Surgical neurology international最新文献

Background: Bow Hunter's syndrome (BHS) is typically defined as transient compression of the vertebral artery (VA) during head rotation. Subaxial and postoperative variants are extremely rare.

Case description: A 50-year-old male with ankylosing spondylitis developed dizziness and syncope following posterior cervical surgery. His symptoms were triggered not by head rotation but by assuming an upright sitting posture. Imaging demonstrated malalignment at the C4-5 level with the formation of a VA loop. Multilevel anterior cervical discectomy and fusion corrected the deformity, restored vertebrobasilar flow, and led to complete clinical recovery.

Conclusion: A 50-year-old male presents with a rare postoperative subaxial variant of BHS provoked by assuming an upright position rather than head rotation. Subaxial VA compression, as highlighted here, should be considered in the differential diagnosis of patients presenting with posture-related dizziness or syncope after posterior cervical surgery.

Background: Ventriculoperitoneal (VP) shunts are widely used to treat hydrocephalus in children with posterior fossa tumors. While many patients gain shunt independence after tumor control, indwelling shunts are often not removed. Shunt-related intracranial cysts are extremely rare and typically develop along the intracranial catheter tract within days to several years after shunt insertion; to date, the longest reported interval has been 19 years. Here, we report a case a cystic lesion with marked perilesional edema developing 45 years after childhood VP shunt placement for tumor-related hydrocephalus.

Case description: We report the case of a 58-year-old man who presented with acute severe left-sided hemiparesis. At the age of 13 years, he underwent resection of a posterior fossa ependymoma, VP shunt placement, and whole-brain radiotherapy. Neuroimaging revealed a large right frontal low-density lesion with vasogenic edema and a cystic cavity surrounding the intracranial shunt catheter. Retrospective review of magnetic resonance imaging performed 3 months earlier showed a smaller preexisting cyst at the same site. The shunt catheter was removed without resistance, and the membranous material adhering to the distal tip caused partial intraluminal obstruction. Postoperatively, the hemiparesis improved markedly; follow-up imaging demonstrated resolution of the edema and reduction in the cyst size. As hydrocephalus did not recur, shunt reinsertion was not required.

Conclusion: This case represents the longest latency reported in the literature for VP shunt-related intracranial cyst formation, occurring 45 years after shunt implantation, exceeding the previously reported maximum interval of 19 years. The acute symptoms closely resemble stroke or infection, underscoring the diagnostic challenge. Clinicians should be vigilant of such delayed complications even decades after shunt placement.

Background: Malignant peripheral nerve sheath tumors (MPNSTs) are one of the most difficult malignant mesenchymal neoplasms to treat. They can arise from a preexisting peripheral nerve sheath or in neurofibromatosis type 1 (NF1) patients. MPNSTs in the head-and-neck region represent approximately 2-6% of all head-and-neck sarcomas and account for 12-19% of all MPNSTs. It has an incidence of 0.001% in the general population, and prognosis is typically poor; only between 20% and 50% of patients survive 5 years after diagnosis. The complete surgical resection is recommended whenever possible.

Case description: The authors report the case of a 31-year-old woman with a history of plexiform neurofibroma, who presented with recurrence with disease progression to MPNST, without association with NF1 disease. The aim of tumor resection is symptomatic relief.

Conclusion: These tumors have a high risk of severe complications and even mortality due to various causes. The benefits - including the emotional ones - can be so significant that, despite their malignant lineage, resection and regrowth control remain worthwhile for as long as possible. Four- or six-hand surgery for these tumors can reduce bleeding, operative time, and complications.

Background: Small (<5 mm) intracranial aneurysms present a therapeutic challenge due to their low annual rupture risk and uncertainties regarding procedure-related morbidity. Evidence from Latin America remains limited.

Methods: We conducted a retrospective multicenter observational study including 1,519 patients treated between 2017 and 2023 in eight referral centers across five Latin American countries. Demographic, clinical, morphological, and treatment-related variables were analyzed. Logistic regression was used to identify independent predictors of treatment-related complications.

Results: The overall complication rate was 6%. Surgical treatment showed higher crude complication rates (11%) compared with endovascular therapy (6%), largely reflecting a greater proportion of ruptured aneurysms. Independent predictors of treatment-related complications were a history of aneurysmal subarachnoid hemorrhage (odds ratio [OR] = 5.03), intraparenchymal hematoma before treatment (OR = 3.56), and ruptured aneurysm status (OR = 2.13). Complications were associated with higher mortality (31% vs. 7%; P < 0.001) and worse 1-year outcomes (Modified Rankin Scale 3-6: 41% vs. 12%; P < 0.001).

