Background: Few studies discuss the complication of pulmonary cement embolism (PCE) due to cement augmented pedicle screw instrumentation (CAPSI) of the thoracolumbar spine.
Case description: A 62 female with a history of multiple myeloma and Sjogren's syndrome on chronic steroids developed an osteoporotic L1 compression fracture and underwent posterior stabilization with a T10-L4 CAPSI. However, postoperatively, the patient developed a surgical site infection and a PCE, resulting in severe respiratory compromise and death 1 month later.
Conclusion: When performing a T10-L4 thoracolumbar CAPSI (i.e., augmented pedicle screw instrumentation of the thoracolumbar spine) to address an L1 osteoporotic compression fracture, a 62 year old patient developed a life ending multi organ deficiency due to sepsis together with a PCE.
{"title":"Cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine - A case report.","authors":"Georgios Tsalimas, Eleni Pappa, Konstantinos Zygogiannis, Spiridon Antonopoulos, Fotios Kakridonis, Ioannis Chatzikomninos","doi":"10.25259/SNI_506_2024","DOIUrl":"10.25259/SNI_506_2024","url":null,"abstract":"<p><strong>Background: </strong>Few studies discuss the complication of pulmonary cement embolism (PCE) due to cement augmented pedicle screw instrumentation (CAPSI) of the thoracolumbar spine.</p><p><strong>Case description: </strong>A 62 female with a history of multiple myeloma and Sjogren's syndrome on chronic steroids developed an osteoporotic L1 compression fracture and underwent posterior stabilization with a T10-L4 CAPSI. However, postoperatively, the patient developed a surgical site infection and a PCE, resulting in severe respiratory compromise and death 1 month later.</p><p><strong>Conclusion: </strong>When performing a T10-L4 thoracolumbar CAPSI (i.e., augmented pedicle screw instrumentation of the thoracolumbar spine) to address an L1 osteoporotic compression fracture, a 62 year old patient developed a life ending multi organ deficiency due to sepsis together with a PCE.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16eCollection Date: 2024-01-01DOI: 10.25259/SNI_295_2024
Maximus Kyung Hyun Lee, Perry A Ball
Background: Diabetic ketoacidosis (DKA) is a life-threatening condition among diabetic patients characterized by metabolic anion gap (AG) acidosis of arterial pH <7.30, glucose >250 mg/dL, and positive ketones. The triggers for DKA can be infection, surgery, and, in reported cases, intraparenchymal hemorrhage (IPH). In rare cases of DKA, despite being in active ketoacidosis, glucose levels may be within normal or accepted range. Such a condition is called euglycemic DKA. It has been recently recognized in association with the use of sodium glucose co-transporter-2 (SGLT-2) inhibitors in the treatment of type 2 diabetes.
Case description: An 83-year-old male taking an SGLT-2 inhibitor (empagliflozin) for type 2 diabetes presented with an IPH. His laboratory studies revealed an elevated AG acidosis, an elevated beta hydroxybutyrate, and serum glucose levels within the acceptable range. Urine studies revealed elevated ketones and glucose. The diagnosis of euglycemic DKA was made, and the patient was treated with insulin and glucose infusions.
Conclusion: Like hyperglycemic ketoacidosis, euglycemic DKA requires prompt recognition and immediate aggressive medical therapy, but the diagnosis can be challenging, and the treatment using insulin in the setting of a normal glucose can be counterintuitive. Euglycemic DKA can often be missed in the setting of blood glucose not being elevated. Prompt recognition and treatment are critical for successful management.
