Pub Date : 2023-11-30eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1776299
Debajyoti Datta, Debarshi Chatterjee, Mona Tiwari
Posterior fossa tumors are one of the most common tumors occurring in children. These tumors are often operated in the Concorde or prone position. Venous congestion can occur due to neck flexion during the positioning causing macroglossia. We report a case of a lingual abscess in a child after surgery in the Concorde position. There was no preoperative evidence of any lingual and dental complaints or injury during intubation. We hypothesize that the lingual abscess in the immediate postoperative period was secondary to venous stasis during the positioning for surgery.
{"title":"Lingual Abscess after Posterior Fossa Surgery: An Unusual Complication of the Concorde Position.","authors":"Debajyoti Datta, Debarshi Chatterjee, Mona Tiwari","doi":"10.1055/s-0043-1776299","DOIUrl":"10.1055/s-0043-1776299","url":null,"abstract":"<p><p>Posterior fossa tumors are one of the most common tumors occurring in children. These tumors are often operated in the Concorde or prone position. Venous congestion can occur due to neck flexion during the positioning causing macroglossia. We report a case of a lingual abscess in a child after surgery in the Concorde position. There was no preoperative evidence of any lingual and dental complaints or injury during intubation. We hypothesize that the lingual abscess in the immediate postoperative period was secondary to venous stasis during the positioning for surgery.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"18 4","pages":"810-812"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10756768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072526","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}
Joaquim Francisco Cavalcante-Neto, Gabriel de Almeida Monteiro, Ariane Butke Brandt, Giovanna Esmeraldo Paz Soares, Davi Jorge Fontoura Solla, Paulo Roberto Lacerda Leal, Gerardo Cristino-Filho, Keven Ferreira da Ponte
Abstract Background Middle cerebral artery (MCA) anomalies are a rare finding and may be associated with vascular changes, such as intracranial aneurysms. Among them, the rete MCA aneurysm is very rare, with only 22 cases reported to date. Case Description A 50-year-old woman presented with subarachnoid, intraventricular, and intracerebral hemorrhage secondary to a ruptured aneurysm of rete MCA from an anomalous collateral artery of the anterior cerebral artery, treated successfully by microsurgical clipping. She presented a good recovery after a 2-year follow-up. Conclusion A systematic review of rete MCA aneurysms is presented, comparing aneurysms originating from twig-like MCA, with 16 reports, and twig-like networks of an anomalous collateral artery, with 6 reports including ours. Several factors influence the treatment decision-making, though microsurgical clipping is the main procedure. A wider use of coiling is requested for a better comparison of the treatment approaches.
{"title":"Rete Middle Cerebral Artery Aneurysm: A Case Report and Systematic Review","authors":"Joaquim Francisco Cavalcante-Neto, Gabriel de Almeida Monteiro, Ariane Butke Brandt, Giovanna Esmeraldo Paz Soares, Davi Jorge Fontoura Solla, Paulo Roberto Lacerda Leal, Gerardo Cristino-Filho, Keven Ferreira da Ponte","doi":"10.1055/s-0043-1775732","DOIUrl":"https://doi.org/10.1055/s-0043-1775732","url":null,"abstract":"Abstract Background Middle cerebral artery (MCA) anomalies are a rare finding and may be associated with vascular changes, such as intracranial aneurysms. Among them, the rete MCA aneurysm is very rare, with only 22 cases reported to date. Case Description A 50-year-old woman presented with subarachnoid, intraventricular, and intracerebral hemorrhage secondary to a ruptured aneurysm of rete MCA from an anomalous collateral artery of the anterior cerebral artery, treated successfully by microsurgical clipping. She presented a good recovery after a 2-year follow-up. Conclusion A systematic review of rete MCA aneurysms is presented, comparing aneurysms originating from twig-like MCA, with 16 reports, and twig-like networks of an anomalous collateral artery, with 6 reports including ours. Several factors influence the treatment decision-making, though microsurgical clipping is the main procedure. A wider use of coiling is requested for a better comparison of the treatment approaches.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract In neuroendovascular treatment, there are many opportunities to guide multiple catheters into the intracranial blood vessels. We report the relationship between two microcatheters according to the guiding order with experimental in vitro studies. We hypothesize that in a bent blood vessel such as a paraclinoid region of the internal carotid artery, the catheter that was first guided tended to pass through the inside, and the catheter that was guided later tended to pass through the outside. The in vitro verification was performed using a microcatheter and a balloon catheter in a silicone vascular aneurysmal model. As a result, it was found that the two catheters were arranged according to our hypothesis. This finding was also observed during the actual operation of balloon-assisted coil embolization. The positional relationship between the two catheters according to the navigation order is very important, in particular during balloon-assisted coiling and stent-assisted coiling via a jailed microcatheter.
