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Optimizing shunt integrity during acute subdural hematoma evacuation. 优化急性硬膜下血肿清除过程中分流管的完整性。
Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_411_2024
Tatsuya Tanaka, Hirofumi Goto, Nobuaki Momozaki, Eiichiro Honda, Eiichi Suehiro, Akira Matsuno

Background: Even mild head trauma can cause severe intracranial hemorrhage in patients with cerebrospinal fluid (CSF) shunts for hydrocephalus. CSF shunts are considered a risk factor for subdural hematoma (SDH). The management of acute SDH (ASDH) in shunted patients with normal pressure hydrocephalus can be challenging. Addressing the hematoma and the draining function of the shunt is important. To preserve the shunt, we set the shunt valve pressure to the highest and perform hematoma evacuation for ASDH. In this study, we report the surgical cases of ASDH in patients with shunts.

Methods: Between 2013 and 2019, five patients with ASDH and CSF shunts underwent hematoma evacuation at our hospital. We retrospectively analyzed data regarding their clinical and radiological presentation, hospitalization course, the use of antithrombotic medications, and response to different treatment regimens.

Results: The patients presented with scores of 5-14 in the Glasgow coma scale and severe neurological signs, consciousness disturbance, and hemiparesis. Most patients were elderly, taking antithrombotic medications (four of five cases), and had experienced falls (4 of 5 cases). All patients underwent hematoma evacuation following resetting their programmable shunt valves to their maximal pressure setting and shunt preservation. ASDH enlargement was observed in only one patient who underwent burr-hole drainage. Glasgow outcome scale scores at discharge were 1 and 3, respectively.

Conclusion: In hematoma evacuation, increasing the valve pressure may reduce the bleeding recurrence. To preserve the shunt, setting the shunt valve pressure to the highest level and performing endoscopic hematoma evacuation with a small craniotomy could be useful.

背景:因脑积水而进行脑脊液(CSF)分流的患者,即使是轻微的头部外伤也可能导致严重的颅内出血。脑脊液分流术被认为是硬膜下血肿(SDH)的危险因素。对分流后的正常压力脑积水患者进行急性 SDH(ASDH)治疗具有挑战性。处理血肿和分流管的引流功能非常重要。为了保留分流管,我们将分流阀压力调到最高,并对 ASDH 进行血肿排空。在本研究中,我们报告了分流患者 ASDH 的手术病例:方法:2013 年至 2019 年期间,5 例 ASDH 和 CSF 分流患者在我院接受了血肿抽吸术。我们回顾性分析了他们的临床和影像学表现、住院过程、抗血栓药物的使用以及对不同治疗方案的反应:结果:患者的格拉斯哥昏迷量表评分为 5-14 分,并伴有严重的神经体征、意识障碍和偏瘫。大多数患者为老年人,正在服用抗血栓药物(5 例中的 4 例),并有跌倒经历(5 例中的 4 例)。所有患者都在将可编程分流阀重新设置为最大压力并保留分流后进行了血肿清除。只有一名接受了毛细孔引流术的患者出现了 ASDH 扩大。出院时格拉斯哥结果量表评分分别为1分和3分:结论:在血肿清除过程中,增加瓣膜压力可减少出血复发。为了保留分流管,将分流管瓣膜压力调至最高,并通过小范围开颅手术进行内镜下血肿清除可能会有所帮助。
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引用次数: 0
A diagnostically challenging case of brain abscess with associated hemorrhage. 一例诊断困难的脑脓肿伴出血病例。
Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_669_2024
Kenichiro Eza, Gen Futamura, Yoshihide Katayama, Kyoko Onishi, Masahiko Wanibuchi

Background: Brain abscesses with associated hemorrhage are rare. Herein, we present a case of brain abscess with associated hemorrhage that posed a diagnostic challenge.

