Asian journal of neurosurgery最新文献

Background: Traumatic head injury, which has a high mortality rate, can present as mild contusions, hemorrhages (subdural, extradural, intraparenchymal), diffuse axonal injuries, or direct penetrating injuries. Glasgow Coma Scale (GCS) is used to assess the severity of head injury. Stress-induced hyperglycemia associated with traumatic brain injury has high mortality compared with hyperglycemia in diabetic patients. Stress-induced hyperglycemia not only occurs due to head injury but also serves as a predictor of its outcome. C-reactive protein (CRP) levels are also associated with severity of head injury. Triglyceride levels are said to correlate with neuroinflammation and apoptosis, thus pivotal with severity of traumatic brain injury. With this background, this study aims to compare the levels of blood glucose, CRP, and serum triglycerides in patients with traumatic head injury according to their level of consciousness.

Objectives: This article compares the levels of blood glucose, CRP, and serum triglyceride in traumatic head injury patients according to their GCS and assesses their trends.

Materials and methods: Patients were divided into two groups (patients with GCS ≤ 8 as group 1 and patients with GCS > 8 as group 2). Blood was collected in these patients at admission, 24 hours after admission, and 48 hours after admission. Glucose was estimated at admission, 24 hours, and 48 hours after admission. CRP and triglycerides were estimated after 24 and 48 hours after admission. The levels were compared between groups and also their trends were assessed.

Statistics: Mean and standard deviation were calculated for the above parameters using Excel. Statistical analysis was done using SPSS software version 26. Statistical significance was assessed using " t -test" and "analysis of variance." A p -value of < 0.05 was considered statistically significant.

Results: Group 1 showed increased levels of glucose after 24 and 48 hours compared with group 2. CRP showed increased levels in group 1 compared with group 2. There was no significant difference in triglyceride levels between the two groups. Levels of blood glucose showed decreasing trends in group 2. CRP showed increasing trend in group 1. Triglyceride levels showed increasing trend in both the groups.

Conclusion: The decreasing trend in glucose levels in group 2 and increasing trend in CRP levels in group 1 are due to the same pathogenesis, which is associated with the severity of head injury. Increased trends in triglyceride levels were seen in both the groups. Since the association of levels of these parameters and their trends with severity of head injury, regular and serial monitoring of these analytes may be used as prognostic marker.

Lower cervical arteriovenous fistulas (AVFs) are rare and complex vascular malformations that pose significant clinical challenges due to their location and variable presentation. While upper cervical AVFs have been extensively studied, lower cervical AVFs remain underresearched. This study aims to review the clinical presentations, management strategies, and outcomes of patients with lower cervical AVFs to enhance understanding and improve treatment approaches. We conducted a retrospective analysis of patients with spinal vascular malformations treated at our institute between June 2006 and December 2023, identifying two cases of lower cervical AVFs. Additionally, a systematic literature review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including 44 patients with lower cervical AVFs, using databases such as Ovid MEDLINE, PubMed, and Cochrane. Data collected included patient demographics, clinical presentation, fistula type, arterial and venous involvement, treatment modality, and neurological outcomes. Among the 44 patients with lower cervical AVFs, including our two cases, 50% were female, and the mean age was 48.68 years (range: 4-76 years). Clinical presentations varied, with 27.3% experiencing hemorrhage, 18.2% presenting with myelopathy, and 18.2% remaining asymptomatic. Venous drainage patterns played a significant role in symptom severity, with complex perimedullary and retrograde venous drainage contributing to worse outcomes. Treatment included endovascular embolization (40.9%), surgical resection (25%), and combined approaches (18.2%), with good recovery achieved in 54.5% of cases. Lower cervical AVFs present diverse clinical challenges due to their variable presentations and complex vascular anatomy. Early diagnosis and tailored management, including endovascular embolization and surgical resection, are essential for optimizing patient outcomes. Further research is needed to better understand the natural history of asymptomatic AVFs and improve treatment protocols.

Objectives: The screening examination for arrhythmias in patients with chronic noncardioembolic ischemic stroke is limited. This study aimed to investigate the prevalence of arrhythmia in patients with chronic noncardioembolic ischemic stroke using a stick-on wearable device.