{"title":"Euglycemic diabetic ketoacidosis in the setting of acute intracerebral hemorrhage.","authors":"Maximus Kyung Hyun Lee, Perry A Ball","doi":"10.25259/SNI_295_2024","DOIUrl":"10.25259/SNI_295_2024","url":null,"abstract":"<p><strong>Background: </strong>Diabetic ketoacidosis (DKA) is a life-threatening condition among diabetic patients characterized by metabolic anion gap (AG) acidosis of arterial pH <7.30, glucose >250 mg/dL, and positive ketones. The triggers for DKA can be infection, surgery, and, in reported cases, intraparenchymal hemorrhage (IPH). In rare cases of DKA, despite being in active ketoacidosis, glucose levels may be within normal or accepted range. Such a condition is called euglycemic DKA. It has been recently recognized in association with the use of sodium glucose co-transporter-2 (SGLT-2) inhibitors in the treatment of type 2 diabetes.</p><p><strong>Case description: </strong>An 83-year-old male taking an SGLT-2 inhibitor (empagliflozin) for type 2 diabetes presented with an IPH. His laboratory studies revealed an elevated AG acidosis, an elevated beta hydroxybutyrate, and serum glucose levels within the acceptable range. Urine studies revealed elevated ketones and glucose. The diagnosis of euglycemic DKA was made, and the patient was treated with insulin and glucose infusions.</p><p><strong>Conclusion: </strong>Like hyperglycemic ketoacidosis, euglycemic DKA requires prompt recognition and immediate aggressive medical therapy, but the diagnosis can be challenging, and the treatment using insulin in the setting of a normal glucose can be counterintuitive. Euglycemic DKA can often be missed in the setting of blood glucose not being elevated. Prompt recognition and treatment are critical for successful management.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manabu Yamamoto, Gaku Fujiwara, H. Takezawa, Yasunori Uzura, S. Yokoya, Hideki Oka
Treatment of chronic subdural hematoma (CSDH) with middle meningeal artery embolization (MMAE) is becoming well established. Transradial artery access (TRA) is considered less invasive than transfemoral artery access (TFA) and is increasingly indicated in the field of endovascular therapy. Therefore, this study focused on postoperative delirium and compared access routes. This is a single-center and retrospective study. The strategy was to perform MMAE for CSDH with symptomatic recurrence at our hospital. Cases from July 2018 to September 2022, when MMAE was introduced in our hospital, were included in this study. Patients were divided into TRA and TFA groups and were compared descriptively for patient background, procedure duration, and incidence of postoperative delirium. Twenty-five patients underwent MMAE, of whom 12 (48%) were treated with TRA. The overall median age was 82 years, with no clear differences between the TRA and TFA groups in the presence or absence of preexisting dementia or antithrombotic therapy. Delirium requiring medication tended to be lower in the TRA group: 2/12 (16.7%) in the TRA group versus 6/13 (46.2%) in the TFA group, and the mean procedure time for patients undergoing bilateral MMAE was 151 min (interquartile range [IQR]: 140–173 min) in the TRA group versus 174 min (IQR: 137–205 min) in the TFA group. TRA was associated with an overall shorter procedure time than TFA. MMAE through TRA tended to have a lower incidence of delirium. MMAE through TRA may be useful in recurrent CSDH with a high elderly population.
采用脑膜中动脉栓塞术（MMAE）治疗慢性硬膜下血肿（CSDH）的方法已逐渐成熟。经桡动脉入路（TRA）被认为比经股动脉入路（TFA）创伤更小，在血管内治疗领域的应用也越来越广泛。因此，本研究重点关注术后谵妄，并对入路进行了比较。策略是在我院对有症状复发的 CSDH 患者实施 MMAE。本研究纳入了我院自2018年7月至2022年9月引入MMAE的病例。患者被分为TRA组和TFA组，并对患者背景、手术时间和术后谵妄的发生率进行了描述性比较。25例患者接受了MMAE，其中12例（48%）接受了TRA治疗。25名患者接受了MMAE手术，其中12人（48%）接受了TRA治疗，总体中位年龄为82岁，TRA组和TFA组在是否存在痴呆或抗血栓治疗方面没有明显差异。需要药物治疗的谵妄在TRA组往往较低：TRA组为2/12（16.7%），而TFA组为6/13（46.2%），接受双侧MMAE的患者的平均手术时间为：TRA组151分钟（四分位间距[IQR]：140-173分钟），而TFA组174分钟（IQR：137-205分钟）。通过 TRA 进行 MMAE 的谵妄发生率较低。通过 TRA 进行的 MMAE 可能适用于高龄人群的复发性 CSDH。
