Surgical neurology international最新文献

Background: Cerebral pseudotumoral schistosomiasis is an uncommon and underreported condition, posing significant diagnostic challenges due to its ability to mimic other neurological conditions, especially in patients presenting with persistent seizures and imaging findings indicative of an infectious etiology.

Case description: We report the case of a 16-year-old male who presented with persistent headaches and recurrent seizures despite adherence to antiseizure medications. Neuroimaging findings suggested an infectious process but were inconclusive in differentiating between a tuberculoma and cerebral schistosomiasis. Given the differing therapeutic approaches required for these conditions, a definitive diagnosis was pursued through a brain tissue biopsy, which confirmed cerebral schistosomiasis. This diagnosis guided appropriate treatment, leading to clinical improvement.

Conclusion: This case highlights the critical role of biopsy in establishing a definitive diagnosis when imaging results are inconclusive and suggests the importance of exploring the use of adjunct diagnostic methods like magnetic resonance spectroscopy, hence decreasing or potentially eliminating the need for an open biopsy.

Background: Non-invasive and invasive methods of cerebral angiography, including computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA), are commonly used to characterize and follow cerebral aneurysms. Prior work has validated two-dimensional size measurements across these modalities. Our study aims to compare the reliability of three-dimensional (3D) shape measurements across CTA, MRA, and DSA.

Methods: A subset of cerebral aneurysms in which more than one form of angiography was performed was selected. Aneurysms were included if they did not change in size or shape between angiographic studies. Aneurysm domes were segmented, and morphometric features were measured consistent with prior reports. Intraclass correlation coefficients (ICCs) for each morphometric measure were calculated using a two-way mixed effect model.

Results: A total of 65 individual aneurysms from 55 patients were included in the study. The majority of aneurysms were imaged with DSA and CTA (43%) or MRA and CTA (40%), with 14% having DSA, MRA, and CTA available for review. The majority of aneurysms were located in the anterior circulation (77%), with an average size was 5 (4-8) mm. ICC ranged from 0.66 to 0.99 for 3D morphometric features, corresponding to "moderate" to "excellent" correlation. Sphericity and non-sphericity index showed the lowest ICC values. With the exception of these two variables, 3D morphometrics showed "good" or "excellent" reliability. No significant difference in mean absolute difference was noted across imaging modalities for each morphometric feature.

Conclusion: The majority of 3D morphometric measures show "good" to "excellent" reliability across CTA, MRA, and DSA, allowing for comparison across imaging modalities.

Background: Occipitocervical fusion (OCF) has been performed for over 70 years to address craniocervical instability caused by trauma, tumors, or congenital anomalies. Despite technological advances, challenges persist due to the unique anatomy, high mobility, and complex pathological processes at the occipitocervical junction. This study aimed to evaluate clinical, radiographic, and surgical outcomes of OCF in patients with craniocervical instability.

Methods: A 2-year cohort study was conducted at Dr. Saad Alwitry's Neurosciences Hospital (April 2021- March 2023) involving 45 patients aged 17-53 (mean age 35.6). Inclusion criteria required radiologically confirmed instability, psychological fitness, and a normal coagulation profile. Patients with advanced rheumatoid arthritis or prior posterior fossa surgery were excluded. OCF procedures were performed using modern rigid instrumentation, including plates and rods, and outcomes were monitored using radiographic fusion assessments and clinical evaluations.

Results: All patients achieved solid fusion (100%) within a mean of 7.06 months (range 5-9 months). Myelopathy and neurological deficits were present in all patients preoperatively, while neck pain affected 73.3%. Postoperatively, 73.3% of patients showed improvement in myelopathic symptoms, and all patients reported resolution of neck pain. Complications included one transient neurological deterioration, one wound infection, and one cerebrospinal fluid leak, all managed successfully. No operative mortalities or vascular injuries occurred.

Conclusion: Rigid occipitocervical fixation stabilizes the craniocervical junction, achieving high fusion rates and symptom resolution with minimal complications. Thorough preoperative planning, precise surgical technique, and an understanding of craniocervical anatomy are crucial for optimal outcomes.

Background: Trigeminal nerve palsy (TNP) in patients with intracranial aneurysms (IAs) results from the disease process or its treatment. We systematically reviewed the literature on trigeminal palsy in patients with IAs.

Methods: PubMed, ScienceDirect and Web of Science were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extraction and quality assessment were performed according to preestablished guidelines.

Results: Twenty studies were included, yielding 69 patients with TNP and IAs. The mean age was 56.9 years and females accounted for 76%. Among the total cases, a cavernous internal carotid artery aneurysm was found in the vast majority (93%), followed by 7% of aneurysms in the basilar artery-superior cerebellar artery, posterior communicating artery, and anterior communicating artery. 96% of the aneurysms were classified as large to giant-sized. Out of the total number of cases, the majority (90%) exhibited trigeminal palsy at the time of their initial presentation. Only a small proportion (n = 7, 10%) developed fifth nerve palsy subsequent to the treatment of their aneurysms. Concurrent versus isolated TNP were exhibited in 79.7% and 20.3% of the cases, respectively. Finally, in terms of outcome, complete recovery from trigeminal palsy was achieved in 76.7% (26/34), with a duration of resolution of <6 months in 77.3% (17/22).

Conclusion: Trigeminal nerve palsies are correlated with IAs, and this correlation depends mainly on the location and size of the aneurysms.

