Asian journal of neurosurgery最新文献

Anterior clinoid process metastases are rare. We present an unusual case of anterior clinoid process metastasis with sudden deterioration of visual function requiring emergency optic nerve decompression, resulting in recovery of visual function. The patient was a 41-year-old man with a diagnosis of leiomyosarcoma of the radius, operated on in 2014, with bone and lung metastases, who had been treated with chemotherapy and appeared to have stable disease at his last follow-up. Six years later, he developed a 1-month history of progressive unilateral loss of visual acuity and visual field defect (initially quadrantanopia that progressed to nasal hemianopia). Brain imaging showed a contrast-enhancing lesion affecting the left anterior clinoid process with extension to the cavernous sinus and sphenoid sinus, causing compression of the left optic nerve. Although the lesion could have suggested a meningioma given the location, in the context of the patient's oncological history, the diagnosis of metastasis was considered more likely. The patient was admitted to the hospital and, during the hospital stay, developed sudden left retro-orbital pain progressing to left amaurosis over approximately 8 hours. Urgent surgery was performed: a pterional craniotomy with partial tumor removal and optic nerve decompression with extradural anterior clinoidectomy. After surgery, the patient had an immediate but partial improvement in visual acuity and in the visual field defect. Metastasis to the anterior clinoid process is very uncommon, with only one case previously reported in the literature. In cases of visual impairment, symptoms may deteriorate rapidly to complete loss of vision, so urgent decompressive surgery of the optic pathway may be indicated to recover visual function, although recovery may be partial.

Background: Ischemic stroke occurring during sleep has been known as wake-up stroke, and many studies have been conducted on the subject. On the other hand, there have only been a few studies on spontaneous intracerebral hemorrhage (ICH) occurring during sleep. To clarify their clinical characteristics and possible risk factors, a single-center retrospective study was conducted on nontraumatic ICH patients admitted to our institution between 2012 and 2017.

Materials and methods: Demographics and outcomes were compared between 119 patients with ICH occurring during sleep (sleep group) and 401 patients with ICH occurring during the awake period (awake group). Multivariate regression analysis was conducted to identify risk factors. Furthermore, clinical presentation in those 119 patients was further classified into three categories (deficits, sudden headache, and failure to wake up), and their association to the outcomes was evaluated.

Results: Compared with the awake group, the frequency of chronic kidney disease (CKD) and diabetes mellitus were significantly higher in the sleep group. Multivariate regression analysis identified CKD as a risk factor for ICH occurring during sleep. The in-hospital mortality rate was significantly higher in the sleep group. Among the three classifications, failure to wake up was indicative of high mortality rate.

>conclusion: The current results that ICH occurring during sleep was indicative of worse outcomes is compatible with prior studies. Poorly controlled nocturnal hypertension in patients with CKD and diabetes mellitus may be responsible for the higher incidence of ICH occurring sleep in those populations. The three classifications according to clinical presentation may be useful as a prognosticator.

An arachnoid cyst is mostly congenital CSF-filled space occurring in the brain and spine. In the spine, they are usually found in the posterior aspect. Anterior cervical arachnoid cyst is very uncommon. A 14-year-old adolescent boy presented with rapidly progressive quadriparesis starting with the left lower limb, which is associated with radiating pain and numbness in both upper extremities. There was no sensory deficit, and the bladder and the bowel were normal. The radiological evaluation with contrast-enhanced MRI was suggestive of an anterior cervical intradural arachnoid cyst, for which the patient underwent surgery with wide fenestration and partial removal of the cyst wall, and the cyst wall was sent for histopathological examination. The patient improved postoperatively without any residual deficit. Anterior cervical arachnid cyst is a very rare lesion and should be considered in children and young adults who presented with neck pain or radiculopathy, especially if they are followed by motor weakness.

