Traumatic middle meningeal artery aneurysm (TMMA) is a rare condition and a known cause of several different bleeding patterns after head injury. Once detected, they need to be treated as an emergency due to their potential for morbidity and mortality. Generally, recurrence does not occur in surgery for acute epidural hematoma if adequate hemostasis is achieved. Here, we report a case of atypical postoperative recurrence of an acute epidural hematoma, possibly due to the development and rupture of a TMMA. A 41-year-old man with left acute epidural hematoma after a head injury was referred to our hospital. Emergency craniotomy was performed immediately, and the hematoma was removed. The source of the bleeding was near the fracture site in the middle cranial fossa, and sufficient hemostasis was confirmed. However, a head computed tomography (CT) scan the next day revealed a recurrence of the acute epidural hematoma. Magnetic resonance (MR) angiogram showed an aneurysm with a diameter of approximately 4 mm in the left middle meningeal artery. The recurrence of the acute epidural hematoma appeared to be related to the formation and a rupture of a middle meningeal artery aneurysm, and to prevent subsequent rebleeding, the patient underwent reoperation, and the hematoma and aneurysm were removed. In surgery for acute epidural hematoma, recurrence can be prevented by removing the hematoma and ensuring hemostasis. Although conventional surgery was performed in this case, a repeat of epidural hematoma occurred. A postoperative middle meningeal artery aneurysm had been thought to have developed, ruptured, and caused a repeat epidural hematoma. In treating acute epidural hematoma, a TMMA development should be considered when an atypical clinical course occurs, such as a recurrence of postoperative bleeding.
{"title":"Traumatic Middle Meningeal Artery Aneurysm: A Rare Cause of Recurrent Acute Epidural Hematoma. A Case Report.","authors":"Toshihide Takahashi, Kiyoyuki Yanaka, Hitoshi Aiyama, Minami Saura, Michihide Kajita, Nobuyuki Takahashi, Eiichi Ishikawa","doi":"10.1055/s-0044-1791580","DOIUrl":"10.1055/s-0044-1791580","url":null,"abstract":"<p><p>Traumatic middle meningeal artery aneurysm (TMMA) is a rare condition and a known cause of several different bleeding patterns after head injury. Once detected, they need to be treated as an emergency due to their potential for morbidity and mortality. Generally, recurrence does not occur in surgery for acute epidural hematoma if adequate hemostasis is achieved. Here, we report a case of atypical postoperative recurrence of an acute epidural hematoma, possibly due to the development and rupture of a TMMA. A 41-year-old man with left acute epidural hematoma after a head injury was referred to our hospital. Emergency craniotomy was performed immediately, and the hematoma was removed. The source of the bleeding was near the fracture site in the middle cranial fossa, and sufficient hemostasis was confirmed. However, a head computed tomography (CT) scan the next day revealed a recurrence of the acute epidural hematoma. Magnetic resonance (MR) angiogram showed an aneurysm with a diameter of approximately 4 mm in the left middle meningeal artery. The recurrence of the acute epidural hematoma appeared to be related to the formation and a rupture of a middle meningeal artery aneurysm, and to prevent subsequent rebleeding, the patient underwent reoperation, and the hematoma and aneurysm were removed. In surgery for acute epidural hematoma, recurrence can be prevented by removing the hematoma and ensuring hemostasis. Although conventional surgery was performed in this case, a repeat of epidural hematoma occurred. A postoperative middle meningeal artery aneurysm had been thought to have developed, ruptured, and caused a repeat epidural hematoma. In treating acute epidural hematoma, a TMMA development should be considered when an atypical clinical course occurs, such as a recurrence of postoperative bleeding.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"825-828"},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741904","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 : 2024-10-03eCollection Date: 2024-12-01DOI: 10.1055/s-0044-1791582
Wei Lun Lee, Azmi Alias, Mei Sin Lim
Blast-related traumatic brain injuries (bTBIs), once considered the signature wound of wars, have increasingly affected civilian populations due to the rise in terrorist attacks and industrial accidents. These injuries are complex, resulting from a combination of primary blast effects, secondary projectiles, tertiary impacts, and quaternary injuries from burns and toxic gas inhalation. Understanding the clinical presentation, management strategies, and outcomes of bTBIs is essential for enhancing patient care and improving prognosis. We report a case of industrial-related severe bTBI with opened depressed skull fracture and intracranial hematoma. The patient underwent decompressive craniectomy and evacuation of clot but postoperatively had a stormy recovery and multiple complications. He eventually succumbed due to his complications. This underscores the complexity of bTBIs and highlights the importance of a multidisciplinary approach in the management of bTBIs. Further research is needed to optimize treatment protocols and rehabilitation strategies for individuals with bTBIs.
