Abstract Objective Trigeminal neuralgia (TN) is a neurological disorder that often presents as severe toothache. The majority of TN patients visit dental clinics first, so TN represents a potential pitfall for dental practitioners. This report describes the development of a trigeminal neuralgia questionnaire (TNQ), assessing 10 characteristics of TN, to assist dentists in screening for TN in dental clinics, and evaluates the effectiveness of TNQ. Materials and Methods Fifty-three patients who visited the TN outpatient department in our institute and completed the TNQ were included in this study. All patients were examined by two neurosurgeons and neuroimaging was performed. Statistical Analysis Patients were classified into a TN group and a non-TN group. TNQ score was retrospectively compared between groups. Furthermore, history and characteristics of TN were investigated in the TN group to clarify the status of the reference situation. Results Thirty-seven cases were assigned to the TN group, and 16 cases to the non-TN group. Mean TNQ score was 8.3 in the TN group and 6.6 in the non-TN group. Setting a TNQ cutoff score of 7 offered 91% sensitivity and 56% specificity for TN. Investigation of the history of the present illness indicated that 39.2% of TN cases were improperly triaged and referred from initial dental clinics, and interdisciplinary practice was insufficient. Conclusion TNQ offers a reliable, convenient method to triage TN patients, and may assist dentists in screening for TN. Multidisciplinary practice is necessary for total management of TN and the TNQ is expected to connect dentists and TN specialists.
{"title":"Questionnaire for Dental Practitioners to Screen for Trigeminal Neuralgia","authors":"Fuminari Komatsu, Kento Sasaki, Riki Tanaka, Kyosuke Miyatani, Yasuhiro Yamada, Yoko Kato, Yuichi Hirose","doi":"10.1055/s-0043-1771368","DOIUrl":"https://doi.org/10.1055/s-0043-1771368","url":null,"abstract":"Abstract Objective Trigeminal neuralgia (TN) is a neurological disorder that often presents as severe toothache. The majority of TN patients visit dental clinics first, so TN represents a potential pitfall for dental practitioners. This report describes the development of a trigeminal neuralgia questionnaire (TNQ), assessing 10 characteristics of TN, to assist dentists in screening for TN in dental clinics, and evaluates the effectiveness of TNQ. Materials and Methods Fifty-three patients who visited the TN outpatient department in our institute and completed the TNQ were included in this study. All patients were examined by two neurosurgeons and neuroimaging was performed. Statistical Analysis Patients were classified into a TN group and a non-TN group. TNQ score was retrospectively compared between groups. Furthermore, history and characteristics of TN were investigated in the TN group to clarify the status of the reference situation. Results Thirty-seven cases were assigned to the TN group, and 16 cases to the non-TN group. Mean TNQ score was 8.3 in the TN group and 6.6 in the non-TN group. Setting a TNQ cutoff score of 7 offered 91% sensitivity and 56% specificity for TN. Investigation of the history of the present illness indicated that 39.2% of TN cases were improperly triaged and referred from initial dental clinics, and interdisciplinary practice was insufficient. Conclusion TNQ offers a reliable, convenient method to triage TN patients, and may assist dentists in screening for TN. Multidisciplinary practice is necessary for total management of TN and the TNQ is expected to connect dentists and TN specialists.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015302","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}
Darpanarayan Hazra, Gina Maryann Chandy, Amit Ghosh
Abstract Background Subthalamic deep brain stimulation (STN-DBS) for refractory Parkinson's disease (PD) is more of a modality of treatment that is empirical, for which a physiological explanation is being sought. This study was done to determine the outcome and complications of patients undergoing STN-DBS for PD. Methods This retrospective observational cohort study was conducted in an advanced neuromedicine facility in eastern India for 9 years (August 2013–August 2022), which included all patients undergoing STN-DBS. Results A total of 53 patients were operated on during the study period. The mean age group of the study population was 60.5 (standard deviation [SD]: 8.2) years with a male (33 [62.3%]) predominance. The most common presenting complaints included rigidity and hypokinesia (27), severe dyskinesia (21), and tremors (17). During the postoperative period, rigidity and hypokinesia (21), severe dyskinesia (16), and tremors (12) improved significantly in a subset of the patients. The majority (45 [84.9%]) of these cases received bilateral monopolar simulation, whereas three patients (5.7%) had bilateral bipolar stimulation. Unilateral bipolar stimulation was used in five (9.4%) patients. In the immediate postoperative period, they were initiated on limb, speech, and swallowing therapy as indicated. Surgery-related complications were seen in five (9.4%) cases. At 6 months of follow-up, a significant improvement in the Unified PD rating scale component (mainly motor examination and complication of PD therapy) was noted in the majority (36 [67.9%]) of patients. One patient developed neuroleptic malignant syndrome and succumbed to his illness on the fourth postoperative day. Conclusion Given these findings, STN-DBS appears to be a good, safe, and effective treatment for a subset of medically refractory PD with an overall improvement in two-thirds of the study cohort and less than 10% risk of complications.