{"title":"Positional Relationship between Two Microcatheters according to the Navigation Sequence within the Curved Vessel in Neuroendovascular Procedures","authors":"Tomotaka Ohshima, Shigeru Miyachi","doi":"10.1055/s-0043-1775586","DOIUrl":"https://doi.org/10.1055/s-0043-1775586","url":null,"abstract":"Abstract In neuroendovascular treatment, there are many opportunities to guide multiple catheters into the intracranial blood vessels. We report the relationship between two microcatheters according to the guiding order with experimental in vitro studies. We hypothesize that in a bent blood vessel such as a paraclinoid region of the internal carotid artery, the catheter that was first guided tended to pass through the inside, and the catheter that was guided later tended to pass through the outside. The in vitro verification was performed using a microcatheter and a balloon catheter in a silicone vascular aneurysmal model. As a result, it was found that the two catheters were arranged according to our hypothesis. This finding was also observed during the actual operation of balloon-assisted coil embolization. The positional relationship between the two catheters according to the navigation order is very important, in particular during balloon-assisted coiling and stent-assisted coiling via a jailed microcatheter.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"24 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract An 86-year-old woman with initially asymptomatic severe right common carotid artery stenosis had frequent transient left hemiparesis 2 years after the initial diagnosis. Magnetic resonance angiography and three-dimensional computed tomography angiography demonstrated short-segment occlusion of the right carotid bifurcation with significant circumferential calcification, while magnetic resonance imaging demonstrated no ischemic lesions. No collateral blood flow through the anterior communicating artery and posterior communicating artery was observed. A bridging bypass from the distal common carotid artery to the proximal cervical internal carotid artery using a saphenous vein graft was made. There were no ischemic symptoms following the procedure. Bridging bypass using the short saphenous vein graft might be useful for short-segment common carotid artery occlusion.
{"title":"A Case of Symptomatic Common Carotid Artery Occlusion Treated by a Bridging Bypass Using Short Saphenous Vein Graft","authors":"Rikiyoshi Yamamoto, Tomohiro Iida, Naoki Oka, Jouji Kokuzawa, Yasuhiko Kaku","doi":"10.1055/s-0043-1775587","DOIUrl":"https://doi.org/10.1055/s-0043-1775587","url":null,"abstract":"Abstract An 86-year-old woman with initially asymptomatic severe right common carotid artery stenosis had frequent transient left hemiparesis 2 years after the initial diagnosis. Magnetic resonance angiography and three-dimensional computed tomography angiography demonstrated short-segment occlusion of the right carotid bifurcation with significant circumferential calcification, while magnetic resonance imaging demonstrated no ischemic lesions. No collateral blood flow through the anterior communicating artery and posterior communicating artery was observed. A bridging bypass from the distal common carotid artery to the proximal cervical internal carotid artery using a saphenous vein graft was made. There were no ischemic symptoms following the procedure. Bridging bypass using the short saphenous vein graft might be useful for short-segment common carotid artery occlusion.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"22 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ronak R. Ankolekar, Kirandeep Kaur, Kiran Jangra, Ashish Aggarwal, Nidhi B. Panda, Hemant Bhagat, Amiya K. Barik