{"title":"Case Report and Literature Review: A Severe Case of Blast-Related Traumatic Brain Injury.","authors":"Wei Lun Lee, Azmi Alias, Mei Sin Lim","doi":"10.1055/s-0044-1791582","DOIUrl":"10.1055/s-0044-1791582","url":null,"abstract":"<p><p>Blast-related traumatic brain injuries (bTBIs), once considered the signature wound of wars, have increasingly affected civilian populations due to the rise in terrorist attacks and industrial accidents. These injuries are complex, resulting from a combination of primary blast effects, secondary projectiles, tertiary impacts, and quaternary injuries from burns and toxic gas inhalation. Understanding the clinical presentation, management strategies, and outcomes of bTBIs is essential for enhancing patient care and improving prognosis. We report a case of industrial-related severe bTBI with opened depressed skull fracture and intracranial hematoma. The patient underwent decompressive craniectomy and evacuation of clot but postoperatively had a stormy recovery and multiple complications. He eventually succumbed due to his complications. This underscores the complexity of bTBIs and highlights the importance of a multidisciplinary approach in the management of bTBIs. Further research is needed to optimize treatment protocols and rehabilitation strategies for individuals with bTBIs.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"816-824"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741952","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 : 2024-09-30eCollection Date: 2024-12-01DOI: 10.1055/s-0044-1790607
Mohammad Elbaroody, Ahmed A Marei, Karim Fathy Sawy, Alaa Eldin Mahmoud, Mark Charl Amin, Amr A M Elkatatny, Hazem Abd Al Badea
Objective The aim of this study was to report our experience in the surgical treatment of compound depressed fractures over the venous sinuses with special highlights on the prediction and dealing with intraoperative sinus injury. Materials and Methods We conducted a retrospective review of all patients who underwent surgery for compound depressed fractures overlying the dural venous sinuses in our hospital between January 2019 and December 2021. Results A total of 34 patients were included in our study. The mean age of the patients was 19.85 years, most of our patients were males 27 (79.4%), and isolated head trauma was the most common mode of trauma (76.5%). The superior sagittal sinus (SSS) was distinguished as the most commonly involved venous sinus below the fractures in 28 patients (82.4%). An intraoperative tear in the sinus was found in 17 patients (50%), which was easily controlled with different methods. In two patients who had a severe head injury with a Glasgow Coma Scale (GCS) score of ≤8 associated with a fissure fracture crossing the sinus, there was a complete tear of the sinus followed by massive bleeding, which required sinus ligation. We lost both of them in following days. Conclusion In experienced tertiary neurotrauma centers, compound depressed fractures over the venous sinuses should be surgically elevated in most cases, taking into consideration that bleeding from the sinus can be controlled in most cases, and complete tear of the sinus with massive bleeding is the least scenario faced in reality and is usually associated with a severe head injury. If expert opinion favors the conservative approach, then close follow-up for months is recommended due to the high possibility of sinus thrombosis and intracranial hypertension, especially in children.
{"title":"Management of Compound Depressed Fractures over Venous Sinuses.","authors":"Mohammad Elbaroody, Ahmed A Marei, Karim Fathy Sawy, Alaa Eldin Mahmoud, Mark Charl Amin, Amr A M Elkatatny, Hazem Abd Al Badea","doi":"10.1055/s-0044-1790607","DOIUrl":"10.1055/s-0044-1790607","url":null,"abstract":"<p><p><b>Objective</b> The aim of this study was to report our experience in the surgical treatment of compound depressed fractures over the venous sinuses with special highlights on the prediction and dealing with intraoperative sinus injury. <b>Materials and Methods</b> We conducted a retrospective review of all patients who underwent surgery for compound depressed fractures overlying the dural venous sinuses in our hospital between January 2019 and December 2021. <b>Results</b> A total of 34 patients were included in our study. The mean age of the patients was 19.85 years, most of our patients were males 27 (79.4%), and isolated head trauma was the most common mode of trauma (76.5%). The superior sagittal sinus (SSS) was distinguished as the most commonly involved venous sinus below the fractures in 28 patients (82.4%). An intraoperative tear in the sinus was found in 17 patients (50%), which was easily controlled with different methods. In two patients who had a severe head injury with a Glasgow Coma Scale (GCS) score of ≤8 associated with a fissure fracture crossing the sinus, there was a complete tear of the sinus followed by massive bleeding, which required sinus ligation. We lost both of them in following days. <b>Conclusion</b> In experienced tertiary neurotrauma centers, compound depressed fractures over the venous sinuses should be surgically elevated in most cases, taking into consideration that bleeding from the sinus can be controlled in most cases, and complete tear of the sinus with massive bleeding is the least scenario faced in reality and is usually associated with a severe head injury. If expert opinion favors the conservative approach, then close follow-up for months is recommended due to the high possibility of sinus thrombosis and intracranial hypertension, especially in children.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"741-752"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740552","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 : 2024-09-30eCollection Date: 2024-12-01DOI: 10.1055/s-0044-1790514