Materials and methods: This was a prospective observational study conducted between July 2020 and February 2022 involving 176 patients with a history of noncardioembolic ischemic stroke. Patients receiving anticoagulant therapy were excluded. For the evaluation of arrhythmias, the patients wore a stick-on wearable device for a maximum of approximately 7 days. We investigated the prevalence of arrhythmia and its associated factors.

Results: The mean measurement time was 121.3 ± 45.3 hours. Atrial fibrillation was present in 2 (1.1%) patients, frequent premature atrial contractions (PACs) in 69 (39.2%), and frequent premature ventricular contractions (PVCs) in 36 (20.5%). Regression analysis showed that the risk factors independently associated with frequent PACs were age (odds ratio [OR] 1.103, 95% confidence interval [CI] 1.055-1.153; p  < 0.001) and cilostazol use (OR 2.681, 95% CI 1.338-5.371; p  = 0.005). Regression analysis showed that the risk factors independently associated with frequent PVCs were age (OR 1.047, 95% CI 1.002-1.095; p  = 0.043), male sex (OR 3.834, 95% CI 1.441-11.045; p  = 0.013), and cilostazol use (OR 2.968, 95% CI 1.363-6.463; p  = 0.006).

Conclusion: The prevalence of frequent PVCs is higher in patients with chronic noncardioembolic ischemic stroke than in the general population. The stick-on wearable device is a useful screening tool for arrhythmia in patients with chronic noncardioembolic ischemic stroke.

Cerebral aneurysms are localized dilations occurring at weakened areas within the brain's arterial circulation. They often occur at the branching points of smaller vessels and are usually saccular in shape, but they can also have fusiform or blister-type shapes. Internal carotid artery (ICA) aneurysms are believed to represent 30 to 50% of all intracranial aneurysms. Most cerebral aneurysms are asymptomatic and are often discovered incidentally during neuroimaging or autopsy. When rupture occurs, it often leads to subarachnoid hemorrhage, which is associated with high morbidity and mortality. Bouthillier's classification (1996) described seven parts of the ICA based on anatomy, which was based on the original Fischer's classification: C1, cervical; C2, petrous; C3, lacerum; C4, cavernous; C5, clinoid; C6, ophthalmic; and C7, communicating. Paraclinoid aneurysms are complex intracranial aneurysms arising from the ICA proximal to the posterior communicating artery and distal to the distal dural ring. They have complicated anatomy and project surgical difficulty. The management of the ventral ICA aneurysm can be broadly divided into two approaches: open surgical and endovascular approaches. Anatomical factors-including size and location-and other shape-related characteristics often play a crucial role in determining the most suitable treatment for a patient. No gold standard technique can be used to treat all patients. Microsurgical approach: the surgical management of cerebral aneurysms, involving the placement of a clip across the aneurysm neck, can be used in both unruptured or ruptured aneurysms. Endovascular approach: there is a majority of endovascular approaches, which include coil embolization and newer techniques like stent-assisted coiling, balloon-assisted coiling, flow diverters, disruptors, and new embolic materials. The treatment options and techniques for managing ICA aneurysms are rapidly evolving. This review article provides a brief overview of the current management strategies and elaborates different techniques that are currently used. The information is available on various internet databases like PubMed, UpToDate, and the National Institutes of Health Web site, and the literature review is compiled to help the surgeon reach the optimal management strategy tailored to the patient for easy decision-making.

Pleomorphic xanthoastrocytoma (PXA) is a rare, Grade II astrocytic tumor typically found in the temporal lobe and often presents with seizures. We report a unique case of intraventricular trigone PXA, a rare location that mimicked an intraventricular meningioma on imaging. A 26-year-old male presented with progressive visual loss, and magnetic resonance imaging revealed a well-defined lesion in the right lateral ventricle. The patient underwent subtotal tumor resection, followed by adjuvant radiotherapy. Histopathological analysis confirmed PXA with BRAF V600E mutation, and subsequent imaging showed successful tumor control with no recurrence after 2 years. This case highlights the importance of differentiating PXA from other neoplasms, such as meningiomas, and demonstrates the favorable prognosis of PXA when appropriately managed.