Conclusion: In this first regional multicenter series, treatment of small intracranial aneurysms in Latin America demonstrated low complication rates and favorable safety profiles for both surgical and endovascular techniques. The predictors identified may support clinical decision-making and improve prognostic assessment.

Background: Aplastic or twig-like middle cerebral artery (Ap/T-MCA) is a rare congenital vascular anomaly characterized by the absence or hypoplasia of the M1 segment, replaced by a network of small tortuous collateral arteries. Although Ap/T-MCA predominantly presents with intracerebral hemorrhage from rupture of fragile vessels, acute ischemic stroke can occur, presenting with diagnostic and therapeutic challenges.

Case description: A 79-year-old woman presented with acute right hemiplegia and aphasia. Initial imaging suggested left M1 segment occlusion of the MCA, prompting emergency thrombolysis and mechanical thrombectomy (MT). Intraoperative angiography revealed a reticulated vascular network replacing the normal M1, consistent with Ap/T-MCA. Subsequently, subarachnoid hemorrhage due to vascular injury developed, along with cerebral infarctions in the anterior cerebral artery (ACA) territory and the frontal lobe of the MCA territory. Postprocedural cardiac evaluations identified no cardioembolic source. The stroke may have resulted from thrombosis within the Ap/T-MCA network or from a thrombus at the terminal segment of the internal carotid artery or the network entrance that migrated to the ACA.

Conclusion: This case report highlights challenges in diagnosing and managing acute ischemic stroke with Ap/T-MCA. Because complex vascular anatomy may suggest M1 occlusion on non-invasive imaging, MT may lead to interventions with high hemorrhagic risk. Caution is warranted when apparent M1 occlusion coexists with a complex network typical of Ap/T-MCA. Understanding the angiographic features and recognizing the potential risks of MT are essential to optimizing outcomes. Further studies are required to establish appropriate management strategies for acute stroke in this rare vascular anomaly.

Background: Transforaminal lumbar interbody fusion (TLIF) is widely used to treat degenerative spinal pathologies. However, deciding whether to use a unilateral or bilateral facetectomy has historically been based on surgeon preference. This study aims to compare radiological, operative, and clinical outcomes of unilateral versus bilateral facetectomy in open or minimally invasive surgery (MIS) TLIF.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, nine cohort studies were identified: two open-only, six MIS-only, and one combined MIS-open TLIF publications. Forest plots generated a pooled analysis for each outcome measure.

Results: Meta-analyses found no difference in lumbar lordosis between facetectomy procedures in open-only, MIS-only, or combined groups. Disc height change was similar in the MIS-only and combined groups. In MIS-only publications, bilateral facetectomy was associated with higher blood loss, postoperative drainage, and surgical duration. One open-only publication reported that bilateral facetectomy experienced statistically significantly greater delta patient health questionnaire-9 (-4.6 ± 5.2 vs. -0.8 ± 4.6, P = 0.03) and quality-adjusted life year (0.3 ± 0.2 vs. 0.1 ± 0.2, P = 0.01). One MIS-only publication reported that unilateral facetectomy incurred significantly greater delta Oswestry disability index after 2 years (25.8 ± 23.5 vs. 8.2 ± 29.6, P = 0.026) while bilateral facetectomy had a greater delta patient-reported outcomes measurement information system-physical function scale after 2 years (13.7 ± 4.4 vs. 3.7 ± 4.0).

Conclusion: Unilateral and bilateral facetectomy produce comparable radiologic, operative, and clinical outcomes. In MIS TLIF, unilateral facetectomy offers reduced blood loss, operative time, and drainage. Unilateral facetectomy is an acceptable and potentially favorable option for standard lumbar degeneration, particularly in MIS TLIF, where exposure is limited to a facet.

Background: In shaken baby syndrome (SBS), the brain tissue is caused to move back and forth inside the skull, resulting in bruising and tearing of the brain and leading to irreversible brain damage. Understanding mothers' knowledge and attitudes toward SBS is helpful for the development of effective interventions, such as educational programs, to prevent SBS and its devastating consequences in newborns and infants. As such, the objectives of this study were to investigate parental perceptions and attitudes regarding SBS.

Methods: This study was a cross-sectional, descriptive investigation conducted between June 2024 and March 2025. Utilizing validated electronic questionnaires, the aim of this work was to assess the awareness, knowledge, and attitudes of parents in Saudi Arabia's western region regarding SBS, and to identify the sources and factors linked to SBS information.