Gaurav Tyagi, Mustafa Iqbal Chandshah, Gyani Jail Singh Birua, Nishanth Sadashiva, Subhas Konar, Manish Beniwal, A R Prabhuraj, T S Lingaraju, Gopal Krishna, Nupur Pruthi, Dhaval P Shukla
Objective Intracranial meningiomas constitute a third of all brain tumors and are among the most common indications for neurosurgical procedures performed worldwide. Most meningiomas present with an indolent, longstanding history. However, the data on outcomes of emergency surgeries for meningioma is limited. This study aims to present our experience of urgent surgical intervention in patients with meningiomas presenting acutely. We also analyze the factors influencing early neurological outcomes and complications. Materials and Methods All nonelective meningioma surgeries done on an emergency basis between January 2015 and December 2019 were retrospectively reviewed. Patients' demography, clinical, and radiological details were recorded for analysis. The surgical procedure, complications, and follow-up outcomes were also included for statistical comparison. Results Forty-four patients qualified for the study with a mean age of 49.4 ± 13.4 years. The average presenting Glasgow Coma Scale (GCS) was 13; 47.7% of cases presented with altered sensorium. The most common lesion location was convexity (25, 56.8%), and the mean tumor volume was 74.1 ± 36.5 mL. Gross peritumor edema with mass effect was seen in 16 patients (36.4%). The mean Karnofsky Performance Status at 3 months' follow-up was 89.3 ± 18.2. Patient age and tumor size did not affect outcomes. The presenting GCS of < 15 (odds ratio [OR] 8.8, confidence interval [CI] 0.95-80.72, p 0.03) and the occurrence of postoperative complications (OR 25.71, CI 2.65-249.2, p 0.001) were associated with unfavorable outcomes. Although not statistically significant, a poor tumor grade was also associated with worse clinical outcomes ( p 0.20). Conclusion Emergency meningioma surgery has comparable outcomes and complication rates with routine elective procedures. Grade II/III meningiomas are more likely to present with acute neurological deterioration and carry a relatively worse prognosis. Poor presenting GCS and postoperative complications are the most critical factors associated with poor patient outcomes in our study.
{"title":"Emergency Surgical Management of Meningiomas: Factors Affecting Early Outcomes and Complications.","authors":"Gaurav Tyagi, Mustafa Iqbal Chandshah, Gyani Jail Singh Birua, Nishanth Sadashiva, Subhas Konar, Manish Beniwal, A R Prabhuraj, T S Lingaraju, Gopal Krishna, Nupur Pruthi, Dhaval P Shukla","doi":"10.1055/s-0044-1790514","DOIUrl":"10.1055/s-0044-1790514","url":null,"abstract":"<p><p><b>Objective</b> Intracranial meningiomas constitute a third of all brain tumors and are among the most common indications for neurosurgical procedures performed worldwide. Most meningiomas present with an indolent, longstanding history. However, the data on outcomes of emergency surgeries for meningioma is limited. This study aims to present our experience of urgent surgical intervention in patients with meningiomas presenting acutely. We also analyze the factors influencing early neurological outcomes and complications. <b>Materials and Methods</b> All nonelective meningioma surgeries done on an emergency basis between January 2015 and December 2019 were retrospectively reviewed. Patients' demography, clinical, and radiological details were recorded for analysis. The surgical procedure, complications, and follow-up outcomes were also included for statistical comparison. <b>Results</b> Forty-four patients qualified for the study with a mean age of 49.4 ± 13.4 years. The average presenting Glasgow Coma Scale (GCS) was 13; 47.7% of cases presented with altered sensorium. The most common lesion location was convexity (25, 56.8%), and the mean tumor volume was 74.1 ± 36.5 mL. Gross peritumor edema with mass effect was seen in 16 patients (36.4%). The mean Karnofsky Performance Status at 3 months' follow-up was 89.3 ± 18.2. Patient age and tumor size did not affect outcomes. The presenting GCS of < 15 (odds ratio [OR] 8.8, confidence interval [CI] 0.95-80.72, <i>p</i> 0.03) and the occurrence of postoperative complications (OR 25.71, CI 2.65-249.2, <i>p</i> 0.001) were associated with unfavorable outcomes. Although not statistically significant, a poor tumor grade was also associated with worse clinical outcomes ( <i>p</i> 0.20). <b>Conclusion</b> Emergency meningioma surgery has comparable outcomes and complication rates with routine elective procedures. Grade II/III meningiomas are more likely to present with acute neurological deterioration and carry a relatively worse prognosis. Poor presenting GCS and postoperative complications are the most critical factors associated with poor patient outcomes in our study.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"715-720"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741976","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 : 2024-09-30eCollection Date: 2024-12-01DOI: 10.1055/s-0044-1791268
