Surgical neurology international最新文献

Background: Stereotactic radiosurgery (SRS) is a validated treatment option for cerebral arteriovenous malformations (AVMs), even if a greater knowledge of its potential delayed complications is still being acquired.

Case description: A 49-year-old man suffered multiple episodes of cerebral hemorrhage in an approximate 10-year follow-up interval in the context of a left central core AVM with deep venous drainage into the internal cerebral veins (Spetzler Martin Grade 4) despite being treated with gamma knife radiosurgery at two separate timepoints, and with an almost complete obliteration confirmed. Approximately 10 years after the first radiosurgery treatment, he developed severe motor aphasia, Grade 3 right hemiparesis, progressive confusion, and memory deficits. Cerebral imaging revealed cystic degeneration in the AVM's periphery. Cyst fenestration and cystoperitoneal shunt were attempted. The treatments were temporarily effective, but a progressive cyst enlargement recurred with clinical deterioration. The patient was therefore proposed for surgical mass and cyst excision through an interhemispheric transcallosal approach. The postoperative magnetic resonance imaging showed complete removal of the lesion, and an uneventful post-operative course ensued. At the 6-month follow-up, our patient experienced a noticeable improvement in his speech, power, dexterity and was able to walk autonomously.

Conclusion: Cystic degeneration of AVMs is a possible long-term complication after SRS. Long-term follow-up and data on such patients remain crucial, even with evidence of complete nidal obliteration.

Background: Filum terminale lipomas (FTLs) are congenital lumbosacral anomalies that can cause tethered cord syndrome (TCS). Most patients with TCS caused by FTL are children, and these are only rarely present in adults.

Case description: A 64-year-old male presented with long-standing bilateral lower-limb weakness and bladder dysfunction. The lumbar magnetic resonance imaging revealed an FTL of the conus, which was not displaced. Following sectioning, the patient's bilateral lower limb weakness resolved, and his bladder function improved.

Conclusion: TCS caused by an FTL in late middle-aged patients is rare. After undergoing untethering with resection of the lipoma, the patient sustained resolution of his motor deficit and improvement in his bladder function.

Background: There are very few reports of intradural disc herniations associated with achondroplasia described in the literature.

Case description: A patient with achondroplasia presented with progressive paraparesis attributed to a magnetic resonance-documented intradural disc herniation at the T12-L1 level occupying more than 90% of the spinal canal. It was successfully removed through a T12 laminectomy with durotomy; note a laminectomy would have been contraindicated if this had been an extradural anterior/anterolateral disc. Postoperatively, the patient progressively improved and, within 6 months, had 4/5 proximal/distal function and full sphincter control.

Conclusion: A patient with achondroplasia and an intradural T12/L1 disc herniation (i.e., unlike an extradural anterior/anterolateral thoracic disc) successfully underwent a decompressive laminectomy with near full resolution of their preoperative paraparesis.

Background: Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Intracranial pressure (ICP) monitoring forms the cornerstone of most severe TBI (sTBI) management guidelines, yet treatment practices vary between high income countries (HIC) and low/middle-income countries (LMICs). We sought to find the reasons for variation in ICP monitoring and treatment practices between neurosurgeons in low- and high-income countries.

Methods: We developed a 34-item anonymous survey questionnaire on ICP monitoring and treatments, which was emailed to neurosurgeons of various neurosurgical societies (Africa, Asia, Europe, and North America) who manage TBI.

Results: One hundred and six respondents from 23 countries completed the questionnaire. Sixty-nine were from Africa, 16 were from North America, 12 were from Western Europe, and 8 were from Asia. About 48.72% of respondents from LMICs versus 96.43% from HICs have had training on ICP use. Among practitioners who monitor ICP invasively in <50% of patients that need it, 41.6% and 37.5% from LMIC cited availability and cost as the major constraints, versus 3.3% and 6.67%, respectively, in HIC. Only 7 (8.97%) from LMIC follow Brain Trauma Foundation guidelines all the time compared to 17.86% from HIC. When asked about their knowledge of randomized controlled trial(RCT), 78.57% of respondents from HIC versus 11.54% from LMIC knew about RCTs that tested the role of ICP monitoring in sTBI.

Conclusion: Significant differences exist in ICP monitoring and treatment in patients with sTBI between high and LMICs. Cost and availability are the main determinants of ICP monitor usage. Practice pattern among the respondents was not completely supported by evidence.

Background: In adults, the cerebellopontine angle (CPA) pilocytic astrocytoma (PA) is very rare. This tumor has radiological features similar to those of a vestibular schwannoma in the few cases reported in the literature.

Methods: In this study, we conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol and scrutinized all original studies pertaining to pontocerebellar angle PA in adult patients. We conducted an analysis of the clinical, radiological, and molecular components of all eligible articles. We have also reported a case involving a 67-year-old male individual in whom the PA exhibited radiological characteristics similar to an epidermoid cyst.

Results: After the screening phase, we found four cases of PA of the pontocerebellar angle. Three cases were identified that resembled vestibular schwannoma; however, in our case, the tumor resembled an epidermoid cyst. These uncommon tumors exhibit distinctive histological patterns and molecular characteristics (adenosine triphosphate dependent helicase (ATP- dependent helicase)+, Isocitrate dehydrogenase 1-), rendering them a potential differential diagnosis for glioblastoma (GBM).

Conclusion: The CPA PA has rarely been found in adult patients and should be considered in the differential diagnosis of vestibular schwannoma and epidermoid cysts. In these rare cases, the histological characteristics of PA are significant for the differential diagnosis of GBM.