Case description: A 50-year-old male presented with the left homonymous hemianopia and was admitted to our hospital due to a subcortical hemorrhage in the right occipital lobe, which was revealed during a head magnetic resonance imaging (MRI). Subsequent imaging suggested an intra-tumoral hemorrhage, so surgical treatment was planned. However, on hospital day 6, the patient suddenly showed a decrease in consciousness level. Head MRI showed a high signal within the capsule on diffusion-weighted imaging, which spread to the ventricle and subarachnoid space. Brain abscess was suspected; therefore, an abscess drainage surgery was performed emergency. The postoperative course was relatively smooth.

Conclusion: A brain abscess that perforates the ventricle has a poor prognosis, which emphasizes the need for early diagnosis and treatment. Although hemorrhage within a brain abscess is rare, it can complicate diagnosis, which, thus, underscores the importance of awareness.

背景:伴有出血的脑脓肿非常罕见。在此,我们介绍一例脑脓肿伴有出血的病例,这给诊断带来了挑战:病例描述:一名 50 岁的男性患者出现左侧同侧偏盲,在头部磁共振成像(MRI)检查中发现右枕叶皮质下出血,遂被送入我院。随后的影像学检查显示是瘤内出血,因此计划进行手术治疗。然而,在住院的第 6 天,患者突然意识减退。头部核磁共振成像显示,弥散加权成像显示囊内有高信号,并扩散到脑室和蛛网膜下腔。怀疑是脑脓肿,因此紧急进行了脓肿引流手术。术后过程相对顺利:结论:脑脓肿穿透脑室的预后较差,这就强调了早期诊断和治疗的必要性。脑脓肿内出血虽然罕见,但会使诊断复杂化,因此强调提高认识的重要性。
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引用次数: 0
Before blaming glucocorticoids for prolonged postoperative hypotension, alternative explanations must be carefully ruled out. 在将术后长期低血压归咎于糖皮质激素之前,必须仔细排除其他解释。
Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_691_2024
Josef Finsterer
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引用次数: 0
Vertebral artery stump syndrome associated with a bihemispheric posterior inferior cerebellar artery. 与双半球小脑后下动脉相关的椎动脉残端综合征。
Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_488_2024
Takayuki Morimoto, Kenta Fujimoto, Sung-Chul Ko, Toshikazu Nishioka, Hidemori Tokunaga

Background: Vertebral artery (VA) stump syndrome (VASS) is an embolic source for cerebral infarction (CI) in the posterior circulation after VA occlusion.

Case description: A 63-year-old patient with a history of hypertension presented to our emergent department with dizziness, vomiting, and gait disturbance. Head magnetic resonance imaging (MRI) showed acute CIs in the bilateral cerebellar hemispheres and the vermis. Magnetic resonance angiography revealed patency of the VA and basilar artery. Left subclavian artery digital subtraction angiography (DSA) revealed severe left VA orifice stenosis and collateral flow from the deep cervical artery into the left V2 segment. Right VA angiography showed retrograde flow to the left V4 segment, branching bihemispheric posterior inferior cerebellar artery (PICA), and to-and-flow appearance in the proximal PICA segment and VA. VASS was diagnosed, and conservative treatment with aspirin was administered. Worsened nausea and gait disturbance had developed during hospitalization. MRI revealed an enlarged posterior circulation CI. Follow-up DSA revealed proximal to-and-flow appearance translocation to the proximal V4 segment and poor PICA flow. We performed proximal V4 segment parent artery occlusion (PAO) by endovascular therapy. No recurrence of symptoms or CI was observed. The patient was discharged on day 32 of hospitalization with 1 on the modified Rankin scale.

Conclusion: We reported a rare case of VASS involving bihemispheric PICA. No CI recurrence was observed after performing PAO of the proximal V4 segment. When treating acute cases of bilateral cerebellar CI due to VASS, the contribution of PICA variations should be considered.

