Surgical neurology international最新文献

Background: This study investigates whether patient satisfaction, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, clinical and radiographic outcomes differ between unilateral and bilateral facetectomy when performing transforaminal lumbar interbody fusions (TLIFs).

Methods: We retrospectively reviewed 373 patients who underwent primary 1- or 2-level TLIF (2016-2023) at a tertiary care center; patients underwent unilateral (n = 160) or bilateral (n = 213) facetectomy. Demographic, surgical, and radiographic data were collected, along with patient-reported satisfaction using the HCAHPS survey.

Results: We found no significant differences in complication rates, reoperation rates, or radiographic outcomes between unilateral and bilateral facetectomy groups. HCAHPS scores showed no statistically significant differences in patient satisfaction across measured domains. Unilateral facetectomy was associated with a shorter hospital stay and more frequent use of minimally invasive techniques. Multivariable regression identified increased BMI associated with increased odds of postoperative infection and additional surgery. Increased operative time was associated with postoperative infection and intraoperative durotomy. Finally, increased length of stay was associated with increased odds of intraoperative durotomy and instrumentation failure.

Conclusion: For TLIF, unilateral versus bilateral facetectomy provided comparable clinical and radiographic outcomes, with no significant differences in patient satisfaction.

Background: In the event of clivus exhibiting longitudinal fractures, the basilar artery (BA) may become entrapped at the fracture site, although this occurrence is infrequent. Occlusion of bilateral BA perforators, accompanied by entrapment of the BA, can result in brainstem ischemia, which often leads to unfavorable outcomes. We report here the usefulness of slab maximum intensity projection (MIP) images of rotational angiography in evaluating the BA perforators.

Case description: A 73-year-old man fell from a two-meter stepladder and was transferred to the emergency department. His Glasgow Coma Scale score was 8. He had left hemiplegia. Head computed tomography (CT) revealed a diffuse subarachnoid hemorrhage; an acute epidural hematoma in the right middle cranial fossa; and fractures in the clivus, right frontal bone, right temporal bone, anterior and lateral wall of the maxillary sinus, zygomatic arch, and bilateral pyramidal bones. CT angiography revealed that the BA was entrapped within the clival fracture and exhibited signs of severe stenosis. Cerebral angiography was performed under general anesthesia. Angiography from the left vertebral artery showed severe stenosis of the BA, but there was no blood flow delay beyond the stenosis. The slab MIP images revealed the occlusion of perforators on the right side of the brainstem, situated at the level of the entrapped BA, as well as the occlusion of the right anterior inferior cerebellar artery. Due to concerns about the risk of bleeding from surgical repair, conservative treatment was performed. Anti-thrombotic treatment was not administered. One and a half months after the injury, his consciousness became clear. He had severe hearing loss due to a fracture of the bilateral pyramidal bone but was able to communicate with others in writing. The left hemiplegia remained. Six months after the injury, his modified Rankin scale was 4.

Conclusion: Slab MIP images of rotational angiography proved instrumental in evaluating the perforators in a case where the BA was found to be entrapped in the clival fracture site. Patients with occlusion of the bilateral perforators have a poor prognosis and may consider surgical treatment. The utilization of the slab MIP image of rotational angiography in the evaluation of the perforators may prove beneficial in determining the indication for surgical intervention.

Background: This video illustrates a minimally invasive neuroendoscopic transorbital technique used for the removal of a right orbital cyst accompanied by frontal sinus reconstruction. The approach enables a direct and efficient corridor to orbital and anterior skull base lesions, reducing the need for brain retraction while ensuring both functional and aesthetic benefits.

Case description: A 38-year-old male patient presented with progressive exophthalmos, double vision, and elevated intraocular pressure caused by a right orbital cyst. Radiological evaluation reveals a thick-walled cystic formation with hyperintense signal intensity on T1- and T2-weighted images. IV contrast-enhanced magnetic resonance ımaging was performed. No contrast enhancement was observed in the lesion. The lesion measures 35 × 30 × 26 mm and appears to be connected to the frontal sinus. Preoperative images showed that the lesion destroyed the frontal sinus and was connected to it. Eyebrow incision was preferred for intraoperative assessment of the frontal sinus to facilitate resection of the lesion within the frontal sinus and surgical maneuvers and reconstruction within the frontal sinus. Through a transorbital endoscopic route, the surgical team performed orbital rim drilling, complete cyst excision, and frontal sinus reconstruction using autologous fat graft material. Orbital rim drilling was performed at the orbital entrance within the skin incision margins, with the bone resection amount not exceeding 5 mm. The purpose of orbital rim drilling is to widen the endoscopic field of view and facilitate the maneuverability of surgical instruments. This did not cause any cosmetic problems. A 0° rigid endoscope and standard endoscopic endonasal surgical instruments were used. The postoperative period was uneventful, and the patient experienced immediate correction of exophthalmos. The histopathological evaluation was reported as an epidermoid cyst with hemorrhage. At the 4-week follow-up, eye movements and intraocular pressure were normal, and diplopia had completely resolved.

Conclusion: The transorbital endoscopic approach represents a safe, efficient, and cosmetically favorable option for treating orbital cystic lesions. It provides excellent visualization of the surgical field with minimal invasiveness, allowing for rapid recovery and optimal cosmetic outcomes. This experience underlines the versatility and clinical usefulness of this technique in properly selected cases.