{"title":"Transradial versus transfemoral access for middle meningeal artery embolization: Choice of the access route considering delirium in the elderly","authors":"Manabu Yamamoto, Gaku Fujiwara, H. Takezawa, Yasunori Uzura, S. Yokoya, Hideki Oka","doi":"10.25259/sni_168_2024","DOIUrl":"https://doi.org/10.25259/sni_168_2024","url":null,"abstract":"\u0000\u0000Treatment of chronic subdural hematoma (CSDH) with middle meningeal artery embolization (MMAE) is becoming well established. Transradial artery access (TRA) is considered less invasive than transfemoral artery access (TFA) and is increasingly indicated in the field of endovascular therapy. Therefore, this study focused on postoperative delirium and compared access routes.\u0000\u0000\u0000\u0000This is a single-center and retrospective study. The strategy was to perform MMAE for CSDH with symptomatic recurrence at our hospital. Cases from July 2018 to September 2022, when MMAE was introduced in our hospital, were included in this study. Patients were divided into TRA and TFA groups and were compared descriptively for patient background, procedure duration, and incidence of postoperative delirium.\u0000\u0000\u0000\u0000Twenty-five patients underwent MMAE, of whom 12 (48%) were treated with TRA. The overall median age was 82 years, with no clear differences between the TRA and TFA groups in the presence or absence of preexisting dementia or antithrombotic therapy. Delirium requiring medication tended to be lower in the TRA group: 2/12 (16.7%) in the TRA group versus 6/13 (46.2%) in the TFA group, and the mean procedure time for patients undergoing bilateral MMAE was 151 min (interquartile range [IQR]: 140–173 min) in the TRA group versus 174 min (IQR: 137–205 min) in the TFA group.\u0000\u0000\u0000\u0000TRA was associated with an overall shorter procedure time than TFA. MMAE through TRA tended to have a lower incidence of delirium. MMAE through TRA may be useful in recurrent CSDH with a high elderly population.\u0000","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141924513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryuzaburo Kanazawa, T. Uchida, T. Higashida, Takao Kono, Hiroki Ebise, Noboru Kuniyoshi
A flow redirection endoluminal device (FRED) is a widely used flow diverter stent. Although high technical success and good treatment results were reported in the SAFE study, cases of technical failure of deployment have also been reported. A case in which a FRED was deployed with the proximal part twisted, but successful deployment was achieved, is presented. A woman in her 40s was diagnosed with a left internal carotid artery aneurysm during radiological investigations for headaches. Due to her family’s strong history of cerebral aneurysms, she opted for preventive treatment. A 5.5-mm FRED was selected because the proximal vessel diameter was ≥5 mm. However, the stent was deployed with the proximal side twisted. Fortunately, using a Scepter C and a CHIKAI 315 cm, the true lumen could be secure, the wire was guided distally, and the FRED was successfully placed. Later, with the patient’s consent, a 3D blood vessel model was created, and whether the stent was difficult to open or whether it was just a technical problem which was verified experimentally. Precisely, the same situation as during the surgery was recreated, and the stent was deployed in the same way. A FRED is an effective device, but there are cases of difficult deployment. The present method may be an option if a FRED is difficult to open.
