Albert A. Sufianov, Iurii A. Iakimov, Nargiza A. Garifullina, Rinat A. Sufianov, Roman V. Kovalenko, Idrisdzhoni A. Kosimzoda
Abstract Objective The study aimed to provide neuroanatomical justification of the extradural resection of the anterior clinoid process (ACP). Material and Method Using a cross-sectional study design, 47 cranial computed tomography (CT) scans were examined. There were 31 (65.96%) females aged 28 to 79 years. The measured dimensions were ACP length and width, and optic strut (OS) width. Index (iacp) was measured as the ratio of ACP width to ACP length. The ACP volume and working operating field (WOF) volume were measured using Syngo.via Siemens program. The percentage expansion of WOF after removal of the ACP was estimated on 5 fixed human cadaver heads with the exoscope VITOM 3D. The possibilities of the combined approach were demonstrated in a clinical case. Results The mean ACP lengths were 11.31 ± 2.76 and 11.54 ± 2.86 mm, on the right and left, respectively. The mean ACP widths were 7.70 ± 1.66 and 7.64 ± 1.67 mm, on the right and left, respectively. Average iacp was 0.67 (minimum 0.45; maximum 0.90). The width of the OS varied in the range from 1.37 to 4.75 mm. The average volume of right ACP was 0.71 ± 0.16 cm3, right WOF was 3.26 ± 0.74 cm3, left ACP was 0.71 ± 0.15 cm3, left and WOF was 3.20 ± 0.76 cm3. Removal of the right ACP expanded the right WOF by 22.21 ± 3.88%, and left ACP by 22.78 ± 5.50%. There was an approximately 25% increase in the WOF from the cadaveric dissections. Taking into account the variability of the ACP and OS, we proposed our own surgical classification of complicated (iacp ≥ 0.67; medium OS 2.5 mm ≤ 4.0 mm; wide OS ≥ 4.0 mm; ACP with pneumatization) and uncomplicated ACP (iacp 0.45 ≤ 0.67 mm; iacp ≤ 0.45; narrow OS ≤ 2.5 mm; ACP without pneumatization). Using this classification, we developed an algorithm for ACP dissection and removal. This was piloted in a clinical case of microsurgical clipping of a left internal carotid artery-posterior communicating artery aneurysm via the left minipterional approach. Conclusion Extradural removal of ACP expands the WOF by approximately 25%, it helps neurosurgeons to improve proximal vascular control and avoid complications, and expands the range of indications for neurosurgical interventions in the skull base area.
{"title":"Anatomical Justification of Extradural Resection of the Anterior Clinoid Process","authors":"Albert A. Sufianov, Iurii A. Iakimov, Nargiza A. Garifullina, Rinat A. Sufianov, Roman V. Kovalenko, Idrisdzhoni A. Kosimzoda","doi":"10.1055/s-0043-1771373","DOIUrl":"https://doi.org/10.1055/s-0043-1771373","url":null,"abstract":"Abstract Objective The study aimed to provide neuroanatomical justification of the extradural resection of the anterior clinoid process (ACP). Material and Method Using a cross-sectional study design, 47 cranial computed tomography (CT) scans were examined. There were 31 (65.96%) females aged 28 to 79 years. The measured dimensions were ACP length and width, and optic strut (OS) width. Index (iacp) was measured as the ratio of ACP width to ACP length. The ACP volume and working operating field (WOF) volume were measured using Syngo.via Siemens program. The percentage expansion of WOF after removal of the ACP was estimated on 5 fixed human cadaver heads with the exoscope VITOM 3D. The possibilities of the combined approach were demonstrated in a clinical case. Results The mean ACP lengths were 11.31 ± 2.76 and 11.54 ± 2.86 mm, on the right and left, respectively. The mean ACP widths were 7.70 ± 1.66 and 7.64 ± 1.67 mm, on the right and left, respectively. Average iacp was 0.67 (minimum 0.45; maximum 0.90). The width of the OS varied in the range from 1.37 to 4.75 mm. The average volume of right ACP was 0.71 ± 0.16 cm3, right