Surgical neurology international最新文献

Background: Bow Hunter's syndrome (BHS) is a rare entity known as rotational vertebral artery occlusion syndrome. Classically, it presents with nausea, vertigo, and dizziness elicited by extension or rotation of the neck. There are several management approach modalities, including surgical and nonsurgical alternatives.

Methods: We conducted an electronic database search on PubMed and Scopus. The search was performed on February 18, 2024, using a combination of keywords related to Bow Hunter Syndrome regarding management. From the latter query, 97 results followed, from which we included 76 and excluded 21 due to the information being irrelevant to our study and non-retrievable publications.

Results: A total of 121 patients were retrieved. The mean age of presentation was 50 years, with a female-to-male ratio of 3:1. There were 108 adult cases, and only 13 were pediatric and adolescents. Symptoms were elicited by right rotation (46%). The most affected levels were C1-C2 (44%). The anterior approach was the most common (40%) and had a better outcome (84%), followed by the posterior (30%), which had more cases with partial recovery (19% vs. 16%).

Conclusion: BHS management is still challenging as there are many factors that we must consider when deciding on the approach. There is inconclusive evidence on the proper management of these patients. Although the suggestions found in our review and our experience are valuable, no definitive management ensures a good quality of life and outcome for these patients. Further research is needed on this topic.

Background: Pituitary adenomas rank third among adult intracranial tumors, with an incidence of 3.9- 7.4 cases/per 100,000 annually. Transsphenoidal surgery has evolved to include endoscopic endonasal surgery (EEA) in many centers due to technological and surgical advancements over the past two decades. We aim to analyze a 12-year cohort of pituitary adenomas operated through EEA, highlighting the evolution of surgical techniques and outcomes.

Methods: A retrospective review of patients undergoing EEA was conducted. A team of an otolaryngologist and neurosurgeon performed surgeries. The cohort was divided into three groups: Phase 1 (P1, 2012-2015), Phase 2 (P2, 2016-2019), and Phase 3 (P3, 2020-2023). Patient demographics, clinical data, and outcomes were collected from electronic medical records and compared over time.

Results: The mean age was 54.2 years, with 53.5% being female. The gross total resection rate was 75.6%, increasing from 62.3% in P1 to 76.3% in P3 (P = 0.003). The mean operative duration was 274.61 min, with no significant correlation to case number. Complication rates, excluding cerebrospinal fluid (CSF) leaks, were similar between the groups, with no statistically significant differences observed for complications such as visual deficit, cranial nerve palsy, and epistaxis. However, meningitis decreased significantly from 3.8% to 0.3% (P < 0.001). Intraoperative CSF leaks decreased from 65.1% to 55% (P = 0.003). The need for revision surgery was lower in P3 (8.5% vs. 5.4% vs. 2.1, P < 0.001). Length of hospitalization decreased from 5.3 days to 3.9 days (P < 0.001).

Conclusion: Our experience with EEA for pituitary adenomas shows significant improvements in surgical outcomes, reduced complications, and better postoperative management, underscoring the importance of experience, technical refinement, and a multidisciplinary approach.

Background: Sacral fractures causing neurological deficits secondary to epileptic seizures are very rare. They are traditionally treated by laminectomy and sacral fixation. However, minimally invasive techniques such as sacroplasty offer more limited surgery with decreased morbidity. Here, a 23-year-old male with a seizure-induced sacral fracture was successfully treated with a decompressive laminectomy and transcorporal sacroplasty.

Methods: After a grand-mal seizure, a 23-year-old male presented with severe paraparesis accompanied by bilateral S1/S2 radiculopathy and urinary/fecal incontinence (Gibbons grade 4). When studies documented a Roy-Camille type 2 sacral fracture with severe central compression of the S1/S2 spinal canal, he underwent an S1-S2 laminectomy with transcorporal sacroplasty.

Results: On the 1^st postoperative day, he ambulated without assistance and demonstrated only mild residual sensory deficits (Gibbons grade 2); 1-month later, he walked without assistance.

Conclusion: A 23-year-old male with a seizure-induced sacral fracture was successfully treated with a decompressive S1/S2 laminectomy/transcorporal sacroplasty.

Background: The surgical suction, irrigator, and retractor are vital instruments in all operative neurosurgical interventions. Several trials previously tried to combine these instruments to reduce the number of working hands in the surgical field and make them more controllable by the surgeon. An instrument combined the suction and irrigation used, and others added suction with the dissector, which was also invented but with many drawbacks.

