Asian journal of neurosurgery最新文献

The thalamus, a gray matter structure, is a crucial relay for various afferent and efferent pathways in the brain. It receives its primary blood supply from the thalamoperforating and thalamogeniculate branches of the posterior cerebral arteries. Damage to the thalamus can lead to classical sensorimotor and amnestic syndromes, as well as neuro-ophthalmological manifestations, including vertical gaze palsy (VGP), pseudo-abducens palsy, skew deviation, cerebral ptosis, and Horner's syndrome. While most cases of VGP are self-limiting, some can persist, significantly affecting daily life. This report describes a case involving a 33-year-old man with a vein of Galen malformation who underwent embolization and subsequently developed VGP in the postoperative period. This complication was attributed to a medial thalamic infarct. Notably, the patient experienced spontaneous resolution of the gaze palsy within 3 months.

Study design: This is a retrospective cohort study.

Introduction: Full-endoscopic lumbar discectomy (FELD), a minimally invasive surgical procedure used to treat lumbar disc herniation (LDH), has been shown to be highly effective with fewer complications. This procedure can be performed using the interlaminar (IL) or transforaminal (TF) approach. The IL approach involves more anatomical structures than the TF approach. However, comprehensive data regarding preoperative and postoperative intervertebral disc height (IDH) changes for patients undergoing full-endoscopic discectomy through the IL versus the TF approach is yet to be documented.

Objective: To compare the preoperative and postoperative IDH on radiographs in patients who underwent the FELD using the IL or TF approach.

Materials and methods: The medical records of patients diagnosed with LDH who underwent FELD between 2014 and 2022 were collected and analyzed. Pre- and postradiographic IDH and clinical scores, including visual analog scale-back pain (VAS-B), Oswestry disability index (ODI), and recurrent LDH, were assessed and compared over a follow-up period of at least 2 years.

Results: A total of 110 patients were included, 82 undergoing the IL procedure and 28 undergoing the TF procedure. The median IDH variance was consistent at 1.0 (interquartile range [IQR] 0.5, 2) for the IL and TF procedures, indicating no significant statistical variance. The IDH ratio was also comparable between the two groups, with the IL group at 84% and the TF group at 85%. However, a notable disparity was observed in postoperative IDH, with a median of 7.5 (IQR 6.5, 8.5) for the IL approach and 8.5 (IQR 7, 9.5) for the TF approach. Importantly, no statistical differences were found in clinical outcomes, including VAS-B, ODI, and recurrent LDH.

Conclusion: After a 2-year follow-up for FELD, there is no significant difference in radiographic outcomes, IDH difference, and IDH ratio between the IL and TF approaches. Additionally, there is no apparent correlation between reductions in IDH and IDH ratio and the decrease in back pain scores (VAS-B) or ODI after the procedures.

Background: The pterional incision is usually performed near the course of the superficial temporal artery (STA), which carries a risk of injury to a branch or even the main trunk of the STA (mSTA). In this study, we assessed the usual course of the mSTA and its parietal branch of the STA (pSTA) and evaluated the efficacy of a modified pterional scalp incision for the preservation of all STA branches.

Materials and methods: Sixteen sides of cadaveric heads were dissected to study the location and paths of the mSTA and pSTA in the vicinity of the ear cartilage and the oculomeatal (OM) line. We also performed a clinical study of 31 patients who underwent pterional craniotomy using the modified pterional scalp incision. Postoperative STA preservation was retrospectively evaluated.

Results: The mean distances between the mSTA and the anterior edge of the ear cartilage were 0.5 and 0.6 mm. The mean angle of the pSTA axis was 88.8 degrees (range 75-95 degrees) from the OM line. Among the patients treated using the modified pterional scalp incision, the mSTA, the pSTA, and the frontal branch of the STA (fSTA) were preserved within the scalp flap in 93.5, 96.7, and 88.9%, respectively.

Conclusion: The mSTA was found to pass very close to the ear cartilage, while the axis of pSTA coursed approximately perpendicular to the OM line. To preserve all branches of the STA, the pterional skin incision should begin just anterior to the ear cartilage and then curve slightly to the posterior above the pinna.

