Asian journal of neurosurgery最新文献

Introduction  Flow diverter (FD) stents are widely used to treat giant aneurysms by reducing blood flow into the aneurysm sac. However, choosing the optimal FD for a patient can be challenging when a nearby artery, such as the ophthalmic artery (OA), is jailed by the FD placement. This study compares the impact of two FD stents with different effective metal surface area (EMSA) values on OA occlusion. Materials and Methods  A numerical model of a 59-year-old female patient with a giant aneurysm in the left internal carotid artery and a jailed OA was created based on clinical data. Two FD stents, FRED4017 and FRED4518, with different EMSA values at the aneurysm neck and OA inlet, were virtually deployed in the model. Blood flow and occlusion amount in the OA were simulated and compared between the two FD stents. Results  FRED4017 had higher EMSA values than FRED4518 at the aneurysm neck (35% vs. 24.6%) and lower EMSA values at the OA inlet (15% vs. 21.2%). FRED4017 caused more occlusion in the OA than FRED4518 (40% vs. 28%), indicating a higher risk of ocular ischemic syndrome. Conclusion  The EMSA value of FD stents affects the blood flow and occlusion amount in the jailed OA. Therefore, selecting an FD stent with a low EMSA value at the OA inlet may be beneficial for patients with a nearby jailed artery at the aneurysm neck.

Pituitary adenomas are a type of of the most frequent intracranial tumors. These tumors can extend outside the sella, but very rarely originate ectopically to the sellar region. A 71-year-old patient presented to our institution, with prior clinical history of noncontrolled arterial hypertension and new-onset high-intensity pulsatile headache. Upon suspicion of a hypertensive emergency with probable brain compromise, a nonenhanced computed tomography of the head was performed. A mass within the sphenoid sinus was found. Endocrinological workup demonstrated a significant elevation of the growth hormone. As an incidental finding, a brain aneurysm was evidenced, which was treated endovascularly prior to the mass treatment. Subsequently, the patient successfully underwent a gross total resection through an endonasal transsphenoidal approach. Histopathological results were consistent with a pituitary ectopic adenoma. A postoperative improvement in levels of somatomedin C was documented postoperatively.

The majority of meningiomas are slow-growing benign tumors that can potentially be highly vascularized; however, acute hemorrhagic onset is rare. Herein, we describe two patients who presented with disturbance of consciousness and severe hemiplegia due to spontaneous hemorrhage from a falx atypical meningioma. A 49-year-old female presenting with a sudden disturbance of consciousness and severe left hemiplegia was found to have a falx meningioma and acute hemorrhage. Emergent resection achieved neurological relief and tumor control. A 60-year-old female with aphasia and severe right hemiplegia also had falx meningioma and hematoma, and successfully treated by emergent resection. Tumor was diagnosed as atypical meningioma in both cases. Both patients achieved mid-term tumor control for 4 and 7 years. Both patients were treated successfully with emergent surgical resection, and neurological relief and mid-term tumor control (7 and 4 years, respectively) were achieved. Given this success, immediate surgical resection with hematoma evacuation should be considered an acceptable therapeutic option for acute hemorrhagic atypical meningioma.

Brain arteriovenous malformation (AVM) is a rare congenital disorder affecting young adults with an incidence of 0.94 per 100,000 population. Intracranial digital subtraction angiography has to be done in all patients and grading of AVM is done as per Spetzler-Martin grading. We report a rare case of left basal ganglia large AVM treated by endovascular embolization. Our experience with endovascular embolization using Onyx is successful in the treatment of large brain AVM. Endovascular embolization with Onyx is safe and feasible in deeply located large AVMs of the brain. Our patient has postoperatively recovered completely without any neurological deficit.

Contrecoup brain injury refers to the classical opposite of the primary impact. Tamil Nadu has the highest rate of road traffic accident in India. Madurai has peak mortality due to accidents in India. Previous studies done on contrecoup head injury had shown patterns of injuries and mechanism of injury. Outcome and management of only occipitofrontal contrecoup head injury has been taken in this study. Mortality in this specific group is very high. Seventy-six patients of this specific head injury were admitted at Government Rajaji Hospital, Madurai. Patients were assessed for Glasgow coma scale (GCS), age, sex, progression of volume, mortality, traumatic brain injury-induced coagulopathy, and pillion rider outcome. Fourteen patients were surgically treated by decompressive craniectomy. Conservative management was done by antiepileptic and antiedema measures. Mostly affected were males ( n  = 54) followed by females ( n  = 22). GCS on admission mean value 9. In our study, mortality was 32% with sudden death of three patients due to hypothalamic compression. Hospital stay of the patient was significantly increased with progression of lesion with mean 9 days and p -value less than 0.01. Pillion riders ( n  = 18) were also affected in our study. Traumatic brain injury-induced coagulopathy ( n  = 12) was also detected, which was treated by injection tranexamic acid and injection vitamin K, thereby not leading to any death due to coagulopathy with significant p -value less than 0.01. We recommend helmet for both main and pillion rider with strict speeding regulations.