Results: A total of 409 parents participated in the study. There was a notable difference in terms of gender (P = 0.016), with fewer males exhibiting good awareness of SBS (19.6%) compared to females (36.0%). There was also a significant difference for marital status (P = 0.048). Finally, regarding the act of shaking the baby, 117 (43.2%) of those parents with poor SBS awareness admitted to shaking their baby when they cried, whereas 38 (27.5%) of those with good awareness reported the same behavior (P = 0.006).

Conclusion: Parents show a low level of awareness and understanding regarding SBS. Incorporating SBS awareness into prenatal education and public health initiatives could significantly contribute to the prevention of child abuse and its dire repercussions.

Background: Abdominal cerebrospinal fluid (CSF) pseudocyst is a rare complication of ventriculoperitoneal (VP) shunt, with an incidence from 0.25% to 10%, and a recurrence rate up to 19.8%. We reported the first documented case from Sudan of a fatal VP shunt-associated intraperitoneal pseudocyst in an infant, highlighting diagnostic and management challenges in resource-limited settings and providing a literature review to explore the management and outcomes.

Case description: An 8-month-old female who underwent two shunt revisions for primary hydrocephalus with a VP shunt presented with acute abdominal distension and fever, which lasted 4 days. Physical examination revealed a palpable, tense mass, dull on percussion, with a positive transillumination test, and a slow-refilling shunt. Abdominal X-ray and ultrasound showed an 11 × 10 cm encapsulated fluid collection surrounding the shunt tip. A computed tomography scan was not performed as it was unavailable. Laboratory findings included leukocytosis and elevated C-reactive protein, but sterile CSF cultures. Laparotomy confirmed the intraperitoneal pseudocyst with extensive bowel adhesions, so we performed both partial excision of the pseudocyst wall and shunt repositioning. Postoperatively, the patient developed hypokalemia with convulsions and abrupt clinical deterioration consistent with intracranial hypotension due to shunt over-drainage, which resulted in a fatal cardiopulmonary arrest on the 7^th postoperative day.

Conclusion: Our case demonstrates a life-threatening intraperitoneal CSF pseudocyst despite intervention; the patient unfortunately passed away due to postoperative complications, primarily severe intracranial hypotension from shunt over-drainage. Infants with low weight for age, several shunt revisions, and postoperative shunt over-drainage have a poor prognosis; in addition, there are delayed diagnosis, treatment, and limited imaging. The early implementation of alternative methods, along with close postoperative monitoring, can help minimize complications and mortality.

Neurological oncogenetics research provides promising new possibilities for treating brain tumors which affect African individuals. The critical neurological research field shows a large deficit in training prospects for African medical students who wish to become residents. This paper proposes initiating specific educational programs that prepare future healthcare leaders to develop original local research that they must design from the ground. Academic training combined with mentoring activities and project group work will produce new researchers who investigate genetic brain diseases affecting African populations. The strategic partnership among international research institutes creates free access to available resources along with knowledge-sharing channels, which drive local resolution advancement. Local healthcare institutions progress scientifically using this program to enhance their patient results. Organizations now require substantial financial commitments to establish superior African medical schools aiming to prepare future neurological oncogenetic research leaders.

Background: The Standard of Care (SOC) for treating significant spinal epidural abscesses (SEA) is STAT surgery for patients with the new-onset of neurological deficits following STAT contrast MR studies confirming significant neural (i.e. mild/moderate, moderate, or marked cord/nerve root) compression. Too many health care professionals, including physicians, and select spine surgeons still wrongly believe delaying "acute" spinal decompressions in patients with SEA for up to 8, 12, and even 24 hours is acceptable even in paralyzed patients.

Methods: Here we review the fact that the standard of care for treating SEA is STAT surgery for patients demonstrating the new-onset of neurological deficits following STAT contrast MR scans confirming significant neural compression.

Results: STAT surgery for newly neurologically symptomatic patients with SEA following STAT contrast MR scans documenting significant neural compression yields the best results. Notably, select patients without neural deficits or significant MR neural compression may be considered for non-surgical treatment. The "gold standard" for diagnosing SEA is the contrast MR, while non-contrast CT studies almost uniformly fail to diagnose SEA, and Myelogram-CT studies have significant limitations (i.e. risk of causing meningitis, and may fail to document cephalad extent of SEA if there is a distal total block to intrathecal contrast).

Conclusion: STAT surgery is the SOC and treatment of choice for patient with SEA demonstrating significant new-onset neurological deficits with significant STAT contrast MR findings of neural compression. Further, STAT means STAT, no waiting period is acceptable (i.e. 8, 12 or up to < 24 hours) particularly in paralyzed patients.