Bheru Dan Charan, Shailesh B Gaikwad, Sushant Agarwal, Savyasachi Jain
Mycotic intracranial aneurysms (MIAs) are rare but can cause significant morbidity and mortality due to rupture. Most patients have additional systemic medical comorbidities making endovascular treatment a vital modality in the treatment of these aneurysms. We aimed to share our institutional experience with the role of endovascular therapy in the treatment of mycotic aneurysms with a literature review. We conducted a retrospective review of our patient database to identify individuals diagnosed with MIAs who underwent endovascular intervention at our institution between January 2002 and December 2021. We have found three patients with ruptured MIAs. All three patients had a heart disease with infective endocarditis. Two patients presented with subarachnoid hemorrhage (SAH) in which, one had a rebleed resulting in intracerebral hemorrhage (ICH), the third patient initially presented with ICH. Distal anterior cerebral artery (ACA) was the site of MIA in two cases and distal middle cerebral artery (MCA) in one patient. Two patients were treated with simple coiling and one patient was treated by glue (n-butyl cyanoacrylate [NBCAs]) injection within the aneurysm. There was no periprocedural complication with complete obliteration of the aneurysm and preservation of the parent artery. All the patients had good outcomes on follow-up. Two patients had a modified Rankin scale (mRS) score of 0 at 6 months and one patient had an mRS score of 3 at the end of 3 months whose preprocedure mRS score was 5. Endovascular embolization of MIAs with coils or liquid embolic agents can be performed in critically ill patients and is an excellent treatment modality with high occlusion rates and low procedural complications.
霉菌性颅内动脉瘤(MIAs)虽然罕见,但可因破裂而导致严重的发病率和死亡率。大多数患者还伴有全身性并发症,因此血管内治疗是治疗这些动脉瘤的重要方法。我们旨在通过文献综述,分享本院在血管内治疗霉菌性动脉瘤方面的经验。我们对患者数据库进行了回顾性审查,以确定 2002 年 1 月至 2021 年 12 月期间在我院接受血管内介入治疗的被诊断为霉菌性动脉瘤的患者。我们发现了三名 MIA 破裂的患者。这三位患者都患有感染性心内膜炎。其中两名患者出现蛛网膜下腔出血(SAH),一名患者再次出血导致脑内出血(ICH),第三名患者最初出现 ICH。两例患者的 MIA 发生部位为大脑前动脉(ACA)远端,一例患者的 MIA 发生部位为大脑中动脉(MCA)远端。两名患者接受了简单的卷曲治疗,一名患者接受了动脉瘤内注射胶水(氰基丙烯酸正丁酯 [NBCAs])治疗。治疗过程中没有出现并发症,动脉瘤完全闭塞,并保留了母动脉。所有患者的随访结果均良好。两名患者在 6 个月后的改良兰金量表(mRS)评分为 0,一名患者在 3 个月后的 mRS 评分为 3,而其术前的 mRS 评分为 5。 使用线圈或液体栓塞剂对 MIA 进行血管内栓塞治疗可在重症患者中进行,是一种具有高闭塞率和低手术并发症的出色治疗方法。
{"title":"Endovascular Treatment of Mycotic Intracranial Aneurysms: A Series of Three Cases with Institutional Treatment Algorithm.","authors":"Bheru Dan Charan, Shailesh B Gaikwad, Sushant Agarwal, Savyasachi Jain","doi":"10.1055/s-0044-1791268","DOIUrl":"10.1055/s-0044-1791268","url":null,"abstract":"<p><p>Mycotic intracranial aneurysms (MIAs) are rare but can cause significant morbidity and mortality due to rupture. Most patients have additional systemic medical comorbidities making endovascular treatment a vital modality in the treatment of these aneurysms. We aimed to share our institutional experience with the role of endovascular therapy in the treatment of mycotic aneurysms with a literature review. We conducted a retrospective review of our patient database to identify individuals diagnosed with MIAs who underwent endovascular intervention at our institution between January 2002 and December 2021. We have found three patients with ruptured MIAs. All three patients had a heart disease with infective endocarditis. Two patients presented with subarachnoid hemorrhage (SAH) in which, one had a rebleed resulting in intracerebral hemorrhage (ICH), the third patient initially presented with ICH. Distal anterior cerebral artery (ACA) was the site of MIA in two cases and distal middle cerebral artery (MCA) in one patient. Two patients were treated with simple coiling and one patient was treated by glue (n-butyl cyanoacrylate [NBCAs]) injection within the aneurysm. There was no periprocedural complication with complete obliteration of the aneurysm and preservation of the parent artery. All the patients had good outcomes on follow-up. Two patients had a modified Rankin scale (mRS) score of 0 at 6 months and one patient had an mRS score of 3 at the end of 3 months whose preprocedure mRS score was 5. Endovascular embolization of MIAs with coils or liquid embolic agents can be performed in critically ill patients and is an excellent treatment modality with high occlusion rates and low procedural complications.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"618-625"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741981","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 : 2024-09-30eCollection Date: 2024-12-01DOI: 10.1055/s-0044-1791228
Fatima Suleman, Ayesha Sohail, Gohar Javed, Syeda Sana Samar