{"title":"Subthalamic Deep Brain Stimulation in Parkinson's Disease: A Boon or Bane – A Single Centre Retrospective Observational Study from India","authors":"Darpanarayan Hazra, Gina Maryann Chandy, Amit Ghosh","doi":"10.1055/s-0043-1771318","DOIUrl":"https://doi.org/10.1055/s-0043-1771318","url":null,"abstract":"Abstract Background Subthalamic deep brain stimulation (STN-DBS) for refractory Parkinson's disease (PD) is more of a modality of treatment that is empirical, for which a physiological explanation is being sought. This study was done to determine the outcome and complications of patients undergoing STN-DBS for PD. Methods This retrospective observational cohort study was conducted in an advanced neuromedicine facility in eastern India for 9 years (August 2013–August 2022), which included all patients undergoing STN-DBS. Results A total of 53 patients were operated on during the study period. The mean age group of the study population was 60.5 (standard deviation [SD]: 8.2) years with a male (33 [62.3%]) predominance. The most common presenting complaints included rigidity and hypokinesia (27), severe dyskinesia (21), and tremors (17). During the postoperative period, rigidity and hypokinesia (21), severe dyskinesia (16), and tremors (12) improved significantly in a subset of the patients. The majority (45 [84.9%]) of these cases received bilateral monopolar simulation, whereas three patients (5.7%) had bilateral bipolar stimulation. Unilateral bipolar stimulation was used in five (9.4%) patients. In the immediate postoperative period, they were initiated on limb, speech, and swallowing therapy as indicated. Surgery-related complications were seen in five (9.4%) cases. At 6 months of follow-up, a significant improvement in the Unified PD rating scale component (mainly motor examination and complication of PD therapy) was noted in the majority (36 [67.9%]) of patients. One patient developed neuroleptic malignant syndrome and succumbed to his illness on the fourth postoperative day. Conclusion Given these findings, STN-DBS appears to be a good, safe, and effective treatment for a subset of medically refractory PD with an overall improvement in two-thirds of the study cohort and less than 10% risk of complications.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015479","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}
Manish Kumar Mishra, Vikrant Yadav, Ravi Shekhar Pradhan, Ravi Shankar Prasad
Abstract Intracranial dermoid cysts are rare dysembryonic tumors of benign nature. These are uncommon in adults. If present, they are usually located in the midline or along the lines of embryonic fusion. The posterior fossa region is an infrequent site. Extradural or interdural locations are even more rare. In this case report, the authors report a laterally located large posterior fossa right cerebellar convexity interdural and extradural dermoid cyst over the sigmoid sinus. It was managed by totally extradural maximum possible safe decompression with microneurosurgical technique. The authors share their experience of addressing this rare pathology at the rarest location with unusual imaging findings.
{"title":"Intracranial Interdural and Extradural Cerebellar Convexity Dermoid Cyst: A Case Report of Rare Tumor at the Rarest Location","authors":"Manish Kumar Mishra, Vikrant Yadav, Ravi Shekhar Pradhan, Ravi Shankar Prasad","doi":"10.1055/s-0043-1771325","DOIUrl":"https://doi.org/10.1055/s-0043-1771325","url":null,"abstract":"Abstract Intracranial dermoid cysts are rare dysembryonic tumors of benign nature. These are uncommon in adults. If present, they are usually located in the midline or along the lines of embryonic fusion. The posterior fossa region is an infrequent site. Extradural or interdural locations are even more rare. In this case report, the authors report a laterally located large posterior fossa right cerebellar convexity interdural and extradural dermoid cyst over the sigmoid sinus. It was managed by totally extradural maximum possible safe decompression with microneurosurgical technique. The authors share their experience of addressing this rare pathology at the rarest location with unusual imaging findings.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015301","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 Trigeminal neuralgia is a nerve disorder that causes unilateral severe facial pain. The clinical features of trigeminal neuralgia are agonizing, paroxysmal, anticipated in one or more divisions of the trigeminal nerve, with repetitive bursts of a few seconds, exacerbated by cutaneous stimuli. Microvascular decompression is proven effective, resulting in a positive outcome. Here, we report two cases of trigeminal neuralgia associated with the vertebral artery, who underwent endoscopic microvascular decompression. This case report aims to show the benefit of computational fluid dynamics evaluation of the neurovascular contact and its effect on change in wall shear stress magnitude of the offending vertebral artery after surgical management with microvascular decompression.