血流重定向腔内装置（FRED）是一种广泛使用的血流分流支架。尽管 SAFE 研究报告了较高的技术成功率和良好的治疗效果，但也有部署技术失败的病例报告。本文介绍了一例在部署 FRED 时近端部分扭曲但成功部署的病例。一名 40 多岁的女性在因头痛进行放射检查时被诊断为左侧颈内动脉瘤。由于其家族有严重的脑动脉瘤病史，她选择了预防性治疗。由于近端血管直径≥5 毫米，因此选择了 5.5 毫米 FRED。然而，支架展开时近端扭曲。幸运的是，通过使用 Scepter C 和 CHIKAI 315 cm，真正的管腔得以确保，导线被引导至远端，FRED 被成功置入。随后，在征得患者同意后，制作了三维血管模型，并通过实验验证了支架是否难以打开，是否只是技术问题。FRED是一种有效的设备，但也存在难以植入的情况。FRED 是一种有效的装置，但也有难以展开的情况。如果 FRED 难以打开，本方法不失为一种选择。
{"title":"A rescue treatment to release the twist of a flow re-direction endoluminal device","authors":"Ryuzaburo Kanazawa, T. Uchida, T. Higashida, Takao Kono, Hiroki Ebise, Noboru Kuniyoshi","doi":"10.25259/sni_513_2024","DOIUrl":"https://doi.org/10.25259/sni_513_2024","url":null,"abstract":"\u0000\u0000A flow redirection endoluminal device (FRED) is a widely used flow diverter stent. Although high technical success and good treatment results were reported in the SAFE study, cases of technical failure of deployment have also been reported. A case in which a FRED was deployed with the proximal part twisted, but successful deployment was achieved, is presented.\u0000\u0000\u0000\u0000A woman in her 40s was diagnosed with a left internal carotid artery aneurysm during radiological investigations for headaches. Due to her family’s strong history of cerebral aneurysms, she opted for preventive treatment. A 5.5-mm FRED was selected because the proximal vessel diameter was ≥5 mm. However, the stent was deployed with the proximal side twisted. Fortunately, using a Scepter C and a CHIKAI 315 cm, the true lumen could be secure, the wire was guided distally, and the FRED was successfully placed. Later, with the patient’s consent, a 3D blood vessel model was created, and whether the stent was difficult to open or whether it was just a technical problem which was verified experimentally. Precisely, the same situation as during the surgery was recreated, and the stent was deployed in the same way.\u0000\u0000\u0000\u0000A FRED is an effective device, but there are cases of difficult deployment. The present method may be an option if a FRED is difficult to open.\u0000","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141922538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Imad Talahma, Aya Khader Zawahra, F. Almakhtoob, Fatima Iyad Shawar, Khulood Marwan Sharabati, Raghad Faisal Dwaik, Marwa K. Abdelshafy, A. A. Farag, Ahmad M. AbuAyyash, Waeel Ossama Hamouda
Intranasal meningoencephaloceles are rarely encountered in pediatric neurosurgery. The symptoms and clinical features may mimic those of nasal polyps or dermoid cysts. Transethmoidal meningoencephalocele is a rare congenital meningoencephalocele of the anterior skull base with diverse clinical presentation. The appropriate surgical intervention is chosen according to the meningoencephalocele type and location. Radiological examinations such as computed tomography and magnetic resonance imaging are helpful for the differential diagnosis of the encephalocele sac and localization of the cranial bone defect. We are reporting a case of basal meningoencephalocele of the transethmoidal type, which was discovered in a 20-day-old boy presenting with cerebrospinal fluid rhinorrhea, respiratory distress, difficulty in feeding, and meningitis. The preoperative images showed a large herniated intranasal sac with bony discontinuity of the cribriform plate; however, three discrete defects of the cribriform plate with their related discrete herniated sacs were identified intraoperatively. Two staged surgeries were performed in succession: transcranial to separate the sacs from the cranial cavity and seal the anterior fossa floor, followed by transnasal to remove the remnant of the intranasal sacs. Patient symptoms and signs markedly improved after the surgeries. We highlight the need for urgent intervention at a very young age if the clinical presentation mandates, and also the importance of meticulous intraoperative identification of all bony and dural defects that might be missed in preoperative images to ensure complete repair and prevent recurrence.
