Surgical neurology international最新文献

Background: Rare arterial abnormalities known as intraorbital ophthalmic artery aneurysms (IOOAAs) present considerable difficulties in diagnosis and treatment. To effectively manage these uncommon illnesses, sophisticated diagnostic methods and meticulous treatment planning are needed. The purpose of this study is to thoroughly examine the clinical manifestations, diagnostic techniques, therapeutic modalities, and results of IOOAAs.

Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing the PubMed and Scopus databases. The search terms included "ophthalmic artery," "aneurysm," "intraorbital," and "orbit." Studies were considered if they included patients with clinically confirmed IOOAAs and were published in English. The data collected encompassed patient demographics, aneurysm characteristics, clinical presentations, diagnostic imaging techniques, treatment methods, and outcomes.

Results: An analysis was conducted on fifteen studies involving fifteen patients with an average age of 46.4 years. Females constituted 40% of the study population. The most common symptom presented was loss of vision, which was seen in 93.3% of cases, while proptosis was found in 46.7% and pain in 40%. Aneurysms were found more on the right side, 66.7%, and varied in size and morphology; saccular aneurysms constituted 33.3% of the total number of aneurysms, while fusiform constituted 20%. The availability of advanced imaging techniques, especially angiography, magnetic resonance imaging (MRI), and computed tomography scans, considerably improved the diagnosis rate. Treatment approaches included surgery in 46.7% of the total number of patients, conservative treatment in 33.3%, and endovascular treatment in 20%. The outcome from these managements was variable, with complete resolution of symptoms seen in 33.3% of patients and partial improvement in 40%. The average time of follow-up and observation was 11.18 months.

Conclusion: Ophthalmic artery aneurysms within the intraorbital compartment are rare yet present formidable challenges for their diagnosis and management. Accurate localization of the aneurysm requires the use of very advanced imaging techniques. In this regard, high-resolution MRI and computed tomography angiography play a pivotal role in the detection of these anomalies within the complex structures of the eye. Proper planning of therapy that better suits the condition and proper follow-up care is important for the best outcomes. Future research should focus on guideline standardization in management and long-term outcome improvements.

Background: Patients with malignancies that have a propensity to develop dural metastasis can present a dural infiltration mimicking a subdural hematoma. Dural metastases originating from prostate cancer mimicking a subdural hematoma are rare.

Case description: The authors describe the case of a 66-year-old man with a history of prostate adenocarcinoma with vertebral metastases who complained of headaches, weakness, anorexia, and dizziness for 1 month. A head computed tomography scan without contrast demonstrated a right pan-hemispheric subdural collection, which was reported to be a subacute subdural hematoma. Due to the patient's history of prostate carcinoma, brain magnetic resonance imaging (MRI) with and without gadolinium was requested before the surgery, which showed substantial enhancement of the subdural collection, suggesting a tumoral collection. Based on the MRI findings, an open biopsy was performed, revealing extensive bone infiltration and a thickened dura with a large subdural tumoral component suggestive of disseminated pachymeningeal carcinomatosis. No hematoma was identified.

Conclusion: This case report demonstrated how metastatic lesions can mimic subdural hematomas. This disease carries a poor prognosis. Diagnosing and managing this rare entity warrants high suspicion to guide the patient and the family members in decision-making.

Background: Primary malignant melanoma is an extremely rare pathology that can occur anywhere in the brain and spinal cord. Patients often present with symptoms like that of brain tumors. This similarity and inability to make a definitive diagnosis from radiological imaging alone make it a challenging diagnosis. Gross total resection is the accepted mainstay of treatment, while histopathological biopsy can confirm the diagnosis.

Case description: A young gentleman who was otherwise healthy presented with neck pain and right-sided weakness. Magnetic resonance imaging revealed an extra-axial mass at the level of the foramen magnum. The patient underwent lateral sub-occipital craniotomy with C1 laminectomy and maximum safe resection of the lesion. Intra-operatively, a firm, moderately vascular black-colored dura-based lesion was found. The frozen section revealed highly pigmented spindle cell neoplasm, and histopathology confirmed that it was malignant melanoma. Postoperative recovery was unremarkable.

Conclusion: Primary malignant melanoma is rare and very challenging to diagnose. It demands an early diagnosis and meticulous surgical management for a favorable prognosis.

Background: Trigeminal neuralgia (TN) is a disease that impairs patients' daily activities. Microvascular decompression (MVD) is known as the best procedure to relieve pain, yet a small portion of patients still experience pain after surgery. This study will analyze the prognostic factor of MVD for TN patients.

Methods: This is a retrospective cohort study of patients with TN who underwent MVD in an Indonesian tertiary hospital from January 2012 to December 2023. It combines medical records and patient interviews followed by statistical analysis to identify prognostic factors influencing the outcome of MVD for TN.