WOF was 3.26 ± 0.74 cm3, left ACP was 0.71 ± 0.15 cm3, left and WOF was 3.20 ± 0.76 cm3. Removal of the right ACP expanded the right WOF by 22.21 ± 3.88%, and left ACP by 22.78 ± 5.50%. There was an approximately 25% increase in the WOF from the cadaveric dissections. Taking into account the variability of the ACP and OS, we proposed our own surgical classification of complicated (iacp ≥ 0.67; medium OS 2.5 mm ≤ 4.0 mm; wide OS ≥ 4.0 mm; ACP with pneumatization) and uncomplicated ACP (iacp 0.45 ≤ 0.67 mm; iacp ≤ 0.45; narrow OS ≤ 2.5 mm; ACP without pneumatization). Using this classification, we developed an algorithm for ACP dissection and removal. This was piloted in a clinical case of microsurgical clipping of a left internal carotid artery-posterior communicating artery aneurysm via the left minipterional approach. Conclusion Extradural removal of ACP expands the WOF by approximately 25%, it helps neurosurgeons to improve proximal vascular control and avoid complications, and expands the range of indications for neurosurgical interventions in the skull base area.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135478330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Hamza Bajwa, Saad Bin Anis, Irfan Yousaf, Mashal Shah
Abstract Objectives The 2021 WHO Classification of Central Nervous System Tumors taxonomy laid further stress on molecular classification and prognostication of glial tumors in comparison to histopathological grading. Research shows that low-grade gliomas (LGGs) can go through malignant differentiation and lead to severe disability and death. Data from various populations will be necessary to ascertain the exact interplay between genotypic predictors of LGG and outcomes. Materials and Methods To assess the molecular pathology for glial tumors in the Pakistani population, the Shaukat Khanum Memorial Cancer Hospital carried out a retrospective chart review of electronic health records from 2008 to 2018, with immunohistochemistry analysis findings from 2010 to 2018. Patients with a pathological diagnosis of a glioma were included. Statistical Analysis Analysis was performed using IBM SPSS Statistics Version 23 and STATA Version 16. A p-value of less than 0.05 was considered statistically significant with 95% confidence intervals reported. Results In all, 281 operable tumors were recorded. The most common procedure was a subtotal resection, and astrocytomas (64.77%) were the most common tumors. Radiation therapy and PCV (procarbazine, CCNU, and vincristine) was received by 85 patients, while radiation therapy and temozolomide were administered to 15 patients. Conclusions Isocitrate dehydrogenase (IDH) wild-type LGG had a lower survival time, while improved survival times were seen for alpha-thalassemia X-linked intellectual disability syndrome (ATRX) retained and 1p19q co-deleted LGGs. Further studies are required to gain a better understanding of lower-grade glial tumor treatment and survival in Pakistan.
与组织病理学分级相比，2021年WHO中枢神经系统肿瘤分类进一步强调神经胶质肿瘤的分子分类和预后。研究表明，低级别胶质瘤(LGGs)可发生恶性分化，导致严重残疾和死亡。为了确定LGG基因型预测因子与预后之间的确切相互作用，需要来自不同人群的数据。为了评估巴基斯坦人群中神经胶质肿瘤的分子病理学，Shaukat Khanum纪念癌症医院对2008年至2018年的电子健康记录进行了回顾性图表审查，并对2010年至2018年的免疫组织化学分析结果进行了分析。包括病理诊断为神经胶质瘤的患者。采用IBM SPSS Statistics Version 23和STATA Version 16进行统计分析。p值小于0.05被认为具有统计学意义，报告95%置信区间。结果共记录可手术肿瘤281例。最常见的手术是次全切除，星形细胞瘤(64.77%)是最常见的肿瘤。85例患者接受放射治疗和PCV(丙卡嗪、CCNU和长春新碱)，15例患者接受放射治疗和替莫唑胺。结论异柠檬酸脱氢酶(IDH)野生型LGG存活时间较短，而α -地中海贫血x相关智力残疾综合征(ATRX)保留和1p19q共缺失的LGG存活时间较长。需要进一步的研究来更好地了解巴基斯坦低级别胶质细胞肿瘤的治疗和生存。