{"title":"Computational Fluid Dynamics Analysis of Trigeminal Neuralgia Associated with the Vertebral Artery: A Report of Two Cases","authors":"Kapil Patil, Fuminari Komatsu, Riki Tanaka, Kento Sasaki, Yasuhiro Yamada, Mai Okubo, Tomoka Katayama, Kyosuke Miyatani, Sachin Chemate, Toru Satoh, Yoko Kato","doi":"10.1055/s-0043-1771324","DOIUrl":"https://doi.org/10.1055/s-0043-1771324","url":null,"abstract":"Abstract Trigeminal neuralgia is a nerve disorder that causes unilateral severe facial pain. The clinical features of trigeminal neuralgia are agonizing, paroxysmal, anticipated in one or more divisions of the trigeminal nerve, with repetitive bursts of a few seconds, exacerbated by cutaneous stimuli. Microvascular decompression is proven effective, resulting in a positive outcome. Here, we report two cases of trigeminal neuralgia associated with the vertebral artery, who underwent endoscopic microvascular decompression. This case report aims to show the benefit of computational fluid dynamics evaluation of the neurovascular contact and its effect on change in wall shear stress magnitude of the offending vertebral artery after surgical management with microvascular decompression.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015164","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}
A 35-year-old female patient was admitted to our emergency department with impairment of consciousness, and somnolence. It was learned that the patient had been suffering from headache and anorexia over the last week. The clinic had begun abruptly, and the patient deteriorated over the last 5 hours before admission. The other medical history was unremarkable, and the patient had no history of recent drug use or an infection. The vital signs at admission to the emergency service were within normal limits. The neurological examination revealed that the patient was nonoriented and mildly cooperative. She could not cooperate properly with the examination and an increase in motor and psychological activity was apparent that was compatible with agitation. Other investigations including motor, sensory, and cerebellar tests were roughly within normal limits. The Kernig's and Brudzinski's signs were negative. The laboratory investigations revealed severe iron deficiency anemia (hemoglobin [Hb]: 5.3 mg/dL, serum ferritin: 30 μg/L), mild hyponatremia (131 mM/L [136–146 mM/L]), hyperkalemia (5.1 mM/L), neutrophilic leukocytosis (neutrophil: 89%), and increment of C-reactive protein (27.9 [0–0.8]). The results of the other investigations including liver-kidney functions, thyroid functions, vitamin B12, and folic acid were within normal limits. The initial cranial magnetic resonance imaging (MRI), performed on the 9th hour of the clinic, was normal ([Fig. 1]). Lumbar puncture investigations revealed normal cerebrospinal fluid (CSF) biochemistry, microscopic examination, and the result of the CSF culture was negative. The infectious disease specialist did not consider an infectious etiology of the central nervous system to explain the clinic. Routine electroencephalogram showed mild slow background activity (7 Hz) without discharge and focal slow activity. At this point, the MRI was repeated the day after, which showed restricted diffusion in the splenium, bilateral corona radiata, and left hippocampus ([Fig. 1]). Two-unit red blood cell (RBC) transfusion was administered for deep anemia (the follow-up test revealed Hb level of 8.3 mg/dL and Na level of 134 mM/L) and methylprednisolone 1 g intravenous treatment was initiated considering a possible underlying limbic encephalitis or autoimmune encephalitis. However, after the RBC transfusion, a marked and rapid clinical improvement was achieved, and the patient completely recovered after 2 days, and methylprednisolone was stopped at the second day of therapy. She was fully oriented and cooperative, and the Glasgow Coma Scale was evaluated as 15 points. The results of the screening tests for tumors including computed tomography (CT) thorax, CT abdomen, and pelvic ultrasound were unremarkable. Besides, the tumor markers were within normal limits. The anti-NMDAR antibody, anti-AMPA1 antibody, anti-AMPA2 antibody, CASPR2 antibody, GABARB1/B2 antibody, and LGI1 antibody tests results were negative. The follow-up MRI,