Results: Good response to carbamazepine is a favorable factor for short-term pain-free following MVD (P = 0.01). The type of pain emerged as the sole significant prognostic indicator for short-term (P < 0.001) and long-term (P = 0.04) pain relief following MVD. The duration of pain, the type of blood vessels compressing, and the location of compression demonstrated no statistically significant prognostic value on post-MVD pain-free outcomes.

Conclusion: MVD outcomes are influenced by several factors, including trigeminal pain type (for short and long-term outcomes) and response to carbamazepine (short-term outcomes). Conversely, other factors thought to influence MVD outcomes, such as the duration of pain, the type of blood vessel compressing the nerve, or the site of nerve compression, have not been proven to influence the procedure's outcome.

Background: Hydrocephalus, characterized by ventricular enlargement often associated with elevated intracranial pressure, necessitates reliable biomarkers for accurate diagnosis. Aquaporin-9 (AQP-9), localized at the interface of cerebrospinal fluid (CSF) spaces and blood vessels, plays a critical role in brain water homeostasis but remains underexplored in the context of hydrocephalus. Further investigation into AQP-9 expression in CSF is essential to elucidate its potential as a diagnostic biomarker and its role in hydrocephalus pathophysiology.

Methods: This experimental study utilized 10-12-week-old Sprague-Dawley rats (Rattus norvegicus) weighing 200-250 g, randomly assigned to three groups. CSF served as the primary unit of analysis. AQP-9 levels were quantified using the enzyme-linked immunosorbent assay Sandwich method, with CSF sampling conducted at 7-day intervals over 21 days.

Results: AQP-9 levels were significantly elevated in hydrocephalic mice compared to controls, with the highest levels on day 21 (887.62 ± 88.72). CSF drainage resulted in a notable reduction in AQP-9 levels at all time points. Statistical analysis confirmed significant differences across groups (P < 0.05), with post hoc tests showing meaningful reductions in AQP-9 levels after drainage compared to hydrocephalic states. These findings suggest AQP-9 as a potential biomarker for hydrocephalus diagnosis and monitoring therapeutic response.

Conclusion: AQP-9 shows promise as a biomarker for hydrocephalus, with levels reflecting disease progression and decreasing after CSF drainage. This highlights its potential for diagnosis and therapeutic monitoring, warranting further validation.

Background: Pathologies of the basal surface of the temporal lobe (TL) and the lateral incisural space (IS) commonly present microsurgical challenges. Since the inferior temporal gyrus (ITG) is part of both the lateral and the basal surfaces, it has a close relationship with the basal surface of the TL and lacks major white matter tracts, reducing the risk of eloquence. This study aims to describe the technique of ITG resection, its applications in four surgical cases, and the relevant anatomical aspects.

Methods: An anatomical review of the TL and the IS was performed. Anatomical pieces fixed using Klingler's technique and alcohol-fixed, silicone-injected cadaver heads were used to demonstrate landmarks and relationships. The step-by-step surgical technique is described, with four case reports exemplifying its application.

Results: The patients reported no visual field impairments, memory complaints, or neurological complications. The resection of the ITG increases the working space and wider the surgical corridor, allowing access to medial temporal basal structures and the tentorial notch.

Conclusion: The resection of the ITG represents a useful technique to reach the basal surface of the TL and the lateral IS since it avoids excessive retraction of the TL which may cause vessel injury, mainly to the vein of Labbé. Furthermore, it provides relaxation of the vein of Labbé when venous congestion is present. However, more studies are necessary to demonstrate short and long-term outcomes of the resection of the ITG.

Background: The lateral spinal artery (LSA) corresponds to the posterolateral arterial axis of the craniocervical junction. Although implicated in various pathologies and injury risks during treatments, the existence and anatomical characteristics of the LSA are debated. We aim to demonstrate the characteristics of the LSA, including its origins, collateral channels, and anatomical variations.

Methods: Neurosurgeons performed far-lateral craniotomies and cervical laminectomies on 18 cadaver heads (36 sides). Neurovascular structures associated with the LSA were examined in epidural, subdural, and subarachnoid spaces.

Results: The main origins of the LSA were the V3 segment of the vertebral artery (VA) (n = 18), the V4 segment of the VA (n = 12), and the posterior inferior cerebellar artery (PICA) (n = 6). The PICA originated from V3 in 6 cases; in 5, the main LSA origin was the intradural PICA. In the 30 cases where the PICA originated from V4, only one main LSA originated from the PICA. In addition to the main origin, we identified supplementary origins, averaging 1.7 per case. In 4 cases, the LSA and posterior meningeal artery (PMA) shared an origin at V3. Twenty-seven cases had anastomosis between the LSA and PICA on the pial surface. Collateral channels at the C2 level through posterior radicular arteries were observed in 13 cases.

