Surgical neurology international最新文献

Background: Undergraduate conferences may improve exposure to neurosurgery among medical students. Hence, this study aimed to evaluate the effect of a neurosurgical skills conference on medical students' comprehension and perceptions of the specialty.

Methods: A before-and-after (BA) study design was employed to assess the effects of a conference that integrated presentations with hands-on sessions. Practical workshops covered craniotomy, spinal fixation, surface anatomy, intracranial pressure (ICP) monitoring, basic surgical skills, and microsurgical simulation. Pre-conference and post-conference surveys, utilizing Likert scales, gauged participants' attitudes, prior neurosurgical exposure, and understanding of neurosurgical skills. Statistical analysis was conducted on dichotomized responses.

Results: Thirty-one participants completed both surveys, with the majority being 1^st and 2^nd-year medical students. Among the participants, 58.1% were female, and 77.4% identified with BAME ethnicities. Following the conference, there was a notable increase in comprehension regarding neurosurgical careers (from 58.1% to 96.8%, P < 0.001) and training criteria (from 22.6% to 93.5%, P < 0.001). The conference enhanced knowledge of indications for craniotomy (P < 0.001), ICP monitoring (P < 0.001), and spinal fixation (P < 0.001). Participants reported improved understanding of the steps involved in craniotomy (P < 0.001), familiarity with basic cranial surgical surface anatomy (P < 0.001), and confidence in performing basic surgical instrument ties (P < 0.001). Although interest in pursuing a career in neurosurgery remained high (from 87.1% to 90.3%, P = 1.000), a majority of participants, both BA the conference, expressed concerns about the impact on personal life (from 58.1% to 64.5%, P = 0.774).

Conclusion: This study underscores the role of undergraduate mixed-method conferences in augmenting understanding of neurosurgery and nurturing early interest.

Background: Chordomas are primary bone tumors derived from the embryonic notochord. They represent 1-4% of all malignant bone tumors. They have a predominantly extra-axial location, arising in the clival region in 35% of reported cases. The prognosis is generally poor, and radical resection remains the first-line treatment. This study aims to describe a case of a clival chordoma that was resected through a combined microscopic transoral and endoscopic endonasal approach, with excellent clinical outcomes.

Case description: A 24-year-old woman with low cranial nerve symptomatology was admitted for a two-stage surgical approach. An occipital-cervical fixation was performed in the first stage, while a combined endonasaltransoral resection was performed later for tumor resection.

Conclusion: Microscopic transoral and endoscopic endonasal approaches offer advantages for treating clival chordomas, with careful consideration of anatomical constraints and potential for postoperative recurrence being essential in approach selection.

Background: With the insurgency and farmer-herder crisis in northeast Nigeria, arrow injuries with various fatalities have been on the increase. Practicing in a low-resource setting with no functional computed tomography (CT) scan necessitates utmost dependence on plain X-rays for decision-making in patient care.

Case description: We present our experience with a patient who presented in our facility with a right transorbital subfrontal arrow injury. The patient had retrograde extraction of the arrow based on plain X-ray findings with no sequelae.

Conclusion: We highlighted the role of X-ray in the management of arrow injuries, although bone window CT without or with angiography is the gold standard of imaging modalities in the management of patients with arrow injuries to the head.

Background: Residual intracranial aneurysms post-clipping or coiling pose a poorly established risk of rupture. Computational fluid dynamic (CFD) offers insights into hemodynamic changes following such interventions. This study aims to assess hemodynamic parameters in residual aneurysms pre- and post-treatment with surgical clips or coils using CFD.

Methods: A retrospective analysis of consecutive patients between January 2015 and January 2024 was conducted. Digital subtraction angiography images were reconstructed using 3D modeling techniques, and hemodynamic parameters were analyzed with ANSYS^® software.