背景:椎动脉(VA)残端综合征(VASS)是VA闭塞后后循环脑梗死(CI)的栓塞源:一名 63 岁的高血压患者因头晕、呕吐和步态障碍到我院急诊科就诊。头部磁共振成像(MRI)显示,双侧小脑半球和蚓部存在急性CI。磁共振血管造影显示VA和基底动脉通畅。左锁骨下动脉数字减影血管造影术(DSA)显示左VA管口严重狭窄,颈深动脉侧支血流进入左V2段。右侧VA血管造影显示逆流至左侧V4节段、双半球小脑后下动脉(PICA)分支,以及PICA近端节段和VA的迂回血流。诊断为 VASS,并使用阿司匹林进行保守治疗。住院期间,恶心和步态障碍加重。磁共振成像显示后循环CI增大。随访的DSA显示近端V4节段出现近端血流转位,PICA血流不畅。我们通过血管内治疗为患者实施了近端V4段母动脉闭塞术(PAO)。未观察到症状或 CI 复发。患者于住院第32天出院,改良Rankin量表评分为1分:我们报告了一例罕见的涉及双半球 PICA 的 VASS 病例。结论:我们报告了一例罕见的涉及双半球 PICA 的 VASS 病例,在对近端 V4 节段进行 PAO 后,未观察到 CI 复发。在治疗因 VASS 引起的急性双侧小脑 CI 病例时,应考虑到 PICA 变异的作用。
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引用次数: 0
The use of ultrasound-guided imaging to localize peripheral nerve injury in pediatric patients: A case report. 使用超声引导成像定位儿科患者的周围神经损伤:病例报告。
Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_580_2024
Mareshah N Sowah, Benjamin R Klein, Mark Attiah, Nidia I Perez Pereda, Roseanna A Murray, Danny Lincoln John, Avidesh Panday, Allan D Levi

Background: The use of ultrasonography to diagnose and manage peripheral nerve injury is not routinely performed, but is an advantageous alternative to magnetic resonance imaging (MRI) in the pediatric population.

Case description: The authors report a case of a toddler-aged female who sustained a supracondylar fracture and subsequent median and ulnar nerve injuries. All preoperative and postoperative imaging was performed through high-resolution ultrasound as opposed to MRI. Starting at 6 months post-nerve repair and with 18 months of follow-up, the patient exhibited substantial improvement in motor strength and sensory function. This case demonstrated a successful outcome while providing an imaging alternative that is portable, relatively low-cost, lacks ionizing radiation, provides additional information on vascular integrity, and obviates the need for general anesthetic such as MRI.

Conclusion: The authors conclude that the use of ultrasonography to diagnose and manage traumatic peripheral nerve injury is advantageous, particularly in the pediatric population.

背景:使用超声波检查诊断和处理周围神经损伤并非常规做法,但在儿科人群中,超声波检查是磁共振成像(MRI)的一种优势替代方法:作者报告了一例肱骨髁上骨折并导致正中神经和尺神经损伤的学步女性病例。所有术前和术后成像均通过高分辨率超声而非核磁共振成像进行。从神经修复术后 6 个月开始,经过 18 个月的随访,患者的运动力量和感觉功能得到了显著改善。该病例显示了成功的结果,同时提供了一种便携式、成本相对较低、无电离辐射、可提供更多有关血管完整性的信息,并且无需像核磁共振成像那样进行全身麻醉的成像替代方法:作者总结道,使用超声波诊断和处理外伤性周围神经损伤具有优势,尤其是在儿科人群中。
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引用次数: 0
Posterior location of the facial nerve on vestibular schwannoma: Report of a rare case and a literature review. 前庭分裂瘤的面神经后方位置:一例罕见病例的报告和文献综述。
Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_586_2024
Biji Bahuleyan, Vineetkumar Thakorbhai Patel, Mariette Anto, Sarah E Hessel, Rochan K Ramesh, K M Girish, Santhosh George Thomas

Background: Posterior location of the facial nerve in relation to vestibular schwannoma (VS) is extremely rare.