{"title":"A Rare Case of Reversible Splenial Lesion Syndrome with Extracallosal Lesions in the Setting of Deep Anemia","authors":"Halil Onder, Selcuk Comoglu","doi":"10.1055/s-0043-1771320","DOIUrl":"https://doi.org/10.1055/s-0043-1771320","url":null,"abstract":"A 35-year-old female patient was admitted to our emergency department with impairment of consciousness, and somnolence. It was learned that the patient had been suffering from headache and anorexia over the last week. The clinic had begun abruptly, and the patient deteriorated over the last 5 hours before admission. The other medical history was unremarkable, and the patient had no history of recent drug use or an infection. The vital signs at admission to the emergency service were within normal limits. The neurological examination revealed that the patient was nonoriented and mildly cooperative. She could not cooperate properly with the examination and an increase in motor and psychological activity was apparent that was compatible with agitation. Other investigations including motor, sensory, and cerebellar tests were roughly within normal limits. The Kernig's and Brudzinski's signs were negative. The laboratory investigations revealed severe iron deficiency anemia (hemoglobin [Hb]: 5.3 mg/dL, serum ferritin: 30 μg/L), mild hyponatremia (131 mM/L [136–146 mM/L]), hyperkalemia (5.1 mM/L), neutrophilic leukocytosis (neutrophil: 89%), and increment of C-reactive protein (27.9 [0–0.8]). The results of the other investigations including liver-kidney functions, thyroid functions, vitamin B12, and folic acid were within normal limits. The initial cranial magnetic resonance imaging (MRI), performed on the 9th hour of the clinic, was normal ([Fig. 1]). Lumbar puncture investigations revealed normal cerebrospinal fluid (CSF) biochemistry, microscopic examination, and the result of the CSF culture was negative. The infectious disease specialist did not consider an infectious etiology of the central nervous system to explain the clinic. Routine electroencephalogram showed mild slow background activity (7 Hz) without discharge and focal slow activity. At this point, the MRI was repeated the day after, which showed restricted diffusion in the splenium, bilateral corona radiata, and left hippocampus ([Fig. 1]). Two-unit red blood cell (RBC) transfusion was administered for deep anemia (the follow-up test revealed Hb level of 8.3 mg/dL and Na level of 134 mM/L) and methylprednisolone 1 g intravenous treatment was initiated considering a possible underlying limbic encephalitis or autoimmune encephalitis. However, after the RBC transfusion, a marked and rapid clinical improvement was achieved, and the patient completely recovered after 2 days, and methylprednisolone was stopped at the second day of therapy. She was fully oriented and cooperative, and the Glasgow Coma Scale was evaluated as 15 points. The results of the screening tests for tumors including computed tomography (CT) thorax, CT abdomen, and pelvic ultrasound were unremarkable. Besides, the tumor markers were within normal limits. The anti-NMDAR antibody, anti-AMPA1 antibody, anti-AMPA2 antibody, CASPR2 antibody, GABARB1/B2 antibody, and LGI1 antibody tests results were negative. The follow-up MRI, ","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015310","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}
Sajjad Saghebdoust, Amir Reza Barani, Mohammad Ali Abouei Mehrizi, Mehran Ekrami, Amir Valinezhad Lajimi, Gholamreza Termechi
Abstract Objective In recent years, endovascular methods have been developed to treat intracranial aneurysms. To date, results of endovascular treatment (EVT) for anterior communicating aneurysms (ACoAs) have never been investigated in Iran. Thus, we sought to assess the mid-term angiographic and clinical outcomes of patients with ACoAs who underwent EVT in a tertiary center. Materials and Methods Electronic health documents of patients with ACoAs who underwent EVT from March 2019 to July 2021 were retrospectively reviewed. Demographic and clinical characteristics of patients, procedural and clinical complications along with immediate and 12 months' postprocedural angiographic and clinical results were included in the analysis. Aneurysm occlusion status was classified based on the Raymond–Roy Occlusion Classification (RROC), and clinical outcomes were assessed using the modified Rankin Scale (mRS). Results Of 38 patients with 38 ACoAs, 32 patients (84.21%) presented with subarachnoid hemorrhage of whom 23 (60.52%) had ruptured ACoAs. EVT included simple coiling in 29 patients (76.32%), balloon-assisted coiling in 6 (15.79%), and stent-assisted coiling in 3 (7.89%). Immediate and 12-month postprocedural angiograms demonstrated complete/near-complete occlusion (RROC I and II) in 32 (84.21%) and 35 patients (97.22%), respectively. Periprocedural complications occurred in five patients (13.15%), and the mortality rate was 5.26%. Thirty-two patients (84.21%) had favorable outcomes (mRS 0–2) at the last follow-up. Conclusion EVT is a safe and beneficial procedure with favorable mid-term clinical and angiographic outcomes for ACoAs. Our results can lay the foundation for further studies in developing countries and are satisfactory enough for neurointerventionists to put EVT on the therapeutic agenda of ACoAs.