Results: Six aneurysms were analyzed: Five unruptured and one ruptured. The aneurysms were located at the basilar apex (2), middle cerebral artery bifurcation (2), and origin of the posterior communicating artery (2). Post-treatment, there was a significant reduction in both aneurysm area (median reduction of 33.73%) and volume (median reduction of 25.3%). Five of the six cases demonstrated fewer low wall shear stress (WSS) areas, which could indicate a reduction in regions prone to thrombus formation and diminished risk of rupture. In the unruptured aneurysms, there was a median increase of 137.6% in average WSS. Notably, the only case with increased low WSS area also had the highest increase in average WSS. One basilar artery aneurysm showed increased WSS across all parameters, suggesting a higher rupture risk.

Conclusion: The increase in average and high WSS area, along with a decrease in low WSS area, reflects a complex balance between factors of stability and rupture risk. However, a simultaneous increase in all WSS parameters may represent the highest rupture risk due to increased mechanical stress on the aneurysm wall, necessitating closer monitoring.

Background: The specific objectives of this study are to identify the carotid cavernous fistula (CCF) type based on computerized tomography angiography (CTA) results, determine the cut-off diameter of the superior ophthalmic vein (SOV) and internal jugular vein (IJV) in CCF patients, and to evaluate the correlation between diameters of the right and left SOV and IJV with CCF type and location.

Methods: A retrospective analysis of data from 35 CCF patients at our institution was conducted between January 2016 and October 2022. The analysis separated the vascular diameters of the right and left SOV and IJV, which were compared to 35 non-CCF patients. The non-CCF group consisted of individuals who underwent CTA for conditions unrelated to vascular abnormalities.

Results: In 35 CCF patients, the dilatation of the left SOV was significantly correlated with direct CCF type with a cutoff of >0.5 cm and significantly associated with indirect CCF type with a cutoff of <0.5 cm (P = 0.017), while the right SOV was not significantly correlated (P = 0.187). There was no significant correlation between the right and left IJV with CCF type or location (right IJV, P = 0.996 and left IJV, P = 0.558). However, the analysis indicated that IJV size differences between CCF and non-CCF patients were significant.

Conclusion: Dilation of the left SOV correlates with both direct and indirect CCF types, while the right SOV and IJV (both sides) do not show a significant correlation with CCF type or location. This suggests that left SOV dilation may serve as an early indicator of CCF type, particularly in cases involving the left side.

Background: Giant cerebral aneurysms have a high rupture rate, are often difficult to treat, and have a poor prognosis. We report two cases in which good results were achieved with a short, two-stage operation using a combination of endovascular treatment (EVT) and direct surgery.

Case description: Case 1 - A 50-year-old man had become immobile due to truncal ataxia after nausea. Magnetic resonance imaging, computed tomography (CT), and angiography revealed a giant thrombosed aneurysm of the right vertebral artery 30 mm in diameter, which compressed medulla oblongata. He underwent endovascular parent artery occlusion (PAO) followed by direct surgical thrombectomy 3 days later.The patient's outcome was modified Rankin score (mRS) 1 at 7 days after the operation and mRS 0 at 1 year. Case 2 - A 40-year-old man developed a progressive visual disturbance. CT showed a giant thrombosed aneurysm of 50 mm diameter in the C2 portion of the left internal carotid artery. A balloon test occlusion (BTO) and cerebral blood flow single-photon emission computed tomography under BTO suggested partial ischemic tolerance due to PAO. PAO followed by low flow bypass and thrombectomy of the aneurysm by direct surgery was performed on the same day.The patient's vision was improved with the outcome of mRS 1.

Conclusion: EVT in a short-term two-stage operation for a thrombosed giant cerebral aneurysm is effective for the purpose of hemostasis in the thrombectomy designed to decompress the suffered brain or nerve. Complete PAO and meticulous perioperative use of antithrombotic agents are necessary to avoid perforator failure and hemorrhagic complications in this technique.

Background: We evaluated whether preoperative functional status influenced surgical outcomes for patients with intramedullary spinal cord tumors (IMSCT).

Methods: We analyzed whether lower preoperative McCormick scores impacted primary outcomes for 78 consecutive patients with IMSCT of World Health Organization (WHO) grades I and II undergoing tumor resection between 2010 and 2018.