Background: Dermoid cysts (DCs) are rare congenital intracranial tumors. Among these tumors, extracranial and intracranial combined localization is extremely rare.

Case description: We present the case of a 49-year-old female patient with no prior medical history, diagnosed with an extradural and intradural extra-axial DC in the left temporo-parietal region, which manifested with signs of increased intracranial pressure. Cerebral magnetic resonance imaging showed an extra-axial lesional process with a cystic signal in the left temporo-parietal region. Surgical resection was successfully performed through a wide left temporo-parietal craniotomy. Histopathological findings were consistent with a DC. The postoperative recovery was uneventful, with improvement of increased intracranial pressure symptoms.

Conclusion: A rare case of combined extra- and intracranial DC of extradural and intradural localization in the temporoparietal region was reported. The tumor was completely removed by wide craniotomy. DCs can occur anywhere in the intracranial and extracranial space. Although they are benign tumors, serious complications can arise if they are not treated promptly and appropriately. Total radical resection is the best solution.

Background: Cirsoid aneurysms are rare, high-flow arteriovenous malformations (AVMs) of the scalp and neck, formed by direct arteriovenous shunts without an intervening capillary bed. They may present with pulsatile swelling, bruit, cosmetic disfigurement, pain, or hemorrhage. Giant, diffuse lesions with feeders from multiple vascular territories are uncommon and pose significant therapeutic challenges.

Case description: A 24-year-old male presented with a 10-12-year history of an enlarging occipital mass, which had rapidly increased in size over the preceding 2-3 years. Examination revealed a pulsatile, warm lesion extending anteriorly to the neck (right > left) with overlying skin thinning and discoloration; a loud bruit was audible. Computed tomography angiography demonstrated a 24 × 22 cm high-flow AVM supplied by multiple feeders from the external carotid and vertebral arteries, with venous drainage into the right internal jugular vein. Preoperative super-selective embolization was performed to reduce vascularity, followed by en bloc surgical resection along the pericranial plane with ligation of all feeders. Reconstruction was achieved using a split-thickness skin graft harvested from the thigh. The initial recovery was uneventful, with complete graft uptake. At 3 months, recurrence secondary to neoangiogenesis was treated with repeat embolization and adjuvant external beam radiotherapy. At the latest follow-up, the graft remained healthy, with no further bleeding or lesion progression.

Conclusion: Giant scalp and neck cirsoid aneurysms require meticulous preoperative imaging, staged endovascular flow reduction, complete surgical excision, and coordinated multidisciplinary management. Recurrence from collateral vessel formation may occur despite optimal therapy, underscoring the importance of long-term clinical and radiological surveillance.

Background: Pseudoaneurysm formation is a known but often underrecognized long-term complication following balloon embolization for traumatic carotid-cavernous fistula (TCCF). While many pseudoaneurysms remain asymptomatic, progressive enlargement and thrombosis may lead to mass effect and delayed neurological manifestations, including seizures and visual disturbances.

Case description: We report the case of a 33-year-old man who presented with new-onset generalized tonic-clonic seizure and binocular visual disturbances 14 years after undergoing transarterial detachable balloon embolization for TCCF. Brain magnetic resonance imaging revealed a large, partially thrombosed pseudoaneurysm arising from the cavernous segment of the internal carotid artery, extending into the suprasellar region with compression of the optic chiasm and adjacent frontal lobe. Humphrey visual field testing demonstrated bitemporal hemianopia. The patient underwent successful endovascular stent-assisted coiling. Post-treatment follow-up showed marked improvement in visual fields and complete seizure resolution, with no evidence of aneurysmal recurrence at 3 years.

Conclusion: This case highlights the importance of long-term surveillance following balloon embolization for TCCF. Delayed pseudoaneurysm growth may lead to significant neurological deficits years after initial treatment. Early recognition and appropriate endovascular intervention are essential to prevent irreversible complications and optimize patient outcomes.

Background: Tinnitus is a common otologic complaint, affecting 10-15% of the general population, with 5% of patients developing disabling symptoms refractory to pharmacological therapy. Neurovascular compression of the VIII cranial nerve has been proposed as a potential etiology, and microvascular decompression (MVD) may represent a therapeutic alternative.

Methods: We present a case series of seven patients with disabling tinnitus, vertigo, and, in some cases, hypoacusis, all of whom were refractory to at least 12 months of pharmacological treatment. Preoperative assessment included audiometry and high-resolution magnetic resonance imaging (fast imaging employing steady-state acquisition sequence), which confirmed a vascular loop contacting the VIII cranial nerve. Patients underwent retrosigmoid MVD, with follow-up ranging from 1 to 10 months.

Results: Five patients (72%) achieved complete resolution of tinnitus and vertigo, while two patients (28%) reported >80% improvement. One patient developed transient House-Brackmann III facial palsy that resolved with steroids. No cases of permanent hearing loss, cerebrospinal fluid leak, or vascular complications were observed. Quality of life scores improved significantly postoperatively. The most common offending vessel was the anterior inferior cerebellar artery.

Conclusion: MVD of the VIII cranial nerve is a safe and effective therapeutic option in selected patients with refractory tinnitus and vertigo, achieving substantial symptomatic improvement with a low complication rate. Larger prospective studies are warranted to validate these findings and establish long-term outcomes.