{"title":"Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Single-Center Experience from a Developing Country","authors":"Sajjad Saghebdoust, Amir Reza Barani, Mohammad Ali Abouei Mehrizi, Mehran Ekrami, Amir Valinezhad Lajimi, Gholamreza Termechi","doi":"10.1055/s-0043-1771316","DOIUrl":"https://doi.org/10.1055/s-0043-1771316","url":null,"abstract":"Abstract Objective In recent years, endovascular methods have been developed to treat intracranial aneurysms. To date, results of endovascular treatment (EVT) for anterior communicating aneurysms (ACoAs) have never been investigated in Iran. Thus, we sought to assess the mid-term angiographic and clinical outcomes of patients with ACoAs who underwent EVT in a tertiary center. Materials and Methods Electronic health documents of patients with ACoAs who underwent EVT from March 2019 to July 2021 were retrospectively reviewed. Demographic and clinical characteristics of patients, procedural and clinical complications along with immediate and 12 months' postprocedural angiographic and clinical results were included in the analysis. Aneurysm occlusion status was classified based on the Raymond–Roy Occlusion Classification (RROC), and clinical outcomes were assessed using the modified Rankin Scale (mRS). Results Of 38 patients with 38 ACoAs, 32 patients (84.21%) presented with subarachnoid hemorrhage of whom 23 (60.52%) had ruptured ACoAs. EVT included simple coiling in 29 patients (76.32%), balloon-assisted coiling in 6 (15.79%), and stent-assisted coiling in 3 (7.89%). Immediate and 12-month postprocedural angiograms demonstrated complete/near-complete occlusion (RROC I and II) in 32 (84.21%) and 35 patients (97.22%), respectively. Periprocedural complications occurred in five patients (13.15%), and the mortality rate was 5.26%. Thirty-two patients (84.21%) had favorable outcomes (mRS 0–2) at the last follow-up. Conclusion EVT is a safe and beneficial procedure with favorable mid-term clinical and angiographic outcomes for ACoAs. Our results can lay the foundation for further studies in developing countries and are satisfactory enough for neurointerventionists to put EVT on the therapeutic agenda of ACoAs.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015478","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 The purpose of this study is to assess demographic, clinical, and unique morphological characteristics of distal anterior cerebral artery (DACA) aneurysm. The relation of outcome included Glasgow Outcome Scale (GOS) using various independent variables, Hunt and Hess clinical grade (H&H), Miller Fischer grade, intraoperative rupture, and comparison of outcomes at discharge and last follow-up. Methods Demographic data, aneurysm characteristics, and treatment outcomes were evaluated in 28 ruptured DACA aneurysms operated over a period of 13 years. Association between independent variables and dependent variables (GOS) at discharge and at last follow-up (13 years) was analyzed, and the interrelationship between these factors and outcome was evaluated. GOS was used to assess functional outcomes. Results Over a period of 13 years, 500 patients harboring ruptured intracranial aneurysms were surgically clipped, and out of them 28 patients (5.6%) had ruptured DACA aneurysms. In this series, 20 (71.4%) patients had low grade and 8 (28.6%) had high grade H&H. Out of the 28 patients, 19 (67.8%) had good recovery, 6 (21.5%) were severely disabled, and 3 (10.7%) died at the time of discharge. On the last follow-up (13 years), smoking (p-value 0.03) and use of temporary clip (p-value 0.00) were significant predictors for unfavorable outcome. Conclusion The results of our case series show that even with ruptured aneurysm excellent overall outcome after microsurgical clipping can be achieved, even though among cerebral aneurysms, DACA aneurysm is considered to have less favorable outcome. Alcohol consumption and use of temporary clip were the predictors for unfavorable outcome at the time of discharge. On the last follow-up, smoking and use of temporary clip were found to be the risk factors for unfavorable outcome. Although the small sample size of this study is a limitation, smoking and use of temporary clip play an important role on the overall outcome. The aim of this study was to analyze data to determine factors which may influence outcome after surgical clipping of ruptured DACA aneurysms.
