病例二为一名15岁男性,表现为突发性严重头痛和急性视力丧失。他的COVID-19检测结果也呈阳性。MRI显示鞍上肿块伴区域性肿块效应。他接受了内窥镜鼻内切除术,随着时间的推移视力有所改善。病理符合颅咽管瘤。没有证据表明手术小组成员术中传播COVID-19,他们在手术后监测了2周。结论:在以急性严重头痛、视力丧失和/或眼麻痹为临床表现的新冠肺炎阳性患者鉴别诊断中,应考虑冠状病毒2型感染背景下的PA;我们讨论了与炎症、凝血性和缺氧相关的机制。急诊情况下经蝶窦切除术中未发现COVID-19传播,这表明采取安全措施可以降低暴露风险。
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引用次数: 0
Before microsurgical skill training on a simulator is recommended to reduce hand tremors, appropriate studies must demonstrate its benefit. 在推荐在模拟器上进行显微外科技能培训以减少手部震颤之前,必须进行适当的研究来证明其益处。
Pub Date : 2024-12-13 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_725_2024
Josef Finsterer
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引用次数: 0
Management of intracranial meningioma: Outcome analysis and clinico radiological profile of 172 patients. 颅内脑膜瘤的治疗:172例临床放射学分析。
Pub Date : 2024-12-13 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_556_2024
Aditya Varshney, Somil Jaiswal, Ankur Bajaj, Awdhesh Yadav, Chhitij Srivastava, Anil Chandra, Bal Krishna Ojha, Shalini Bhalla, Pooja Jaiswal, Brijesh Pratap Singh, Manish Kumar Singh

Background: Meningioma is the most common primary intracranial tumor. This single-center study aimed to analyze the clinicopathological, radiological profile, and outcomes of patients with intracranial meningiomas in terms of functional status, morbidity, mortality, and recurrence-free survival (RFS).

Methods: Patients of intracranial meningioma treated between January 01, 2010, and December 31, 2019, at the Department of Neurosurgery, King George's Medical University, India, were included in this study. Retrospective data analysis of 172 patients with intracranial meningioma was done.

Results: The majority of the patients, that is, 94 (54.65%), presented in the 4th and 5th decade. The mean size of the meningioma was 36.4 ± 4 mm (range: 26-68 mm). Of the 172 patients, 128 (74.41%) were diagnosed as non-skull base meningiomas, and in 44 patients (25.59%), meningioma originated from the skull base. Recurrence was observed on follow-up imaging in 11 patients after a mean postoperative interval of 55.2 ± 5.8 months. Radiological meningioma recurrence paralleled with clinical deterioration in seven patients. Three of these patients were subjected to the second surgery, followed by radiotherapy, and in the remaining four patients, Gamma knife or fractionated radiotherapy was given.

Conclusion: The majority of patients had good functional outcomes (KPS >70) at discharge. Morbidity and mortality was 18.60% and 3.49%, respectively. Meningioma size ≥4 cm, age >45 years, World Health Organization Grade (II, III), non-skull base location, and Simpson grade III, IV of resection showed significantly shorter RFS.