Abstract Objectives The choice of inhalational or intravenous anesthetic agents is debatable in neurosurgical patients. Desflurane, a cerebral vasodilator, may be advantageous in ischemic cerebral pathologies. Hence, we planned to compare desflurane and propofol in patients with moyamoya disease (MMD) with the objective of comparing neurological outcomes. Materials and Methods This prospective pilot trial was initiated after institutional ethics committee approval. Patients with MMD undergoing revascularization surgery were randomized into two groups receiving either desflurane or propofol intraoperatively. Neurological outcomes were assessed using a modified Rankin score (mRS) at discharge and an extended Glasgow outcome score (GOS-E) at 1 month. Intraoperative parameters, including hemodynamic parameters, end-tidal carbon dioxide, entropy, intraoperative brain relaxation scores (BRS), and rescue measures for brain relaxation, were compared. Statistical Analysis The normality of quantitative data was checked using Kolmogorov–Smirnov tests of normality. Normally distributed data were compared using unpaired t-tests, skewed data using Mann–Whitney U tests, and categorical variables using chi-squared tests. Results A total of 17 patients were randomized, 10 in the desflurane and 7 in the propofol group. mRS (1.3 ± 0.6 and 1.14 ± 0.4, p = 0.450) and GOS-E (6.7 ± 0.6 and 6.85 ± 0.5, p = 0.45) were comparable between desflurane and propofol groups, respectively. BRS was significantly higher in the desflurane group (3.6 ± 0.5) compared to the propofol group (2.1 ± 0.3, p = 0.001), with a significant number of patients requiring rescue measures in the desflurane group (70%, p < 0.001). Other outcome parameters were comparable (p > 0.05). Conclusion We conclude that postoperative neurological outcomes were comparable with using either an anesthetic agent, desflurane, or propofol in MMD patients undergoing revascularization surgery. Maintenance of anesthesia with propofol had significantly superior surgical field conditions.
{"title":"Propofol versus Desflurane in Moyamoya Disease Patients—A Pilot Study","authors":"Ronak R. Ankolekar, Kirandeep Kaur, Kiran Jangra, Ashish Aggarwal, Nidhi B. Panda, Hemant Bhagat, Amiya K. Barik","doi":"10.1055/s-0043-1775588","DOIUrl":"https://doi.org/10.1055/s-0043-1775588","url":null,"abstract":"Abstract Objectives The choice of inhalational or intravenous anesthetic agents is debatable in neurosurgical patients. Desflurane, a cerebral vasodilator, may be advantageous in ischemic cerebral pathologies. Hence, we planned to compare desflurane and propofol in patients with moyamoya disease (MMD) with the objective of comparing neurological outcomes. Materials and Methods This prospective pilot trial was initiated after institutional ethics committee approval. Patients with MMD undergoing revascularization surgery were randomized into two groups receiving either desflurane or propofol intraoperatively. Neurological outcomes were assessed using a modified Rankin score (mRS) at discharge and an extended Glasgow outcome score (GOS-E) at 1 month. Intraoperative parameters, including hemodynamic parameters, end-tidal carbon dioxide, entropy, intraoperative brain relaxation scores (BRS), and rescue measures for brain relaxation, were compared. Statistical Analysis The normality of quantitative data was checked using Kolmogorov–Smirnov tests of normality. Normally distributed data were compared using unpaired t-tests, skewed data using Mann–Whitney U tests, and categorical variables using chi-squared tests. Results A total of 17 patients were randomized, 10 in the desflurane and 7 in the propofol group. mRS (1.3 ± 0.6 and 1.14 ± 0.4, p = 0.450) and GOS-E (6.7 ± 0.6 and 6.85 ± 0.5, p = 0.45) were comparable between desflurane and propofol groups, respectively. BRS was significantly higher in the desflurane group (3.6 ± 0.5) compared to the propofol group (2.1 ± 0.3, p = 0.001), with a significant number of patients requiring rescue measures in the desflurane group (70%, p < 0.001). Other outcome parameters were comparable (p > 0.05). Conclusion We conclude that postoperative neurological outcomes were comparable with using either an anesthetic agent, desflurane, or propofol in MMD patients undergoing revascularization surgery. Maintenance of anesthesia with propofol had significantly superior surgical field conditions.