The aim of this study was to demonstrate that anteriorly placed transforaminal lumbar interbody fusion (TLIF) footprint bullet cage is a safe and effective bailout option if difficult left common iliac vein (LCIV) anatomy is unexpectedly encountered during the L5-S1 lateral anterior lumbar interbody fusion (L-ALIF). This retrospective case series includes four patients who received anteriorly placed TLIF cages at L5-S1 during L-ALIF surgery. Demographics, complications, and clinical/radiographic results were collected. The analysis included four female patients with a mean age of 59.0 years and mean body mass index (BMI) of 23.9. Three patients had degenerative conditions and one patient had a deformity. All the patients had an LCIV obstructing the center of the L5-S1 disk space, and titanium TLIF bullet cages were placed and secured with washers and screws. The L5-S1 segmental lordosis increased by 8.3 ± 6.1 degrees with a final mean lordosis of 23.5 ± 8.4 degrees; the L5-S1 intradiskal angle increased by 12.0 ± 7.0 degrees with a final mean disk angle of 18.8 ± 7.0 degrees; the posterior disk height increased by 4.4 ± 2.7 mm with a final mean disk height of 8.0 ± 2.1 mm. The mean numerical rating scale (NRS) for back pain improved by 5.3 ± 2.5 and the mean NRS leg pain improved by 7.7 ± 2.5 over a mean follow-up of 14 months (range: 6-20). There have been no perioperative complications or implant failure to date. If challenging vascular anatomy is encountered during L-ALIF exposure that prevents ALIF footprint cage placement, proceeding with smaller TLIF bullet cage placement anteriorly rather than abandoning the surgical approach is a safe and effective option.

Flow diverter (FD) is often the first-line treatment for giant internal carotid artery aneurysms, with a high rate of aneurysm occlusion. However, up to 10% of giant cerebral aneurysms increase in size after FD treatment. Surgery is usually considered if the giant internal carotid artery aneurysm continues to enlarge and cause compression. We report a case of a giant internal carotid artery aneurysm that continued to increase in size after FD treatment and was subsequently treated surgically. We also review the literature on the management of giant cerebral aneurysms that increased in size after FD. A 41-year-old female patient was diagnosed with a right giant internal carotid artery aneurysm and was initially treated with FD. After FD, the patient's vision in the right eye did not improve. Despite medical treatment, her vision continued to deteriorate. The patient presented at our hospital with reduced vision in both eyes. Magnetic resonance imaging and digital subtraction angiography with balloon test occlusion confirmed the presence of a giant thrombosed aneurysm in the right internal carotid artery, compressing the right optic nerve and optic chiasm. The patient underwent external carotid artery-middle cerebral artery bypass surgery using a radial artery graft, aneurysm sac dissection with thrombus removal, and reconstructive clipping of the aneurysm neck. After surgery, the patient's vision in both eyes improved immediately and did not develop any new neurological symptoms. Extracranial-intracranial arterial reconstructive surgery is a viable option for treating giant internal carotid artery aneurysms that have undergone FD treatment but continue to present with progressive mass effects.

Objectives  This article evaluates the outcomes and efficacy of detachable balloon embolization by single balloon delivery catheter, while identifying factors associated with successful embolization in traumatic carotid cavernous fistula (TCCF) patients. Materials and Methods  We retrospectively collected data of TCCF patients who underwent detachable balloon embolization during March 2020 to April 2024. All cases utilized a single balloon delivery catheter for detachable balloon deployment (GOLDBAL, BALT Extrusion, France). We analyzed demographic, clinical, imaging, and angiographic data, including outcomes, complications, and factors associated with successful embolization. Results  Thirty patients were treated with detachable balloon embolization. The mean age of the patients was 41.1 years (range 17-65 years). The median duration of symptom was 2.0 months (range 0.25-60 months). The most common mechanism of injury is motorcycle accident (83.3%). Nearly all patients had eye redness and proptosis. Angiographic data indicated 29 patients (96.7%) had drainage to the inferior petrosal sinus, 28 (93.3%) had drainage to the superior ophthalmic vein, and 8 (26.7%) had drainage to the superior petrosal sinus. Five cases (16.7%) were classified as small-sized fistula, 19 (63.3%) as medium-sized, and 6 (20%) as large-sized. Regarding the location of the fistula, 8 cases (26.7%) were found in the horizontal segment, while 22 cases (73.3%) were located in the ascending or genu segment of the cavernous internal carotid artery (ICA). Among the 24 patients (80%) who underwent successful embolization, the ICA was preserved in 23 out of 24 patients (95.8%). The remaining patient had ICA occlusion but exhibited no clinical symptoms. Residual cavernous aneurysm was found in two patients, one patient had persistent cranial nerve deficit, while the other was asymptomatic. Statistical analysis demonstrated a significant difference was associated with the fistula location at the ascending or genu segment of the cavernous ICA in relation to successful embolization Conclusion  Despite the availability of several endovascular treatment options for TCCF, using detachable balloon embolization is a relatively straightforward procedure. When combined with a thorough understanding of cavernous sinus anatomy, this approach can significantly enhance the occlusion rate and preserve ICA patency while minimizing complications, particularly when the fistula is located at the ascending or genu segment of the cavernous ICA.