The aim of this study was to determine the impact of helmet therapy (HT) as a treatment for craniosynostosis, with a focus on the outcomes of skull morphology, reoperation rate, complications of HT, and quality of life of patients who receive it. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review utilized the PICO format: Does HT following strip craniectomy (SC) improve outcomes (outcome) compared to SC alone (comparison) in patients undergoing craniosynostosis correction (intervention)? Searches were performed from January 1, 2000 to December 31, 2022, using PubMed, Cochrane Library, and Ovid Medline databases. Study quality was evaluated using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment scale. Fourteen studies meeting the inclusion criteria were identified. Among these, 438 patients underwent SC-HT, while 104 patients underwent SC without HT. The preoperative cephalic indices for sagittal craniosynostosis in the HT and non-HT groups were 66.8 and 67.8, respectively, which improved postoperatively to 75 and 76.2, respectively. Limited long-term follow-up hindered a definitive assessment of reoperation rates. Complication rates related to HT were low at approximately 2.9%, primarily consisting of skin irritation. Parental satisfaction was high, correlating with a strong compliance rate. Existing literature does not demonstrate a clear superiority between SC with or without HT for treating nonsyndromic sagittal craniosynostosis. Outcomes appear comparable, but evidence is constrained by the predominance of single-center retrospective studies with limited methodological rigor. There is a pressing need for international multicenter trials to furnish more robust and generalizable findings.
{"title":"The Role of Helmet Therapy in Craniosynostosis: A Systematic Review.","authors":"Fatima Suleman, Ayesha Sohail, Gohar Javed, Syeda Sana Samar","doi":"10.1055/s-0044-1791228","DOIUrl":"10.1055/s-0044-1791228","url":null,"abstract":"<p><p>The aim of this study was to determine the impact of helmet therapy (HT) as a treatment for craniosynostosis, with a focus on the outcomes of skull morphology, reoperation rate, complications of HT, and quality of life of patients who receive it. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review utilized the PICO format: Does HT following strip craniectomy (SC) improve outcomes (outcome) compared to SC alone (comparison) in patients undergoing craniosynostosis correction (intervention)? Searches were performed from January 1, 2000 to December 31, 2022, using PubMed, Cochrane Library, and Ovid Medline databases. Study quality was evaluated using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment scale. Fourteen studies meeting the inclusion criteria were identified. Among these, 438 patients underwent SC-HT, while 104 patients underwent SC without HT. The preoperative cephalic indices for sagittal craniosynostosis in the HT and non-HT groups were 66.8 and 67.8, respectively, which improved postoperatively to 75 and 76.2, respectively. Limited long-term follow-up hindered a definitive assessment of reoperation rates. Complication rates related to HT were low at approximately 2.9%, primarily consisting of skin irritation. Parental satisfaction was high, correlating with a strong compliance rate. Existing literature does not demonstrate a clear superiority between SC with or without HT for treating nonsyndromic sagittal craniosynostosis. Outcomes appear comparable, but evidence is constrained by the predominance of single-center retrospective studies with limited methodological rigor. There is a pressing need for international multicenter trials to furnish more robust and generalizable findings.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"610-617"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741956","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}
Objective This study aims to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the head injury fast-track system and surgical treatment outcomes. Materials and Methods A retrospective review was conducted on patients who underwent emergency neurological procedures according to the head injury fast-track system. Data from April 2018 to April 2020 (pre-COVID) were compared with data from May 2020 to May 2022 (during COVID). Results The analysis comprised 128 patients in the prepandemic group and 119 patients in the pandemic group, with 5 patients diagnosed with COVID infection during the pandemic. Acute subdural hematoma resulting from motorcycle accidents was the most common diagnosis in both groups (56.3 and 47.5%, respectively). The initial Glasgow coma scale (GCS) score was significantly lower during the pandemic compared to the prepandemic period ( p = 0.025). Time metrics in the emergency department, including door to computed tomography (CT), emergency room (ER) exit, and incision times, were significantly longer in the pandemic group ( p < 0.05). However, there were no statistically significant differences in in-hospital mortality rates (25.8 and 17.7%, respectively; p = 0.12) or the percentage of patients with a favorable functional outcome (Glasgow outcome scale ≥4). At 1 month, a favorable functional outcome was observed in 51.6% of prepandemic patients and 57.1% of pandemic patients ( p = 0.69), while at 6 months, the percentages were 56.8 and 64.5%, respectively ( p = 0.23). Conclusions Our study revealed significant delays in hospital processes for head injuries during the COVID-19 pandemic. However, we found no significant impact on mortality rates or functional outcomes of patients.
