Asian journal of neurosurgery最新文献

Calcifying pseudoneoplasms of the neuraxis (CAPNON) are rare non-neoplastic calcified lesions that can occur throughout the entire neuraxis. Cranial nerves may be involved in skull base lesions. Surgical resection usually has a good prognosis, with only a few cases of recurrence reported in the relevant literature. We experienced a recurrent case of CAPNON in Meckel's cave extending to the cerebellopontine cistern with involvement of the trigeminal nerve after initial resection of the cystic part of the lesion. A 48-year-old man presented with a 4-year history of right-sided ptosis. Magnetic resonance imaging revealed a calcified lesion arising in Meckel's cave, with a cystic lesion extending to the cerebellopontine cistern. The cystic part of the lesion was excised during the initial surgery using the right lateral suboccipital approach. However, the cystic lesion regrew to its preoperative size within 23 months. The right extradural subtemporal approach was used to successfully remove both the calcified mass in the right Meckel cave and the cystic lesion extending to the right cerebellopontine cistern during the resection of the lesion. The patient's neurological symptoms resolved postoperatively. CAPNON was identified during the histopathological examination. This report describes a rare case of CAPNON in Meckel's cave with a unique clinical course. After the first operation, cystic lesions recurred in the cerebellopontine cistern, but they were successfully treated by a second operation.

Objective: With social media's increasing prevalence, platforms like Instagram have emerged as key sources of altmetrics. This study aimed to analyze the posts shared on Instagram referencing traumatic spine injury in terms of account type, languages, geographical distribution, content analysis, and audience engagement.

Materials and methods: Public Instagram posts were isolated and evaluated using the hashtags "#spinetrauma," "#spinefracture," "#spinetraumasurgeries," "#spinalcordinjuryrecovery," "#spinetraumasurvivor," and "#spinalcordinjury." The authors analyzed the top 1,000 posts for the variables: account type, languages, geographical distribution, content analysis, and audience engagement. In total, 345 posts were included for analysis using SPSS (version 26).

Results: Of the 345 Instagram posts and reels (Ps and Rs) that met our eligibility requirements, 183 (53%) were written in English. Surgeons' and physicians' accounts contributed 210 Ps/Rs (60.8%), while patients' accounts amounted to 63 Ps/Rs (18.3%). Out of 263 Ps/Rs with a known country of origin, the United States had the highest number with 56 Ps/Rs (16.2%). Content analysis revealed 114 Ps/Rs (33%) focused on pathology and 118 Ps/Rs (34.2%) posted radiological images. Regarding audience engagement, the survivor stories had the highest mean likes and comments per post, 126.5 ( p  = 0.107) and 8.7 ( p  = 0.018), respectively. It was followed by pathology-related content (mean likes/posts: 117.4 [ p  = 0.015], mean comments/post: 6.9 [ p  = 0.003]).

Conclusion: Reported traumatic spine injury-related content has not been evaluated through social media avenues. This analysis demonstrates the leading role of surgeons in posting and educating the audience regarding traumatic spine injury, with the highest audience interest in survivor stories and pathologies. Our findings advance our knowledge of how social media portrays spine trauma, highlighting opportunities for future research and emphasizing the need for careful consideration of ethical and methodological challenges in social media studies related to medicine.

Introduction: The accurate identification of predictors of mortality is of utmost importance in risk stratification, as it empowers health care teams to efficiently allocate resources and interventions to patients who are at a higher risk. Our objective was to investigate the factors linked to in-hospital mortality in patients who have suffered a traumatic brain injury (TBI).

Materials and methods: This study employed a retrospective design, utilizing data from the National Trauma Registry of Iran spanning September 17, 2016, to July 31, 2022. The study included TBI patients admitted to participating hospitals with a hospital stay exceeding 24 hours, those who died during hospitalization, or those transferred from other facilities. TBI cases were identified using specific International Classification of Diseases, Tenth Revision codes. The study incorporated various variables, including baseline characteristics such as age (categorized into pediatric, adult, and geriatric groups), gender, trauma mechanism, and mode of transportation. Clinical characteristics considered included the Glasgow coma scale (GCS), injury severity score (ISS), types of injuries sustained, interventions performed, and vital signs. The primary outcome was mortality following hospital admission.

Results: The study included 874 patients, and the observed mortality rate was 12.2%. Road traffic crashes were identified as the leading cause of TBI, accounting for 72.5% of the cases. Utilizing multiple logistic regression analysis, the study confirmed that older age, severe GCS score, tracheostomy, and abnormal oxygen saturation were significant predictors of mortality.

Conclusion: The findings of this study demonstrate that older age, lower GCS scores (severe TBI), tracheostomy, and abnormal oxygen saturation are significant predictors of mortality in patients with TBI. These results emphasize the significance of incorporating age, neurological status, and respiratory function into the assessment of prognosis and mortality risk in TBI patients. By considering these factors, health care professionals can better evaluate the potential outcomes and allocate appropriate care for TBI patients.

