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.
{"title":"Optimizing shunt integrity during acute subdural hematoma evacuation.","authors":"Tatsuya Tanaka, Hirofumi Goto, Nobuaki Momozaki, Eiichiro Honda, Eiichi Suehiro, Akira Matsuno","doi":"10.25259/SNI_411_2024","DOIUrl":"10.25259/SNI_411_2024","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"354"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383104","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 : 2024-09-27eCollection Date: 2024-01-01DOI: 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.
{"title":"A diagnostically challenging case of brain abscess with associated hemorrhage.","authors":"Kenichiro Eza, Gen Futamura, Yoshihide Katayama, Kyoko Onishi, Masahiko Wanibuchi","doi":"10.25259/SNI_669_2024","DOIUrl":"10.25259/SNI_669_2024","url":null,"abstract":"<p><strong>Background: </strong>Brain abscesses with associated hemorrhage are rare. Herein, we present a case of brain abscess with associated hemorrhage that posed a diagnostic challenge.</p><p><strong>Case description: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"346"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383346","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 : 2024-09-27eCollection Date: 2024-01-01DOI: 10.25259/SNI_691_2024
Josef Finsterer
{"title":"Before blaming glucocorticoids for prolonged postoperative hypotension, alternative explanations must be carefully ruled out.","authors":"Josef Finsterer","doi":"10.25259/SNI_691_2024","DOIUrl":"10.25259/SNI_691_2024","url":null,"abstract":"","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"352"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383090","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}
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。
{"title":"Vertebral artery stump syndrome associated with a bihemispheric posterior inferior cerebellar artery.","authors":"Takayuki Morimoto, Kenta Fujimoto, Sung-Chul Ko, Toshikazu Nishioka, Hidemori Tokunaga","doi":"10.25259/SNI_488_2024","DOIUrl":"10.25259/SNI_488_2024","url":null,"abstract":"<p><strong>Background: </strong>Vertebral artery (VA) stump syndrome (VASS) is an embolic source for cerebral infarction (CI) in the posterior circulation after VA occlusion.</p><p><strong>Case description: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"350"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383129","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 : 2024-09-27eCollection Date: 2024-01-01DOI: 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.
{"title":"The use of ultrasound-guided imaging to localize peripheral nerve injury in pediatric patients: A case report.","authors":"Mareshah N Sowah, Benjamin R Klein, Mark Attiah, Nidia I Perez Pereda, Roseanna A Murray, Danny Lincoln John, Avidesh Panday, Allan D Levi","doi":"10.25259/SNI_580_2024","DOIUrl":"10.25259/SNI_580_2024","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case description: </strong>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.</p><p><strong>Conclusion: </strong>The authors conclude that the use of ultrasonography to diagnose and manage traumatic peripheral nerve injury is advantageous, particularly in the pediatric population.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"347"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383115","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 : 2024-09-27eCollection Date: 2024-01-01DOI: 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。
{"title":"Posterior location of the facial nerve on vestibular schwannoma: Report of a rare case and a literature review.","authors":"Biji Bahuleyan, Vineetkumar Thakorbhai Patel, Mariette Anto, Sarah E Hessel, Rochan K Ramesh, K M Girish, Santhosh George Thomas","doi":"10.25259/SNI_586_2024","DOIUrl":"10.25259/SNI_586_2024","url":null,"abstract":"<p><strong>Background: </strong>Posterior location of the facial nerve in relation to vestibular schwannoma (VS) is extremely rare.</p><p><strong>Case description: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"345"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383347","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}
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.
{"title":"A case of spontaneous direct vertebral artery - External vertebral venous plexus fistula in the upper cervical portion.","authors":"Takayuki Morimoto, Kenta Fujimoto, Sungchul Ko, Toshikazu Nishioka, Hidemori Tokunaga","doi":"10.25259/SNI_736_2024","DOIUrl":"10.25259/SNI_736_2024","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Case description: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"351"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383089","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}
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.
{"title":"Multidrug-resistant tuberculosis of spine diagnosis and management: An institutional experience of 21 cases.","authors":"Sunil Bhosale, Dipen Mukesh Ariwala, Akshay Phupate, Nandan Marathe, Harini Seshadri, Umang Sheth","doi":"10.25259/SNI_398_2024","DOIUrl":"https://doi.org/10.25259/SNI_398_2024","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"344"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396454","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}
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.
{"title":"Combined endovascular therapy and surgery for central giant cell granuloma in the temporal bone: A case report.","authors":"Takayuki Morimoto, Sung-Chul Ko, Keiji Shimada, Toshikazu Nishioka, Hidemori Tokunaga","doi":"10.25259/SNI_487_2024","DOIUrl":"10.25259/SNI_487_2024","url":null,"abstract":"<p><strong>Background: </strong>Central giant cell granuloma (CGCG) is an uncommon, benign intraosseous lesion that most frequently occurs in the mandible and maxilla.</p><p><strong>Case description: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"335"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383092","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 : 2024-09-20eCollection Date: 2024-01-01DOI: 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。
{"title":"Combined presigmoid approach: A literature review.","authors":"Sama S Albairmani, Ahmed Muthana, Tabarek F Mohammed, Mahmood F Al-Zaidy, Oday Atallah, Ahmed Aljuboori, Zaid Aljuboori, Norberto Andaluz, Samer S Hoz","doi":"10.25259/SNI_594_2024","DOIUrl":"10.25259/SNI_594_2024","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>n</i> = 204, 37.5%), followed by type-2 (<i>n</i> = 197, 36%), type-4 (<i>n</i> = 54, 9.9%), type-5 (<i>n</i> = 51, 9.4%), and type-3 (<i>n</i> = 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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"15 ","pages":"342"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11450886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142383093","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}