{"title":"The Impact of the Pandemic of COVID-19 on the Head Injury Fast-Track System and Surgical Outcome.","authors":"Thunya Norasethada, Kriengsak Limpastan, Tanat Vaniyapong, Wanarak Watcharasaksilp, Chumpon Jetjumnong, Chanon Srihagulang, Thanat Kanthawang, Todsapon Praphanuwat, Withawat Vuthiwong, Jirapong Vongsfak","doi":"10.1055/s-0044-1791267","DOIUrl":"10.1055/s-0044-1791267","url":null,"abstract":"<p><p><b>Objective</b> This study aims to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the head injury fast-track system and surgical treatment outcomes. <b>Materials and Methods</b> A retrospective review was conducted on patients who underwent emergency neurological procedures according to the head injury fast-track system. Data from April 2018 to April 2020 (pre-COVID) were compared with data from May 2020 to May 2022 (during COVID). <b>Results</b> The analysis comprised 128 patients in the prepandemic group and 119 patients in the pandemic group, with 5 patients diagnosed with COVID infection during the pandemic. Acute subdural hematoma resulting from motorcycle accidents was the most common diagnosis in both groups (56.3 and 47.5%, respectively). The initial Glasgow coma scale (GCS) score was significantly lower during the pandemic compared to the prepandemic period ( <i>p</i> = 0.025). Time metrics in the emergency department, including door to computed tomography (CT), emergency room (ER) exit, and incision times, were significantly longer in the pandemic group ( <i>p</i> < 0.05). However, there were no statistically significant differences in in-hospital mortality rates (25.8 and 17.7%, respectively; <i>p</i> = 0.12) or the percentage of patients with a favorable functional outcome (Glasgow outcome scale ≥4). At 1 month, a favorable functional outcome was observed in 51.6% of prepandemic patients and 57.1% of pandemic patients ( <i>p</i> = 0.69), while at 6 months, the percentages were 56.8 and 64.5%, respectively ( <i>p</i> = 0.23). <b>Conclusions</b> Our study revealed significant delays in hospital processes for head injuries during the COVID-19 pandemic. However, we found no significant impact on mortality rates or functional outcomes of patients.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"753-759"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741954","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: 2024-12-01DOI: 10.1055/s-0044-1790606
Salman T Shaikh, T A Dwarakanath, Aliasgar V Moiyadi
Technology and neurosurgery have gone hand in hand since a long time. Technological development of robotics in neurosurgery over the last couple of decades has been rapid, yet it still has a long way to go before it becomes a "routine" element of the standard neurosurgical procedure. Apart from the obvious advantages they have over humans, that is, precision, consistency, endurance, and reproducibility, robots also provide additional freedom of movement beyond what is anatomically feasible for humans. Since its first practical application in 1985, the promise of robotics has spurred development and design of numerous such devices for application in neurosurgery. In the current era, the role of robots in neurosurgery is limited to programming movements and planning trajectories for deep cranial targets, biopsies, spinal screw placements, deep brain stimulation, and stereotactic radiosurgery. This narrative, nonsystematic review discusses the evolution of various robotic systems, with a focus on their neurosurgical applications.