{"title":"A 10-Year Survival-Trend Analysis of Low-Grade Glioma and Treatment Patterns from an LMIC","authors":"Mohammad Hamza Bajwa, Saad Bin Anis, Irfan Yousaf, Mashal Shah","doi":"10.1055/s-0043-1771369","DOIUrl":"https://doi.org/10.1055/s-0043-1771369","url":null,"abstract":"Abstract Objectives The 2021 WHO Classification of Central Nervous System Tumors taxonomy laid further stress on molecular classification and prognostication of glial tumors in comparison to histopathological grading. Research shows that low-grade gliomas (LGGs) can go through malignant differentiation and lead to severe disability and death. Data from various populations will be necessary to ascertain the exact interplay between genotypic predictors of LGG and outcomes. Materials and Methods To assess the molecular pathology for glial tumors in the Pakistani population, the Shaukat Khanum Memorial Cancer Hospital carried out a retrospective chart review of electronic health records from 2008 to 2018, with immunohistochemistry analysis findings from 2010 to 2018. Patients with a pathological diagnosis of a glioma were included. Statistical Analysis Analysis was performed using IBM SPSS Statistics Version 23 and STATA Version 16. A p-value of less than 0.05 was considered statistically significant with 95% confidence intervals reported. Results In all, 281 operable tumors were recorded. The most common procedure was a subtotal resection, and astrocytomas (64.77%) were the most common tumors. Radiation therapy and PCV (procarbazine, CCNU, and vincristine) was received by 85 patients, while radiation therapy and temozolomide were administered to 15 patients. Conclusions Isocitrate dehydrogenase (IDH) wild-type LGG had a lower survival time, while improved survival times were seen for alpha-thalassemia X-linked intellectual disability syndrome (ATRX) retained and 1p19q co-deleted LGGs. Further studies are required to gain a better understanding of lower-grade glial tumor treatment and survival in Pakistan.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136014862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Objective Programmable valves provide an equal or superior neurological outcome when compared with fixed pressure ones, with fewer complications, in treating idiopathic normal pressure hydrocephalus (iNPH) patients. Long-term costs of these treatments have not been properly compared in literature. We sought to compare costs, efficacy, and safety of 1-year treatment of iNPH patients with programmable valve Sphera Pro and a fixed pressure valve. Materials and Methods A prospective cohort of iNPH patients treated with programmable valve was compared with a historical cohort of iNPH patients treated with fixed pressure valve. Our primary outcome was mean direct cost of treating iNPH up to 1 year. Efficacy in treating iNPH and safety were assessed as secondary outcomes. Statistical Analysis Proportions were compared using chi-square or Fisher's exact tests. Normally distributed variables were compared using the Student's t-test or the Mann–Whitney's U test. Differences in the evolution of the variables over time were assessed using generalized estimating equations. All tests were two-sided, with an α of 0.05. Results A total of 19 patients were analyzed in each group (mean age 75 years, the majority male). Comorbidities and clinical presentation were similar between groups. Both fixed pressure and programmable valve patients had neurological improvement over time (p < 0.001), but no difference was seen between groups (p = 0.104). The fixed pressure valve group had more complications than the programmable valve group (52.6% vs. 10.5%, respectively, p = 0.013). Annual treatment cost per patient was US$ 3,820 ± 2,231 in the fixed pressure valve group and US$ 3,108 ± 553 in the programmable valve group. Mean difference was US$712 (95% confidence interval, 393–1,805) in favor of the programmable valve group. Conclusion The Sphera Pro valve with gravitational unit had 1 year treatment cost not higher than that of fixed pressure valve, and resulted in similar efficacy and fewer complications.