Case description: An elderly man presented with the right cerebellopontine angle (CPA) syndrome. Magnetic resonance imaging showed the partly cystic and partly solid right CPA lesion extending to the internal auditory meatus. Seventh nerve monitoring showed the facial nerve on the posterior surface of the tumor. At surgery, the facial nerve was seen on the posterior surface of the tumor under the microscope. Partial excision of the tumor was done with preservation of the facial nerve both anatomically and electrophysiologically.

Conclusion: The posterior location of the facial nerve should be anticipated in all patients with VS. The surgical strategy must be altered appropriately to preserve the facial nerve.

背景:与前庭分裂瘤(VS)相关的面神经后方位置极为罕见:一名老年男性出现右侧小脑角(CPA)综合征。磁共振成像显示,右侧 CPA 部分囊性、部分实性病变延伸至内耳肉腔。第七次神经监测显示面神经位于肿瘤后方。手术时,在显微镜下看到面神经位于肿瘤后表面。手术对肿瘤进行了部分切除,在解剖学和电生理学上保留了面神经:结论:所有 VS 患者都应预计到面神经的后方位置。结论:所有 VS 患者都应预计到面神经位于后方,必须适当改变手术策略以保留面神经。
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引用次数: 0
A case of spontaneous direct vertebral artery - External vertebral venous plexus fistula in the upper cervical portion. 一例自发性上颈部椎动脉-椎外静脉丛直接瘘。
Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_736_2024
Takayuki Morimoto, Kenta Fujimoto, Sungchul Ko, Toshikazu Nishioka, Hidemori Tokunaga

Background: Spontaneous direct vertebral artery-external vertebral venous plexus (VA-EVVP) fistula is a rare disease that presents in patients with neurofibromatosis type 1 (NF-1) or trauma.

Case description: An 82-year-old female patient with no neurological deficits or trauma presented to our hospital with right hemianopsia. Head magnetic resonance imaging (MRI) revealed left occipital cerebral infarction and magnetic resonance angiography demonstrated high signal intensity in the left transverse sinus (TS). The attending doctor diagnosed an old infarction on the left occipital lobe and dural arteriovenous fistula (AVF) in the TS. After 3 years after the first diagnosis, her new attending doctor re-checked the MRI and performed digital subtraction angiography (DSA). The DSA examination revealed a single-hole AVF between the vertebral artery and external vertebral plexus at the C2 level, which was diagnosed as upper cervical VA-EVVP. The patient presented with tinnitus due to a high-flow VA-EVVP fistula, so we performed coil embolization of the fistula under general anesthesia using a double-catheter technique and achieved subtotal embolization, which diminished the intracranial reflux. The 6-month follow-up DSA image revealed complete obliteration of the AVF.

Conclusion: We report a rare case of upper cervical VA-EVVP fistula in a patient with no history of trauma and relevant medical conditions. Coil embolization of the fistula was performed using a combination of balloon-assisted and double-catheter techniques. Although the patient showed residual shunt flow after the intervention, follow-up DSA revealed complete obliteration. These findings should provide novel insights for the treatment strategy against VA-EVVP fistula.

