Asian journal of neurosurgery最新文献

Introduction: Classic bicoronal skin incisions for bifrontal craniotomy are usually performed near the course of the superficial temporal artery (STA). This frequently results in injuries to the frontal branch (fSTA) or even the STA's main trunk. We investigate the usual course of the fSTA and evaluate a previously proposed modification to bicoronal scalp incisions for its rate of STA preservation.

Materials and methods: Sixteen sides of cadaveric heads were dissected. We investigated the location of the fSTA in relation to the temporal peak of the hairline. We also performed a retrospective study of 19 patients with cerebral aneurysms who underwent microsurgery using the modified bicoronal incision. The patients were treated at our facility between June 2017 and Jan 2022. Patients' data were retrospectively reviewed and evaluated for postoperative STA preservation.

Results: The majority of fSTAs (68.75%) passed through and just anterior to the temporal peak. The average distances between the fSTA and the temporal peak from the anterior and posterior aspects were 0.44 (0.2-0.7) cm and 0.52 (0.3-0.8) cm. The mean distance between the STA bifurcation and the zygomatic root was 3 cm. Using the modified bicoronal scalp incision, the right fSTA of 14/19 (73.7%) patients and the left fSTA of 16/19 (84.2%) patients were preserved in the scalp flap.

Conclusion: The most anterior part of the fSTA was located very close to the temporal peak of the hairline. The modified bicoronal skin incision for bifrontal craniotomy and modified transbasal craniotomy was an effective means of STA preservation.

Introduction: Retrosigmoid suboccipital (RMSO) craniotomy is the most commonly used approach for lesions of cerebellopontine angle. The problem with RMSO craniotomy is the risk of injury to the transverse and sigmoid sinus during the fashioning of the craniotomy. This problem creates a craniectomy defect that is larger than the bone flap removed. Placement of such a bone flap would cause problems that are similar to the craniectomy defects. To avoid this complication, cranioplasty reconstruction is advised.

Objectives: In this study, we introduced a novel, low-cost technique for RMSO cranioplasty using a single standard polyvinyl chloride plastic skull model as a guide for cranioplasty flap development and observed the functional and cosmetic outcomes.

Results: None of the patients required reoperation, and there was no evidence of cerebrospinal fluid (CSF) leak, bleeding, infection, or poor scar formation. No patient experienced undue incisional pain or headache at long-term follow-up. The patients and their family members were satisfied with the cosmetic results of the procedure.

Conclusion: This technique has been proven to be not only cost-effective but also time-saving and easily reproduced, which may be significantly relevant in countries such as India, where the financial burden of healthcare is very high. This study identifies long-term improvement in CSF leaks and the long-term advantage of polymethylmethacrylate closure with less postoperative incisional pain and headache and improvement retroauricular cosmesis.

Horner's syndrome, characterized by ptosis, miosis, and anhidrosis, results from oculosympathetic complex injury, often due to trauma affecting the superior cervical ganglion. Although rare following carotid surgery, we present a case of Horner's syndrome after elective carotid endarterectomy (CEA). This report explores potential mechanism, including prolonged surgical retraction and hematoma formation, while reviewing similar cases in the literature. A 45-year-old woman presented with recurrent dizziness and progressive left-sided hearing impairment over 5 years. She also reported neck discomfort and experienced five episodes of amaurosis fugax in her left eye within 1 week. Computed tomography revealed occlusion of the right common and internal carotid artery (ICA), along with a 90% stenosis at the left common carotid bifurcation extending into the left ICA. Subsequently, an elective left CEA was performed. Within 24 hours postoperatively, she developed clinical signs of Horner's syndrome, including left-sided ptosis, miosis, anhidrosis, and concurrent facial nerve palsy. Notably, there was no evidence of hematoma formation or sensorimotor deficits. This case highlights the rare occurrence of Horner's syndrome as a postoperative complication of CEA. Surgeons should be mindful of anatomical variations and potential intraoperative mechanisms contributing to this complication to enhance prevention strategies. Recognizing this risk is essential for optimizing postoperative care and patient counseling.