Primary spontaneous Intracerebral Hemorrhage (PSICH) is a devastating disease occurring in 24.6 cases per 100,000 people per year, more common with chronic arterial hypertension. Emergent hematoma evacuation remains a lifesaving intervention especially in younger patients with large hematoma volume and are clinically deteriorating. Timely and appropriate management is key to improving outcomes. In this study, we compared whether conventional craniotomy or neuroendoscopic surgery would lead to improved mortality and better functional outcomes in patients with PSICH. Specifically, we wanted to determine the extent of hematoma clearance, intraoperative blood loss, intraoperative time, degree of rebleeding, total complications, and length of hospital stay among the surgical approaches utilized. We searched from the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE/PubMed, the U.S. National Institutes of Health Ongoing Trials Register, Embase database, Health Research and Development Information Network (HERDIN), and the World Health Organization International Clinical Trials Registry Platform for studies to be included. Patients with deep hypertensive intracerebral hemorrhage of either sex, aged 18 to 60 years, with a Glasgow Coma Score of 6 to 12, with hematoma volume of 30 to 80 mL, and received treatment within 24 hours with either conventional craniotomy or neuroendoscopic surgery were allowed. Outcomes evaluated were mortality and functional outcome. The risk of bias was assessed using the ROBINS-I tool for nonrandomized studies. The final search yielded four eligible studies. Both conventional craniotomy and neuroendoscopic surgery did not show any statistically significant difference in postoperative mortality (risk ratio [RR]: 1.32, 95% confidence interval [CI]: 0.48-3.62, p  = 0.59, I ² : 42%) and postoperative functional outcome (RR: 3.17, 95% CI: 0.76-13.3, p  = 0.11, I ² : 83%). Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions yielded similar results in amount of volume evacuated, intraoperative blood loss, length of hospital stay, number of rebleeding, and total complications. This meta-analysis and review shows that conventional craniotomy and neuroendoscopic surgery both lead to good postoperative functional outcomes with similar death rates. Neuroendoscopic surgery showed statistically significant shorter operative time. Both interventions result in high volume of hematoma evacuated, low number of rebleeding, and total complications, as well as similar amount of intraoperative blood loss and length of hospital stay.

Background: With the existence of the fibrofatty adhesion (FFA) in the temporal region in relation to the frontotemporal branch of the facial nerve, the suprafascial dissection technique for two-layer pterional scalp flap creation was developed for standard pterional craniotomy. However, the exact anatomy of the FFA has not been well described. We clarified the anatomy of the FFA in cadavers and clinical cases.

Materials and methods: Fourteen sides of the cadaveric head were dissected, and the location of the FFA was measured. Twenty patients with cerebral aneurysm who underwent pterional craniotomy using the suprafascial dissection technique between December 2023 and January 2025 were retrospectively reviewed and evaluated for the location of the FFA.

Results: In the cadaveric study, the mean distances between the superoposterior border of the FFA and the junction of the frontozygomatic process (FZP) and zygomatic arch were 2.2, 2.1, and 2.5 cm at the posterior, superoposterior, and superior borders of the FFA, respectively. The superior edge of the FFA was located inferior to the junction of the FZP and the temporal line at 2 and 1.8 cm on average for the cadaveric and clinical study, respectively.

Conclusion: The FFA was located in a small area posterior to the FZP, superior to the zygomatic arch, and below the junction of the FZP and the temporal line. The existence and anatomy of the FFA confirmed the safety of suprafascial dissection for pterional craniotomy. When exposing the zygomatic arch is necessary, interfascial or subfascial dissection must be performed.

Penetrating brain injury (PBI) accompanied by vascular injury is a severe trauma, often resulting in high mortality, particularly in low- and middle-income countries where many aspects of health care facilities are limited. Effective management of PBI requires efficient prehospital management, followed with advanced neurosurgical equipment, and continuous neurocritical monitoring. Delays in treatment due to inadequate transport infrastructure, scarce facilities, lack of specialized personnel, and inadequate transport infrastructure significantly elevate mortality rates. Neurointensive monitoring with radiological modalities plays significant role in detecting secondary processes in PBI, nevertheless facing significant limitations due to restricted access and resource allocation under national health insurance limit in clinical practice. Furthermore, undetected vascular complications could contribute to the high mortality observed in these environments. This case highlights the dilemmas in the neurocritical care of PBI as well as the need for improved health care policies for better health care.

Traumatic spinal cord injury (TSCI) is a prevalent condition associated with high morbidity and mortality. The pathophysiology of TSCI involves primary injury from the traumatic insult itself and secondary injury (SI) from maladaptive biological processes that serve to aggravate the original insult, such as edema and inflammation, which exacerbate the primary injury and prevent healing and recovery. Research is currently underway to derive therapies to reduce SI-mediated damage. Hypertonic saline (HTS) has emerged as one such therapy. We conducted a literature search for animal and human studies investigating the role of HTS in TSCI on PubMed. Murine studies have shown it to possess antiedema, anti-inflammatory, and vasodilatory properties, which aid in reducing SI and thus improving functional outcomes. Combining HTS with other drugs such as procoagulants, methylprednisolone, and nitroprusside has also been shown to possess greater therapeutic benefit in rodent models of TSCI compared with single therapy with HTS. No human studies have been done till now to assess the benefits of HTS in improving human TSCI outcomes. Future research must focus on determining specific dosing and frequency regimens for HTS in human TSCI patients and on elucidating the extent of benefit it provides to them in improving their outcomes.