摘要目的探讨大脑远前动脉(DACA)动脉瘤的人口学、临床和独特形态学特征。结果的关系包括使用各种自变量的Glasgow结局量表(GOS)、Hunt and Hess临床分级(H&H)、Miller Fischer分级、术中破裂、出院时和末次随访时的结果比较。方法对13年来28例DACA破裂动脉瘤的人口学资料、动脉瘤特征及治疗结果进行分析。分析出院时和最后随访时(13年)自变量和因变量(GOS)的相关性，并评价这些因素与预后的相互关系。GOS用于评估功能预后。结果13年间，500例颅内动脉瘤破裂患者行手术夹闭，其中28例(5.6%)为DACA破裂动脉瘤。在这个系列中，20例(71.4%)患者为低级别H&H, 8例(28.6%)患者为高级别H&H。28例患者中恢复良好19例(67.8%)，严重残疾6例(21.5%)，出院时死亡3例(10.7%)。在最后一次随访(13年)中，吸烟(p值为0.03)和使用临时夹子(p值为0.00)是不良结局的显著预测因素。结论本病例系列的结果表明，尽管在脑动脉瘤中，DACA动脉瘤被认为预后较差，但即使是破裂的动脉瘤，显微手术夹闭后也能获得良好的整体预后。饮酒和使用临时夹是出院时不良预后的预测因素。在最后一次随访中，吸烟和使用临时夹子被发现是不良结果的危险因素。虽然本研究样本量小是一个局限性，但吸烟和使用临时夹子对总体结果起着重要作用。本研究的目的是分析数据，以确定可能影响手术夹闭破裂的DACA动脉瘤后预后的因素。
{"title":"Factors Affecting the Outcome after Surgical Clipping of Ruptured Distal Anterior Cerebral Artery (DACA) Aneurysms","authors":"Gopal Raman Sharma, Prasanna Karki, Sumit Joshi, Prakash Paudel, Damber Bikram Shah, Pokharel Baburam, Gyawali Bidhan","doi":"10.1055/s-0043-1771371","DOIUrl":"https://doi.org/10.1055/s-0043-1771371","url":null,"abstract":"Abstract Objective The purpose of this study is to assess demographic, clinical, and unique morphological characteristics of distal anterior cerebral artery (DACA) aneurysm. The relation of outcome included Glasgow Outcome Scale (GOS) using various independent variables, Hunt and Hess clinical grade (H&H), Miller Fischer grade, intraoperative rupture, and comparison of outcomes at discharge and last follow-up. Methods Demographic data, aneurysm characteristics, and treatment outcomes were evaluated in 28 ruptured DACA aneurysms operated over a period of 13 years. Association between independent variables and dependent variables (GOS) at discharge and at last follow-up (13 years) was analyzed, and the interrelationship between these factors and outcome was evaluated. GOS was used to assess functional outcomes. Results Over a period of 13 years, 500 patients harboring ruptured intracranial aneurysms were surgically clipped, and out of them 28 patients (5.6%) had ruptured DACA aneurysms. In this series, 20 (71.4%) patients had low grade and 8 (28.6%) had high grade H&H. Out of the 28 patients, 19 (67.8%) had good recovery, 6 (21.5%) were severely disabled, and 3 (10.7%) died at the time of discharge. On the last follow-up (13 years), smoking (p-value 0.03) and use of temporary clip (p-value 0.00) were significant predictors for unfavorable outcome. Conclusion The results of our case series show that even with ruptured aneurysm excellent overall outcome after microsurgical clipping can be achieved, even though among cerebral aneurysms, DACA aneurysm is considered to have less favorable outcome. Alcohol consumption and use of temporary clip were the predictors for unfavorable outcome at the time of discharge. On the last follow-up, smoking and use of temporary clip were found to be the risk factors for unfavorable outcome. Although the small sample size of this study is a limitation, smoking and use of temporary clip play an important role on the overall outcome. The aim of this study was to analyze data to determine factors which may influence outcome after surgical clipping of ruptured DACA aneurysms.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015629","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 Currently, awake craniotomy (AC) is one of the most often employed procedures to map and resect tumors in eloquent brain areas, avoiding the use of general anesthesia (GA) and thereby reducing anesthesia-related complications and cost of surgery. Resource limitations are one of the basic reasons for avoiding AC in low- and middle-income countries (LMICs). The aim of this study is to describe the simplified protocol of awake brain surgery that can be implemented in a limited financial setting in LMICs and to share our first experience. Twenty-five patients diagnosed with tumor of the left frontotemporal lobes, all involving Broca's and Wernicke's areas, were operated on using AC. Brain mapping was executed using mono- and bipolar direct electrical stimulation including cortical and subcortical (axonal) mapping profiles, investigating basically cortical language centers. Neither neuronavigation nor intraoperative magnetic resonance imaging (MRI) was utilized due to financial constraints. AC was performed successfully in 23 of 25 patients, achieving a near-total resection in 16 (69.5%) patients, subtotal resection in 4 patients (17.39%) patients, and partial resection in 3 (13.04%) patients. In two patients, due to psychological instability—agitation and fear during the awake phase—speech test was not technically possible, so they were reintubated by giving them GA. There was no mortality in the early or postoperative period. In spite of the absence of advanced pre- and intraoperative technologies such as intraoperative MRI and navigation systems, AC can be safely performed in LMICs. These tools along with intraoperative cortical mapping and language testing can guarantee better surgical outcomes and quality of life. However, our study confirms that omitting these tools does not make a huge difference in getting good results with AC and that AC is not absolutely impossible. AC can be performed successfully, preserving eloquent brain areas, with minimum and basic set of the armamentarium like system for cortical and subcortical intraoperative neurostimulation which provides cortical/subcortical brain mapping.