{"title":"Evolution of Robotics in Neurosurgery.","authors":"Salman T Shaikh, T A Dwarakanath, Aliasgar V Moiyadi","doi":"10.1055/s-0044-1790606","DOIUrl":"10.1055/s-0044-1790606","url":null,"abstract":"<p><p>Technology and neurosurgery have gone hand in hand since a long time. Technological development of robotics in neurosurgery over the last couple of decades has been rapid, yet it still has a long way to go before it becomes a \"routine\" element of the standard neurosurgical procedure. Apart from the obvious advantages they have over humans, that is, precision, consistency, endurance, and reproducibility, robots also provide additional freedom of movement beyond what is anatomically feasible for humans. Since its first practical application in 1985, the promise of robotics has spurred development and design of numerous such devices for application in neurosurgery. In the current era, the role of robots in neurosurgery is limited to programming movements and planning trajectories for deep cranial targets, biopsies, spinal screw placements, deep brain stimulation, and stereotactic radiosurgery. This narrative, nonsystematic review discusses the evolution of various robotic systems, with a focus on their neurosurgical applications.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"598-609"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741995","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}
Introduction Scalp nerve block (SNB) attenuates the hemodynamic response to pin insertion and delivers excellent postoperative analgesia. This study aimed to evaluate the efficacy of SNB using ketamine as an adjuvant to bupivacaine on perioperative hemodynamic responses and postoperative pain in patients undergoing craniotomy for supratentorial glioma. Materials and Methods Sixty patients were randomized into two groups. They were given scalp nerve block either with bupivacaine and saline (group S) or bupivacaine and ketamine (group K). Primary outcome was to compare the change in mean arterial pressure (MAP) and heart rate (HR) at defined time points from baseline. Secondary outcomes included time to request for first analgesia, total analgesic consumption in intraoperative and postoperative periods till 24 hours, and numeric rating scale pain score at various time points in postoperative period till 24 hours. Results Fifty-seven patients were included in analysis. HR and MAP were comparable intraoperatively till closure. As soon as closure began, a significant increase in HR (group K vs. group S, 69.76 ± 9.03 vs. 93.96 ± 9.98, p -value = < 0.0001) and MAP (group K vs. group S, 79.4 ± 4.12 vs. 87.17 ± 12.67, p -value = 0.002) was noted in group S patients. This increase persisted in the postoperative period as well. The median total opioid consumed during intraoperative period in group K was 200 mcg versus 300 mcg in group S, p -value < 0.0001. Conclusion Adding ketamine as an adjuvant to bupivacaine for SNB not only provides significant hemodynamic stability but also reduces both intra- and postoperative analgesic consumption.
引言 头皮神经阻滞(SNB)可减轻插针时的血流动力学反应,并提供良好的术后镇痛效果。本研究旨在评估使用氯胺酮辅助布比卡因进行头皮神经阻滞对接受幕上胶质瘤开颅手术的患者围术期血流动力学反应和术后疼痛的疗效。材料和方法 60 名患者被随机分为两组。他们分别接受布比卡因和生理盐水(S 组)或布比卡因和氯胺酮(K 组)头皮神经阻滞。主要结果是比较平均动脉压(MAP)和心率(HR)在规定时间点与基线的变化。次要结果包括要求首次镇痛的时间、术中和术后至 24 小时的镇痛剂总用量,以及术后至 24 小时不同时间点的疼痛评分。结果 57 名患者参与了分析。术中至闭合前,心率和血压相当。关闭手术一开始,S 组患者的心率(K 组 vs. S 组,69.76 ± 9.03 vs. 93.96 ± 9.98,p 值 = < 0.0001)和血压(K 组 vs. S 组,79.4 ± 4.12 vs. 87.17 ± 12.67,p 值 = 0.002)就显著增加。这种增加在术后也持续存在。K 组患者术中阿片类药物总消耗量的中位数为 200 微克,而 S 组为 300 微克,p 值=0.002 结论 在 SNB 中加入氯胺酮作为布比卡因的辅助药物,不仅能显著稳定血流动力学,还能减少术中和术后镇痛药的消耗。
{"title":"Efficacy of Ketamine as an Adjuvant to Scalp Block for Hemodynamic Stability in Patients Undergoing Elective Craniotomy for Supratentorial Glioma: A Prospective Randomized Controlled Trial.","authors":"Ashutosh Kaushal, Sharmishtha Pathak, Priyanka Gupta, Praveen Talwar, Anuj Jain, Sunaina Tejpal Karna","doi":"10.1055/s-0044-1791269","DOIUrl":"10.1055/s-0044-1791269","url":null,"abstract":"<p><p><b>Introduction</b> Scalp nerve block (SNB) attenuates the hemodynamic response to pin insertion and delivers excellent postoperative analgesia. This study aimed to evaluate the efficacy of SNB using ketamine as an adjuvant to bupivacaine on perioperative hemodynamic responses and postoperative pain in patients undergoing craniotomy for supratentorial glioma. <b>Materials and Methods</b> Sixty patients were randomized into two groups. They were given scalp nerve block either with bupivacaine and saline (group S) or bupivacaine and ketamine (group K). Primary outcome was to compare the change in mean arterial pressure (MAP) and heart rate (HR) at defined time points from baseline. Secondary outcomes included time to request for first analgesia, total analgesic consumption in intraoperative and postoperative periods till 24 hours, and numeric rating scale pain score at