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"24 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Cerebral cavernous malformation is an angiographically occult, well-circumscribed, benign hamartoma consisting of thin-walled sinusoidal vascular channels. Intracranial mucormycosis represents one of the most severe manifestations of mucor infection. We, hereby, report a case of cavernous malformation made rarer with concomitant mucormycosis. A 22-year-old female presented with left-sided facial seizures since age of 7 years and headache for the past 3 years. Magnetic resonance imaging brain revealed a right posterior frontal lobe cavernous malformation. Right frontal craniotomy with excision of cavernoma was done. Gross examination showed a solid cystic mass with multiple mulberry protrusions. Histopathological examination revealed features of cavernous malformation with evidence of mucormycosis. A final diagnosis of cavernous malformation with mucormycosis was rendered and microbiological studies were advised. To the best of our knowledge, this is the first case report of a cerebral cavernous malformation with mucormycosis in an immunocompetent patient without any risk factor.
{"title":"Intracranial Cavernous Malformation with Concomitant Isolated Cerebral Mucormycosis Infection: A Case Report","authors":"Pratishtha Sengar, Nityanand Pandey, Vikas Kailashiya, Varun Kumar Singh","doi":"10.1055/s-0043-1772765","DOIUrl":"https://doi.org/10.1055/s-0043-1772765","url":null,"abstract":"Abstract Cerebral cavernous malformation is an angiographically occult, well-circumscribed, benign hamartoma consisting of thin-walled sinusoidal vascular channels. Intracranial mucormycosis represents one of the most severe manifestations of mucor infection. We, hereby, report a case of cavernous malformation made rarer with concomitant mucormycosis. A 22-year-old female presented with left-sided facial seizures since age of 7 years and headache for the past 3 years. Magnetic resonance imaging brain revealed a right posterior frontal lobe cavernous malformation. Right frontal craniotomy with excision of cavernoma was done. Gross examination showed a solid cystic mass with multiple mulberry protrusions. Histopathological examination revealed features of cavernous malformation with evidence of mucormycosis. A final diagnosis of cavernous malformation with mucormycosis was rendered and microbiological studies were advised. To the best of our knowledge, this is the first case report of a cerebral cavernous malformation with mucormycosis in an immunocompetent patient without any risk factor.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"21 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Adrenaline-soaked wicks are often employed to decongest nasal mucosa during transsphenoidal pituitary surgeries to ensure proper hemostasis and visibility of the operating field. Considerable debate exists regarding the optimum concentration of adrenaline that strikes a balance between hemostasis as well as the hemodynamic side effects of adrenaline. This study assessed cardiac indices like cardiac output and cardiac index using a FloTrac Vigileo cardiac output monitor to compare two different concentrations of adrenaline used for topical instillation. Methods and Materials 60 adult patients undergoing transsphenoidal pituitary surgery were randomly assigned to receive cotton wicks soaked in adrenaline solution (either 1:100,000 or 1:200,000) for nasal decongestion. Following a standardized anesthetic regime, a FloTrac Vigileo cardiac output monitor was attached with the invasive arterial line for precise monitoring and recording of cardiac indices (cardiac output and cardiac index). Additionally, quality of surgical field (as reported by the operating surgeon) blood loss, incidences of adverse hemodynamic events, and rescue drug usage were recorded. Results No difference in cardiac outputs and cardiac indexes of the patients was observed during baseline to 55 minutes and at 80 minutes and onward, whereas difference rose to statistical significance at the time points of 60 minutes and 70 minutes (p < 0.05). Other parameters like stroke volume, stroke volume variation, and hemodynamic parameters were similar. Quality of the surgical fields (as reported by the surgeon), intraoperative bleeding, incidences of adverse effects, and frequency of rescue drugs usage were similar. Conclusion Instillation of 1:100,000 dilution of adrenaline solution compared with 1:200,000 for nasal decongestion is associated with significant rise in cardiac output and cardiac index at 60 and 70 minutes of the surgery with similar blood loss and hemodynamic variables. Therefore, the lower concentration of adrenaline can be recommended for usage during transsphenoidal pituitary surgeries.