Background: Pneumocephalus, characterized by air in the cranial cavity, is a rare condition typically associated with surgical procedures but may also result from trauma, infection, or spontaneously. Cranial nerve palsies following pneumocephalus are seldom documented in the literature, and, in particular, facial nerve palsies due to pneumocephalus following lumbar spine surgery have not yet been reported.

Case description: A 47-year-old male patient underwent surgery due to a herniated disc. Isolated grade 4 facial palsy, according to the House-Brackmann scale, on the left side developed after surgery. Computed tomography revealed pneumocephalus in the basal cisterns. The patient was treated without any problems conservatively.

Conclusion: While most cases are due to intracranial surgery, pneumocephalus caused by spinal surgery is extremely rare. Pneumocephalus usually occurs without symptoms but can occasionally be accompanied by headaches and rarely leads to focal neurological or cranial nerve deficits. This case emphasizes the importance of considering pneumocephalus as a possible complication after spinal surgery and highlights its rare association with cranial nerve deficits.

Background: Arterial dissection is a rare complication of mechanical thrombectomy, and the risk factors and clinical course are not well known. We report a case of iatrogenic dissection on atherosclerotic stenosis of the middle cerebral artery (MCA) caused by stent retriever thrombectomy for internal carotid artery (ICA) embolic occlusion.

Case description: A 78-year-old woman underwent mechanical thrombectomy for ICA embolic occlusion. Preprocedural angiography indicated a thrombus from the C1 segment of the left ICA to the proximal M1 segment of the left MCA and slow antegrade contrast opacification of the mid- to distal-M1. A stent retriever was deployed across the stenotic lesion and pulled back to retrieve a thrombus. Although reperfusion was achieved, mid-M1 occlusion occurred the next day. We considered that endothelial damage from the stent retriever caused iatrogenic dissection at existing atherosclerotic stenosis at mid-M1.

Conclusion: Stent retriever thrombectomy can worsen atherosclerotic stenosis. Vascular imaging follow-up is important after thrombectomy in patients with intracranial stenotic lesions. Clinicians should be aware that iatrogenic dissections can be more likely in atherosclerotic vessels following stent retriever thrombectomy.

Background: Radiographically, trabeculae have been observed commonly in chronic subdural hematoma (CSDH) patients. Nevertheless, few authors have focused on how the trabeculae develop. We, herein, report a case of recurrent CSDH in which the evolution of trabeculae was observed with serial brain computed tomography.

Case description: A 75-year-old man with symptomatic left-sided CSDH who had undergone a burr-hole craniostomy 14 days in our institution earlier came back with a recurrent CSDH with trabeculae within the hematoma cavity. The trabeculae, which had not been present in the first surgery, developed relatively rapidly, converging toward the burr hole. The recurrent CSDH was successfully treated with the middle meningeal artery embolization. During the procedure, a vascular brush was observed around the burr hole, indicating the trabeculae were rich in blood flow.

Conclusion: Surgical manipulation of the outer membrane during the first surgery might likely have elicited local inflammation and subsequent neovasculization of the outer membrane, resulting in trabeculae formation around the burr hole.

Background: Some reports are suggesting the efficacy of continuous irrigation therapy for brain abscesses, but the way how to irrigate and perfusion abscesses and cerebral spinal fluid has not yet been established. Here, we present the case of successfully treated by continuous irrigation therapy for the severe bacterial brain abscess, meningitis, and encephalitis.

Case description: A 62-year-old man presented to our hospital with a chief complaint of headache and vomiting. Magnetic resonance imaging revealed an encapsulated lesion with peripheral contrast in the left cerebellar hemisphere, and the lesion showed high signal intensity on diffusion-weighted imaging. We diagnosed him with a brain abscess. In addition to drainage of the cerebellar lesion by small craniotomy and systemic administration of antibiotics, continuous irrigation therapy was performed for 7 days until the cell count of the cerebrospinal fluid became negative. Saline with antibiotics was infused through from ventricular drain, which was inserted through the anterior horn of the lateral ventricle to spiral drainage. His state of consciousness improved, and he was able to live at home.

Conclusion: Our proposed novel continuous irrigation therapy may lead to a positive outcome in brain abscesses.

Background: Optic nerve sheath hemangiomas (ONSHs) are rare vascular tumors from the blood vessels surrounding the optic nerve, accounting for <1% of optic tumors and 0.5% of vascular malformations. Although benign, their location near the optic nerve poses a risk of significant nerve damage and vision loss. Symptoms often include visual disturbances, eye pain, and strabismus, making it difficult to make a diagnosis. Advances in imaging, especially magnetic resonance imaging (MRI), have improved early detection and diagnosis. In addition, insights into the molecular mechanisms, including endothelial signaling and angiogenesis, have facilitated the development of more effective treatments, such as targeted therapies and minimally invasive surgical options.

Case description: We present the case of a 57-year-old woman who experienced progressive left-eye swelling, increased tearing, and declining visual acuity. Imaging studies, including MRI and computed tomography scans, revealed a left intraconal mass suggestive of ONSH. A transcranial-modified orbitofrontal approach was employed for tumor resection due to its proximity to vital structures. Postoperative histopathology confirmed hemangioma. At 1-year follow-up, the patient exhibited significant improvement in visual function and resolution of orbital swelling.

Conclusion: This case highlights the critical role of surgical intervention in managing ONSHs that threaten visual function and cause mass effects. The transcranial-modified orbitofrontal approach proved effective in providing optimal access for safe tumor resection and improving visual outcomes. Integrating advanced imaging techniques and intraoperative monitoring contributes significantly to enhancing prognosis in ONSH cases.