Objectives: Central nervous system infections are linked to a substantial rise in perioperative mortality, with postoperative neurosurgical infections being both prevalent and severe. Although the Surviving Sepsis Campaign (SSC) guidelines offer a framework for managing sepsis, their effect on clinical outcomes in neurosurgical patients has yet to be fully explored. The aim of this study was to compare mortality rates and clinical outcomes in neurosurgical patients with sepsis and septic shock treated according to the SSC protocol versus standard care.

Materials and methods: This single-center retrospective analysis on prospectively acquired data included 159 patients with neurosurgical sepsis and septic shock, divided into two groups: 77 patients managed according to the SSC guidelines and 82 patients receiving standard treatment. Data on baseline characteristics, initial management within the first hour, and 30-day clinical outcomes were collected and analyzed.

Results: The mortality rate was significantly lower in the SSC protocol group. Additionally, intensive care unit (ICU) length of stay was significantly shorter, and the number of ventilator- and vasopressor-free days was significantly higher in the SSC protocol group ( p  < 0.001). Hydrocortisone use was associated with reduced vasopressor requirements and shorter hospital stays ( p  = 0.001 and p  < 0.001, respectively). Thiamine use was linked to a shorter hospital stay ( p  = 0.023), while continuous renal replacement therapy significantly reduced vasopressor use ( p  = 0.013).

Conclusion: Implementing the SSC protocol within the first hour of treatment significantly reduced mortality, shortened ICU length of stay, and increased the number of ventilator- and vasopressor-free days.

Inflammatory hypothalamo-hypophyseal disorders are uncommon, representing only 1% of hypophyseal lesions. Among these, postpartum lymphocytic hypophysitis emerges as a particularly notable etiology. As a relatively recent entity, its recognition mandates a multidisciplinary approach to ensure preservation of compromised vital prognosis and amelioration of associated neuro-ophthalmologic and/or hypophyseal manifestations. We present a remarkable case of lymphocytic hypophysitis in a 32-year-old woman, unveiled during the postpartum period. Despite employing magnetic resonance imaging (MRI), preoperative diagnosis remained challenging. Surgical intervention became imperative due to progressive visual impairments. Postoperative course demonstrated favorable evolution, characterized by significant enhancement in visual acuity and normalization of cerebral MRI findings during follow-up.

Cocaine is among the most commonly used recreational drugs in Scotland, contributing to significant socioeconomic and severe health challenges. The prevalence of cocaine-induced midline destructive lesions (CIMDL) is rising due to increased cocaine insufflation. Here, we report a case of a patient who developed acute hydrocephalus and meningitis as complications of CIMDL due to long-term cocaine abuse. A 39-year-old woman with a history of chronic nasal cocaine abuse presented with fever, malaise, and gait imbalance. On arrival at accident and emergency department, she had altered sensorium, Glasgow coma scale (GCS) of 10, and left-sided hemiparesis, requiring emergency intubation. Imaging revealed acute hydrocephalus and brain edema. She underwent an emergency external ventricular drain (EVD) to temporize her raised intracranial pressure. Her constellation of problems and biochemical parameters directed toward a diagnosis of acute bacterial meningitis. Her blood cultures grew methicillin-sensitive Staphylococcus aureus , and she was started on broad-spectrum antibiotics. Her computed tomography scans showed air in the sphenoid sinus, clival erosion, and partial erosion of the anterior arch of C1, consistent with CIMDL. She developed posterior circulation ischemic strokes, which were attributed to her endocarditis and tricuspid valve vegetations that were detected on her transthoracic echocardiogram. Eventually, she underwent a ventriculoperitoneal shunt for permanent cerebrospinal fluid diversion. Neurologically, she was E4V5M6 with residual left hemiparesis at the time of discharge. She is on aggressive rehabilitation under the care of oral maxillofacial surgery, otorhinolaryngology, and a skull base team for her CIMDL. This case highlights the importance of multidisciplinary care and support in managing such cases, especially aiming to prevent the recurrence of infection leading to significant morbidity or even mortality.