Spinal extradural angiolipomas (SEALs) are rare, benign neoplasms composed of mature adipocytes and vascular elements. They are often noninfiltrating and located in the posterior aspect of the spinal canal at the level of thoracic/dorsal vertebrae. Back pain, progressive paraparesis, and sensory disturbance in lower limbs are the typical symptoms. Here, we discuss two cases of SEALs presenting with subacute paraparesis. The magnetic resonance imaging of one patient was reported to be suggestive of spinal metastasis/plasmacytoma/sarcoma, while the other was reported as a spinal extradural hematoma. After laminectomy, both lesions were recognized as encapsulated extradural tumors and en-bloc resection was done. Postoperatively, the neurological deficits improved and there was no recurrence on 2-year follow-up. Histopathology characterized both of them to be extradural angiolipomas. Current experience and literature support curative surgical resection as the gold standard. The prognosis is excellent in most cases, even if total resection is not feasible. It is due to the slow-growing nature of the tumor and absence of malignant transformation.

Anterior clinoid process metastases are rare. We present an unusual case of anterior clinoid process metastasis with sudden deterioration of visual function requiring emergency optic nerve decompression, resulting in recovery of visual function. The patient was a 41-year-old man with a diagnosis of leiomyosarcoma of the radius, operated on in 2014, with bone and lung metastases, who had been treated with chemotherapy and appeared to have stable disease at his last follow-up. Six years later, he developed a 1-month history of progressive unilateral loss of visual acuity and visual field defect (initially quadrantanopia that progressed to nasal hemianopia). Brain imaging showed a contrast-enhancing lesion affecting the left anterior clinoid process with extension to the cavernous sinus and sphenoid sinus, causing compression of the left optic nerve. Although the lesion could have suggested a meningioma given the location, in the context of the patient's oncological history, the diagnosis of metastasis was considered more likely. The patient was admitted to the hospital and, during the hospital stay, developed sudden left retro-orbital pain progressing to left amaurosis over approximately 8 hours. Urgent surgery was performed: a pterional craniotomy with partial tumor removal and optic nerve decompression with extradural anterior clinoidectomy. After surgery, the patient had an immediate but partial improvement in visual acuity and in the visual field defect. Metastasis to the anterior clinoid process is very uncommon, with only one case previously reported in the literature. In cases of visual impairment, symptoms may deteriorate rapidly to complete loss of vision, so urgent decompressive surgery of the optic pathway may be indicated to recover visual function, although recovery may be partial.

Background: Ischemic stroke occurring during sleep has been known as wake-up stroke, and many studies have been conducted on the subject. On the other hand, there have only been a few studies on spontaneous intracerebral hemorrhage (ICH) occurring during sleep. To clarify their clinical characteristics and possible risk factors, a single-center retrospective study was conducted on nontraumatic ICH patients admitted to our institution between 2012 and 2017.

Materials and methods: Demographics and outcomes were compared between 119 patients with ICH occurring during sleep (sleep group) and 401 patients with ICH occurring during the awake period (awake group). Multivariate regression analysis was conducted to identify risk factors. Furthermore, clinical presentation in those 119 patients was further classified into three categories (deficits, sudden headache, and failure to wake up), and their association to the outcomes was evaluated.

Results: Compared with the awake group, the frequency of chronic kidney disease (CKD) and diabetes mellitus were significantly higher in the sleep group. Multivariate regression analysis identified CKD as a risk factor for ICH occurring during sleep. The in-hospital mortality rate was significantly higher in the sleep group. Among the three classifications, failure to wake up was indicative of high mortality rate.

>conclusion: The current results that ICH occurring during sleep was indicative of worse outcomes is compatible with prior studies. Poorly controlled nocturnal hypertension in patients with CKD and diabetes mellitus may be responsible for the higher incidence of ICH occurring sleep in those populations. The three classifications according to clinical presentation may be useful as a prognosticator.

An arachnoid cyst is mostly congenital CSF-filled space occurring in the brain and spine. In the spine, they are usually found in the posterior aspect. Anterior cervical arachnoid cyst is very uncommon. A 14-year-old adolescent boy presented with rapidly progressive quadriparesis starting with the left lower limb, which is associated with radiating pain and numbness in both upper extremities. There was no sensory deficit, and the bladder and the bowel were normal. The radiological evaluation with contrast-enhanced MRI was suggestive of an anterior cervical intradural arachnoid cyst, for which the patient underwent surgery with wide fenestration and partial removal of the cyst wall, and the cyst wall was sent for histopathological examination. The patient improved postoperatively without any residual deficit. Anterior cervical arachnid cyst is a very rare lesion and should be considered in children and young adults who presented with neck pain or radiculopathy, especially if they are followed by motor weakness.