Methods: We designed a new surgical instrument that performs the function of three surgical instruments simultaneously. It works as a dissector, suction, and irrigator in the surgical field. Its innovative design unites three instruments, and every one of them has its holding method by the surgeon's hand. They united into one maneuver. The surgeon's work becomes easier by decreasing the number of hands in the surgical field; this will result in a reduction in time and better efficiency. Furthermore, its innovative design reduces the possibility of blockage of the suction tube, and the feasibility of reopening is much easier as compared with the available suction.

Results: We use the 3D-printed design of the instrument by neurosurgeons. It was quite comfortable with better control by the surgeon and reduced the number of hands in the field, resulting in an increment of the operative field visible to the surgeon.

Conclusion: This new instrument acts as three conventional instruments simultaneously to provide better control to the surgeon and increase the operative field visible to the surgeon.

Background: Chylothorax is an extremely rare complication of spinal surgery. We were only able to identify 15 previous cases overall, with only 5 involving a posterior approach.

Case description: A 16-year-old female presented with a chylothorax following a T4-L4 posterior spinal fusion for scoliosis. Postoperatively, the patient developed respiratory distress due to a left-sided pleural effusion. Laboratory tests (i.e., both gross and laboratory analysis) documented the fluid to be chyle. The patient required the placement of a chest drain and a low triglyceride diet to manage and resolve the chylothorax successfully.

Conclusion: Chylothorax is a rare complication of spinal surgery and should be considered among the differential diagnoses involving postoperative respiratory compromise attributed to pleural effusions.

Background: The United States (US) has one of the highest rates of gunshot-related incidents in the world. Gunshot wounds to the head (GSWH) in the pediatric population are also common, with high morbidity and mortality rates.

Methods: We performed a retrospective study to analyze if there was a notable change in trends in pediatric GSWH at our Level 1 Pediatric Trauma Center due to the COVID-19 pandemic. A retrospective study was conducted including patients under the age of 18 presenting with GSWH from January 2014 to May 2023. Variables assessed included demographics, interventions, and outcomes. Data from the county's Child Death Review Team Annual Report on mortality related to gunshot-related deaths from January 2014 to June 2023 were analyzed.

Results: In total, thirty-five patients were evaluated at our institution for GSWH. Nineteen patients were treated during the 6 years before the pandemic and sixteen during the 3-year pandemic. Nine patients died at the hospital, with an overall increase during the pandemic. In the county, seventy-two children were killed from gun violence, with 58% (42) from GSWH. Death from GSWH increased in the county cohort during the pandemic.

Conclusion: The pandemic affected the outcomes of patients with GSWH at our institution with an overall increase in rates of self-inflicted and drive-by shootings, a doubling of neurosurgical interventions, an increase in acuity of care for long-term disposition, and an increase in mortality. At a county level, there was an increase in overall deaths from GSWHs, the majority of which were nonaccidental.

Background: Magnetic resonance imaging-guided focused ultrasound (MRgFUS) thalamotomy offers incisionless treatment for essential tremor or tremor-dominant Parkinson's disease, gaining acceptance as an alternative to deep brain stimulation. Compared to other methods, it offers real-time efficacy assessment without ionizing radiation.

Case description: A 63-year-old male underwent MRgFUS, initially yielding subtle results due to skull limitations. However, significant tremor relief emerged 6 hours post-procedure, sustained for 5 days. Imaging confirmed thalamotomy effect. A second treatment was delivered at day five for longevity.

Conclusion: For patients with challenging skull characteristics and initial suboptimal outcomes, staged procedures may be considered, with potential delayed benefits and the need for lesion expansion for long-term relief.

Background: Microsurgery is crucial in neurosurgery, requiring precise skills for interventions on delicate structures. Effective training is essential for developing these skills. In Peru and Latin America, however, there is a notable shortage of specialized training centers and high costs associated with foreign simulators, hindering the development of neurosurgical skills. To address this issue, the NeuroZone3D Research Center has initiated a project to create a national dataset on Peruvian craniometry and develop locally adapted training models.

Methods: The "NeuroCircle Microsurgery Model" was created through a multi-phase process. Phase 1 involved designing a simulation platform using a 3D printer. Phase 2 focused on creating a realistic biomodel with polyurethane and advanced modeling techniques. In Phase 3, the biomodel was assembled and integrated into the platform. Phase 4 included using a wooden module, a cost-effective exoscope simulation, and surgical instruments to provide a realistic training environment.

