Surgical neurology international最新文献

Background: Minimally invasive spine surgery (MISS) has become increasingly common, but there are barriers to its adoption in acute trauma. To investigate these barriers, clinical data on preoperative factors and outcomes were compared between patients undergoing percutaneous and open spinal trauma procedures.

Methods: In this retrospective cohort study of the National Trauma Data Bank, we analyzed trauma patients nationwide who underwent spine procedures from 2017 to 2023. Using International Classification of Diseases, Tenth Revision codes, index procedures classified as "open", "percutaneous/MISS", or "converted." Comorbidities, demographic data, and adverse events were analyzed and compared between groups.

Results: Of the 187,382 patients included, 13.2% underwent MISS. Open surgery correlated with males, older patients, and major comorbidities, including diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease. MISS correlated with smoking and greater injury severity. Except for surgical site infections, all adverse events were more prevalent following open procedures.

Conclusion: From 2017 to 2023, traumatic spinal surgery increased significantly, and the percentage approached percutaneously procedures increased from 11.7% to 15.2%, while adverse events were more common after open surgery.

Background: Acute subdural hematoma (ASDH) of the interhemispheric fissure is frequently experienced but is rarely indicated for surgery. We report a case of ASDH of the interhemispheric fissure that was treated with an endoscopic procedure.

Case description: A 73-year-old woman had undergone craniotomy for subarachnoid hemorrhage (SAH) due to a ruptured anterior communicating artery aneurysm and ventriculoperitoneal shunt for hydrocephalus after SAH. On X day, she fell and bruised the back of her head, resulting in weakness of the left upper and lower limbs, and she was brought to the emergency department on X + 1 day. When she came to our hospital, she was found to have left hemiplegia with lower limb dominance. Head computed tomography (CT) scan showed a 2.5 cm thick ASDH on the right side of the posterior half of the interhemispheric fissures. It was thought that paralysis was caused by this lesion, and we decided to perform surgery based on the belief that symptoms would improve if the mass effect could be alleviated. As for the surgical technique, craniotomy and ventriculoperitoneal shunt had been performed in the past; endoscopic evacuation of hematoma was performed with a small craniotomy. The day after surgery, a head CT scan confirmed that the hematoma had been successfully removed to a deep level and the pre-operative left hemiplegia had improved. Two months after surgery, the patient was discharged from the hospital with a modified Rankin Scale 2.

Conclusion: We have experienced a case of interhemispheric fissure ASDH that was treated by endoscopic hematoma evacuation. Endoscopic procedure is non-invasive, and good results were achieved.

Background: The craniovertebral junction (CVJ) is surgically challenging due to its complex anatomy and proximity to vital neurovascular structures. This study aims to evaluate the use of 3D multiplanar reconstruction technique and its impact on surgical and radiological outcomes.

Methods: Thirty patients with CVJ anomalies operated on between July 2022 and December 2024 were included. Of the thirty patients, 15 had basilar invagination, six had atlanto-axial dislocation, five had C2 fractures with instability, and four had Arnold-Chiari malformations with instability. Preoperative 3D-computed tomography (CT) and CT angiography reconstructions were performed to evaluate vertebral artery (VA) anatomy, C2 pedicle, C1 lateral mass, C1-C2 facet joint inclination, pseudo-joints, and craniocervical tilt. All patients underwent C1- C2 fixation or occipito-cervical fixation with joint manipulation using spacers. Pre and postoperative neurological recovery were assessed using Nurick and modified Japanese Orthopedic Association grading. Postoperative CT was done in all cases.

Results: Twenty-six underwent C1-C2 fixation and four patients underwent occipito-cervical fixation. No VA injuries or screw-related complications occurred. One patient required revision due to implant failure. Neurological improvement occurred in 90% of cases. Radiological indices (Chamberlain line, McRae line, atlanto-dental interval, clivus canal angle) showed significant postoperative improvement.

Conclusion: Preoperative 3D multiplanar CT reconstruction enables detailed analysis of CVJ anatomy and VA variations, improving safety and surgical outcomes in complex anomalies.

