Surgical neurology international最新文献

Background: Orbital bullet injuries resulting from high-velocity trauma pose significant clinical challenges due to the potential for severe ocular and systemic complications. This meta-analysis consolidates the existing body of knowledge on direct orbital bullet injuries with respect to clinical outcomes, management strategies, and long-term effects.

Methods: The literature search was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using databases such as PubMed and Scopus. Seventeen articles were reviewed, out of which six studies met the inclusion criteria. Extracted data included details on study design, sample size, patient demographics, projectile type, clinical presentation, imaging modalities used in establishing the diagnosis, surgical interventions performed, duration of follow-up, and the outcomes achieved. Data synthesis was done using fixed and random effects models; heterogeneity testing was assessed using the I² statistic.

Results: A total of 688 patients with orbital bullet injuries were analyzed. The average age years ranged from 7 to 58, with a predilection for the male gender, about 70%. These injuries caused marked visual impairment, which included optic nerve injuries, legal blindness, cornea injuries, hyphema, orbital fractures, vitreous hemorrhage, lid lacerations, cataracts, and retinal injuries. Optic nerve injuries exhibited substantial variability (I² = 100%, H² = 1.254 × 10⁸). Legal blindness was common (I² = 100%, H² = 1.628 × 10⁷), with high rates reported in conflict zones. Corneal injuries and hyphema were also prevalent, with significant heterogeneity observed (I² = 100%, H² = 8.183 × 10⁶ for corneal injuries and I² = 99.861%, H² = 721.638 for hyphema). Only orbital fractures, vitreous hemorrhage, lid lacerations, cataracts, and retinal injuries showed very high heterogeneity with varying clinical presentation. Early surgical intervention and advanced imaging techniques played a very vital role in the management of these injuries and those which improved the prognosis of outcome.

Conclusion: Orbital bullet injuries remain a great clinical challenge and are very variable in nature. This huge variability of injury patterns and outcomes enjoins that treatment must be individualized, with very early intervention, evolved imaging modalities, and thorough surgical management for the best possible improvement in the patient's outcomes and prevention of long-term sequelae. Further studies should be done to come up with unified guidelines regarding the evaluation and treatment of such complex injuries.

Background: Congenital arterial defects such as cerebral arteriovenous malformations (AVMs) increase brain bleeding risk. Conservative therapy, microsurgical removal, percutaneous embolization, stereotactic radiosurgery (SRS), or a combination may treat this serious disease. This study compares angioembolization with SRS to SRS alone in ruptured or unruptured brain ateriovenous malformations (BAVM) patients.

Methods: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations for this study. Until September 2023, PubMed/Medline, Cochrane, and Clinicaltrials.gov were searched for literature. English-language studies comparing SRS alone to embolization with SRS on ruptured or non-ruptured AVMs that could not be operated on were considered. The Newcastle-Ottawa Scale assessed research study quality.

Results: Results included 46 studies with a total of 7077 participants. There was a greater obliteration rate in the SRS-only group (60.4%) than in the embolization plus SRS group (49.73%). Particularly in the SRS-only group, ruptured AVMs showed a noticeably greater obliteration rate than unruptured AVMs (P = 0.002). However, no notable differences were found in hemorrhagic events or radiation-induced changes between the two groups; however, the SRS-only group had a slightly greater, yet not statistically significant, mortality rate.

Conclusion: Our data showed that ruptured brain AVMs had a much greater obliteration rate than unruptured ones, mostly due to SRS alone, without embolization. The aggregated data showed no significant changes, whereas SRS alone decreased radiation-induced alterations and hemorrhagic rates but with increased mortality. SRS alone may have a higher risk-to-reward ratio for nidus obliteration in ruptured brain AVM patients, so it should be used without embolization, although more research is needed to determine the effects of immediate and late complications.

Background: Collision sellar tumors are rare disease entities. Less than 30 cases have been reported in the literature in the last 20 years. We present the case of one patient diagnosed with a collision sellar tumor and describe the use of Enhanced Contact Endoscopy for pituitary gland and tumoral identification not previously described in the literature.

Case description: The patient is a 57-year-old man who presented with visual field deficits and intense frontal headache accompanied by a slight hypothyroidism. Magnetic resonance imaging shows two different lesions in the sellar area, with a pendular effect of the pituitary stalk displaced to the side of the pituitary adenoma. The patient was operated on with an endoscopic endonasal subsellar approach, aiding with an enhanced contact endoscopy to demarcate the pituitary gland from the tumor adequately. Pathology diagnosis was compatible with pituitary adenoma (First lesion) and papillary craniopharyngioma (Second lesion). A short surgical video was added to complement the learning of the technique for enhanced contact endoscopy for a description of the microvasculature pattern.

Conclusion: Collision sellar tumors are a rare pathology in the sellar region and could benefit from a variety of combined treatments for optimal outcomes. Enhanced contact endoscopy for pituitary surgery could be useful for distinguishing the normal pituitary gland from the tumor.

Background: Craniosynostosis may result in malformations of the orbit, which can be observed in clinical presentations. Craniosynostosis impairs the normal growth of the skull, which typically occurs perpendicular to the fused suture. Craniosynostosis is classified into non-syndromic and syndromic, with an incidence of 1: 2000-2500 live births. It is commonly affects the sagittal suture (40-60%), followed by the coronal suture (20-30%), the metopic suture (<10%), and rarely the lambdoid suture. Computed tomography (CT) scan plays a crucial role in identifying the type of cranial abnormality and associated disruptions in the orbital axis (OX).

Methods: The research sample was craniosynostosis patients who were examined at the Radiology Department of Dr. Soetomo General Hospital at Surabaya, Indonesia for the period January 2017-March 2022, male or female aged <8 years and have never had head surgery. Evaluation of the position and axis of the extraocular muscles within the orbits is drawn on the coronal section. In this study, pediatric CT images were acquired at 100 kVp (CTDIvol 2.3 mGy; DLP 84.8 mGy*cm; scan time 6.1 s; helical pitch 0.297). The research was conducted using a case-control method. The case group consisted of patients with craniosynostosis, while the control group included patients without craniosynostosis, encompassing those with conditions such as meningoencephalitis. After the data source is obtained, then the case and control data are matched and then the Chi-square correlation test is carried out through Statistical Package for the Social Sciences.

Results: A significant correlation was found between the incidence of craniosynostosis and abnormalities of OX (P-value: 0.000; OR: 22.81; R: 0.635).

Conclusion: There is a significant correlation between the incidence of craniosynostosis that has two or more sutural fusions and abnormalities of OX. Strabismus associated with craniosynostosis is typically detected in patients at an older age. Hopefully, by analyzing the eye angle through CT scans while craniosynostosis is established, abnormalities of the orbital axis can be identified. So the progression of strabismus can be prevented.

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.

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.

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.

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.

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 4^th and 5^th 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.