{"title":"Simplifying the Technique of Awake Brain Surgery in a Condition of Less Equipped Neurosurgical Institution in Uzbekistan","authors":"Dilshod Mukhammadvalievich Mamadaliev, Gayrat Maratovich Kariev, Ulugbek Maksudovich Asadullaev, Jakhongir Bakhodirovich Yakubov, Kamoliddin Sodikjonovich Zokirov, Khabibullo Abdukholikovich Khasanov, Tokhir Makhmudovich Akhmediev, Dmitriy Sergeyevich Korotkov","doi":"10.1055/s-0043-1771326","DOIUrl":"https://doi.org/10.1055/s-0043-1771326","url":null,"abstract":"Abstract Currently, awake craniotomy (AC) is one of the most often employed procedures to map and resect tumors in eloquent brain areas, avoiding the use of general anesthesia (GA) and thereby reducing anesthesia-related complications and cost of surgery. Resource limitations are one of the basic reasons for avoiding AC in low- and middle-income countries (LMICs). The aim of this study is to describe the simplified protocol of awake brain surgery that can be implemented in a limited financial setting in LMICs and to share our first experience. Twenty-five patients diagnosed with tumor of the left frontotemporal lobes, all involving Broca's and Wernicke's areas, were operated on using AC. Brain mapping was executed using mono- and bipolar direct electrical stimulation including cortical and subcortical (axonal) mapping profiles, investigating basically cortical language centers. Neither neuronavigation nor intraoperative magnetic resonance imaging (MRI) was utilized due to financial constraints. AC was performed successfully in 23 of 25 patients, achieving a near-total resection in 16 (69.5%) patients, subtotal resection in 4 patients (17.39%) patients, and partial resection in 3 (13.04%) patients. In two patients, due to psychological instability—agitation and fear during the awake phase—speech test was not technically possible, so they were reintubated by giving them GA. There was no mortality in the early or postoperative period. In spite of the absence of advanced pre- and intraoperative technologies such as intraoperative MRI and navigation systems, AC can be safely performed in LMICs. These tools along with intraoperative cortical mapping and language testing can guarantee better surgical outcomes and quality of life. However, our study confirms that omitting these tools does not make a huge difference in getting good results with AC and that AC is not absolutely impossible. AC can be performed successfully, preserving eloquent brain areas, with minimum and basic set of the armamentarium like system for cortical and subcortical intraoperative neurostimulation which provides cortical/subcortical brain mapping.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015174","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}
Sharon Bossert, Prashin Unadkat, Kevin N. Sheth, Gordon Sze, Michael Schulder
Abstract Background MRI (magnetic resonance imaging) using low-magnet field strength has unique advantages for intraoperative use. We compared a novel, compact, portable MR imaging system to an established intraoperative 0.15 T system to assess potential utility in intracranial neurosurgery. Methods Brain images were acquired with a 0.15 T intraoperative MRI (iMRI) system and a 0.064 T portable MR system. Five healthy volunteers were scanned. Individual sequences were rated on a 5-point (1 to 5) scale for six categories: contrast, resolution, coverage, noise, artifacts, and geometry. Results Overall, the 0.064 T images (M = 3.4, SD = 0.1) had statistically higher ratings than the 0.15 T images (M = 2.4, SD = 0.2) (p < 0.01). All comparable sequences (T1, T2, T2 FLAIR and SSFP) were rated significantly higher on the 0.064 T and were rated 1.2 points (SD = 0.3) higher than 0.15 T scanner, with the T2 fluid-attenuated inversion recovery (FLAIR) sequences showing the largest increment on the 0.064 T with an average rating difference of 1.5 points (SD = 0.2). Scanning time for the 0.064 T system obtained images more quickly and encompassed a larger field of view than the 0.15 T system. Conclusions A novel, portable 0.064 T self-shielding MRI system under ideal conditions provided images of comparable quality or better and faster acquisition times than those provided by the already well-established 0.15 T iMR system. These results suggest that the 0.064 T MRI has the potential to be adapted for intraoperative use for intracranial neurosurgery.