Introduction: High-grade gliomas (HGGs) have dismal prognosis even with multimodality treatment entailing surgery, radiotherapy, and chemotherapy. Hence, assessment of improvement in quality of life (QOL) for evaluating treatment is critical. Target delineation for radiotherapy in HGG is often done according to the European Organization for Research and Treatment of Cancer (EORTC) and Radiotherapy and Oncology Group (RTOG) contouring guidelines, which differs on exclusion and inclusion of peritumoral edema believed to harbor malignant cells; the guidelines have not been prospectively compared for probable difference in QOL, considering the probable difference in treated volume.

Objective: This article compares QOL in HGG patients receiving postoperative radiotherapy using target volume delineation based on the RTOG or EORTC guidelines.

Materials and methods: In this single-center, prospective randomized exploratory study, postoperative HGG patients were randomized to either receive radiotherapy according to the EORTC guidelines of target delineation (60 Gy/30 fractions to tumor bed and residual tumor) or the RTOG guidelines (46 Gy/23fractions to tumor bed, residual tumor, and peritumoral edema with 14 Gy/7 fraction boost to the tumor bed and residual tumor) with concurrent temozolomide (TMZ) followed by 6 months of adjuvant TMZ. The aim and primary endpoint of the study was to assess and compare QOL between the arms. Descriptive statistics were used to convey demographic data, proportions for categorical variables, and mean, median, range, and standard deviation for continuous variables. Effect size was assessed using partial eta squared test where values of 0.01, 0.06, and 0.14 signify small, medium, and large effect size, respectively. Repeated measures analysis of variance test was used for comparison of means and assessment of QOL between the EORTC and RTOG groups at 6 months. Absolute volume of planning target volume (PTV) receiving 46 and 60 Gy were described, PTV 46/60 was also described in terms of % of whole brain volume.

Results: Eighteen patients underwent randomization (9 in EORTC and RTOG group each). Statistically significant improvement was noted in the overall posttreatment values in the physical well-being (PWB) domain ( p  = 0.007).

Conclusion: This is the first study to compare the EORTC and RTOG delineation techniques in terms of QOL. No significant differences in QOL were noted between the two arms. Significant improvement was noted posttreatment in PWB of overall patients.

Background: This study aimed to compare the efficacy and safety of two anesthetic techniques in patients undergoing carpal tunnel release surgery: intravenous regional anesthesia (IVRA) and the wide-awake local anesthesia no tourniquet (WALANT) technique.

Materials and methods: A retrospective observational dual-center study was conducted, including 102 patients diagnosed with moderate-to-severe carpal tunnel syndrome (CTS) unresponsive to conservative treatment. Outcomes were assessed using the visual analog scale (VAS) for pain and the Duruoz Hand Index (DHI) for hand functionality. Comparisons were made based on age, gender, preoperative VAS scores, incision length, and surgical procedure duration.

Results: The outcomes of the WALANT ( n  = 51) and IVRA ( n  = 51) techniques in CTS surgery were compared. The IVRA group had a shorter operation time (2.49 ± 0.50 minutes) and faster return to daily activities (10.13 ± 9.50 days) compared with the WALANT group (operation time: 7.27 ± 1.35 minute, return to daily activities: 17.64 ± 2.52 days) ( p  < 0.05). Additionally, postoperative analgesic requirements were significantly lower in the IVRA group (8/51; 15.6%) than in the WALANT group (37/51; 72.5%) ( p  < 0.05). Both groups showed significant postoperative improvements in VAS and DHI scores ( p  < 0.05), with the IVRA group demonstrating a greater improvement in DHI scores (14.76 ± 0.43) compared with the WALANT group (12.76 ± 0.45) ( p  < 0.05).

Conclusion: IVRA with small incisions demonstrated superior outcomes in CTS surgery compared with WALANT, including shorter operation times, faster recovery, and reduced postoperative analgesic requirements. These findings suggest that IVRA may be a more favorable option for both patients and surgeons in carpal tunnel release surgery.