Surgical neurology international最新文献

Background: The long-term outcomes, adverse events, and occlusion rates of the Sugita clip remain unknown. This study evaluated the effectiveness and safety of the Sugita clip by assessing its outcomes and related complications.

Methods: Patients who underwent cerebral aneurysm clipping for ruptured or unruptured cerebral aneurysms using the Sugita clip at Nagoya University Hospital and its affiliated facilities between January 01, 2016, and December 31, 2017, were enrolled. We retrospectively investigated patient background, operative information, intraoperative and perioperative complications, device malfunctions, occlusion and parent artery patency rates, and postoperative modified Rankin scale (mRS). We divided patients into two groups based on postoperative mRS to investigate factors that cause deterioration in neurological prognosis.

Results: In total, 228 patients with unruptured intracranial aneurysms (UIAs) and 364 with ruptured intracranial aneurysms (RIAs) were included. Concerning postoperative mRS (91-365 days), 223 patients with UIAs and 258 with RIAs had good outcomes (mRS 0-2). Regarding device safety, there were no reports of aneurysm recurrence, parent artery occlusion due to clip slippage, foreign body reactions in the surrounding brain tissue, or device malfunctions. Factors that affected neurological outcomes in UIAs included perioperative hemorrhagic and ischemic complications. Contrastingly, in RIAs, age, Hunt and Kosnik grade, World Federation of Neurosurgical Societies (WFNS) grade, and perioperative ischemic complications were found to affect neurological prognosis.

Conclusion: Postoperative mRS of patients who underwent aneurysm surgery using the Sugita clip was comparable to that of global treatment, with no device-related complications, supporting the effectiveness and safety of the Sugita clip.

Background: Congenital facet joint agenesis or hypoplasia is rare, with most reported cases limited to unilateral L5-S1 defects.

Case description: A 40-year-old male with features suggestive of skeletal dysplasia (i.e., short stature, congenital coxa vara, and multiple cardiac and orthopedic anomalies) presented with worsening low back pain and right L5 radiculopathy. The magnetic resonance imaging demonstrated L5-S1 spondylolisthesis with right foraminal stenosis. The 3D computed tomography confirmed multiple absent or hypoplastic facet joints from T12 to S1. He underwent a L5-S1 laminectomy, discectomy, with a transforaminal lumbar interbody fusion (TLIF). Postoperatively, back and leg pain symptoms resolved, and there were no instrument-related complications.

Conclusion: This case highlights the congenital absence/hypoplasia of multiple T12-S1 lumbar facet joints, including at the L5S1 level in a patient with likely undiagnosed skeletal dysplasia, successfully managed with a TLIF.

Background: Dissecting aneurysms of the middle cerebral artery (MCA) are rare, under-recognized vascular lesions with diverse etiologies and complex management pathways. The current literature is fragmented, lacking a consensus on optimal treatment and outcome predictors. This study aims to systematically review and synthesize all reported cases of MCA dissecting aneurysms, analyzing clinical features, anatomical patterns, therapeutic strategies, and outcomes.

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comprehensive literature searches were performed across PubMed and Scopus databases up to June 2024. Crude estimates are reported, and meta-analysis is also performed.

Results: From 878 records, 65 studies (1964-2025) met criteria, totaling 114 MCA dissecting aneurysm/pseudoaneurysm patients (mean age ≈42.8 years; pediatric 8.8%; female 54%). Hypertension (12.3%) and prior head trauma (9.6%) were common. Aneurysms most often involved M1 (38.6%), then M2 (29.8%), and M3-M4 (31.6%); right-sided 34.2%. Management was endovascular in 59 (51.8%), microsurgical in 38 (33.3%), bypass in 12 (10.5%), and conservative in 17 (15%). Overall, good outcome (modified Rankin scale: 0-2) occurred in 56 (49.1%); complete occlusion in 73 (64%); and rebleeding and mortality each 11 (9.6%). Meta-analysis showed higher occlusion with endovascular therapy (62%, 95% confidence interval [CI]: 0.46-0.77; P < 0.001) versus surgery (36%, 95% CI: 0.08-0.64; P = 0.012), with markedly higher surgical rebleeding (55%) and mortality (45%).

Conclusion: Reported outcomes of MCA dissecting aneurysms show that aneurysm occlusion is achievable with both endovascular and surgical strategies, but interpretation is limited by heterogeneity and mostly case-based data evidence.

Background: Atlanto-occipital assimilation (AOA) and congenital posterior arch defects of the atlas share an embryologic origin and may coexist. Such variants can mimic acute fractures in trauma evaluations and can be associated with retro-odontoid pseudotumor (ROPT) that regresses after stabilization.