Objective: Deeply located intracranial lesions such as intraparenchymal and intraventricular lesions are surgically challenging and associated with unavoidable complications such as seizure, surgical bed hematoma, and brain contusion caused by traction. The objective of this study is to evaluate the safety and effectiveness of the microscopic tubular retractor of a plastic syringe for the resection of deeply located brain lesions.

Materials and methods: We retrospectively studied 157 patients with deep-seated intracranial lesions who underwent microscopic resection with the help of a tubular retractor made of a plastic syringe and Teflon introducer between January 2018 and January 2024 in a tertiary hospital. All deep-seated lesions were such as neurocytoma, lymphoma, ependymoma, colloid cysts, metastatic brain tumors, astrocytoma, and meningiomas. We evaluated all patients postoperatively with computed tomography (CT) scan on the first/second day of surgery. The amount of blood loss, the complications, and the mortality rate were recorded.

Results: There were 104 males and 53 females with a mean age of 54.13 (range: 15-80) years. Gross total resection was obtained in 85.35% and subtotal in 14.65% of patients. Complications such as surgical bed hematoma in 5.73%, seizure in 3.18%, weakness in 2.54%, and contusion in 3.82% of patients were noted. The blood loss varied from 30 to 500 mL (average, 100 mL). The mortality rate was observed in 2.54% of all patients. Follow-up ranged from 1 to 25 months (average, 10 months).

Conclusion: Plastic syringe tubular retractor with Teflon introducer system is safe and effective for the treatment of deeply located intracranial lesions in terms of low morbidity and excellent rate of resection.

Introduction: Cranioplasty involves repairing the skull defect using an autologous bone flap or synthetic molds. The temporalis muscle, detached during decompressive craniectomy (DC), may be reattached to the bone flap for better cosmetic reconstruction. Along with the masseter and pterygoid muscles, the temporalis muscle significantly contributes to the human bite force. In this study, we analyze patients' bite force in which the temporalis muscle was either dissected and reattached or left undisturbed during cranioplasty.

Materials and methods: All patients who previously underwent DC for traumatic brain injury or stroke were grouped into two, depending on the method of cranioplasty. In group 1, patients underwent temporalis muscle dissection and reattachment to the bone flap or prosthesis. In group 2, the temporalis muscle was left undisturbed. The bite force of the subjects was measured bilaterally in both groups by a gnathodynamometer before cranioplasty and 3 months after the surgery. We compared the difference in bite force of the subjects individually on both sides, preoperatively and postoperatively, as well as between the groups.

Results: This study included 36 patients over 18 years of age, with 18 patients in each group. Preoperatively, the bite force of all the subjects was decreased on the side of the DC compared with the normal side. After cranioplasty, the bite force significantly improved compared with preoperative values in both groups.

Conclusion: Temporalis dissection can be safely done during cranioplasty. There is improvement in bite force after cranioplasty with or without temporalis dissection.

Diminished prepontine interval is a challenging intraoperative finding that creates an additional risk while doing an endoscopic third ventriculostomy (ETV) due to the proximity of the basilar artery to the ventriculostomy site. It is not a contraindication for the procedure especially in patients with thinned floors through which the vascular structures can be easily visualized and it was not proven to be a risk factor for failure of the procedure. Old children with hydrocephalus secondary to tectal glioma have a high chance of successful ETV, thus avoiding shunt dependency. A 12-year-old male patient presented with headache and grade III papilledema, magnetic resonance imaging brain revealed tectal glioma and triventricular hydrocephalus. He underwent a successful ETV despite a challenging intraoperative, extremely diminished prepontine interval. At 1-year follow-up, brain imaging showed a complete resolution of hydrocephalus and stationary course for the tectal glioma. The present case highlights that diminished prepontine interval is not a contraindication for doing ETV unless safety cannot be guaranteed, and it was not proven to be a risk factor for ETV failure. Creating a stoma on the dorsum sellae after palpating the bone or just behind it using blunt fenestration is a safe way especially in the presence of a thinned third ventricle floor with clearly visualized vascular structures.