【摘要】目的与固定压力瓣膜相比，可编程瓣膜在治疗特发性常压脑积水(iNPH)患者中具有相同或更好的神经预后，且并发症更少。这些治疗的长期成本在文献中还没有得到适当的比较。我们试图比较使用可编程阀Sphera Pro和固定压力阀治疗1年iNPH患者的成本、疗效和安全性。材料与方法采用可编程瓣膜治疗iNPH患者的前瞻性队列与采用固定压力瓣膜治疗iNPH患者的历史队列进行比较。我们的主要终点是治疗iNPH长达1年的平均直接成本。治疗iNPH的有效性和安全性作为次要结果进行评估。统计分析比例的比较采用卡方检验或Fisher精确检验。正态分布变量的比较采用学生t检验或Mann-Whitney U检验。使用广义估计方程评估变量随时间变化的差异。所有检验均为双侧检验，α为0.05。结果每组共分析19例患者，平均年龄75岁，男性居多。两组患者的合并症和临床表现相似。随着时间的推移，固定压力和可编程瓣膜患者的神经功能均有所改善(p <0.001)，但组间无差异(p = 0.104)。固定压力阀组并发症发生率高于可编程阀组(52.6% vs. 10.5%， p = 0.013)。固定压力瓣膜组每位患者的年治疗费用为3,820±2,231美元，可编程瓣膜组为3,108±553美元。可编程阀组的平均差异为712美元(95%可信区间，393 - 1805)。结论spsphera Pro带重力单元瓣膜1年治疗费用不高于固定压力瓣膜，且疗效相近，并发症少。
{"title":"Treatment of Idiopathic Normal Pressure Hydrocephalus with a Novel Programmable Valve: Prospective Evaluation of Costs, Efficacy, and Safety","authors":"Rodolfo Casimiro Reis, Renata Harumi Gobbato Yamashita, Davi Jorge Fontoura Solla, Laís Fajardo Ramin, Manoel Jacobsen Teixeira, Fernando Campos Gomes Pinto","doi":"10.1055/s-0043-1771370","DOIUrl":"https://doi.org/10.1055/s-0043-1771370","url":null,"abstract":"Abstract Objective Programmable valves provide an equal or superior neurological outcome when compared with fixed pressure ones, with fewer complications, in treating idiopathic normal pressure hydrocephalus (iNPH) patients. Long-term costs of these treatments have not been properly compared in literature. We sought to compare costs, efficacy, and safety of 1-year treatment of iNPH patients with programmable valve Sphera Pro and a fixed pressure valve. Materials and Methods A prospective cohort of iNPH patients treated with programmable valve was compared with a historical cohort of iNPH patients treated with fixed pressure valve. Our primary outcome was mean direct cost of treating iNPH up to 1 year. Efficacy in treating iNPH and safety were assessed as secondary outcomes. Statistical Analysis Proportions were compared using chi-square or Fisher's exact tests. Normally distributed variables were compared using the Student's t-test or the Mann–Whitney's U test. Differences in the evolution of the variables over time were assessed using generalized estimating equations. All tests were two-sided, with an α of 0.05. Results A total of 19 patients were analyzed in each group (mean age 75 years, the majority male). Comorbidities and clinical presentation were similar between groups. Both fixed pressure and programmable valve patients had neurological improvement over time (p < 0.001), but no difference was seen between groups (p = 0.104). The fixed pressure valve group had more complications than the programmable valve group (52.6% vs. 10.5%, respectively, p = 0.013). Annual treatment cost per patient was US$ 3,820 ± 2,231 in the fixed pressure valve group and US$ 3,108 ± 553 in the programmable valve group. Mean difference was US$712 (95% confidence interval, 393–1,805) in favor of the programmable valve group. Conclusion The Sphera Pro valve with gravitational unit had 1 year treatment cost not higher than that of fixed pressure valve, and resulted in similar efficacy and fewer complications.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction We report 30 cases of nonmeningothelial dural-based lesions encountered during a 3-year study period. Materials and Methods We retrospectively reviewed pathology records of patients operated for extra-axial, dural-based lesions during the years 2016 to 2018 and included nonmeningothelial lesions as a part of this study. Results Among the 3,243 neurosurgical specimens for histopathologic examination, only 30 (0.93%) were “nonmeningothelial dural-based lesions.” Six (20%) patients were in the pediatric age group. Pathologic assessment identified 13 cases of solitary fibrous tumor/hemangiopericytoma (43.3%) and 7 cases of Ewing's sarcoma/primitive neuroectodermal tumor (23.3%). Two cases (6.7%) were of metastasis. Other lesions included a single case each of non-Hodgkin's lymphoma, undifferentiated sarcoma, solitary plasmacytoma, and granulocytic sarcoma. Nonneoplastic lesions included two cases each of Rosai–Dorfman disease and nonspecific inflammatory lesions. Conclusion Nonmeningothelial dural-based lesions being rare, thorough examination of morphological features is a must by the pathologist, to arrive at the accurate diagnosis. Ancillary tests, if required, should be employed in the context of the morphologic picture.