Vertebrobasilar dolichoectasia (VBD) is a vasculopathy characterized by elongation and dilation of the affected artery. We present a case of trigeminal neuralgia (TN) secondary to VBD, successfully treated with microvascular decompression (MVD) using an autologous muscle graft (AMG). Additionally, we conducted a review of the literature and meta-analysis of 14 studies involving 303 patients to evaluate the efficacy of this surgical approach. A 63-year-old man experienced recurrent, lancinating pain in the V1, V2, and V3 branches of the right trigeminal nerve. Due to the intractable symptoms, he underwent MVD with an AMG after thorough neurological evaluation. At the 1-year follow-up, he was pain-free without the need for further medication. TN secondary to VBD is a rare and challenging condition, often refractory to medical treatment. MVD with an AMG offers significant symptom relief. Further research, including prospective studies or randomized controlled trials comparing AMG with other graft materials, is necessary to confirm its efficacy.

Introduction: Degenerative cervical myelopathy (DCM), encompassing cervical spondylotic myelopathy and posterior longitudinal ligament ossification, is now being documented frequently and significantly burdening the health care systems. The pathogenesis of DCM remains somewhat obscure, and the focus is now on identifying the role of genetic risk factors. Identifying these risk factors is essential for formulating future studies for novel preventive and therapeutic measures.

Materials and methods: In a cohort study, we evaluated the genetic association of two genes involved in the pathophysiology of DCM, that is, COL11A1 (single-nucleotide polymorphism [SNP] rs1337185) and ADAMTS5 (SNP rs162509).

Results: A total of 60 subjects (27 with DCM and 33 without DCM) were included. The primary and minor allelic frequencies were evaluated and compared between the cohorts. Significant association was found for SNP rs162509 of gene ADAMTS5 for DCM (odds ratio [OR] 2.5375, 95% confidence interval [CI] 0.655-9.89, p  = 0.177), whereas no conclusive relation was found for SNP rs1337185 of the COL11A1 gene (OR 0.93, 95% CI 0.24-3.68, p  = 0.91).

Conclusion: Preliminary data from our study identify a probable association of two candidate genes, which play a pivotal role in the matrix synthesis and degradation. The complex etiopathogenesis of DCM may be guided by alterations in these genes and mediated through the altered gene products. Further studies are needed to substantiate and validate this.

The co-occurrence of spontaneous intracranial hypotension (SIH) due to thoracic dural tear and factor XIII deficiency (FXIIID) is rare and may result in chronic subdural hematoma (CSDH). CSDH often recurs and is difficult to treat, despite appropriate treatment. However, there is no definitive knowledge on the optimal timing of factor XIII (FXIII) supplementation or therapeutic interventions, such as epidural blood patch (EBP) and burr hole drainage (BHD). We present a case of refractory SIH and CSDH associated with FXIIID. Considering an ineffective initial EBP, we performed a second EBP after observing sufficiently high FXIII activity; SIH was cured subsequently. The patient experienced SIH recurrence after 14 months and was treated with a combination of EBP and BHD, with sufficient FXIII supplementation. CSDH disappeared and did not recur for more than 12 months. During the treatment of SIH and CSDH associated with FXIIID, surgical treatment such as EBP appeared ineffective due to low FXIII activity. This necessitates intravenous supplementation of FXIII to maintain sufficient FXIII activity. Regular monitoring of FXIII activity is also necessary to prevent CSDH recurrence.

Introduction: Failed back surgery syndrome affects 10 to 46% of lumbar spine surgery patients, often resulting in persistent pain and functional impairment. Sacroiliac joint pain (SIJP) is a significant contributor, particularly following spinal fusion. This study aimed to assess SIJP incidence following lumbar surgery with and without fusion, and identify risk factors for sacroiliac joint syndrome (SIJS).