{"title":"Large transethmoidal meningoencephalocele in a neonate involving three discrete defects in lamina cribriform: A case report","authors":"Imad Talahma, Aya Khader Zawahra, F. Almakhtoob, Fatima Iyad Shawar, Khulood Marwan Sharabati, Raghad Faisal Dwaik, Marwa K. Abdelshafy, A. A. Farag, Ahmad M. AbuAyyash, Waeel Ossama Hamouda","doi":"10.25259/sni_248_2024","DOIUrl":"https://doi.org/10.25259/sni_248_2024","url":null,"abstract":"\u0000\u0000Intranasal meningoencephaloceles are rarely encountered in pediatric neurosurgery. The symptoms and clinical features may mimic those of nasal polyps or dermoid cysts. Transethmoidal meningoencephalocele is a rare congenital meningoencephalocele of the anterior skull base with diverse clinical presentation. The appropriate surgical intervention is chosen according to the meningoencephalocele type and location. Radiological examinations such as computed tomography and magnetic resonance imaging are helpful for the differential diagnosis of the encephalocele sac and localization of the cranial bone defect.\u0000\u0000\u0000\u0000We are reporting a case of basal meningoencephalocele of the transethmoidal type, which was discovered in a 20-day-old boy presenting with cerebrospinal fluid rhinorrhea, respiratory distress, difficulty in feeding, and meningitis. The preoperative images showed a large herniated intranasal sac with bony discontinuity of the cribriform plate; however, three discrete defects of the cribriform plate with their related discrete herniated sacs were identified intraoperatively. Two staged surgeries were performed in succession: transcranial to separate the sacs from the cranial cavity and seal the anterior fossa floor, followed by transnasal to remove the remnant of the intranasal sacs. Patient symptoms and signs markedly improved after the surgeries.\u0000\u0000\u0000\u0000We highlight the need for urgent intervention at a very young age if the clinical presentation mandates, and also the importance of meticulous intraoperative identification of all bony and dural defects that might be missed in preoperative images to ensure complete repair and prevent recurrence.\u0000","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141922733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09eCollection Date: 2024-01-01DOI: 10.25259/SNI_158_2024_RT
[This retracts the article DOI: 10.25259/SNI_158_2024.].
[此文收回 DOI: 10.25259/SNI_158_2024.]。
{"title":"Retraction: The effect of resection of gliomas of the primary motor and sensory cortex on functional recovery and seizure outcome: A 10-year retrospective study.","authors":"","doi":"10.25259/SNI_158_2024_RT","DOIUrl":"10.25259/SNI_158_2024_RT","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.25259/SNI_158_2024.].</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study was designed to assess the effectiveness and safety of using a modified Kocher’s point for ventriculostomy using endoscopic third ventriculostomy (ETV) and external ventricular drainage (EVD) in 200 patients at PAR Private Hospital in Erbil, Iraqi Kurdistan. In this retrospective analysis, a total of 200 patients who were diagnosed with obstructive hydrocephalus and underwent ETV and EVD utilizing a modified entry site were included. The revised Kocher point was located 11.5 cm posterior and superior to the nasion, 3 cm laterally, and 0–1 cm before the coronal suture. The use of this modified Kocher’s point has brought much improvement in surgical precision and safety. This would minimize incidences of bleeding and misplacement of the catheters. The anatomical structure was well organized, and nothing was challenging in the process of traversing through the foramen of Monro into the third ventricle. It was easily introduced through the modified Kocher point with increasing efficacy and near zero possibility of sustaining injury to the limiting cerebral region. Using the modified point of Kocher provides added reliability and accuracy to ventriculostomy, thereby reducing complications and increasing the overall outcome of surgeries. It overcomes all the drawbacks of classical entry sites and, further, helps in increasing the productivity of ETV and EVD. More research must be done to support the benefits of this modification in other clinical settings.