The aim of this study was to demonstrate that anteriorly placed transforaminal lumbar interbody fusion (TLIF) footprint bullet cage is a safe and effective bailout option if difficult left common iliac vein (LCIV) anatomy is unexpectedly encountered during the L5-S1 lateral anterior lumbar interbody fusion (L-ALIF). This retrospective case series includes four patients who received anteriorly placed TLIF cages at L5-S1 during L-ALIF surgery. Demographics, complications, and clinical/radiographic results were collected. The analysis included four female patients with a mean age of 59.0 years and mean body mass index (BMI) of 23.9. Three patients had degenerative conditions and one patient had a deformity. All the patients had an LCIV obstructing the center of the L5-S1 disk space, and titanium TLIF bullet cages were placed and secured with washers and screws. The L5-S1 segmental lordosis increased by 8.3 ± 6.1 degrees with a final mean lordosis of 23.5 ± 8.4 degrees; the L5-S1 intradiskal angle increased by 12.0 ± 7.0 degrees with a final mean disk angle of 18.8 ± 7.0 degrees; the posterior disk height increased by 4.4 ± 2.7 mm with a final mean disk height of 8.0 ± 2.1 mm. The mean numerical rating scale (NRS) for back pain improved by 5.3 ± 2.5 and the mean NRS leg pain improved by 7.7 ± 2.5 over a mean follow-up of 14 months (range: 6-20). There have been no perioperative complications or implant failure to date. If challenging vascular anatomy is encountered during L-ALIF exposure that prevents ALIF footprint cage placement, proceeding with smaller TLIF bullet cage placement anteriorly rather than abandoning the surgical approach is a safe and effective option.

Flow diverter (FD) is often the first-line treatment for giant internal carotid artery aneurysms, with a high rate of aneurysm occlusion. However, up to 10% of giant cerebral aneurysms increase in size after FD treatment. Surgery is usually considered if the giant internal carotid artery aneurysm continues to enlarge and cause compression. We report a case of a giant internal carotid artery aneurysm that continued to increase in size after FD treatment and was subsequently treated surgically. We also review the literature on the management of giant cerebral aneurysms that increased in size after FD. A 41-year-old female patient was diagnosed with a right giant internal carotid artery aneurysm and was initially treated with FD. After FD, the patient's vision in the right eye did not improve. Despite medical treatment, her vision continued to deteriorate. The patient presented at our hospital with reduced vision in both eyes. Magnetic resonance imaging and digital subtraction angiography with balloon test occlusion confirmed the presence of a giant thrombosed aneurysm in the right internal carotid artery, compressing the right optic nerve and optic chiasm. The patient underwent external carotid artery-middle cerebral artery bypass surgery using a radial artery graft, aneurysm sac dissection with thrombus removal, and reconstructive clipping of the aneurysm neck. After surgery, the patient's vision in both eyes improved immediately and did not develop any new neurological symptoms. Extracranial-intracranial arterial reconstructive surgery is a viable option for treating giant internal carotid artery aneurysms that have undergone FD treatment but continue to present with progressive mass effects.

Objectives  This article evaluates the outcomes and efficacy of detachable balloon embolization by single balloon delivery catheter, while identifying factors associated with successful embolization in traumatic carotid cavernous fistula (TCCF) patients. Materials and Methods  We retrospectively collected data of TCCF patients who underwent detachable balloon embolization during March 2020 to April 2024. All cases utilized a single balloon delivery catheter for detachable balloon deployment (GOLDBAL, BALT Extrusion, France). We analyzed demographic, clinical, imaging, and angiographic data, including outcomes, complications, and factors associated with successful embolization. Results  Thirty patients were treated with detachable balloon embolization. The mean age of the patients was 41.1 years (range 17-65 years). The median duration of symptom was 2.0 months (range 0.25-60 months). The most common mechanism of injury is motorcycle accident (83.3%). Nearly all patients had eye redness and proptosis. Angiographic data indicated 29 patients (96.7%) had drainage to the inferior petrosal sinus, 28 (93.3%) had drainage to the superior ophthalmic vein, and 8 (26.7%) had drainage to the superior petrosal sinus. Five cases (16.7%) were classified as small-sized fistula, 19 (63.3%) as medium-sized, and 6 (20%) as large-sized. Regarding the location of the fistula, 8 cases (26.7%) were found in the horizontal segment, while 22 cases (73.3%) were located in the ascending or genu segment of the cavernous internal carotid artery (ICA). Among the 24 patients (80%) who underwent successful embolization, the ICA was preserved in 23 out of 24 patients (95.8%). The remaining patient had ICA occlusion but exhibited no clinical symptoms. Residual cavernous aneurysm was found in two patients, one patient had persistent cranial nerve deficit, while the other was asymptomatic. Statistical analysis demonstrated a significant difference was associated with the fistula location at the ascending or genu segment of the cavernous ICA in relation to successful embolization Conclusion  Despite the availability of several endovascular treatment options for TCCF, using detachable balloon embolization is a relatively straightforward procedure. When combined with a thorough understanding of cavernous sinus anatomy, this approach can significantly enhance the occlusion rate and preserve ICA patency while minimizing complications, particularly when the fistula is located at the ascending or genu segment of the cavernous ICA.