{"title":"Nonmeningothelial Dural-Based Lesions: A Histopathological Analysis","authors":"Pooja K. Gajaria, Asha S. Shenoy, Naina A. Goel","doi":"10.1055/s-0043-1771315","DOIUrl":"https://doi.org/10.1055/s-0043-1771315","url":null,"abstract":"Abstract Introduction We report 30 cases of nonmeningothelial dural-based lesions encountered during a 3-year study period. Materials and Methods We retrospectively reviewed pathology records of patients operated for extra-axial, dural-based lesions during the years 2016 to 2018 and included nonmeningothelial lesions as a part of this study. Results Among the 3,243 neurosurgical specimens for histopathologic examination, only 30 (0.93%) were “nonmeningothelial dural-based lesions.” Six (20%) patients were in the pediatric age group. Pathologic assessment identified 13 cases of solitary fibrous tumor/hemangiopericytoma (43.3%) and 7 cases of Ewing's sarcoma/primitive neuroectodermal tumor (23.3%). Two cases (6.7%) were of metastasis. Other lesions included a single case each of non-Hodgkin's lymphoma, undifferentiated sarcoma, solitary plasmacytoma, and granulocytic sarcoma. Nonneoplastic lesions included two cases each of Rosai–Dorfman disease and nonspecific inflammatory lesions. Conclusion Nonmeningothelial dural-based lesions being rare, thorough examination of morphological features is a must by the pathologist, to arrive at the accurate diagnosis. Ancillary tests, if required, should be employed in the context of the morphologic picture.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lashmi Venkatraghavan, Suparna Bhardwaj, Sujoy Banik, Tumul Chowdhury, Mary Pat McAndrews, Taufik Valiante
Abstract Objective Emergence from anesthesia starts from the limbic structures and then spreads outwards to brainstem, reticular activating systems, and then to the cortex. Epilepsy surgery often involves resection of limbic structures and hence may disrupt the pattern of emergence. The aim of this study was to explore the pattern of emergence from anesthesia following epilepsy surgery and to determine associated variables affecting the emergence pattern. Setting and Design Tertiary care center, prospective observational study. Materials and Methods We conducted a prospective observation pilot study on adult patients undergoing anterior temporal lobectomy and amygdalohippocampectomy for epilepsy. Anesthesia management was standardized in all patients, and they were allowed to wake up with “no touch” technique. Primary outcome of the study was the pattern of emergence (normal emergence, agitated emergence, or slow emergence) from anesthesia. Secondary outcomes were to explore the differences in preoperative neuropsychological profile and limbic structure volumes between the different patterns of emergence. Quantitative variables were analyzed using Student's t-test. Qualitative variables were analyzed using chi-square test. Results Twenty-nine patients completed the study: 9 patients (31%) had agitated emergence, and 20 patients had normal emergence. Among the agitated emergence, 2 patients had Riker scale of 7 indicating violent emergence. Patient demographics, anesthetic used, neuropsychological profile, and limbic structure volumes were similar between normal emergence and agitated emergence groups. However, two patients who had severe agitation (Riker scale of 7) had the lowest intelligence quotient. Conclusion Our pilot study showed that emergence agitation is not uncommon in patients undergoing epilepsy surgery. However, due to smaller sample size, the role of preoperative neuropsychologic profile and hippocampal volumes in predicting the pattern of emergence is inconclusive.
