Surgical neurology international最新文献

Background: The lag screw is a common technique and device used in orthopedic surgery for compressing simple fractures. Here, a lag screw was used to treat a traumatic L5-S1 fracture in a 53-year-old patient with ankylosing spondylitis (AS) resulting in 15 mm of anterior subluxation.

Case description: A 53-year-old patient with AS resulting in 15 mm of anterior subluxation was successfully managed with a lag screw instrumented fusion.

Conclusion: A lag screw successfully stabilized a traumatic L5-S1 lumbar spinal fracture in a patient with AS.

Background: This study primarily aimed to assess the volumetric attributes of the midbrain and perimesencephalic structures preoperatively and following surgical interventions in patients diagnosed with brain herniation secondary to traumatic brain injury (TBI).

Methods: We evaluated patients based on radiological findings and clinical symptoms indicative of brain herniation. We performed semi-automated segmentation of the intracranial structures most relevant to trauma and of interest for the current study, such as hematoma, ventricles, midbrain, and perimesencephalic cisterns. Using preoperative and postoperative computed tomography scans, we measured and analyzed the volume of these structures. Patients were grouped based on their discharge Glasgow Coma Scale (GCS) scores: GCS 15 and non-GCS 15.

Results: From May 2018 to February 2020, we included 20 patients in the study. Our volumetric analysis revealed that preoperative midbrain volume (5.84 cc vs. 4.37 cc, P = 0.034) was a significant differentiator between GCS 15 and non-GCS 15 groups. Preoperative midbrain volume remained significant in univariate (odds ratio [OR] = 2.280, 95% confidence interval (CI) = 1.126-5.929, P = 0.04) and multivariate logistic regression analysis (adjusted OR = 3.204, 95% CI = 1.228-12.438, P = 0.038) even after adjusting for age, sex, and admission GCS score. We identified a cut-off point of 4.86 ccs in preoperative midbrain volume, which demonstrated a discriminatory performance of 0.788 area under the receiver operating characteristic curve, 80.0% accuracy, 77.8% sensitivity, and 81.8% specificity between the two groups.

Conclusion: Our findings suggest that patients presenting with lesser midbrain compression preoperatively tended to have improved clinical outcomes postsurgery. Thus, we propose that this preoperative midbrain volume cut-off point holds predictive value for clinical outcomes within our cohort.

Background: Iatrogenic injury to neck vasculature is a potentially life-threatening complication of spine surgery. We present an illustrative case describing the use of the Pipeline^TM Embolization Device (PED) in the emergent reconstruction of the vertebral artery (VA) following vessel laceration. In addition, we document a systematic review concerning the use of the PED in acute to chronic iatrogenic injury of the internal carotid or VAs.

Methods: This study was a systematic literature review and illustrative case example.

Results: A 73-year-old woman underwent anterior cervical discectomy and fusion (ACDF) surgery complicated by left VA injury. The incision was promptly packed and pressure held while the vessel was salvaged using a Pipeline^TM stent. At 6 months follow-up, the patient had no residual symptoms. A systematic review identified 11 publications meeting study criteria, in which 16 patients were reported to have an injury to the internal carotid or VAs. Patients were grouped into acute, subacute, and chronic cohorts. In the acute group, the majority of patients experienced injury during transsphenoidal resection or ACDF procedures. All cases in the acute group received immediate intervention with the deployment of a PED device. One patient experienced continued contrast extravasation, necessitating vessel sacrifice through superficial temporal artery-middle cerebral artery bypass. All patients recovered to their neurologic baseline. In the subacute and chronic groups, two patients experienced complications, with the majority going on to recover to their neurologic baseline.

Conclusion: PED placement is a viable management strategy for restoring anatomic integrity to head-and-neck vasculature following acute iatrogenic injury.

Background: The occurrence of secondary vascular pathology in paragangliomas is extremely rare, particularly in carotid body tumors (CBTs).

Case description: A 73-year-old female presented with computed tomography angiography revealing a right CBT with a large intratumoral contrast collection. Digital subtraction angiography confirmed a CBT with an internal carotid artery (ICA) intratumoral pseudoaneurysm. Interventional neuroradiology performed coil embolization of the pseudoaneurysm, and a covered stent was placed in the ICA. Surgical intervention was deferred, and the patient was closely monitored with Doppler ultrasound.

Conclusion: Diagnostic imaging is crucial in the management of CBT, offering detailed assessment of tumor morphology and their anatomical relationships, particularly in identifying coexisting vascular anomalies. Recognition of vascular pathologies, such as intratumoral pseudoaneurysms, is critical, as failure to do so could lead to life-threatening complications, including severe bleeding during surgical resection. In cases where surgical resection is high risk due to tumor classification or patient comorbidities, palliative endovascular treatment presents a viable alternative. This approach not only reduces tumor vascularity and provides symptomatic relief but also minimizes procedural risks. While surgical resection remains the gold standard for complete tumor removal, embolization serves as an option in complex or inoperable cases and may also be used to reduce intraoperative risks when surgery is feasible.