various time points in postoperative period till 24 hours. <b>Results</b> Fifty-seven patients were included in analysis. HR and MAP were comparable intraoperatively till closure. As soon as closure began, a significant increase in HR (group K vs. group S, 69.76 ± 9.03 vs. 93.96 ± 9.98, <i>p</i> -value = < 0.0001) and MAP (group K vs. group S, 79.4 ± 4.12 vs. 87.17 ± 12.67, <i>p</i> -value = 0.002) was noted in group S patients. This increase persisted in the postoperative period as well. The median total opioid consumed during intraoperative period in group K was 200 mcg versus 300 mcg in group S, <i>p</i> -value < 0.0001. <b>Conclusion</b> Adding ketamine as an adjuvant to bupivacaine for SNB not only provides significant hemodynamic stability but also reduces both intra- and postoperative analgesic consumption.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"760-766"},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741955","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}
Hemorrhagic strokes are considered as contraindications of extracorporeal membrane oxygenation (ECMO) therapy because of anticoagulant administration and ECMO-associated coagulopathy. We present a rare case of successful microsurgical clipping under ECMO for a poor-grade subarachnoid hemorrhage (SAH) patient with severe neurogenic pulmonary edema (NPE). A 50-year-old man presenting with the sudden loss of consciousness was diagnosed with poor-grade SAH with severe NPE, and was intubated. Because of severe hypoxemia refractory to conventional treatment, venovenous ECMO was used 6 hours after admission. To avoid thrombosis inside the ECMO circuit despite no anticoagulants, a heparin-bonded ECMO was maintained at a comparatively high blood flow rate. Subsequently, the patient underwent a microsurgical clipping under ECMO. Intraoperatively we had difficulty in bleeding control, and therefore the multiple transfusions were necessary to correct anemia and ECMO-associated coagulopathy. The aneurysmal clipping was accomplished without hemorrhagic intracranial complications. After 2 years from onset, his activities of daily life were independent. To our knowledge, this is the first report of successful microsurgical clipping for poor-grade SAH under ECMO without any anticoagulants. The use of a heparin-bonded ECMO tubing, maintenance of a slightly higher ECMO pump speed, and multiple transfusions to correct ECMO-associated coagulopathy could make the micro-neurosurgical procedures under ECMO possible. This report demonstrated the possibility to extend the range of application of microsurgical clipping for poor-grade SAH patients requiring ECMO treatment.
{"title":"Successful Microsurgical Clipping under Extracorporeal Membrane Oxygenation Treatment for a Poor-Grade Subarachnoid Hemorrhage Patient with Severe Pulmonary Neurogenic Lung.","authors":"Katsuya Saito, Shoko Ito, Takahiro Miyata, Keita Mayanagi, Joji Inamasu, Masashi Nakatsukasa","doi":"10.1055/s-0044-1791189","DOIUrl":"10.1055/s-0044-1791189","url":null,"abstract":"<p><p>Hemorrhagic strokes are considered as contraindications of extracorporeal membrane oxygenation (ECMO) therapy because of anticoagulant administration and ECMO-associated coagulopathy. We present a rare case of successful microsurgical clipping under ECMO for a poor-grade subarachnoid hemorrhage (SAH) patient with severe neurogenic pulmonary edema (NPE). A 50-year-old man presenting with the sudden loss of consciousness was diagnosed with poor-grade SAH with severe NPE, and was intubated. Because of severe hypoxemia refractory to conventional treatment, venovenous ECMO was used 6 hours after admission. To avoid thrombosis inside the ECMO circuit despite no anticoagulants, a heparin-bonded ECMO was maintained at a comparatively high blood flow rate. Subsequently, the patient underwent a microsurgical clipping under ECMO. Intraoperatively we had difficulty in bleeding control, and therefore the multiple transfusions were necessary to correct anemia and ECMO-associated coagulopathy. The aneurysmal clipping was accomplished without hemorrhagic intracranial complications. After 2 years from onset, his activities of daily life were independent. To our knowledge, this is the first report of successful microsurgical clipping for poor-grade SAH under ECMO without any anticoagulants. The use of a heparin-bonded ECMO tubing, maintenance of a slightly higher ECMO pump speed, and multiple transfusions to correct ECMO-associated coagulopathy could make the micro-neurosurgical procedures under ECMO possible. This report demonstrated the possibility to extend the range of application of microsurgical clipping for poor-grade SAH patients requiring ECMO treatment.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"19 4","pages":"812-815"},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741947","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}