Background: Adult-onset aqueductal stenosis (AOAS) is an uncommon cause of hydrocephalus in adults. Its etiopathogenesis is poorly understood, with various proposed mechanisms, spectrum of presentation, and management. Very little has been reported on this anomaly in African literature. This study aimed to describe the pattern of presentation, clinical spectrum, and early outcomes following the shunt procedure in our population practice setting.

Methods: This was a retrospective case series of patients with non-tumoral AOAS managed between 2008 and 2023 in a tertiary center in South-West Nigeria. Relevant demographic, clinical-radiologic, and outcome data were retrieved and analyzed.

Results: There were seven males and one female. Their age ranged from 18 to 50 years. The duration of symptoms ranged from 3 to 120 months. All patients admitted having headaches; however, visual deterioration (n = 5) was the most common presenting symptom. Features of endocrinopathy (n = 1), cerebellar dysfunction (n = 2), cognitive deficit (n = 2), spontaneous cerebrospinal fluid leak (n = 1), and sphincteric dysfunction (n = 1) were also observed. The mean Evan's index at the presentation was 0.43. Ventriculoperitoneal shunt (VPS) insertion was performed in seven patients with good outcomes. One patient opted for a referral. One patient had shunt revision 6 years later on account of shunt disconnection.

Conclusion: AOAS is an infrequent cause of hydrocephalus in our setting, with most patients seeking medical consultation following visual deterioration. Proper evaluation of adults with long-standing headaches and associated features is advocated to avert total visual loss in this subgroup. VPS insertion is a viable treatment option with a good outcome.

Background: Craniopharyngiomas pose a significant clinical challenge due to their complex anatomical location and potential for neurological sequelae. Surgical management options include transcranial and endoscopic approaches, each with its advantages and limitations. This systematic review and meta-analysis aims to comprehensively compare the outcomes of transcranial and endoscopic surgery for craniopharyngioma, integrating the latest evidence from ten pertinent journal articles.

Methods: A systematic search of electronic databases, including Google Scholar, PubMed, MEDLINE, and Embase, was conducted to identify relevant studies published between 2010 and 2022. A total of eight articles comparing outcomes of transcranial and endoscopic surgery for craniopharyngioma were included in the study. Data extraction and quality assessment were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: The transcranial approach was less effective in achieving gross total resection (odds ratio [OR] = 0.47, 95% confidence interval [CI] = 0.32-0.70) compared to the endoscopic approach, with low heterogeneity (I² = 41%). However, both approaches had similar odds for near-total resection, subtotal resection, and partial resection. The transcranial approach was associated with lower odds of total neurological complications (OR = 0.6, 95% CI = 0.4-0.9), higher odds of tumor recurrence (OR = 1.86, 95% CI = 1.12-3.09), and lower odds of visual improvement (OR = 0.43, 95% CI = 0.32-0.58) compared to the endoscopic approach. There was no significant difference in mortality rate between the two approaches.

Conclusion: Our meta-analysis comparing the efficacy of transcranial and endoscopic surgery for craniopharyngioma reveals that the endoscopic approach is preferred for managing specific conditions due to its higher likelihood of achieving complete resection and potentially better postsurgery outcomes, minimizing neurological complications.

Background: Traumatic brain injury (TBI) is a common result of external physical forces that damage the brain, affecting over 50 million people annually, with a higher prevalence in males. Children aged 0-4 years are the most susceptible, particularly in low-and middle-income countries, where 90% of TBI-related deaths occur. TBI significantly affects children's quality of life. This study aimed to estimate the incidence of pediatric TBI during working hours among parents and caregivers in Saudi Arabia.

Methods: A questionnaire-based cross-sectional survey was conducted over 2 months, from July to August 2023. The survey data were electronically gathered using a questionnaire sent over social media channels. It includes working as a caregiver for children in Saudi Arabia.

Results: Involving 395 respondents, the primary focus was on child head injuries occurring during the working hours of parents and caregivers. Most respondents were in the 36-45 age bracket, predominantly female (66.1%) and married (81.8%). The age of the child at the time of injury was significantly associated with head injuries during parents' and caregivers' working hours, with the highest incidence among children aged 7-14 years (83.1%). The severity of the injury, hospital admission, need for intensive care, and surgical intervention were significantly associated with child injuries during these hours.

Conclusion: In this study, we found a significantly higher incidence of head injuries in children during the working hours of both parents and caregivers. Factors such as longer work hours, the presence of a nanny, more children, male gender, and older child age were associated with this risk.

Background: There has been no clear consensus on the clinical markers to distinguish alcohol-related seizures (ARSs) from epileptic seizures. We have reported the usefulness of gamma oscillation (30-70 Hz) regularity (GOR) analysis using interictal electroencephalography (EEG) data to evaluate epileptogenic focus. We conducted interictal GOR analysis using scalp EEG and susceptibility-weighted imaging (SWI) to visualize the epileptogenic focus in two cases initially suspected to have ARS.

Case description: In each case, a significantly high GOR area suggestive of epileptogenic focus was detected and that area was consistent with that where SWI showed hemosiderin deposit. In one patient, seizures were well controlled with the introduction of anti-seizure medication (ASM). In another patient, ASM was introduced but is refractory, and epilepsy surgery is being considered in the future.

Conclusion: The interictal GOR analysis and SWI can successfully contribute to identify the patients suspected to have ARS who may have epileptogenic focus and can be treated with ASM and epilepsy surgery.