Case description: Case 1- A 60-year-old man presented after a head impact while surfing. High-resolution computed tomography revealed a C1 posterior arch midline cleft with smooth corticated margins and unilateral AOA. Although the axial plane suggested a transverse fracture line, multiplanar reconstructions confirmed occiput-C1 continuity, and short tau inversion recovery magnetic resonance imaging showed no marrow edema. The patient improved with conservative management. Case 2: An 80-year-old woman presented with neck pain and hand clumsiness. Imaging demonstrated AOA and a ROPT compressing the cord. Occipitocervical fixation without direct decompression led to radiological regression of the mass and clinical improvement.

Conclusion: Coexisting AOA and Currarino Type A posterior arch defect have practical implications for neurosurgical decision-making: Accurate fracture differentiation in trauma settings and recognition that ROPT may regress following stabilization.

Background: Meningiomas are the most common intracranial tumor. Ionizing radiation has been implicated in the pathogenesis of radiation-induced meningiomas (RIM). Compared to spontaneous meningiomas, RIM are a clinically aggressive entity and are more likely to develop clinical and radiologic progression.

Methods: Systematic searches of Medline, Embase, and Cochrane Central Register of Controlled Trials were performed. Pooled data were used to calculate rates of survival, tumor control, and adverse events.

Results: Thirty studies met the final inclusion criterion within this meta-analysis. In total, these studies reported on 927 RIMs in 825 patients. Patients were grouped by whether they received cranial radiotherapy ([CRT]; n = 555 patients) or scalp radiotherapy for tinea capitis ([TC]; n = 270 patients). The median dose prescribed to the CRT and TC groups was ~30 Gy and 1.5 Gy, respectively. The radiation interval to meningioma development between CRT and TC groups were 21.54 and 40.49 years, respectively (P < 0.0001). Twenty-six studies reported a 1-year overall survival rate, with a pooled survival rate of 95.46% (95% confidence interval [CI]: 92.31-97.82%, I2 = 51.9%, P = 0.0012). One-year progression-free survival was reported by 9 studies, with a pooled rate of 99.71% (95% CI: 97.62-100.00%, I² = 3.3%, P = 0.4076). From two studies, the pooled 1-year local recurrence rate was 16.54% (95% CI: 0.00-34.06%, I² = 0.0%, P = 0.5918), while the overall pooled local recurrence rate was 27.35% (95% CI: 17.98-36.73%, I² = 74.5%, P < 0.0001) from 23 studies.

Conclusion: High- and low-dose cranial radiation therapy can differentially influence the latency and grade of RIM, with higher dose CRT associated with earlier onset and more atypical tumors RIM screening may be warranted in individuals with an early exposure to cranial radiation given the increased risk of developing secondary neoplasms. These findings support structured long-term magnetic resonance imaging surveillance for survivors of childhood cranial irradiation, with risk adapted follow-up protocols to enable earlier detection and management.

Background: Cryptococcus neoformans is an opportunistic fungus with marked neurotropism, classically affecting immunocompromised patients, even though occasionally reported in immunocompetent hosts. Skull involvement is exceptionally rare and may radiologically mimic malignant tumors, causing diagnostic delays.

Case description: A 34-year-old immunocompetent male presented with a painless, progressive left parieto-occipital scalp swelling over 3 weeks. Imaging revealed a well-defined, dumbbell-shaped cystic mass beneath the scalp, causing lytic skull erosion and limited intracranial extension, suggestive of atypical meningioma or skull-based sarcoma. Surgical excision was performed, showing dural infiltration without leptomeningeal spread. Histopathology, the mass revealed granulomatous inflammation with abundant CD68+ histiocytes, mixed B- and T-cell infiltrates, and encapsulated budding yeasts (5-10 μm) within enlarged perivascular spaces. Gomori Methenamine Silver and periodic acid-Schiff staining confirmed fungal elements; culture identified Cryptococcus species.

Conclusion: Skull cryptococcosis in immunocompetent patients is rare but can occasionally present as an inflammatory pseudotumor with osteomyelitis and extracranial extension. Its imaging resemblance to aggressive neoplasms underscores the importance of including fungal etiologies in the differential diagnosis of destructive skull lesions, regardless of the immune status.

Background: Posterior cervical fixation with lateral mass screws (LMSs) and cervical pedicle screws (CPS) is well established, but free-hand and fluoroscopy-guided techniques remain limited by accuracy and safety concerns. Intraoperative O-arm navigation provides real-time three-dimensional (3D) imaging and may improve precision while reducing complications. This study evaluates screw accuracy, safety, operative parameters, and functional outcomes using O-arm-guided posterior cervical fixation.