{"title":"A Novel Portable, Mobile MRI: Comparison with an Established Low-Field Intraoperative MRI System","authors":"Sharon Bossert, Prashin Unadkat, Kevin N. Sheth, Gordon Sze, Michael Schulder","doi":"10.1055/s-0043-1760857","DOIUrl":"https://doi.org/10.1055/s-0043-1760857","url":null,"abstract":"Abstract Background MRI (magnetic resonance imaging) using low-magnet field strength has unique advantages for intraoperative use. We compared a novel, compact, portable MR imaging system to an established intraoperative 0.15 T system to assess potential utility in intracranial neurosurgery. Methods Brain images were acquired with a 0.15 T intraoperative MRI (iMRI) system and a 0.064 T portable MR system. Five healthy volunteers were scanned. Individual sequences were rated on a 5-point (1 to 5) scale for six categories: contrast, resolution, coverage, noise, artifacts, and geometry. Results Overall, the 0.064 T images (M = 3.4, SD = 0.1) had statistically higher ratings than the 0.15 T images (M = 2.4, SD = 0.2) (p < 0.01). All comparable sequences (T1, T2, T2 FLAIR and SSFP) were rated significantly higher on the 0.064 T and were rated 1.2 points (SD = 0.3) higher than 0.15 T scanner, with the T2 fluid-attenuated inversion recovery (FLAIR) sequences showing the largest increment on the 0.064 T with an average rating difference of 1.5 points (SD = 0.2). Scanning time for the 0.064 T system obtained images more quickly and encompassed a larger field of view than the 0.15 T system. Conclusions A novel, portable 0.064 T self-shielding MRI system under ideal conditions provided images of comparable quality or better and faster acquisition times than those provided by the already well-established 0.15 T iMR system. These results suggest that the 0.064 T MRI has the potential to be adapted for intraoperative use for intracranial neurosurgery.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015306","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 A spinal arachnoid cyst is a rare entity representing only 1 to 3% of spinal canal lesions. Very few of them are reported to be symptomatic. Moreover, occurrence in multiples is even rarer. Extradural type is more common than intradural. In the spine, it is rare in the sacral region. Other common pathologies, such as a dermoid or epidermoid cyst, are often considered at presentation. Even magnetic resonance imaging can miss the diagnosis sometimes. We report a case with symptoms of paraparesis and incontinence at presentation, initially misdiagnosed as a dermoid cyst, later found to be multiple intradural arachnoid cysts located in the sacral region. Spinal arachnoid cysts may cause debilitating symptoms. The disease is completely curable if the detection and classification are early as in our case.
{"title":"Multiple Symptomatic Spinal Intradural Arachnoid Cysts: A Case Report","authors":"Vikrant Sharma, Suryanarayanan Bhaskar, Sarbesh Tiwari","doi":"10.1055/s-0043-1774376","DOIUrl":"https://doi.org/10.1055/s-0043-1774376","url":null,"abstract":"Abstract A spinal arachnoid cyst is a rare entity representing only 1 to 3% of spinal canal lesions. Very few of them are reported to be symptomatic. Moreover, occurrence in multiples is even rarer. Extradural type is more common than intradural. In the spine, it is rare in the sacral region. Other common pathologies, such as a dermoid or epidermoid cyst, are often considered at presentation. Even magnetic resonance imaging can miss the diagnosis sometimes. We report a case with symptoms of paraparesis and incontinence at presentation, initially misdiagnosed as a dermoid cyst, later found to be multiple intradural arachnoid cysts located in the sacral region. Spinal arachnoid cysts may cause debilitating symptoms. The disease is completely curable if the detection and classification are early as in our case.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135691160","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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