Lhermitte-Duclos disease (LDD) is a rare, autosomal dominant, dysplastic gangliocytoma of the cerebellum. It is a slow-growing benign tumor. The challenges in the surgical resection of these tumors lie in accurately delineating the tumor margin from the normal cerebellar parenchyma. Intraoperative ultrasound has the potential to overcome these limitations. A 30-year-old woman was diagnosed as having LDD showing a typical "tigroid" appearance on MRI. Intraoperative ultrasound was used to delineate the tumor margins and near-total resection was done via right suboccipital craniectomy. The diagnosis was confirmed on histopathological examination. Postoperatively there were no neurological deficits, and the patient is on regular follow-up for screening of Cowden's syndrome. We report this case to highlight the undervalued utility of intraoperative ultrasonography while dealing with patients with LDD. This modality serves as an effective tool to maximize the extent of resection without adding to postoperative morbidity.

Cerebrospinal fluid (CSF) provides buoyant support to the brain and spinal cord. According to the Monroe-Kellie doctrine, confined space in the cranium causes any change in CSF volume contributing to significant intracranial pressure changes, which cause a variety of pathologies and symptoms. We, hereby, present a case of a 33-year-old gentleman who after a motorcycle road traffic accident came to us complaining of persistent headache and neck pain with subdural hematoma (SDH) like presentation, clinically and radiologically, but was reevaluated and diagnosed as traumatic intracranial hypotension and successfully managed surgically after that. Hygromas are believed to be compensatory enlargement of the subdural space due to the loss of CSF volume. The true mechanism of the development of SDH or hygroma due to intracranial hypotension is yet to be hypothesized but provisionally described by a rupture of the bridging veins by being pulled away from the dura because of the low intracranial pressure (ICP) and brain descent. Many prior cases in the literature are shown to have treated the patient with immediate burr hole and decompression of SDH, but this paradoxically worsens the patient due to further lowering of ICP. The causes of prolonged postconcussion headaches are often unidentified, of which intracranial hypotension caused by a CSF leak is potentially under-recognized. In such cases, bilateral SDH with mass effect must be ruled out of any CSF leak before attempting the lifesaving decompressive surgery, as it may paradoxically lead to further morbidity and mortality of the patient.

Neurenteric cysts, also known as endodermal or enterogenous cysts, are uncommon benign congenital lesions of the central nervous system (CNS) characterized by an epithelial lining of endodermal origin. These cysts predominantly affect the spinal canal and cord. Intramedullary neurenteric cysts are exceptionally rare, with fewer than 100 reported isolated cases. Their distinct characteristics, clinical presentation, and challenges in diagnosis and treatment necessitate a detailed case analysis and review. We present the case of a 33-year-old male patient with an intriguing case of an isolated intramedullary cystic lesion in the cervicodorsal spinal cord, extending from the cervicobulbar junction to the D4 vertebra level. The patient's clinical presentation included a 6-month history of progressive weakness in the left upper limb, accompanied by pain and numbness. Neurological examination revealed muscle atrophy, reduced strength, spastic paraparesis, and sensory deficits. Radiological findings demonstrated an expansile cystic lesion with marked signal heterogeneity, intense enhancement, and the presence of a "cap sign" indicative of subacute hemorrhage. Diagnosis of spinal intramedullary neurenteric cysts is reliant on histopathology. Surgical removal remains the recommended treatment, as a conservative approach can lead to irreversible neurological deficits. However, complete resection may be challenging due to potential adhesions to surrounding structures. In such cases, a more conservative approach, avoiding cyst spillage into the subarachnoid space, is preferred. Vigilant radiological follow-up is crucial to monitor for potential cyst recurrence. These rare cases highlight the need for further scientific literature and improved diagnostic and therapeutic strategies.