Results: The "NeuroCircle Microsurgery Model" provided a stable and effective training environment. Feedback from training sessions with neurosurgery residents and medical students indicated significant improvements in microsurgical skills. Participants valued the model's realism and its role in enhancing their surgical proficiency.

Conclusion: The "NeuroCircle Microsurgery Model" is a significant advancement in microsurgery training for Peru and Latin America. Its development provides a valuable, locally adaptable tool for improving surgical skills and addresses the critical training gaps in the region.

Background: The incidence of cerebrospinal fluid (CSF) leaks/dural tears (DT) occurring during anterior cervical diskectomy and fusion (ACDF) are typically relatively low. However, this frequency markedly increases when anterior corpectomy and fusion (ACF) are performed to address ossification of the posterior longitudinal ligament (OPLL).

Methods: The reported frequencies of CSF leaks/DT occurring during elective ACDF (i.e. exclusive of trauma), ranges from 0.24% to 1.7%. Notably, this incidence substantially rises for multilevel ACF addressing anterior OPLL, markedly varying from 3.4 - 44.7%.

Results: The classical risks of anterior cervical CSF leaks/DT with anterior cervical surgery may be minimized utilizing an operating microscope. For OPLL, careful evaluation of preoperative non-contrast CT studies is critical, especially to document whether any of the 3 signs of dural penetrance is present. Here, posterior operative choices should be strongly considered in the presence of sufficient lordosis and/or a Positive K Line (+ K Line) as this will avoid an anterior cervical CSF leak/dural fistula. Alternatively, for patients with kyphosis and a Negative K Line (- K Line), preoperative anticipation and planning to treat an intraoperative anterior CSF leak/DT (i.e. direct anterior primary dural graft repair with 7-0 Gore-Tex sutures, microdural staples, microfibrillar collagen, wound-peritoneal shunt, and lumbar drain or lumboperitneal shunt) are essential in the course of performing direct anterior OPLL resection.

Conclusion: The incidence of anterior cervical CSF leaks/DT is relatively low (i.e. range 0.24 - 1.7%) where ACDF is performed for disc disease/spur/spondylosis exclusive of OPLL. However, where ACF is performed for multilevel OPLL, the risk of CSF Leaks/DT is substantially higher (i.e. range 4.3-44.7%).

Background: The brain-gut axis represents a bidirectional communication network between the gut microbiome and the central nervous system that plays an important role in homeostasis. Compelling evidence now confirms that ischemic stroke disrupts this delicate balance by inducing gut dysbiosis.

Methods: A comprehensive literature search was performed in PubMed, Web of Science, and Google Scholar for articles published between January 2000 and January 2023 using relevant keywords. Studies were limited to English and included original studies, literature, and systematic reviewers from peer-reviewed journals which discussed gut microbiota composition in models/subjects with ischemic stroke or assessed stroke impact on gut microbiota. Comments, meeting abstracts, and case reports were excluded. From the 80 relevant articles, we summarized key findings related to gut microbiota changes after stroke and their association with stroke outcomes.

Results: Emerging preclinical evidence underscores the pivotal role of the gut microbiome in glial cell development and function. Germ-free models exhibit compromised microglial activation and impaired cellular debris clearance, exacerbating tissue damage following ischemic stroke. Targeted interventions, including prebiotics, probiotics, and fecal microbiota transplantation, have demonstrated efficacy in rescuing glial phenotypes in preclinical stroke models. Beyond its local effects, the gut microbiome significantly influences systemic immunity. Ischemic stroke polarizes pro-inflammatory phenotypes of neutrophils and T cells, amplifying neurovascular inflammation. Microbiota manipulation modulates leukocyte trafficking and metabolic signaling, offering potential avenues to mitigate infarct pathology.

Conclusion: Our review demonstrates that in preclinical stroke models, modulating the lipopolysaccharide, short-chain fatty acid, and trimethylamine N-oxide pathways through the gut-brain axis reduces infarct sizes and edema and improves functional recovery after ischemic stroke. Further exploration of this important axis may unveil additional adjunctive stroke therapies by elucidating the complex interplay between the microbiome and the brain. Rigorously controlled clinical studies are now warranted to translate these promising preclinical findings and investigate whether manipulating the microbiome-brain relationship can help improve outcomes for stroke patients. Overall, continued research on the gut-brain axis holds exciting possibilities for developing novel treatment strategies that may enhance recovery after stroke.