Asian journal of neurosurgery最新文献

Introduction  Predicting the shape of the occluded middle cerebral artery (MCA) from the contralateral MCA might help catheterization in endovascular mechanical thrombectomy (EMT). Materials and Methods  We analyzed magnetic resonance (MR) angiography in 100 consecutive patients who had MR imaging for diseases other than acute ischemic stroke. To assess the symmetricity of MCA, the shape of M1, length of M1, number of M2, number of early branches (EBs), and distance from the top of the internal carotid artery to EB were investigated. Results  The shape of M1 was upward in 42%, horizontal in 47%, and downward in 11%. The M1 shape was the same on both sides in 64%, which exceeded the probability assumed to be left-right independent. The number of M2 trunks and EBs matched left and right in 86 and 55% of patients, respectively; however, these agreement rates were not higher than those with independent left and right sides. No left-right correlation was found between the M1 length and the distance from the internal carotid artery to EB. Conclusion  Based on our data, the symmetry of MCA was observed only in the shape of the M1 segment. This finding could be beneficial for EMT targeting MCA embolisms.

Introduction  Extubation is associated with hemodynamic changes and emergence phenomena leading to cough, sore throat, dysphonia, and dysphagia in the postoperative period. The aim of our study was to compare intracuff 2% alkalinized lignocaine with 1% alkalinized lignocaine and saline in reducing endotracheal tube induced emergence phenomena and haemodynamic changes at extubation in neurosurgical patients. Materials and Methods  In this randomized controlled study, 90 adult patients of either sex, scheduled to undergo neurosurgical procedures were randomly divided into three groups of 30 each to receive either 1% alkalinized lignocaine (AL1), 2% alkalinized lignocaine (AL2), or saline as cuff inflation media. Intracuff pressures and haemodynamic variables were noted intraoperatively and during emergence. The presence of postextubation cough, sore throat, dysphonia, and dysphagia were monitored until 24 hours postoperatively. Data were analyzed using Chi-square test and ANOVA. A p -value of less than 0.05 was considered significant. Results  The intracuff pressures were significantly less with alkalinized lignocaine as compared to saline, after 3 hours of induction. Post extubation, hemodynamic parameters and incidence of coughing and bucking at extubation were significantly less in Groups AL1 ( p  = 0.024) and AL2 ( p  = 0.02) as compared to saline. On assessment of laryngotracheal morbidity, the incidence of coughing was found to be significantly less with 2% alkalinized lignocaine as compared to saline ( p  = 0.021) at 1 hour after extubation. Sore throat was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour ( p  = 0.008, 0.002 respectively) and 8 hours ( p  = 0.01 in both groups), and in Group AL2 versus saline at 24 hours ( p  = 0.044) after extubation. The incidence of dysphonia was significantly less in Groups AL1 and AL2 as compared with saline at 1 hour ( p  = 0.016, p  = 0.002) and 24 hours ( p  = 0.012 in both groups) and in Group AL2 versus saline at 8 hours (p  = 0.03) postoperatively. No significant differences were noted between 1% alkalinized lignocaine and 2% alkalinized lignocaine. Conclusion  Intracuff alkalinized lignocaine 1% and 2% were significantly better than saline in reducing coughing and bucking at extubation, post extubation haemodynamic changes and incidence of postoperative cough, sore throat, and dysphonia.

Objective  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. Materials and Methods  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. Results  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. Conclusion  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.

Although many authors have recommended the retractorless technique to avoid retractor-induced brain injury, others usually use brain retractors with a meticulous technique to facilitate the surgery, especially for sylvian fissure dissection. The intrasylvian retraction technique was described for sylvian fissure opening, but no clinical evidence was found. We evaluate the efficacy and safety of this technique for the distal transsylvian approach. We reviewed the video records of clinical cases where the distal transsylvian approach was performed using the intrasylvian retraction technique for aneurysm treatment and middle cerebral artery (MCA) bypass between September 2018 and August 2022. Operative techniques are described. The efficacy and safety of the technique were assessed by full exposure of the sylvian fissure and new postoperative perisylvian hematoma, respectively. One hundred twenty-five cases were included and had an average age of 53.5 (range 16-85) years. Women comprised 73.6%. Aneurysm surgery, pure MCA revascularization, and aneurysm surgery with MCA revascularization were 106 (84.8%), 12 (9.6%), and 7 cases (5.6%), respectively. The most common aneurysm location was the internal carotid artery-posterior communicating artery junction in 37 cases (34.9%), followed by the anterior communicating artery in 27 (25.5%). Full exposure of the Sylvian fissure was achieved in all cases. No perisylvian hematoma was detected by immediate postoperative computed tomography in any patient. Using an appropriate technique for brain retractor application, sylvian fissure dissection was safely performed. The intrasylvian retraction technique effectively facilitated sylvian fissure dissection and provided wide exposure for the distal transsylvian approach.