{"title":"Comparison of Cardiac Indices Using Two Different Concentrations of Topical Adrenaline during Endoscopic Transsphenoidal Pituitary Surgery: A Prospective Randomized Observational Study","authors":"Archana Gautam, Rudrashish Haldar, Shashi Srivastava, Devendra Gupta, Awadhesh Kumar Jaiswal, Prabhaker Mishra","doi":"10.1055/s-0043-1775585","DOIUrl":"https://doi.org/10.1055/s-0043-1775585","url":null,"abstract":"Abstract Introduction Adrenaline-soaked wicks are often employed to decongest nasal mucosa during transsphenoidal pituitary surgeries to ensure proper hemostasis and visibility of the operating field. Considerable debate exists regarding the optimum concentration of adrenaline that strikes a balance between hemostasis as well as the hemodynamic side effects of adrenaline. This study assessed cardiac indices like cardiac output and cardiac index using a FloTrac Vigileo cardiac output monitor to compare two different concentrations of adrenaline used for topical instillation. Methods and Materials 60 adult patients undergoing transsphenoidal pituitary surgery were randomly assigned to receive cotton wicks soaked in adrenaline solution (either 1:100,000 or 1:200,000) for nasal decongestion. Following a standardized anesthetic regime, a FloTrac Vigileo cardiac output monitor was attached with the invasive arterial line for precise monitoring and recording of cardiac indices (cardiac output and cardiac index). Additionally, quality of surgical field (as reported by the operating surgeon) blood loss, incidences of adverse hemodynamic events, and rescue drug usage were recorded. Results No difference in cardiac outputs and cardiac indexes of the patients was observed during baseline to 55 minutes and at 80 minutes and onward, whereas difference rose to statistical significance at the time points of 60 minutes and 70 minutes (p < 0.05). Other parameters like stroke volume, stroke volume variation, and hemodynamic parameters were similar. Quality of the surgical fields (as reported by the surgeon), intraoperative bleeding, incidences of adverse effects, and frequency of rescue drugs usage were similar. Conclusion Instillation of 1:100,000 dilution of adrenaline solution compared with 1:200,000 for nasal decongestion is associated with significant rise in cardiac output and cardiac index at 60 and 70 minutes of the surgery with similar blood loss and hemodynamic variables. Therefore, the lower concentration of adrenaline can be recommended for usage during transsphenoidal pituitary surgeries.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"24 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Objective This study aimed to examine potential risk factors associated with cerebrospinal fluid overdrainage after ventriculoperitoneal (VP) shunting. Materials and Methods We retrospectively examined the medical records of hydrocephalus patients who underwent VP shunting at a single institution between January 2011 and December 2017 and had a minimum 3-year follow-up. Variables studied included age, gender, hydrocephalus etiology, symptoms, shunt valve, ventricular catheter entry point, and neurosurgical history, including history of external ventricular drainage. Radiographic variables included Evans index, bicaudate index, callosal angle, measurements of frontal lobe thickness, and bifrontal–parietal ratio. Results Among the 182 study patients, 11 experienced overdrainage. Age, gender, etiology, symptoms, and surgical history did not significantly differ between patients who experienced overdrainage and those who did not. Evans index, bicaudate index, and callosal angle did not significantly differ between the groups. Measurements of frontal lobe thickness and bifrontal–-parietal ratio were significantly lower in the overdrainage group. Conclusion Bifrontal–parietal ratio may be useful to predict overdrainage after VP shunt surgery.