{"title":"Neuroanatomical refinement of Kocher’s point for enhanced precision in ventriculostomy: A technical note and a literature review","authors":"I. I. Sulaiman","doi":"10.25259/sni_551_2024","DOIUrl":"https://doi.org/10.25259/sni_551_2024","url":null,"abstract":"\u0000\u0000This study was designed to assess the effectiveness and safety of using a modified Kocher’s point for ventriculostomy using endoscopic third ventriculostomy (ETV) and external ventricular drainage (EVD) in 200 patients at PAR Private Hospital in Erbil, Iraqi Kurdistan.\u0000\u0000\u0000\u0000In this retrospective analysis, a total of 200 patients who were diagnosed with obstructive hydrocephalus and underwent ETV and EVD utilizing a modified entry site were included. The revised Kocher point was located 11.5 cm posterior and superior to the nasion, 3 cm laterally, and 0–1 cm before the coronal suture.\u0000\u0000\u0000\u0000The use of this modified Kocher’s point has brought much improvement in surgical precision and safety. This would minimize incidences of bleeding and misplacement of the catheters. The anatomical structure was well organized, and nothing was challenging in the process of traversing through the foramen of Monro into the third ventricle. It was easily introduced through the modified Kocher point with increasing efficacy and near zero possibility of sustaining injury to the limiting cerebral region.\u0000\u0000\u0000\u0000Using the modified point of Kocher provides added reliability and accuracy to ventriculostomy, thereby reducing complications and increasing the overall outcome of surgeries. It overcomes all the drawbacks of classical entry sites and, further, helps in increasing the productivity of ETV and EVD. More research must be done to support the benefits of this modification in other clinical settings.\u0000","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141921935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hirokuni Hashikata, Hideki Hayashi, Wataru Yoshizaki, Yoshinori Maki, Hiroki Toda
Extracranial hypoglossal schwannomas are rare, and transcranial skull base surgery can be challenging due to their proximity to the lower cranial nerves, jugular vein, vertebral artery, and carotid artery. The application of neuroendoscopic surgery for extracranial hypoglossal schwannomas has rarely been reported. A 53-year-old woman previously underwent lateral suboccipital surgery for a hypoglossal schwannoma when she was 25 years old. The patient had experienced aggravated dysphagia over the past month. Radiological examination revealed a recurrent extracranial hypoglossal schwannoma invading the left side of the clivus. The neuroendoscopic transnasal far-medial approach was performed, and the recurrent schwannoma was completely removed without any significant perioperative complications or recurrence for 3 years. Our report highlights the usefulness of the neuroendoscopic transnasal far-medial approach for the removal of recurrent extracranial hypoglossal schwannomas. The neuroendoscopic approach offers a viable and less invasive alternative to traditional transcranial skull-base surgery, especially in complex cases involving critical anatomical structures. The reported case study underscores the potential of neuroendoscopic surgery as a valuable tool in managing challenging skull-base tumors.
{"title":"Successful treatment of recurrent extracranial hypoglossal schwannoma using the neuroendoscopic transnasal far-medial approach","authors":"Hirokuni Hashikata, Hideki Hayashi, Wataru Yoshizaki, Yoshinori Maki, Hiroki Toda","doi":"10.25259/sni_547_2024","DOIUrl":"https://doi.org/10.25259/sni_547_2024","url":null,"abstract":"\u0000\u0000Extracranial hypoglossal schwannomas are rare, and transcranial skull base surgery can be challenging due to their proximity to the lower cranial nerves, jugular vein, vertebral artery, and carotid artery. The application of neuroendoscopic surgery for extracranial hypoglossal schwannomas has rarely been reported.\u0000\u0000\u0000\u0000A 53-year-old woman previously underwent lateral suboccipital surgery for a hypoglossal schwannoma when she was 25 years old. The patient had experienced aggravated dysphagia over the past month. Radiological examination revealed a recurrent extracranial hypoglossal schwannoma invading the left side of the clivus. The neuroendoscopic transnasal far-medial approach was performed, and the recurrent schwannoma was completely removed without any significant perioperative complications or recurrence for 3 years.