{"title":"Emergence Patterns from General Anesthesia after Epilepsy Surgery: An Observational Pilot Study","authors":"Lashmi Venkatraghavan, Suparna Bhardwaj, Sujoy Banik, Tumul Chowdhury, Mary Pat McAndrews, Taufik Valiante","doi":"10.1055/s-0043-1771365","DOIUrl":"https://doi.org/10.1055/s-0043-1771365","url":null,"abstract":"Abstract Objective Emergence from anesthesia starts from the limbic structures and then spreads outwards to brainstem, reticular activating systems, and then to the cortex. Epilepsy surgery often involves resection of limbic structures and hence may disrupt the pattern of emergence. The aim of this study was to explore the pattern of emergence from anesthesia following epilepsy surgery and to determine associated variables affecting the emergence pattern. Setting and Design Tertiary care center, prospective observational study. Materials and Methods We conducted a prospective observation pilot study on adult patients undergoing anterior temporal lobectomy and amygdalohippocampectomy for epilepsy. Anesthesia management was standardized in all patients, and they were allowed to wake up with “no touch” technique. Primary outcome of the study was the pattern of emergence (normal emergence, agitated emergence, or slow emergence) from anesthesia. Secondary outcomes were to explore the differences in preoperative neuropsychological profile and limbic structure volumes between the different patterns of emergence. Quantitative variables were analyzed using Student's t-test. Qualitative variables were analyzed using chi-square test. Results Twenty-nine patients completed the study: 9 patients (31%) had agitated emergence, and 20 patients had normal emergence. Among the agitated emergence, 2 patients had Riker scale of 7 indicating violent emergence. Patient demographics, anesthetic used, neuropsychological profile, and limbic structure volumes were similar between normal emergence and agitated emergence groups. However, two patients who had severe agitation (Riker scale of 7) had the lowest intelligence quotient. Conclusion Our pilot study showed that emergence agitation is not uncommon in patients undergoing epilepsy surgery. However, due to smaller sample size, the role of preoperative neuropsychologic profile and hippocampal volumes in predicting the pattern of emergence is inconclusive.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Parent artery occlusion is a definitive treatment method for preventing rebleeding of dissecting aneurysms. We herein report a case of a ruptured distal posterior inferior cerebellar artery (PICA) dissecting aneurysm treated with internal trapping using n-butyl-2-cyanoacrylate (NBCA). A 65-year-old man visited our hospital with a complaint of headache and neck pain that began 1 week before his arrival. He had a history of spontaneous subarachnoid hemorrhage of unknown cause. Computed tomography of the brain revealed a small amount of subarachnoid hemorrhage, and distal subtraction angiogram showed a distal PICA dissecting aneurysm. We placed a guiding catheter in the left vertebral artery and an intermediate catheter in the PICA. A microcatheter was guided toward the proximal side of the aneurysm and was wedged into the parent artery. The dissecting aneurysm was treated with parent artery occlusion using 50% NBCA. The postoperative course was uneventful, and the patient was discharged 3 weeks after treatment without any neurological deficit. Parent artery occlusion with internal trapping using NBCA could be a safe and definitive treatment method for distal PICA dissecting aneurysms. Angiographical evaluation of the collateral network in the distal branch of PICA before embolization and wedged microcatheter technique in the parent artery are important for successful embolization using NBCA.
{"title":"Endovascular Embolization with n-Butyl Cyanoacrylate for Ruptured Distal Posterior Inferior Cerebellar Artery Dissecting Aneurysm","authors":"Ryosuke Shintoku, Aiki Marushima, Sho Okune, Takato Hiramine, Junzo Nakao, Toshihide Takahashi, Tenyu Hino, Hisayuki Hosoo, Yoshiro Ito, Mikito Hayakawa, Eiichi Ishikawa, Yuji Matsumaru","doi":"10.1055/s-0042-1757432","DOIUrl":"https://doi.org/10.1055/s-0042-1757432","url":null,"abstract":"Abstract Parent artery occlusion is a definitive treatment method for preventing rebleeding of dissecting aneurysms. We herein report a case of a ruptured distal posterior inferior cerebellar artery (PICA) dissecting aneurysm treated with internal trapping using n-butyl-2-cyanoacrylate (NBCA). A 65-year-old man visited our hospital with a complaint of headache and neck pain that began 1 week before his arrival. He had a history of spontaneous subarachnoid hemorrhage of unknown