Methods: This ambispective observational cohort analyzed 147 screws placed under O-arm-based 3D navigation. Primary outcome was screw accuracy graded on intraoperative O-arm scans; secondary outcomes included breach rates, complications, operative metrics, blood loss, radiation dose, and functional scores (Visual Analog Scale [VAS], modified Japanese Orthopaedic Association [mJOA], Nurick, American Spinal Injury Association) assessed over 1 year.

Results: Overall screw accuracy was 99.3%, with 146 screws fully contained and one C2 CPS showing a high-grade breach (0.7%) without neurological deficit. No wound infections, hardware failures, or reoperations were recorded. Functional outcomes improved significantly: mean VAS decreased from 5.5 to 1.8, mJOA increased from 12.6 to 14.3, and Nurick grade improved from 3.1 to 2.4 at 12 months (all P < 0.01). Average operative time was 236 min, blood loss 350 mL, and mean radiation dose 1145 mGy•cm.

Conclusion: In this observational cohort of 147 screws for posterior cervical fixation with O-arm navigation, we achieved a screw placement accuracy of 99.3% with only one high-grade breach and no neurological deficits or reoperations.

Background: Epilepsy surgery is a well-established therapeutic option for patients with refractory focal epilepsy. Comprehensive clinical evaluation should encompass documentation of seizure semiology, high spatial resolution magnetic resonance imaging (MRI) sequences, prolonged video electroencephalography, and detailed neuropsychological assessment. Resective surgery remains the cornerstone for medically refractory focal-onset epilepsy. However, even after exhaustive investigation, subtle parenchymal changes on imaging can delay surgical resection, exacerbating the epilepsy burden on quality of life.

Case description: A 30-year-old male patient with a long-standing history of seizures was referred to an epilepsy center. The seizures were stereotypical and highly frequent, with unremarkable neurological findings. Multiple trials of anti-seizure medications failed to control the epileptic events. The presurgical evaluation aimed to identify the precise brain regions involved in the primary organization of seizures and to map the eloquent cortex. The extent of epileptic zone resection significantly influences surgical outcomes. Preoperative MRI revealed subtle findings suggestive of a lesion at the bottom of the inferior frontal sulcus, immediately anterior to the precentral sulcus. The patient underwent resection, guided by neuronavigation and intraoperative electrocorticography. Three-dimensional cortical reconstruction facilitated the intraoperative identification of landmarks and electrocorticography-guided resection of pathological brain tissue. Histopathological evaluation revealed neuronal depopulation and irreversible chronic injuries in the remaining neurons. The patient was discharged without neurological deficits or seizures.

Conclusion: In the literature, no specific lesions have been identified or characterized by microscopic inspection in up to 7.7% of cases. Asleep motor mapping identifies eloquent zones and mitigates functional impairment post-resection; direct electrical stimulation remains the gold standard technique for cortical mapping.

Background: Dialysis disequilibrium syndrome (DDS) is a rare but serious neurologic complication of hemodialysis caused by rapid osmotic shifts leading to cerebral edema. Although well recognized in nephrology, DDS is underappreciated in neurosurgical practice, where it often presents only after significant intracranial hypertension has developed. As dialysis use expands, early neurosurgical awareness is increasingly important.

Methods: This narrative review synthesizes current evidence on DDS pathophysiology, clinical features, diagnostic considerations, and management, with a specific focus on neurosurgical implications. Data from case reports, pooled analyses, and neurocritical care studies were examined to characterize intracranial pressure (ICP) changes associated with renal replacement therapy and to identify points for multidisciplinary intervention.

Results: DDS most frequently occurs during early or rapid hemodialysis in patients with markedly elevated urea levels. A pooled analysis shows ICP elevation in up to 73% of neurosurgical patients receiving intermittent hemodialysis versus 38% treated with continuous modalities. Despite these risks, standardized neurosurgical protocols for prevention or monitoring remain lacking. Evidence supports gradual urea clearance, early use of continuous therapies, and timely hyperosmolar treatment when cerebral edema develops. However, delayed recognition and limited cross-disciplinary coordination continue to hinder effective management.

Conclusion: DDS is a preventable neurocritical complication that requires stronger integration into neurosurgical practice. Improved interdisciplinary communication, structured monitoring strategies, and incorporation of DDS into neurocritical care training could support earlier recognition and safer dialysis initiation. Reframing DDS as a shared neurosurgical-nephrology responsibility is essential to moving from reactive treatment toward prevention and improving neurologic outcomes.