Background: Arachnoid cysts (ACs) are cerebrospinal fluid-filled lesions of uncertain etiology, occasionally associated with other congenital malformations. While many remain asymptomatic, large or expanding cysts can cause hydrocephalus and neurological compromise, warranting intervention. Optimal management strategies for newborns with complex cyst anatomy remain debated, especially when initial fenestration fails.

Case description: We report the clinical course and surgical management of a full-term male newborn prenatally diagnosed with a large left frontoparietal AC, agenesis of the corpus callosum, and suspected schizencephalic changes. Postnatal imaging confirmed cyst-induced obstructive hydrocephalus. An initial endoscopic cystoventriculostomy was performed at 13 days of life, but neuroimaging showed persistent cyst growth and ventricular dilation. Two subsequent surgeries were required: A contralateral cystoventricular diversion and, finally, a cystoperitoneal shunt using stereotactic navigation and programmable valve implantation. Serial magnetic resonance imaging demonstrated progressive cyst size reduction and midline realignment. Postoperative anthropometric analysis showed normalization of head circumference growth curves. At 4 months, the infant showed a stable neurological status and improved psychomotor milestones.

Conclusion: This case highlights the challenges of managing congenital ACs complicated by hydrocephalus, particularly when primary endoscopic fenestration fails. A staged, individualized neurosurgical approach, guided by neuroimaging and clinical evolution, can achieve both structural resolution and developmental stabilization. The use of stereotactic navigation and programmable shunt systems may enhance long-term outcomes in refractory neonatal cases.

Background: Pituitary macroadenomas often cause progressive visual loss secondary to chiasmatic or optic nerve compression. At present, there are no precise preoperative evaluation methods capable of predicting postoperative visual outcome. The evaluation of the peripapillary retinal nerve fiber layer (RNFL) and macular thicknesses by optical coherence tomography (OCT) can provide parameters for the severity of optic neuropathy, with possible prognostic value.

Methods: 30 patients were enrolled in this prospective study. Adult patients with sellar preoperative magnetic resonance imaging suggestive of pituitary macroadenomas with suprasellar extensions were included in the study. Patients were evaluated with computerized visual perimetry (VP) and OCT before and after pituitary surgery. Postoperatively, OCTs and VPs were repeated at 30 and 120 days. Surgical procedure consisted of endoscopic endonasal transsphenoidal resection (EETR) of the macroadenoma.

Results: There was a significant improvement in VPs after surgery. Except for two, the thicknesses of the eight sectors of the peripapillary RNFL and the 27 sectors of the three layers of ganglion cell complex of the macula showed no changes postoperatively. All patients with altered preoperative RNFL scans already demonstrated PV abnormalities.

Conclusion: Despite most patients show important perimetric improvements after EETR of pituitary macroadenomas, OCT parameters tend to remain stable, suggesting that postoperative visual recovery is independent of the increase in retinal neuronal layers. Furthermore, OCT is capable of adequately detecting signs of compressive optic neuropathy, but peripapillary RNFL appears to demonstrate no advantage over VP for the early detection of visual compromise in the scenario of pituitary macroadenomas.

Background: Giant skull base meningiomas are rare and surgically demanding due to proximity to critical neurovascular structures, prolonged operative time, and reduced resection rates. Reports encompassing multiple skull base regions remain limited. This case-based series includes anterior, middle, and posterior fossa tumors, emphasizing anatomical diversity and surgical strategies.

Case description: Eleven patients with giant skull base meningiomas were retrospectively reviewed, including tumors ≥5 cm and surgically complex lesions. The mean age was 47.7 years (range 32-62), with a female predominance (8 females, 3 males). Presenting symptoms included visual loss, headache, anosmia, hemiparesis, and cranial nerve deficits. Approaches were tailored to tumor location, most commonly pterional and retrosigmoid, followed by bifrontal and combined skull base craniotomies. Gross total resection was achieved in 8 of 11 patients (72.7%). Near-total or subtotal resection (3/11) was performed when tumors encased critical neurovascular structures. Visual outcomes were favorable, with recovery or preservation in most anterior and middle fossa cases. Transient cranial nerve palsies occurred in two patients and resolved on follow-up. No postoperative mortality occurred. During follow-up ranging from 4 months to 5 years, no recurrences were observed, and residual disease remained stable.