背景:自发性直接椎动脉-椎体外静脉丛(VA-EVVP)瘘是一种罕见疾病,多见于神经纤维瘤病 1 型(NF-1)或外伤患者:一位82岁的女性患者因右半身不遂到我院就诊,她既无神经功能障碍,也无外伤。头部磁共振成像(MRI)显示左枕叶脑梗死,磁共振血管造影显示左侧横窦(TS)高信号强度。主治医生诊断为左枕叶陈旧性脑梗塞和 TS 硬膜动静脉瘘(AVF)。首次诊断 3 年后,她的新主治医生重新检查了核磁共振成像,并进行了数字减影血管造影(DSA)检查。数字减影血管造影(DSA)检查显示,在 C2 水平的椎动脉和椎体外神经丛之间有一个单孔 AVF,诊断为上颈椎 VA-EVVP。患者因VA-EVVP高流量瘘管而出现耳鸣,因此我们在全身麻醉下使用双导管技术对瘘管进行了线圈栓塞,实现了次全栓塞,减少了颅内反流。6 个月的随访 DSA 图像显示动静脉瘘完全闭塞:我们报告了一例罕见的上颈椎 VA-EVVP 管瘘管病例,患者无外伤史和相关疾病。我们采用球囊辅助和双导管技术对瘘管进行了线圈栓塞。虽然患者在介入治疗后出现了分流残留血流,但随访的 DSA 显示瘘管已完全阻塞。这些发现为VA-EVVP瘘的治疗策略提供了新的思路。
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引用次数: 0
Multidrug-resistant tuberculosis of spine diagnosis and management: An institutional experience of 21 cases. 脊柱耐多药结核病的诊断与管理:21 个病例的机构经验。
Pub Date : 2024-09-27 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_398_2024
Sunil Bhosale, Dipen Mukesh Ariwala, Akshay Phupate, Nandan Marathe, Harini Seshadri, Umang Sheth

Background: We aimed to establish a standardized protocol for managing multidrug-resistant (MDR) spinal tuberculosis (TB), addressing the surgical options, ranging from computed tomography-guided biopsy to intraoperative sampling.

Methods: This study developed a treatment/management protocol based on an analysis of clinical, radiological, and postoperative outcomes for 21 patients with spinal MDR-TB. Over 24 months, 21 patients with multidrug-resistant spinal TB underwent the following testing: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), numerical rating scale (NRS), and the American Spinal Injury Association Scale. Radiological criteria were based upon a comparison of preoperative and 6-month to 2-year postoperative plain radiographs.

Results: The 21 patients underwent guided biopsies (35%) or intraoperative sampling (65%). For the surgical cases, dorsal vertebrae were most frequently involved (75%), and 90% underwent posterior surgical procedures. Postoperatively, ESR, CRP, kyphosis angle, and NRS score were significantly reduced. The 3 MDR patients who failed treatment were transitioned to the extensively drug-resistant (XDR) protocol wherein bedaquiline, linezolid, cycloserine, and clofazimine were given after drug sensitivity testing drug regimen, needed no further surgery, and none exhibited additional neurological deterioration.

Conclusion: Regular clinical, laboratory, radiological, and outcome analysis is vital for following MDR spinal TB patients; early detection of relatively rare treatment failures (i.e., 3/21 patients in this series) allows for prompt initiation of XDR treatment, resulting in better outcomes.

背景:我们的目标是建立一个管理耐多药(MDR)脊柱结核(TB)的标准化方案,解决从计算机断层扫描引导活检到术中取样等各种手术方案:本研究根据对 21 名脊柱 MDR-TB 患者的临床、放射学和术后结果的分析,制定了治疗/管理方案。在24个月的时间里,21名脊柱耐多药结核病患者接受了以下检测:红细胞沉降率(ESR)、C反应蛋白(CRP)、数字评分量表(NRS)和美国脊柱损伤协会量表。放射学标准基于术前和术后 6 个月至 2 年的平片对比:21名患者接受了引导下活检(35%)或术中取样(65%)。在手术病例中,背侧椎体最常受累(75%),90%的患者接受了后路手术。术后,ESR、CRP、后凸角度和 NRS 评分均显著降低。3名治疗失败的MDR患者在药物敏感性检测后转为广泛耐药(XDR)方案,即给予贝达喹啉、利奈唑胺、环丝氨酸和氯法齐明等药物治疗,无需进一步手术,且无一出现其他神经系统恶化症状:结论:定期进行临床、实验室、放射学和疗效分析对于跟踪 MDR 脊柱结核病患者至关重要;及早发现相对罕见的治疗失败(即本系列中的 3/21 例患者)可以及时开始 XDR 治疗,从而获得更好的疗效。
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引用次数: 0
Combined endovascular therapy and surgery for central giant cell granuloma in the temporal bone: A case report. 颞骨中央巨细胞肉芽肿的联合血管内治疗和手术:病例报告。
Pub Date : 2024-09-20 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_487_2024
Takayuki Morimoto, Sung-Chul Ko, Keiji Shimada, Toshikazu Nishioka, Hidemori Tokunaga