Background: Isolated sphenoid sinus fungal mucoceles are extremely rare and potentially associated with visual disturbances, cranial nerve (CN) deficits, or pituitary dysfunction. Their initial symptoms are often absent or nonspecific, and routine examination offers little information, resulting in diagnostic and therapeutic delays. A high index of suspicion and a thorough understanding of their clinical presentation, neuroradiological features, microbiological implications, and complication profile are crucial for early diagnosis and prompt management. We, herein, analyze a series of consecutive cases of isolated sphenoid sinus fungal mucoceles whom we treated, add to the currently existing published cases, and review the pertinent literature.

Methods: From the databases of endoscopic endonasal skull base and rhinological surgical procedures maintained by our groups, all cases with isolated sphenoid sinus fungal mucoceles were retrieved and included in the study. Clinical and radiological findings, histopathologic evidence of fungal rhinosinusitis, culture results, clinicopathological designation, treatment details, and outcome of CN neuropathies were analyzed.

Results: Headache was the most common symptom (seven cases). Oculomotor (three cases) and abducens (two cases) nerve palsies were encountered in five out of eight patients. Visual loss was seen in two cases. Hypopituitarism was seen in one case. All patients underwent endoscopic endonasal wide bilateral sphenoidectomy. CN palsies improved in four out of five cases.

Conclusion: Endoscopic endonasal wide sphenoidectomy is the surgical treatment of choice and should be performed in a timely manner to prevent permanent sequelae. Histopathological and microbiological examination findings should both be obtained as they dictate the next steps of therapeutic intervention.

Background: Scientific literature, with no conflicts of interest, shows that even below the limits defined by the International Commission on Non-Ionizing Radiation Protection, microwaves from telecommunication technologies cause numerous health effects: neurological, oxidative stress, carcinogenicity, deoxyribonucleic acid and immune system damage, electro-hypersensitivity. The majority of these biological effects of non-thermal microwave radiation have been known since the 1970s.

Methods: Detailed scientific, political, and military documents were analyzed. Most of the scientific literature comes from PubMed. The other articles (except for a few) come from impacted journals . The rare scientific documents that were not peer reviewed were produced by recognized scientists in their fields. The rest of the documentation comes from official sources: political (e.g., European Union and World Health Organization), military (e.g., US Air Force and NATO), patents, and national newspapers.

Results: (1) Since their emergence, the authorities have deployed and encouraged the use of wireless technologies (2G, 3G, 4G, WiFi, WiMAX, DECT, Bluetooth, cell phone towers/masts/base stations, small cells, etc.) in full awareness of their harmful effects on health. (2) Consequences of microwave radiation from communication networks are comparable to the effects of low-power directed-energy microwave weapons, whose objectives include behavioral modification through neurological (brain) targeting. Above 20 gigahertz, 5G behaves like an unconventional chemical weapon. (3) Biomedical engineering (via graphene-based nanomaterials) will enable brain-computer connections, linked wirelessly to the Internet of Everything through 5G and 6G networks (2030) and artificial intelligence, gradually leading to human-machine fusion (cyborg) before the 2050s.

Conclusion: Despite reports and statements from the authorities presenting the constant deployment of new wireless communication technologies, as well as medical research into nanomaterials, as society's ideal future, in-depth research into these scientific fields shows, above all, an objective linked to the current cognitive war. It could be hypothesized that, in the future, this aim will correspond to the control of humanity by machines.

Background: Giant cell tumor of bone (GCTB) is a rare benign tumor that may also exhibit aggressive local behavior. Recurrence of GCTB is common even after complete resection. GCTB typically occurs in long bones, and only 2.7% are found in the spine. Here, a 28-year-old female with a magnetic resonance (MR)-documented L5 lumbar spine GCTB presented with a cauda equina syndrome effectively managed with a decompressive laminectomy/L4-S1 fusion.

Case description: A 28-year-old female presented with a 1-year history of lower extremity pain/paresthesia that had exacerbated over the previous 1 month. When the MR imaging revealed cauda equina compression due to a L5 hypodense lesion, the patient successfully underwent a decompressive laminectomy/L4-S1 fusion. The histopathology examination confirmed the presence of a GCTB.

Conclusion: While gross total excision for GCTB is the treatment of choice, for those undergoing only subtotal/partial resections, additional adjuvant therapy may be warranted. Notably, even despite extensive resections, these lesions have a high rate of recurrence.