Conclusion: The main origins of the LSA are around the dural ring of the VA and are associated with the PICA's origin. Other potential channels supplying the LSA were also identified. The LSA and PMA may share an origin from the VA.

Background: Phantom limb pain (PLP) is a chronic neuropathic pain syndrome experienced by individuals following limb amputation. Despite the use of various pharmacological treatments, including opioids, antidepressants, and anticonvulsants, effective pain relief remains challenging for many patients. Motor cortex stimulation (MCS) has emerged as a promising alternative for managing PLP.

Methods: We present the management of three patients with chronic, refractory PLP who underwent epidural MCS at Lille University Hospital Center. The quadripolar electrode lead was implanted into the epidural space under local anesthesia. Stereotactic angiography was used to determine the target coordinates, and the optimal location was confirmed with the guidance of a three-dimensional brain magnetic resonance imaging reconstruction and neurophysiological testing. Pain intensity was assessed using the Visual Analog Scale (VAS) at baseline and at the end of the follow-up period, which had a mean duration of 7 ± 2.16 months.

Results: Two of the three patients experienced a decrease in pain by 50%, and one had a 44.4% reduction. The average preoperative VAS score significantly decreased from 7.0 ± 1.73 to 3.67 ± 1.15 at the final follow-up (P = 0.00985). All patients reported a reduction in analgesic medication intake, and no major complications occurred.

Conclusion: PLP is one of the most challenging conditions to treat. MCS is an adjustable and reversible technique that appears to be effective in treating patients with this chronic pain syndrome refractory to other treatment modalities.

Background: Dry needling (DN) has emerged as a potential treatment for mechanical neck pain, but the evidence remains inconclusive. This study aimed to assess the efficacy of DN in improving pain and functionality in patients with chronic mechanical neck pain.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Databases, including PubMed, Cochrane Library, Scopus, and Google Scholar, were searched from December 2013 to January 2024. Studies involving adult participants with chronic mechanical neck pain treated with DN were included in the study. The primary outcomes were pain pressure threshold (PPT), Neck Disability Index (NDI), and cervical range of motion. Statistical analysis used a random-effect model.

Results: Nine RCTs with a total of 540 participants were included in the study. DN significantly improved the PPT with an MD of 0.52 (95% confidence interval [CI], 0.39-0.65; P < 0.001). NDI also showed a significant improvement, with an MD of -0.68 (95% CI, -1.32--0.05; P = 0.04). In terms of cervical range of motion, DN improved flexion (MD 4.07, 95% CI, 0.39-7.75; P = 0.03) and right rotation (MD 8.20, 95% CI, 3.05-13.35; P = 0.002), but no significant differences were observed in extension, left rotation, or lateral flexions (P > 0.05).

Conclusion: DN appears effective in short-term pain relief and functional outcomes for patients with mechanical neck pain but shows limited impact on the cervical range of motion.

Background: The pathogenesis, surgical techniques, and outcomes of pituitary adenomas (PAs) remain variable. We compared our surgical techniques and perioperative/long-term PA outcomes to highlight the hybrid microscopic/endoscopic technique used to optimize efficiency, cost savings, and outcomes in PA surgery.

Methods: Consecutive PA cases performed from January 2017 through February 2020 were evaluated retrospectively. A cost analysis by surgical approach was performed combining this primarily microscopic series, with endoscopic visual assist, and a separate cohort of consecutive intra-institutional endoscopic-only PA resections.

Results: Among 160 patients included in the main cohort analysis (mean age 51.5 ± 16.2; 89 females [55.6%]), a microscope was used in 81.9% of cases, with endoscopic assistance (hybrid) or the endoscope alone used in the remaining cases. Surgical complications occurred in 5 cases (3.1%): postoperative diabetes insipidus in 3 (1.9%), electrolyte imbalances requiring additional drug treatment in 3 (1.9%), and syndrome of inappropriate anti-diuretic hormone release in 2 (1.2%). Thirty-three additional patients were included in the cost analysis (193 total). Patients treated with a microscopic-only approach had the lowest operating time (mean normalized operating room costs 1.00 [95% confidence interval (CI) 0.95, 1.04], P < 0.001; mean normalized total direct costs 5.00 [95%CI 4.69, 5.31], P = 0.008), with hybrid and endoscopic-only approaches having higher comparable operating times and costs.

Conclusion: PA surgery using a primarily microscopic approach (with endoscopic assistance for complex cases) remains a safe, efficient, and cost-effective strategy and results in shorter anesthesia time to reduce patient complications while maintaining excellent endocrinologic outcomes.

Keywords: Endoscope, Hybrid approach, Microscope, Pituitary adenoma, Transnasal surgery, Transsphenoidal surgery.