Background: Central giant cell granuloma (CGCG) is an uncommon, benign intraosseous lesion that most frequently occurs in the mandible and maxilla.

Case description: A 31-year-old female with a medical history of Kawasaki disease presented to our hospital complaining of a clogged right ear. Head computed tomography revealed a mass in the squamous part of the right temporal bone, with osteolytic changes and invasion of the external auditory canal, middle ear, temporomandibular joint, and mastoid air cells. Enhanced magnetic resonance imaging (MRI) showed a strong signal in the intraosseous lesion. Digital subtraction angiography revealed tumor staining from multiple feeders, including the middle meningeal, posterior deep temporal, and posterior auricular arteries. Preoperative feeder embolization using a detachable coil and Embosphere Microspheres were performed for the middle meningeal artery under general anesthesia. After the endovascular treatment, we operated on the temporal bone lesion. Postoperative enhanced MRI showed subtotal resection and residual tumor near the external auditory canal, which was left in place to prevent opening the external auditory canal. The histopathological examination showed proliferation of mononuclear cells intermingled with osteoclast-like multinucleated giant cells. A diagnosis of CGCG was made. The postoperative course was uncomplicated, and the patient was discharged on day 10 of hospitalization.

Conclusion: We reported a rare case of CGCG in the temporal bone, managed by endovascular therapy and surgical resection. This combination therapy resulted in subtotal resection, preserving surrounding normal structures, such as the external auditory canal and tympanic cavity.

背景:中央巨细胞肉芽肿(CGCG中央巨细胞肉芽肿(CGCG)是一种不常见的骨内良性病变,最常发生在下颌骨和上颌骨:一名有川崎病病史的 31 岁女性来我院就诊,主诉右耳堵塞。头部计算机断层扫描显示,右颞骨鳞状部位有肿块,并伴有溶骨性改变,外耳道、中耳、颞下颌关节和乳突气室均受侵犯。增强磁共振成像(MRI)显示骨内病变处有强信号。数字减影血管造影术显示,包括脑膜中动脉、颞后深动脉和耳后动脉在内的多条供血动脉均有肿瘤染色。术前,我们在全身麻醉下使用可拆卸线圈和Embosphere微球对脑膜中动脉进行了馈源栓塞。血管内治疗后,我们对颞骨病变进行了手术。术后增强磁共振成像显示肿瘤次全切除,外耳道附近有残留肿瘤,为防止打开外耳道,我们将肿瘤留在原位。组织病理学检查显示,单核细胞与破骨细胞样多核巨细胞混杂增生。诊断结果为 CGCG。术后过程并不复杂,患者于住院第 10 天出院:我们报告了一例罕见的颞骨 CGCG 病例,该病例通过血管内治疗和手术切除得到了控制。结论:我们报告了一例罕见的颞骨CGCG病例,该病例通过血管内治疗和手术切除进行了处理,这种综合疗法实现了次全切除,保留了周围的正常结构,如外耳道和鼓室。
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引用次数: 0
Combined presigmoid approach: A literature review. 联合胸骨前入路:文献综述。
Pub Date : 2024-09-20 eCollection Date: 2024-01-01 DOI: 10.25259/SNI_594_2024
Sama S Albairmani, Ahmed Muthana, Tabarek F Mohammed, Mahmood F Al-Zaidy, Oday Atallah, Ahmed Aljuboori, Zaid Aljuboori, Norberto Andaluz, Samer S Hoz

Background: The presigmoid approach represents the standard route to reach the petrous area anterior to the sigmoid sinus. Several lateral skull base approaches have been integrated into this approach for the purpose of widening the window, leading to variable combined approaches and variable terminology. Herein, the authors conducted a systematic review of the literature to simplify understanding of the potential combination of different approaches and their complications.