背景:脑膜瘤是最常见的原发性颅内肿瘤。本单中心研究旨在分析颅内脑膜瘤患者在功能状态、发病率、死亡率和无复发生存(RFS)方面的临床病理、放射学特征和预后。方法:本研究纳入2010年1月1日至2019年12月31日在印度乔治国王医科大学神经外科接受治疗的颅内脑膜瘤患者。对172例颅内脑膜瘤患者的资料进行回顾性分析。结果:94例(54.65%)患者主要出现在第4、5 10年。脑膜瘤平均大小为36.4±4mm(范围26 ~ 68mm)。172例患者中,128例(74.41%)诊断为非颅底脑膜瘤,44例(25.59%)脑膜瘤起源于颅底。11例患者术后平均间隔55.2±5.8个月,随访影像学发现复发。7例脑膜瘤放射学复发伴临床恶化。其中3例患者接受第二次手术,随后进行放疗,其余4例患者给予伽玛刀或分段放疗。结论:大多数患者出院时功能预后良好(KPS bbb70)。发病率为18.60%,死亡率为3.49%。脑膜瘤大小≥4cm,年龄bb0 ~ 45岁,世界卫生组织分级(II、III),非颅底位置,Simpson三级、四级切除,RFS明显缩短。
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引用次数: 0
Comparison of dexmedetomidine versus fentanyl-based total intravenous anesthesia technique on the requirement of propofol, brain relaxation, intracranial pressure, neuronal injury, and hemodynamic parameters in patients with acute traumatic subdural hematoma undergoing emergency craniotomy: A randomized controlled trial. 右美托咪定与芬太尼全静脉麻醉技术对急诊开颅急性外伤性硬膜下血肿患者异丙酚需求、脑松弛、颅内压、神经元损伤和血流动力学参数的比较:一项随机对照试验。
Pub Date : 2024-12-13 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_892_2024
Vivek Chandar Chinnarasan, Prasanna Udupi Bidkar, Srinivasan Swaminathan, Manoranjitha Mani, Balasubramaniyan Vairappan, Protiti Chatterjee, Jerry Jame Joy, Ankita Dey, Rajasekar Ramadurai, Adethen Gunasekaran

Background: Propofol is one of the most used intravenous anesthetic agents in traumatic brain injury (TBI) patients undergoing emergency neurosurgical procedures. Despite being efficacious, its administration is associated with dose-related adverse effects. The use of adjuvants along with propofol aids in limiting its consumption, thereby mitigating the side effects related to propofol usage. This study aims to compare the safety and efficacy of dexmedetomidine-propofol versus fentanyl-propofol-based total intravenous anesthesia (TIVA) in adult TBI patients.

Methods: A hundred patients posted for emergency evacuation of acute subdural hematoma were enrolled, and they were randomized into two groups of 50 each. Propofol-based TIVA with a Schneider target-controlled infusion model was used for induction and maintenance. Patients in Group F received fentanyl, and those in Group D received dexmedetomidine infusions as adjuvants. Advanced hemodynamic parameters were monitored. Intracranial pressure (ICP) and brain relaxation were measured after dural opening. The mean propofol consumption, number of additional fentanyl boluses, and blood samples for S100b (a biomarker of neuronal injury) were also collected.

Results: The mean propofol consumption in Group D (88.7 ± 31.8 μg/kg/min) was lower when compared to Group F (107.9 ± 34.6 μg/kg/min), (P = 0.005). The mean intraoperative fentanyl requirement and postoperative S100b were significantly reduced in Group D. Subdural ICPs and brain relaxation scores were comparable. Hemodynamic parameters were well maintained in both groups.

Conclusion: In TBI, dexmedetomidine as an adjunct to propofol-based TIVA results in a greater reduction in total propofol consumption and intraoperative opioid requirements while maintaining hemodynamic stability when compared to fentanyl.

背景:异丙酚是创伤性脑损伤(TBI)患者接受紧急神经外科手术时最常用的静脉麻醉剂之一。尽管有效,但其施用与剂量相关的不良反应有关。与异丙酚一起使用佐剂有助于限制其用量,从而减轻与异丙酚使用有关的副作用。本研究旨在比较右美托咪定-异丙酚与芬太尼-异丙酚全静脉麻醉(TIVA)在成人TBI患者中的安全性和有效性。方法:将100例急性硬膜下血肿患者随机分为两组,每组50例。采用施耐德靶控输注模型的基于异丙酚的TIVA诱导和维持。F组以芬太尼为佐剂,D组以右美托咪定为佐剂。监测高级血流动力学参数。硬脑膜切开后测量颅内压(ICP)和脑松弛度。还收集了异丙酚的平均消耗量、额外芬太尼丸的数量和S100b(神经元损伤的生物标志物)的血液样本。结果:D组异丙酚平均消耗量(88.7±31.8 μg/kg/min)低于F组(107.9±34.6 μg/kg/min),差异有统计学意义(P = 0.005)。d组术中芬太尼的平均需求量和术后S100b均显著降低。硬膜下ICPs和脑放松评分具有可比性。两组血流动力学参数均维持良好。结论:在TBI中,与芬太尼相比,右美托咪定作为基于异丙酚的TIVA的辅助,在保持血流动力学稳定性的同时,更能减少异丙酚的总消耗量和术中阿片类药物的需求。
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引用次数: 0
Spontaneous cerebrospinal fluid rhinorrhea as a primary presentation of idiopathic intracranial hypertension, management strategies, and clinical outcome. 自发性脑脊液鼻漏作为特发性颅内高压的主要表现,管理策略和临床结果。
Pub Date : 2024-12-11 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_560_2024
Ahmed Elshanawany, Farrag Mohammad