{"title":"Bifrontal–Parietal Ratio: A Novel Risk Factor for Cerebrospinal Fluid Overdrainage after Ventriculoperitoneal Shunting","authors":"Chonnawee Chaisawasthomrong, Kriangsak Saetia","doi":"10.1055/s-0043-1775729","DOIUrl":"https://doi.org/10.1055/s-0043-1775729","url":null,"abstract":"Abstract Objective This study aimed to examine potential risk factors associated with cerebrospinal fluid overdrainage after ventriculoperitoneal (VP) shunting. Materials and Methods We retrospectively examined the medical records of hydrocephalus patients who underwent VP shunting at a single institution between January 2011 and December 2017 and had a minimum 3-year follow-up. Variables studied included age, gender, hydrocephalus etiology, symptoms, shunt valve, ventricular catheter entry point, and neurosurgical history, including history of external ventricular drainage. Radiographic variables included Evans index, bicaudate index, callosal angle, measurements of frontal lobe thickness, and bifrontal–parietal ratio. Results Among the 182 study patients, 11 experienced overdrainage. Age, gender, etiology, symptoms, and surgical history did not significantly differ between patients who experienced overdrainage and those who did not. Evans index, bicaudate index, and callosal angle did not significantly differ between the groups. Measurements of frontal lobe thickness and bifrontal–-parietal ratio were significantly lower in the overdrainage group. Conclusion Bifrontal–parietal ratio may be useful to predict overdrainage after VP shunt surgery.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"23 s1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ira Agrawal, Shahina Bano, Ajay Chaudhary, Arvind Ahuja
Abstract Purpose The aim of this study was to evaluate the role of permeability surface area product in grading brain gliomas using computed tomography (CT) perfusion Materials and Methods CT perfusion was performed on 33 patients with brain glioma diagnosed on magnetic resonance imaging. Of these, 19 had high-grade glioma and 14 had low-grade glioma on histopathological follow-up. CT perfusion values were obtained and first compared between the tumor region and normal brain parenchyma. Then the relative values of perfusion parameters were compared between high- and low-grade gliomas. Cut-off values, sensitivity, specificity, and strength of agreement for each parameter were calculated and compared subsequently. A conjoint factor (permeability surface area product + cerebral blood volume) was also evaluated since permeability surface area product and cerebral blood volume are considered complimentary factors for tumor vascularity. Results All five perfusion parameters namely permeability surface area product, cerebral blood volume, cerebral blood flow, mean transit time, and time to peak were found significantly higher in the tumor region than normal brain parenchyma. Among these perfusion parameters, only relative permeability surface area product and relative cerebral blood volume were found significant in differentiating high- and low-grade glioma. Moreover, relative permeability surface area product was significantly better than all other perfusion parameters with highest sensitivity and specificity (97.74 and 100%, respectively, at a cut-off of 9.0065). Relative permeability surface area product had a very good agreement with the histopathology grade. The conjoint factor did not yield any significant diagnostic advantage over permeability surface area product. Conclusion Relative permeability surface area product and relative cerebral blood volume were helpful in differentiating high- and low-grade glioma; however, relative permeability surface area product was significantly better than all other perfusion parameters. Grading brain gliomas using relative permeability surface area product can add crucial value in their management and prognostication; hence, it should be evaluated in the routine CT perfusion imaging protocol.