Materials and methods: This prospective, nonrandomized clinical trial included 102 patients undergoing lumbar decompression alone (Dec group, n  = 50) or decompression with fusion (DecPlus group, n  = 52) at two university hospitals. Patients with persistent postoperative pain were assessed for SIJS using clinical provocative tests and fluoroscopy-guided sacroiliac joint blocks. Primary outcomes included SIJP incidence, visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) for disability, and Short-Form (SF)-36 Health Survey for quality of life. Patients were followed for 3 months postoperatively.

Results: SIJP was diagnosed in 36.3% of patients, with significantly higher incidence in the DecPlus group (50%) compared with the Dec group (22%) ( p  < 0.01). Pain scores (VAS) improved significantly in both groups, but ODI and SF-36 scores showed greater improvement in the Dec group ( p  < 0.01). SIJP has a significant relation with the upper instrumented vertebra (UIV) and length of fusion; however, extension of fusion to S1 does not significantly increase the SIJP. There was no significant association between SIJP and smoking, body mass index, or other comorbidities.

Conclusion: Based on our study, lumbar instrumented posterolateral fusion, compared with decompression without fusion, should be considered a risk factor for SIJP. In patients with instrumented fusion, the UIV and the length of fusion are related to SIJP; however, extending fusion to S1 does not significantly affect SIJP incidence.

Introduction: Road traffic accidents are a significant cause of mortality and morbidity worldwide, with traumatic brain injury (TBI) being a common consequence. Pillion riders on motorized two-wheelers (MTWs) represent a vulnerable group, often with inadequate protective measures.

Objective: To assess the pattern and severity of brain injury in pillion riders of MTWs, evaluate the mechanism and type of injury, highlight the importance of helmet use, and study associated injuries and outcomes.

Materials and methods: This cross-sectional observational study was conducted at a tertiary care center from August 2022 to January 2024, including 120 pillion riders presenting with TBI. Data regarding demographics, injury characteristics, helmet use, clinical findings, radiological parameters, management, and outcomes were collected and analyzed.

Results: The mean age of patients was 38.59 ± 15.35 years, with males comprising 59.2%. Motorcycles were the predominant vehicle (90%), and cross-saddle was the common seating position (70%). Only 6.7% of pillion riders used helmets. Skull fractures were observed in 68.3%, subarachnoid hemorrhage in 59.2%, subdural hemorrhage in 50%, and contusions in 69.2% of cases. Based on the Glasgow Coma Scale, 47.5% had mild, 16.7% had moderate, and 35.8% had severe TBI. The mortality rate was 35.8%, with craniocerebral injury being the cause of all deaths. None of the helmet users succumbed to injuries.

Conclusion: Pillion riders sustain serious TBIs comparable to or more severe than riders. The mortality rate is substantial, particularly among those not wearing helmets. Mandatory helmet use for pillion riders could significantly reduce mortality and injury severity. Further comparative studies between riders and pillion riders are warranted to better understand injury patterns and develop targeted preventive strategies.

We report a rare case of de novo ectopic dural arteriovenous fistula (dAVF) that developed late after the endovascular embolization of a brain arteriovenous malformation (AVM). A 25-year-old man with severe chronic headache was diagnosed with an unruptured right frontal AVM located on the medial side of the Sylvian fissure. The AVM was completely occluded using transarterial liquid embolization. However, 12 months after the embolization, the patient developed right pulsatile tinnitus. Angiography revealed a de novo dAVF at the convexity, distant from the original AVM nidus. The dAVF was supplied by multiple dural arteries and a small pial contribution and drained into a cortical vein previously used as the AVM's drainage route. The fistula was successfully treated with additional embolization and radiosurgery. It is well known that large, superficial AVMs tend to involve meningeal arterial supply. However, this case demonstrated delayed ectopic dAVF formation along a draining vein far from the nidus. Although the exact etiology remains unclear, drastic hemodynamic changes in cortical veins previously used as shunt draining route may induce unexpected angiogenesis, leading to the formation of such an unusual de novo dAVF. Even after successful AVM occlusion, long-term follow-up imaging is important, and the possibility of dAVF formation would offer stronger clinical guidance.