Background: Causes of cerebrospinal fluid (CSF) rhinorrhea could be divided into primary (spontaneous) and secondary (head trauma and iatrogenic). Idiopathic intracranial hypertension (IIH) has emerged as a cause for spontaneous CSF rhinorrhea but is still underestimated, may be overlooked and needs special consideration in management. The objective of this study is to demonstrate spontaneous CSF rhinorrhea as the primary presentation of IIH and explore the algorithm of management.

Methods: All patients with spontaneous (primary) CSF rhinorrhea were included with complete clinical and radiological assessment. We performed lumbar puncture and CSF pressure measurements in the lateral decubitus position for all included patients to detect those with intracranial hypertension. A pressure of 20 cmH2O in cases of CSF rhinorrhea is considered a cutoff for diagnosing raised intracranial pressure. When intracranial hypertension was diagnosed, patients were subjected immediately to lumboperitoneal shunt. If CSF leakage stopped after shunt insertion, we would not perform skull base repair, and the patient was sent for follow-up. However, if CSF leakage did not stop after shunt insertion despite normalization of intracranial tension or recurrence of CSF rhinorrhea despite shunt patency or there was intracranial pneumocephalus, skull base repair would be performed.

Results: During the period of the study, 293 cases of CSF rhinorrhea were seen. Only 42 (14.3%) patients were diagnosed with spontaneous CSF rhinorrhea, and the remaining were posttraumatic. Thirty-seven patients (88.1%) of 42 patients revealed high CSF pressure readings. All 37 patients received lumboperitoneal shunt followed by CSF rhinorrhea stoppage. Later, during follow-up, 7 patients developed recurrence of leakage; 3 of them revealed shunt obstruction, and rhinorrhea improved after shunt revision. The other 4 patients revealed patent shunt and needed skull base repair.

Conclusion: Spontaneous CSF rhinorrhea is considered secondary to IIH until proven otherwise. Initial placement of lumboperitoneal shunt may provide an effective alternative to skull base repair for the treatment of patients with IIH presenting with CSF rhinorrhea.

背景:脑脊液鼻漏的病因可分为原发性(自发性)和继发性(头部外伤和医源性)。特发性颅内高压(Idiopathic intracranial hypertension, IIH)已成为自发性脑脊液鼻漏的原因之一,但仍被低估,可能被忽视,在治疗中需要特别考虑。本研究的目的是证明自发性脑脊液鼻漏是IIH的主要表现,并探讨管理算法。方法:对所有自发性(原发性)脑脊液鼻漏患者进行完整的临床和影像学评估。我们对所有纳入的患者在侧卧位进行腰椎穿刺和脑脊液压力测量,以检测颅内高压。在脑脊液鼻漏病例中,20 cmH2O的压力被认为是诊断颅内压升高的截止值。当诊断出颅内高压时,患者立即接受腰腹腔分流术。如果分流器插入后脑脊液漏停止,我们将不进行颅底修复,并将患者送去随访。然而,如果在插入分流器后颅张力恢复正常,脑脊液漏仍未停止,或分流器通畅后脑脊液鼻漏复发,或存在颅内气颅,则需要进行颅底修复。结果:研究期间共发现脑脊液鼻漏293例。只有42例(14.3%)患者被诊断为自发性脑脊液鼻漏,其余为创伤后患者。42例患者中有37例(88.1%)出现脑脊液高压读数。37例患者均行腰腹腔分流术,并行脑脊液鼻漏封堵术。随访期间,7例患者再次出现漏出;其中3例出现分流梗阻,分流翻修后鼻漏改善。其余4例显示分流未闭,需颅底修复。结论:自发性脑脊液鼻漏被认为是继发于IIH,除非另有证明。对于伴有脑脊液鼻漏的IIH患者,初始放置腰腹腔分流术可能是颅底修复的有效替代方法。
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引用次数: 0
Awake resection of a right motor cortex arteriovenous malformation in a pediatric patient: A case report and review of the literature. 醒着切除小儿右运动皮质动静脉畸形一例报告及文献复习。
Pub Date : 2024-12-06 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_192_2024
Syed Faisal Nadeem, Anum Gujrati, Fatima Mubarak, Ahsan Ali Khan, Syed Ather Enam