Background  Untreated cerebrospinal fluid (CSF) rhinorrhea and otorrhea can lead to adverse complications like meningitis and hence should not be overlooked. Acetazolamide reduces CSF production by 48%. The actual role of acetazolamide in the amelioration of traumatic CSF rhinorrhea and otorrhea is not clear as, till date, very few formal studies have been conducted. Aim of the study was to determine the role of acetazolamide in traumatic cerebrospinal fluid rhinorrhea and otorrhea. Materials and Methods  A randomized controlled trial was conducted among 134 patients with head injuries presenting to the neurosurgery department of a tertiary care center in North India, with complaints of CSF rhinorrhea and otorrhea within 72 hours of traumatic injury. One-hundred thirty-four patients were randomized into intervention and control group. Comparative analysis was not possible in 58 patients as in due course they were either operated for head injury or lumbar drain was put due to excessive CSF leak; hence, forth comparative analysis was done in 76 patients. Out of these 76 patients, 44 patients belonged to the intervention group (Acetazolamide given) and 32 belong to the control group (Acetazolamide not given). The day of the stoppage of CSF Leak was the main endpoint of this study. Result  Majority of the patients were in the age group of 21 to 30 years and were predominantly males. Road traffic accident was observed in 84 (75%) patients. There was no statistically significant difference noted in the mean number of days of CSF leak whether acetazolamide was given or not ( p  = 0.344). The complication associated with CSF leak was meningitis. The percentage of patients developing meningitis was more after lumber drain insertion. Conclusion  In our study, there was no advantage of adding acetazolamide to the conservative management of traumatic CSF leak. Therefore, the practice of routinely giving acetazolamide should be reconsidered.

Herein, we describe a 55-year-old female patient with a functional movement disorder (FMD) who presented with normal pressure hydrocephalus (NPH)-like clinic. The neuroimaging data and positive response to the tap test initially suggested NPH. However, a detailed investigation of the clinic features yielded a final diagnosis of FMD. Via the presentation of this patient, we expand the phenomenology of FMD. To our knowledge, this is the first presentation of a patient with FMD mimicking NPH. Therefore, we think this rare illustration is interesting and may provide valuable perspectives for clinical practice.

Object  Trigeminal neuralgia (TN) consists of excruciating paroxysmal pain, which lasts for seconds to minutes, in the distribution of fifth cranial nerve. TN is not life-threatening, but life became miserable because of high intensity of pain. This study aimed to assess the overall success rates of different treatments, considering pain relief, recurrence rates, and potential side effects. Material and Methods  A total of 203 patients of TN treated in the period of last 10 years, that is, 2013 to 2022, were included. Medial management was in 103, radiofrequency ablation in 17, neurectomy in 9, tumor excision in 6, and microvascular decompression (MVD) was done in 68 patients. Magnetic resonance imaging brain with fast imaging employing steady-state acquisition was the basic investigation to decide the etiology of disease. Results  Preliminary findings from our institutional experience indicate that a multidisciplinary approach, combining medical, surgical, and noninvasive treatments, yielded the most favorable results in managing TN. The majority of patients achieved significant pain reduction and improved quality of life with these selected therapies. However, certain subgroups of patients exhibited a higher propensity for treatment resistance, necessitating further investigation into personalized treatment strategies. Conclusion  Our study concludes that there is no definitive treatment modality (either medical or surgical) available for patients with TN. As the etiology of TN is varied, management of TN also varied, that is, multidisciplinary approach. Every type of treatment has pros and cons but when the cause of TN is vascular compression and patient's general condition permits for surgery, in such cases MVD should be preferred over the ablative procedures.

Introduction  Knowledge of preoperative and intraoperative intracranial pressure (ICP) enables the neuroanesthesiologist to optimize cerebral perfusion pressure. However, ICP is rarely monitored during the intraoperative period. In this report, subdural site ICP measurement is validated with intraventricular ICP measurement, and the feasibility of subdural ICP monitoring during the intraoperative period is discussed. Materials and Methods  In this prospective pilot study, ICP measurement at the subdural site was achieved with an intravenous cannula and the ventricular site with a ventricular cannula. Both were transduced using a fluid-filled pressure transducer and connected to the monitor for display of the number and the waveforms. Monitoring of intraoperative ICP using both the techniques was done in all patients recruited into the study. The correlation between the two modalities of measurement was studied by the Spearman correlation test and their limits of agreement were studied using the Bland-Altman plot. A case series describing the perioperative management based on the subdural ICP values are also described. Results  Subdural ICP showed a strong correlation with intraventricular ICP ( r _s = 0.93, p  = 0.01). Agreement analysis using the Bland-Altman plot showed that the mean difference of ICP between the modalities was 1.44 mm Hg (95% confidence interval, -0.6 to 3.49, p  = 0.122). Discussion  This study validates the ICP values measured at the subdural site with the intraventricular site. Subdural site ICP monitoring can be achieved rapidly with readily available systems and helps in making intraoperative clinical decisions. Conclusion  Cannula-based subdural ICP is a satisfactory alternative to intraventricular ICP monitoring in the intraoperative period.

The new World Health Organization nomenclature of pituitary tumors was introduced in the year 2022 after much deliberation. This nomenclature clearly demarcates the anterior lobe (adenohypophyseal), posterior lobe (neurohypophyseal), and hypothalamic tumors. There is also focus on other tumors arising in the sellar region. The nomenclature has also advocated the routine use of immunohistochemistry in describing the pituitary transcription factors that plays a fundamental role in distinguishing the cell lineage of these tumors. However, the nomenclature is complex in understanding due to inclusion of pathological correlates like transcription factors, hormones, biomarkers, and various controversies that have emerged regarding the renaming of pituitary adenomas (PA) as PiTNETs ("Pituitary Neuroendocrine tumors") because majority of the adenomas are benign and have rare metastatic behavior while classifying them as PiTNETs will create unnecessary misinterpretation of these as aggressive tumors that will lead to apprehension among the patients. The new classification gives deeper insight into the histological picture of the various pituitary tumors but other than contributing to the follow-up strategy and postsurgery management, this classification does not add anything new that could be advantageous for the neurosurgeons in clinical practice and decision making, especially in deciding the plan of action for surgery. Hence, there is need of a more comprehensive, integrated, neuroradiological-based classification with more emphasis on the invasiveness of these tumors that would assist the neurosurgeons in planning the treatment strategy and managing patients of pituitary tumors.