Introduction  Spinal arachnoid cysts are rare. Most of these lesions are located in the thoracic and thoracolumbar regions. Magnetic resonance imaging is a valuable tool for understanding their location and provides important information regarding their origin and expansion. The aim of our study was to evaluate the demographics, presentations, surgical management, and outcome of a spinal arachnoid cyst. Materials and Methods  All the patients from January 2003 to December 2021 who were symptomatic for spinal arachnoid cysts were taken for study. A retrospective analysis was performed. Radiological investigations were performed, and patients were graded according to the Nabors classification. Operative results were graded according to surgical technique. Results  The study included 22 patients, 11 female and 11 male patients, with a male-to-female ratio of approximately 1:1. The mean age of presentation was 34.7 years (4-60 years). Of 22 patients, 15 have intradural arachnoid cysts, 7 have an intradural extramedullary arachnoid cyst, and 8 have an intramedullary arachnoid cyst. Symptoms varied from weakness in the lower limbs (50%), quadriparesis and spasticity (32%), bladder/bowel incontinence (14%), and pain (10%). Out of 22 patients, complete cyst excision was performed in 17 patients, marsupialization in 4 patients, and cystic-subarachnoid shunt in one patient. Weakness and spasticity gradually recovered over a period of time. At 1-year follow-up, all the patients had complete improvement in their weakness, spasticity, and bladder functions. No recurrence of the cyst was seen at 1-year follow-up. Conclusion  Spinal arachnoid cysts are very rare in the spinal cord. Most of the lesions are located in the thoracic and thoracolumbar regions. Asymptomatic cyst requires counseling and conservative management, whereas symptomatic cyst, if operated on with surgical expertise, recurrence and complications are very low. The best surgical technique for operating these spinal arachnoid cysts is still under question, but symptom improvement is seen in all operative procedures.

Bow Hunter's syndrome (BHS) is a very rare condition in which there is rotational vertebral artery (VA) insufficiency. The association of BHS with rotational atlantoaxial instability is extremely rare. We are reporting a case of pediatric BHS who presented with features of VA insufficiency on neck rotation. Careful evaluation revealed rotational C1-C2 instability. Provocative digital subtraction angiography and dynamic neck computed tomography were the mainstay of our diagnostic armamentarium. Our case emphasizes the fact that VA abnormalities need special consideration in young patients with craniovertebral junction instability and a high degree of suspicion is necessary in most instances for accurate diagnosis.

Stroke is a leading cause of morbidity and mortality in humans. Most strokes are ischemic in nature and early recanalization of occluded vessels determines good outcomes. Recanalization of occluded vessels depends on many angiographic and demographic features. These factors need to be identified for better patient overall outcomes. Better preoperative knowledge of factors can help in customizing our treatment approach and explaining the prognosis to the guardians of the patients. We aim to share our institutional experience with mechanical thrombectomy (MT) for stroke and studied factors that affect an angiographic recanalization of vessels . A retrospective single-center study was conducted involving 104 patients who underwent MT at our institution between January 2016 and December 2019. Patient demographics, baseline characteristics, pre- and postprocedural imaging findings, and other clinical data were meticulously reviewed. We divided patients into successful recanalization (modified thrombolysis in cerebral ischemia [mTICI] 2b or 3) and unsuccessful recanalization (mTICI 2a or 1) groups and various factors were analyzed to evaluate their impact on recanalization rates. In the univariate analysis, a significant association was observed between successful recanalization and several factors: the absence of rheumatic heart disease (RHD) as a risk factor ( p  = 0.035), the presence of a hyperdense vessel sign ( p  = 0.003), and the use of treatment methods including aspiration ( p  = 0.031), stent retriever ( p  = 0.001), and Solumbra ( p  = 0.019). However, in the multivariate analysis, none of these factors exhibited statistical significance. The presence of RHD is a risk factor associated with poor angiographic recanalization in all three MT treatment modalities. Based on the above variables we can guide the patients/relatives prior to MT procedure for their better outcome and risk-benefit ratio.

Congenital internal carotid artery hypoplasia is a rare condition characterized by underdevelopment or reduced caliber of the internal carotid artery during embryonic development. This anomaly presents significant challenges in management, particularly in neurosurgical interventions for cerebrovascular events. We present a case report of a 67-year-old male who presented with subarachnoid hemorrhage and intraparenchymal hemorrhage extending as intraventricular hemorrhage due to a ruptured left true posterior communicating artery aneurysm, associated with intraoperative findings of left internal carotid artery aneurysm, accompanied by incidental findings of bilateral congenital hypoplasia of the internal carotid artery on computed tomography angiography. Surgical intervention involved a left frontotemporal craniotomy, during which both aneurysms were successfully clipped. This case underscores the critical importance of meticulous preoperative evaluation, utilizing advanced neuroimaging modalities to identify such anomalies, particularly in patients with acute cerebrovascular events. Furthermore, it emphasizes the necessity for meticulous surgical planning and intraoperative vigilance to effectively manage associated vascular pathologies.