Conclusion: This series illustrates the anatomical spectrum and surgical complexity of giant skull base meningiomas. Favorable outcomes were achieved with individualized approaches and multidisciplinary planning. These cases contribute practical insights to the limited literature and reinforce the need for tailored management strategies.

Background: Brainstem cavernous malformations (BSCMs) may occur as multiple lesions, each capable of producing new neurological symptoms on hemorrhage. To date, there have been no reports of surgical intervention for a new hemorrhage occurring in a different region of the brainstem in patients with a prior history of BSCM resection.

Case description: A woman in her 60s presented with progressive gait instability and right lower limb weakness. Thirteen years earlier, she underwent aneurysm clipping and ventriculoperitoneal shunting for subarachnoid hemorrhage, during which multiple intracranial cavernomas were incidentally identified. She later suffered a pontine hemorrhage managed conservatively (9 years prior) and a right pontomedullary hemorrhage requiring resection through a lateral suboccipital approach (7 years prior). Two years ago, a new hemorrhage at the left pontomesencephalic junction was initially asymptomatic but subsequently enlarged, causing worsening ataxia and right hemiparesis. Resection was performed through a left subtemporal approach, guided by fiber tractography, neuronavigation, and multimodal intraoperative neuromonitoring (including motor-evoked potentials). Complete excision was achieved without new neurological deficits, and the patient regained independent ambulation.

Conclusion: Even after prior brainstem surgery, subsequent resections of newly developed cavernomas in distinct locations can be performed safely. Detailed preoperative planning with tractography and rigorous intraoperative monitoring are pivotal in minimizing surgical risk and optimizing outcomes.

Background: Although air embolism is a rare intraoperative complication associated with sitting or semi-sitting positioning during neurosurgical procedures, it carries a high morbidity and mortality rate. Prompt recognition is paramount; however, the treatment options are limited. We present the first case of intraoperative venous air embolism (VAE) that was successfully treated with venovenous extra-corporal membrane oxygenation (VVECMO) in a patient undergoing retro-sigmoid craniotomy for a vestibular schwannoma resection in the sitting position.

Case description: We present a young male who developed VAE requiring VV-ECMO after undergoing vestibular schwannoma resection through right retro-sigmoid craniotomy in sitting position. Diagnosis was made intraoperatively with the aspiration of air through the subclavian central venous catheter. Patient developed both indirect and direct pathophysiological changes of air embolism. Successful VV-ECMO resulted in resolution of indirect effects and good prognosis of the patient.

Conclusion: Acuteness of judgment, understanding, and prompt response is required to diagnose and successfully treat pulmonary air embolism. In this report, we will discuss the occurrence, diagnosis, pathophysiology, and treatment of acute pulmonary air embolism in an operative setting. To date successful treatment of air embolism through venovenous extracorporeal membranous oxygenation, secondary to neurosurgical procedure has not been reported.

Background: Bobble-head doll syndrome (BHDS) is a rare movement disorder characterized by rhythmic head oscillations at a frequency of 2-3 Hz, typically in a yes-yes or no-no pattern. It is most commonly associated with suprasellar arachnoid cysts, causing pressure on midbrain structures, thalamus, and cerebrospinal fluid (CSF) pathways, resulting in movement abnormalities and hydrocephalus. While it usually presents in children aged 3-5 years, late adolescent or adult presentations are exceedingly uncommon.

Case description: We report a 23-year-old male with progressive involuntary side-to-side head movements since childhood, which had worsened over the preceding year and led to gait instability requiring support. He had a history of ventriculoperitoneal shunt placement in infancy for hydrocephalus, later removed due to infection. Magnetic resonance imaging revealed a large posterior fossa arachnoid cyst compressing the third ventricle, with intermittent CSF obstruction contributing to progressive neurological decline. The patient underwent endoscopic cyst fenestration, which restored CSF circulation and relieved mass effect. Head movements subsided almost completely within 48 h postoperatively, and gait improved significantly over 2 weeks. Six-month follow-up imaging confirmed resolution of ventricular compression and restoration of aqueductal flow.

Conclusion: This case highlights a rare delayed presentation of BHDS in adulthood, underscoring the importance of timely surgical intervention. Endoscopic fenestration proved highly effective in restoring CSF dynamics, resolving abnormal movements, and improving functional outcomes, and may offer advantages over CSF diversion alone.