\u0000\u0000\u0000\u0000Our report highlights the usefulness of the neuroendoscopic transnasal far-medial approach for the removal of recurrent extracranial hypoglossal schwannomas. The neuroendoscopic approach offers a viable and less invasive alternative to traditional transcranial skull-base surgery, especially in complex cases involving critical anatomical structures. The reported case study underscores the potential of neuroendoscopic surgery as a valuable tool in managing challenging skull-base tumors.\u0000","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141922168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samer S. Hoz, Li Ma, Ahmed Muthana, Mahmood F. Al-Zaidy, F. O. Ahmed, M. Ismail, Rachel C. Jacobs, Prateek Agarwal, A. Al-Bayati, Raul G. Nogueira, Michael J. Lang, Bradley A. Gross
Cranial nerve palsy (CNP) in patients with intracranial aneurysms (IAs) can impose significant burdens on a patient’s quality of life. The literature has a paucity of reviews addressing patterns of overall reported cranial nerve (CN) involvement and outcomes in patients with IA. The literature systematically reviewed CNP at presentation in the setting of IA using PubMed, Web-of-Science, and Scopus according to the PRISMA guidelines. Fifty-two studies reported a total of 513 patients with IA and 630 CNPs observed at presentation: oculomotor (58.25%), abducent (15.87%), optic (12.06%), trochlear (8.7%), and trigeminal (1.9%). Most common aneurysms are located in a posterior communicating artery (46%) and cavernous internal carotid artery (29.2%). Trends of CNP based on the rupture status of IAs showed that 80% were associated with unruptured IAs and 20% with ruptured IAs. Post-treatment of IA, 55% of patients had complete resolution of CNP, with most (89%; n = 134) resolving within the first 6 months. Stratified by CNP type: Complete resolution rate is 100% in CN VII–IX, 60% in CN VI, 59% in CN IV, 54% in CN III, 45% in CN V, and 43% in CN II. In patients with cranial nerve palsies attributed to IAs, the location and rupture status of the aneurysm could determine the type and severity of the nerve palsy. Most patients experienced favorable outcomes in terms of their resolution and long-term function of the CNP after treatment of the IA.
{"title":"Cranial nerve palsies and intracranial aneurysms: A narrative review of patterns and outcomes","authors":"Samer S. Hoz, Li Ma, Ahmed Muthana, Mahmood F. Al-Zaidy, F. O. Ahmed, M. Ismail, Rachel C. Jacobs, Prateek Agarwal, A. Al-Bayati, Raul G. Nogueira, Michael J. Lang, Bradley A. Gross","doi":"10.25259/sni_531_2024","DOIUrl":"https://doi.org/10.25259/sni_531_2024","url":null,"abstract":"\u0000\u0000Cranial nerve palsy (CNP) in patients with intracranial aneurysms (IAs) can impose significant burdens on a patient’s quality of life. The literature has a paucity of reviews addressing patterns of overall reported cranial nerve (CN) involvement and outcomes in patients with IA.\u0000\u0000\u0000\u0000The literature systematically reviewed CNP at presentation in the setting of IA using PubMed, Web-of-Science, and Scopus according to the PRISMA guidelines.\u0000\u0000\u0000\u0000Fifty-two studies reported a total of 513 patients with IA and 630 CNPs observed at presentation: oculomotor (58.25%), abducent (15.87%), optic (12.06%), trochlear (8.7%), and trigeminal (1.9%). Most common aneurysms are located in a posterior communicating artery (46%) and cavernous internal carotid artery (29.2%). Trends of CNP based on the rupture status of IAs showed that 80% were associated with unruptured IAs and 20% with ruptured IAs. Post-treatment of IA, 55% of patients had complete resolution of CNP, with most (89%; n = 134) resolving within the first 6 months. Stratified by CNP type: Complete resolution rate is 100% in CN VII–IX, 60% in CN VI, 59% in CN IV, 54% in CN III, 45% in CN V, and 43% in CN II.\u0000\u0000\u0000\u0000In patients with cranial nerve palsies attributed to IAs, the location and rupture status of the aneurysm could determine the type and severity of the nerve palsy. Most patients experienced favorable outcomes in terms of their resolution and long-term function of the CNP after treatment of the IA.\u0000","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141922996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The outcome of a subdural hematoma after embolization of the middle meningeal artery depends on many influencing factors","authors":"J. Finsterer","doi":"10.25259/sni_587_2024","DOIUrl":"https://doi.org/10.25259/sni_587_2024","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141924768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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