Methods: PubMed, EMBASE and Web of Science databases were searched on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include studies describing modifications of the presigmoid approach.

Results: We included 27 studies comprising 545 patients. Five combination types applied to the presigmoid approach were identified: Anterior petrosal (Kawase's) approach (Type-1), Supra-tentorial approach (Type-2), Infratemporal fossa approach (Type-3), retrosigmoid approach (Type-4), and Far-lateral suboccipital approach (Type-5). Type-1 combined approach was the commonest type (n = 204, 37.5%), followed by type-2 (n = 197, 36%), type-4 (n = 54, 9.9%), type-5 (n = 51, 9.4%), and type-3 (n = 39, 7.2%). Meningioma was the typical target lesion in all types except type 3, where it is solely used for paraganglioma. The petroclival region was the prevalent access location in all the types of combined presigmoid approaches (type-1, 92%; type-2, 95%; type-3, 100%; type-4, 59%; and type-5, 64%). The intraoperative lateral patient position was dominantly utilized in type-1, type-3, and type-5 approaches (65%, 100%, and 100%, respectively), while park-bench was the most common position in type-2 (36%) and type-4 (100%) approaches. Overall, all types exhibited good outcomes in the form of gross total resection of the lesion and the absence of surgical complications in the follow-up.

Conclusion: Presigmoid approaches are becoming increasingly complex with the application and integration of the lateral skull base approaches, resulting in broadening the surgical field and easy access to the targeted lesions. The importance of designing a comprehensive nomenclature of the combined presigmoid approaches may add distinctive contributions to the growing knowledge of neurosurgery.

背景:乙状窦前入路是到达乙状窦前枕部的标准路径。为了扩大手术窗口,有几种侧颅底入路被整合到这一入路中,导致了不同的联合入路和不同的术语。在此,作者对文献进行了系统性回顾,以简化对不同方法的潜在组合及其并发症的理解:方法:根据《系统综述和荟萃分析首选报告项目》指南,对 PubMed、EMBASE 和 Web of Science 数据库进行检索,以纳入描述乙状结肠前入路改良方法的研究:结果:我们共纳入了 27 项研究,包括 545 名患者。确定了应用于蝶骨前入路的五种组合类型:前枕(川濑)入路(Type-1)、胸骨上入路(Type-2)、颞下窝入路(Type-3)、后蝶骨入路(Type-4)和远外侧枕下入路(Type-5)。1型联合方法是最常见的类型(204例,37.5%),其次是2型(197例,36%)、4型(54例,9.9%)、5型(51例,9.4%)和3型(39例,7.2%)。除 3 型仅用于副神经节瘤外,脑膜瘤是所有类型的典型靶病变。在所有类型的蝶鞍前联合入路中,瓣膜区域是最常见的入路位置(类型1,92%;类型2,95%;类型3,100%;类型4,59%;类型5,64%)。1型、3型和5型方法主要采用患者术中侧卧位(分别为65%、100%和100%),而2型(36%)和4型(100%)方法中最常见的体位是公园椅。总体而言,所有类型的手术都取得了良好的效果,即病灶全部切除,且随访中无手术并发症:结论:随着颅底外侧入路的应用和整合,颅前入路正变得越来越复杂,从而拓宽了手术视野,并方便了目标病灶的入路。为综合蝶鞍前入路设计一个全面的术语非常重要,可为不断增长的神经外科知识做出独特的贡献。
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引用次数: 0
期刊
Surgical neurology international
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