Background: Neurosurgical training requires a deep understanding of brain anatomy, especially white matter fiber pathways, to enhance surgical precision. Traditional dissection techniques, such as Klingler's white matter dissection, are essential, but newer methods can provide additional clarity. This study explores the application of a fluorescent-assisted technique to improve the visualization and understanding of white matter fibers during neurosurgical training.

Methods: Twelve human brains were dissected following Klingler's protocol, with a focus white matter fiber pathway. Fluorescent alcoholic and oily solutions were applied to highlight the fibers. Ultraviolet (UV) blacklight and yellow monochromatic filters were used to enhance visualization. Dissections were documented through photography, and the effectiveness of the fluorescent techniques was analyzed.

Results: The application of UV light and fluorescent solutions enhanced the visualization of fiber pathways, particularly in regions with irregular fibers, such as the sagittal stratum. The alcoholic solution flowed along the anatomical paths of the fibers, aiding in their differentiation. The oily solution proved effective in specific areas, such as the internal capsule. The use of fluorescent techniques allowed for improved identification and anatomical detailing of major white matter tracts.

Conclusion: The fluorescent-assisted dissection technique significantly enhances the visualization of white matter fibers, offering a valuable tool for neurosurgical training. This method deepens anatomical understanding, provides a three-dimensional perspective of brain structures, and can improve surgical outcomes. The study suggests potential applications in other fields, such as glioma simulation and bypass patency testing.

Background: Chronic subdural hematoma (CSDH) is a prevalent neurological disorder, especially among the elderly, where blood accumulates between the brain and its outer covering. The primary treatment for CSDH involves surgical intervention, such as burr-hole craniotomy, with or without irrigation of the subdural space. The efficacy of irrigation versus no irrigation in reducing recurrence, mortality, and postoperative complications remains debated. The study aimed to compare the effectiveness and safety of irrigation versus no irrigation in the surgical management of CSDH through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library, targeting RCTs published in English comparing irrigation with no irrigation in CSDH management. Four RCTs with a total of 843 patients met the inclusion criteria. Two reviewers extracted data independently, and the risk of bias 2 tool was used for quality assessment. The primary outcome was recurrence; secondary outcomes included mortality and postoperative complications. Statistical analyses were performed using RevMan 5.3.

Results: The meta-analysis included four RCTs with 843 patients, revealing that irrigation significantly reduces the recurrence of CSDH compared to no irrigation (odds ratios [OR] = 0.66, 95% confidence interval [CI]: 0.44-0.98, P = 0.04), with no observed heterogeneity (I² = 0%). Mortality rates showed no significant difference between the irrigation and no irrigation groups (OR = 1.10, 95% CI: 0.59-2.06, P = 0.77), also with no heterogeneity (I² = 0%). Postoperative complications initially showed no significant difference (OR = 0.39, 95% CI: 0.09-1.69, P = 0.21) and moderate heterogeneity (I² = 52%). However, sensitivity analysis resolving the heterogeneity indicated a significant reduction in complications favoring the irrigation group (P = 0.03).

Conclusion: This meta-analysis suggests that irrigation during burr-hole drainage significantly reduces CSDH recurrence without increasing mortality or postoperative complications, supporting its use in clinical practice. Further, high-quality RCTs are necessary to confirm these findings and assess long-term outcomes.

Background: Carotid webs are a potential cause of occult cerebral infarction. Although they occur frequently, proper diagnosis and treatment are crucial; surgery has been shown to provide a good outcome. Although thrombus on the carotid web have been reported, digital subtraction angiography (DSA)-confirmed cases of pre-dispersed thrombus are rare. In this study, we report a case in which a thrombus on the carotid web concealed a shelf-like defect, complicating its diagnosis.

Case description: A 47-year-old woman without stroke risk factors presented to our hospital with aphasia and right hemiplegia. On arrival, the symptoms had improved. Magnetic resonance (MR) imaging showed left middle cerebral artery stenosis; however, there was no cerebral infarction. DSA was performed post-admission to examine middle cerebral artery stenosis, which showed no middle cerebral artery stenosis but left internal carotid artery (ICA) origin stenosis and contrast pooling. We diagnosed a transient ischemic attack due to artery-to-artery embolism caused by left ICA stenosis and accompanied by a contralateral carotid web. The same symptoms appeared 6 days later. MR imaging showed a new cerebral infarction and the left middle cerebral artery occlusion. A mechanical thrombectomy procedure revealed a change in ICA origin shape compared to the 1^st time, with a shelf-like defect within the carotid web. She subsequently underwent carotid artery stenting and was discharged with mild dysesthesia in her right fingers (modified Rankin Scale of 1).

Conclusion: Thrombus on the carotid web conceals characteristic shelf-like defects and may cause misdiagnosis. However, contrast pooling and contralateral carotid web are important findings for early treatment.