Background: Intracranial arteriovenous malformations (AVMs) are extremely rare in the pediatric population, with an estimated prevalence of 0.014-0.028%. About 75-80% of pediatric AVMs present with intracranial hemorrhage, a source of significant morbidity and mortality. Awake craniotomy (AC) has become the standard approach for resecting eloquent area intracranial lesions in the adult population. Its use, however remains limited in the pediatric population and has very rarely been reported for an AVM of the motor cortex in this age group.

Case description: We report the case of a 17-year-old, right-handed boy who presented to our setup with a 2-month history of left-sided hemiparesis and left facial hypoesthesia following an episode of acute loss of consciousness (ALOC) while playing football. A computed tomography scan done after ALOC revealed an AVM in the right frontoparietal cortex with associated acute hemorrhage. Digital subtraction angiography (DSA) was done which revealed a right-sided grade II AVM with arterial supply from the right middle cerebral artery and venous drainage into the superior sagittal and cavernous sinuses. The patient underwent elective neuronavigation-guided right frontoparietal AC and resection of AVM. Postoperative DSA revealed no residual disease. The patient's neurologic deficits showed improvement in the first few days following surgery. He was discharged with advice to follow up in a neurosurgery clinic to monitor his postoperative recovery and ensure compliance with physiotherapy.

Conclusion: This case represents only the second pediatric patient in the available medical literature to have ever undergone AC for intracranial AVM resection. Pediatric AVMs are a rare entity and pose the risk of significant morbidity and mortality. Awake surgery has the potential to reduce iatrogenic neurological deficits in the pediatric population significantly. More work must be done to increase pediatric patient compliance with awake surgery.

背景:颅内动静脉畸形(AVMs)在儿科人群中极为罕见,估计患病率为0.014-0.028%。大约75-80%的儿童动静脉畸形存在颅内出血,这是一个显著的发病率和死亡率的来源。清醒开颅术(AC)已成为成人切除大面积颅内病变的标准方法。然而,它的使用在儿科人群中仍然有限,并且很少有报道在这个年龄组中发生运动皮质的动静脉畸形。病例描述:我们报告了一个17岁的右撇子男孩,他在踢足球时出现急性意识丧失(ALOC),有2个月的左侧偏瘫和左侧面部感觉减退的病史。ALOC后的计算机断层扫描显示右侧额顶叶皮质AVM伴急性出血。数字减影血管造影(DSA)显示右侧II级AVM,动脉供应自右侧大脑中动脉,静脉引流至上矢状窦和海绵窦。患者接受选择性神经导航引导下的右侧额顶叶AC和AVM切除术。术后DSA显示无残留病变。患者的神经功能缺陷在手术后的最初几天有所改善。出院时建议到神经外科诊所随访,以监测其术后恢复情况并确保物理治疗的依从性。结论:在现有医学文献中,该病例仅是第二位接受AC手术切除颅内AVM的儿科患者。小儿动静脉畸形是一个罕见的实体,并造成显著的发病率和死亡率的风险。清醒手术有可能显著减少儿科人群的医源性神经功能缺陷。必须做更多的工作来提高儿科患者对清醒手术的依从性。
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引用次数: 0
Integrated dexmedetomidine-sevoflurane algorithm for anesthetic induction - A viable asset for neurosurgery. 右美托咪定-七氟醚综合麻醉诱导算法-神经外科的可行资产。
Pub Date : 2024-12-06 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_934_2024
Kunal Kumar Sharma, Bharti Chauhan
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引用次数: 0
期刊
Surgical neurology international
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