Asian journal of neurosurgery最新文献

Malignant melanoma is third most common cause of brain metastasis after lung and breast cancer. Most patients with brain metastases from malignant melanoma are diagnosed after treatment for known extracranial metastases and have a poor outcome despite various local and systemic therapeutic approaches. Here we discuss an unusual case of a 61-year-old male patient who presented with a brain metastasis as the initial disease presentation and the presumed primary lesion was later found in the gastrointestinal tract and the scalp. Treatment consisted of a surgical removal of the large intracranial lesion. Further evaluation for primary lesion was done by general physical examination, contrast-enhanced computed tomography (CECT) of the chest and whole abdomen. Apart from that, colonoscopy was done, and a biopsy was taken from a suspicious colonic lesion. The scalp pigmented lesion was also evaluated. Both biopsies were in favor of melanoma. Recently, management of metastatic melanoma of the brain is decided according to the number of lesions, accessibility, visceral metastasis, and resectability of the lesion. Various treatment options are surgical resection, whole brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS). Malignant melanoma is relatively radioresistant, so the results are debatable. In conclusion, the prognosis of intracranial malignant melanoma is determined by the following factors: (1) the type of lesion; (2) the involvement of the leptomeninges; (3) the extent of tumor excised; and (4) the molecular immunology borstel number 1 (MIB 1) antibody index, which is the most relevant factor for prognosis in this type of cancer.

Mechanical stimulation of the trigeminal nerve during craniofacial, skull base, or dental surgeries may cause bradycardia, hypotension, or cardiac arrest. This phenomenon is called trigeminal cardiac reflex (TCR). We encountered a rare case of a patient who experienced sinus arrest due to temporary clipping of the intracranial carotid artery during the clipping of a ruptured aneurysm. We discuss possible reasons for the occurrence of TCR in this case. A man in his 30s with no medical history presented with a sudden-onset headache. Computed tomography revealed a subarachnoid hemorrhage in the basal cistern and left Sylvian fissure. Angiography revealed a saccular aneurysm of the left internal carotid-anterior choroidal artery. A left frontotemporal craniotomy and dural incision were performed, followed by a trans-Sylvian approach. Cardiac arrest occurred twice during the temporary clipping of the intracranial carotid artery. After surgery, we performed a cardiac ultrasound echo and a 1-week Holter electrocardiogram. Neither showed abnormalities. No arrhythmia or cardiac events were observed over a one and half-year follow-up period. The cardiac arrest might have been triggered by the stimulation of the trigeminal nerve in the internal carotid artery. The repeated and anatomical features of this case suggest that TCR triggered cardiac arrest. The high probability that cardiac arrest was induced by trigeminal nerve stimulation should be considered during the temporary clipping of the internal carotid artery. However, the predisposing factors and exact underlying mechanisms for these arrhythmias remain unknown and require further investigation.

Background  The left (Lt) and right (Rt) middle cerebral artery bifurcation (MCAB) aneurysms have mostly been regarded as identical. Considering substantial Lt-Rt differences in hemispheric infarction, however, the presence of Lt-Rt differences may not be denied totally in patients with ruptured MCAB aneurysms. We herein investigated whether such Lt-Rt differences existed by a single-center retrospective study. Materials and Methods  Clinical data prospectively acquired between 2011 and 2021 on 99 patients with ruptured MCAB aneurysms were analyzed. They were dichotomized based on the laterality, and demographic and outcome parameters were compared. Additionally, a literature review was conducted to elucidate possible Lt-Rt differences in the frequency of ruptured MCAB aneurysms (Rt/Lt ratio). Results  Among the 99 patients, 42 had Lt and 57 had Rt ruptured MCAB aneurysms, with the Rt/Lt ratio of 1.36. Neither demographic, radiographic, nor outcome variables differed significantly between the two groups. A total of 19 studies providing information on the laterality of the ruptured MCAB were retrieved by literature search. A sum total for the Lt and Rt MCAB aneurysms was 671 and 940, making the Rt/Lt ratio of 1.40. After adding our data, a sum total for the Lt and Rt MCAB aneurysms was 713 and 997, making the Rt/Lt ratio of 1.40. Conclusion  The Rt ruptured MCAB aneurysms were 1.40 times more frequent than the Lt-sided counterpart. While there may be some Lt-Rt differences in the MCA anatomy, it remains to be seen whether such anatomical differences are truly responsible for the disproportionately higher frequency of Rt MCAB aneurysms.

Objective  Treatment of ruptured broad-necked intracranial aneurysms by endovascular therapy is technically burdensome. It is commonly treated with stent- and balloon-assisted coils embolization. The aim of this study was to evaluate clinical and radiological outcomes following double micro-catheter (MC) technique. Materials and Methods  A retrospective study was done on 16 broad-necked (neck diameter ≥ 4 mm and dome-to-neck ratio < 2) ruptured intracranial aneurysms in 16 patients treated with double MC technique at our center between December 2021 and December 2023. Clinical outcome was evaluated by modified Rankin Score, postcoiling radiological outcome was evaluated by Raymond-Roy occlusion grade, and treatment-related complications were assessed. Results  There were 16 patients, 9 females and 7 males; with a mean age of 51.3 years (35-70 years). All the patients underwent dual MC coils embolization for all aneurysms. Raymond-Roy occlusion class I was achieved in 81.3% (13) cases and Raymond-Roy class II was achieved in 18.7% (3) cases immediately after the procedure. There were no serious postprocedure-related complications or recanalization of the aneurysm at the mean follow-up of 4.8 months (range 2-10 months). Conclusion  Our study presents the safety and effectiveness of double MC system for treating ruptured broad-necked intracranial aneurysm. Large numbers of studies with longer follow-up period are required to secure validity of double MC technique.

Rathke's cleft cyst (RCC) is a benign cystic lesion that is commonly discovered incidentally and remains asymptomatic in most cases. However, its association with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion leading to hyponatremia (HN) is rare and has only been sporadically reported in the medical literature. In this article, we present a unique case of RCC manifesting with HN and discuss the diagnostic and management challenges encountered in a neurosurgical context. Additionally, we provide a comprehensive review of existing literature on RCC presenting with HN to enhance our understanding of this rare presentation. A 56-year-old woman with acute-onset blurry vision, headaches, and low fluid intake was diagnosed with euvolemic HN secondary to SIADH. Further evaluation revealed an intrasellar cystic lesion consistent with RCC, which was successfully resected through endoscopic transnasal transsphenoidal surgery, resulting in a complete recovery without the need for hormone replacement. The most likely explanation for the HN due to SIADH in this case is the release of accumulated antidiuretic hormone (ADH) due to compression by the cyst and the irritating effect of inflammation at this location. Accurate evaluation and classification of HN are essential for proper diagnosis and management, considering the rarity of RCC presenting with HN. A multidisciplinary approach to treatment can lead to favorable functional outcomes; however, further research is necessary to better comprehend this unique clinical entity and optimize neurosurgical approaches.

The introduction of cadaveric dissection of cerebral vasculature as a part of the neurosurgical training module would help the neurosurgical residents to understand the complex neuroanatomy of the brain vasculature and help gain confdence during the surgical procedure.To the best of our knowledge microsurgical anatomical studies of theMCA have not been done among the Northwest Indian population. Anatomical variations of MCA that have not been described before may come in as a surprise during any surgical intervention. Hence, we intend to record the anatomical variations of the MCA anatomy and its implications in contemporary vascular surgery and neurosurgical practice. The objective of this work was to study and compare the microsurgical anatomy and variations of MCA in Northwest Indian cadavers with the available literature.

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

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