Results: Patients averaged 33.6 years of age, 57.5% were male, and lesions predominantly involved the cervical 23 (29.5%) followed by the thoracic spine 19 (24.3%). Over the average follow-up interval of 69.83 months, IMSCTs recurred in 11.5% of patients, with 6.4% showing functional deterioration. At follow-up, 73.5% of patients with a preoperative modified McCormick score of two or one showed better functional improvement.

Conclusion: The WHO pathological grades I and II did not significantly influence outcomes for patients with intramedullary spinal cord lesions. However, patients with low preoperative McCormick scores (two or one) demonstrated better functional outcomes.

Background: Intrasellar kissing carotid arteries are a rare variant in which bilateral internal carotid arteries run very near each other at their cavernous sinus portion. We encountered a woman with the pituitary gland mimicking a pituitary microadenoma because the pituitary gland was compressed bilaterally by intrasellar kissing carotid arteries.

Case description: A 61-year-old woman with a chronic headache underwent magnetic resonance imaging, which revealed a sellar mass measuring 10.2 mm in height, 8.2 mm in length, and 4.0 mm in width at the midintercarotid level. Blood levels of all pituitary and target-organ hormones were within normal range. The height and superior convex shape of the sellar mass suggested that it was a nonfunctioning microadenoma, which was monitored over the past 16 years. A recent three-dimensional reconstruction of magnetic resonance angiography clearly showed that the pituitary gland was squeezed upward, compressed bilaterally, and extended superiorly by intrasellar kissing carotid arteries.

Conclusion: The pituitary gland can be squeezed upward by intrasellar kissing carotid arteries and mimic pituitary tumor.

Background: Ewing's sarcoma (ES) is a rare malignant tumor primarily affecting young individuals, with cranial localization being particularly uncommon. While intracranial metastatic ES is infrequent, only four cases of intracranial metastatic ES are reported in the literature; it presents unique diagnostic and therapeutic challenges.

Case description: We present a distinctive case of ES to delineate its clinical, radiological, and histopathological characteristics. Our patient, a 33-year-old, manifested symptoms of intracranial hypertension and gait disturbance. Neurological examination revealed a static and kinetic cerebellar syndrome. Imaging studies and stereotactic biopsy confirmed the diagnosis of primary and metastatic cerebral ES. The treatment regimen encompassed chemotherapy and radiation therapy.

Conclusion: Our case underscores the importance of considering ES in the differential diagnosis of dural-based lesions exhibiting cystic components and heterogeneous contrast enhancement, particularly in young individuals. Early recognition and intervention hold promise for optimizing patient outcomes.

Background: In the carotid bulb (CB), the vascular morphology can cause a decrease in blood flow velocity near the vessel wall. In addition, the CB is a common site for plaque formation. Particularly, echo-lucent plaques (ELPs) are known to pose a risk for cerebral embolism, requiring careful attention. In carotid ultrasonography (CU), ELPs may be difficult to distinguish from blood flow within the vessel using only B-mode imaging; thus, the use of color Doppler imaging (CDI) is recommended. However, when blood flow is extremely slow, even CDI may fail to differentiate between ELPs and the flow. We encountered a case where superb micro-vascular imaging (SMI) successfully detected extremely low-velocity blood flow, thereby excluding the presence of an ELP that CDI could not discern.

Case description: A 64-year-old male with a history of smoking, hyperlipidemia, and percutaneous coronary intervention for myocardial infarction presented for an atherosclerosis screening. CU with CDI indicated a lesion showing a flow void near the wall of the CB, raising suspicions of significant blood flow stasis or the presence of an ELP or thrombus. He had no neurological findings or carotid bruits. A head magnetic resonance imaging revealed no findings suggestive of cerebral embolization. Using SMI during additional CU, we detected extremely low-velocity blood flow near the wall of the CB, allowing us to exclude an ELP.

Conclusion: When a flow void is observed with CDI in CU, and it is difficult to differentiate between an ELP and extremely low-velocity blood flow, the application of SMI can sometimes detect the extremely low-velocity blood flow. This approach may help avoid invasive examinations such as CU with contrast agents or cerebral angiography.