{"title":"Role of Permeability Surface Area Product in Grading of Brain Gliomas using CT Perfusion","authors":"Ira Agrawal, Shahina Bano, Ajay Chaudhary, Arvind Ahuja","doi":"10.1055/s-0043-1774820","DOIUrl":"https://doi.org/10.1055/s-0043-1774820","url":null,"abstract":"Abstract Purpose The aim of this study was to evaluate the role of permeability surface area product in grading brain gliomas using computed tomography (CT) perfusion Materials and Methods CT perfusion was performed on 33 patients with brain glioma diagnosed on magnetic resonance imaging. Of these, 19 had high-grade glioma and 14 had low-grade glioma on histopathological follow-up. CT perfusion values were obtained and first compared between the tumor region and normal brain parenchyma. Then the relative values of perfusion parameters were compared between high- and low-grade gliomas. Cut-off values, sensitivity, specificity, and strength of agreement for each parameter were calculated and compared subsequently. A conjoint factor (permeability surface area product + cerebral blood volume) was also evaluated since permeability surface area product and cerebral blood volume are considered complimentary factors for tumor vascularity. Results All five perfusion parameters namely permeability surface area product, cerebral blood volume, cerebral blood flow, mean transit time, and time to peak were found significantly higher in the tumor region than normal brain parenchyma. Among these perfusion parameters, only relative permeability surface area product and relative cerebral blood volume were found significant in differentiating high- and low-grade glioma. Moreover, relative permeability surface area product was significantly better than all other perfusion parameters with highest sensitivity and specificity (97.74 and 100%, respectively, at a cut-off of 9.0065). Relative permeability surface area product had a very good agreement with the histopathology grade. The conjoint factor did not yield any significant diagnostic advantage over permeability surface area product. Conclusion Relative permeability surface area product and relative cerebral blood volume were helpful in differentiating high- and low-grade glioma; however, relative permeability surface area product was significantly better than all other perfusion parameters. Grading brain gliomas using relative permeability surface area product can add crucial value in their management and prognostication; hence, it should be evaluated in the routine CT perfusion imaging protocol.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Posterior fossa localization of a hydatid cyst is uncommon; in these cases, the cyst usually locates in the cerebellum. Localization within the subarachnoid spaces or the cerebrospinal fluid ventricular system is exceptional. In the present report, which appears to be the seventh in the literature, we describe two cases of a hydatid cyst in the cerebellopontine cistern. Magnetic resonance imaging findings revealed a nonneoplastic cystic lesion mimicking an arachnoid cyst. The hydatid nature of the cyst was unexpected preoperatively. In both cases, the cyst was successfully removed using the puncture, aspiration, irrigation, and resection technique via a retrosigmoid approach. Histopathological examination confirmed the cysts to be Echinococcus granulosus in nature. Hydatid cyst may be considered in the differential diagnosis of arachnoid cysts of the cerebellopontine cistern to determine which surgical procedure to perform and to avoid unexpected complications. Previous published cases were also discussed.
{"title":"Hydatid Cyst of the Cerebellopontine Cistern: Report of Two Cases with Literature Review","authors":"Hatim Belfquih, Ali Akhaddar","doi":"10.1055/s-0043-1775860","DOIUrl":"https://doi.org/10.1055/s-0043-1775860","url":null,"abstract":"Abstract Posterior fossa localization of a hydatid cyst is uncommon; in these cases, the cyst usually locates in the cerebellum. Localization within the subarachnoid spaces or the cerebrospinal fluid ventricular system is exceptional. In the present report, which appears to be the seventh in the literature, we describe two cases of a hydatid cyst in the cerebellopontine cistern. Magnetic resonance imaging findings revealed a nonneoplastic cystic lesion mimicking an arachnoid cyst. The hydatid nature of the cyst was unexpected preoperatively. In both cases, the cyst was successfully removed using the puncture, aspiration, irrigation, and resection technique via a retrosigmoid approach. Histopathological examination confirmed the cysts to be Echinococcus granulosus in nature. Hydatid cyst may be considered in the differential diagnosis of arachnoid cysts of the cerebellopontine cistern to determine which surgical procedure to perform and to avoid unexpected complications. Previous published cases were also discussed.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"11 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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