cause. Computed tomography of the brain revealed a small amount of subarachnoid hemorrhage, and distal subtraction angiogram showed a distal PICA dissecting aneurysm. We placed a guiding catheter in the left vertebral artery and an intermediate catheter in the PICA. A microcatheter was guided toward the proximal side of the aneurysm and was wedged into the parent artery. The dissecting aneurysm was treated with parent artery occlusion using 50% NBCA. The postoperative course was uneventful, and the patient was discharged 3 weeks after treatment without any neurological deficit. Parent artery occlusion with internal trapping using NBCA could be a safe and definitive treatment method for distal PICA dissecting aneurysms. Angiographical evaluation of the collateral network in the distal branch of PICA before embolization and wedged microcatheter technique in the parent artery are important for successful embolization using NBCA.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Objective Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static variables being unreliable. Goal-directed fluid therapy with dynamic variables allows reliable determination of fluid responsiveness and promises better outcomes. We aimed to compare the intraoperative fluid requirement between conventional central venous pressure (CVP)-guided and pulse pressure variance (PPV)-guided fluid management in supratentorial tumor surgeries. Materials and Methods This prospective, randomized, double-blind, single-center trial was conducted with 72 adults undergoing supratentorial tumor surgery in a supine position. Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8 mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed. Statistical Analyses All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples t-test was used for normal distribution data and Mann–Whitney U test for nonnormal distribution data. The chi-square test or Fischer's exact test was used for categorical variables. Results The CVP group received significantly more intraoperative fluids than the PPV group (4,340 ± 1,010 vs. 3,540 ± 740 mL, p < 0.01). Incidence of hypotension was lower in the PPV group (4 [11.1%] vs. 0 [0%], p = 0.04). Brain relaxation scores, serum lactate levels, periorbital and conjunctival edema, and incidence of postoperative nausea and vomiting were comparable between the groups. Conclusion The requirement for intraoperative fluids was less in PPV-guided fluid management with better hemodynamic stability, adequate brain conditions, and no compromise of perfusion.
摘要目的考虑到继发性脑损伤的风险，神经外科手术中适当的液体管理至关重要。由于静态变量不可靠，体积状态的确定具有挑战性。目标导向的流体治疗与动态变量可以可靠地确定流体反应，并承诺更好的结果。我们的目的是比较传统的中心静脉压(CVP)引导和脉压变化(PPV)引导下的幕上肿瘤手术中的液体需求。材料和方法本前瞻性、随机、双盲、单中心试验对72名成人进行仰卧位幕上肿瘤手术。患者被分为两组，每组36例患者接受CVP和ppv引导的液体治疗。CVP引导组接受CVP大于8mmhg的靶剂量，同时每小时补充术中损失和维持液体。PPV引导组在补充维持液的同时，给予目标PPV低于13%的药物。术中给予的总液体和低血压的发生率与脑放松评分一起记录。术后评估血清乳酸水平、眶周和结膜水肿以及术后恶心和呕吐。所有统计分析均使用Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States)进行。为比较两组间的均数(CVP vs. PPV)，正态分布资料采用独立样本t检验，非正态分布资料采用Mann-Whitney U检验。对分类变量使用卡方检验或菲舍尔精确检验。结果CVP组术中液体量明显多于PPV组(4340±1010 mL vs 3540±740 mL);0.01)。PPV组低血压发生率较低(4[11.1%]比0 [0%]，p = 0.04)。脑松弛评分、血清乳酸水平、眶周和结膜水肿以及术后恶心和呕吐发生率在两组之间具有可比性。结论ppv引导下的液体管理术中液体需要量少，血流动力学稳定性好，脑条件充足，不影响血流灌注。
{"title":"Pulse Pressure Variance (PPV)-Guided Fluid Management in Adult Patients Undergoing Supratentorial Tumor Surgeries: A Randomized Controlled Trial","authors":"Janani Gopal, Shashi Srivastava, Nidhi Singh, Rudrashish Haldar, Ruchi Verma, Devendra Gupta, Prabhakar Mishra","doi":"10.1055/s-0043-1771364","DOIUrl":"https://doi.org/10.1055/s-0043-1771364","url":null,"abstract":"Abstract Objective Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static variables being unreliable. Goal-directed fluid therapy with dynamic variables allows reliable determination of fluid responsiveness and promises better outcomes. We aimed to compare the intraoperative fluid requirement between conventional central venous pressure (CVP)-guided and pulse pressure variance (PPV)-guided fluid management in supratentorial tumor surgeries. Materials and Methods This prospective, randomized, double-blind, single-center trial was conducted with 72 adults undergoing supratentorial tumor surgery in a supine position. Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8 mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed. Statistical Analyses All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples t-test was used for normal distribution data and Mann–Whitney U test for nonnormal distribution data. The chi-square test or Fischer's exact test was used for categorical variables. Results The CVP group received significantly more intraoperative fluids than the PPV group (4,340 ± 1,010 vs. 3,540 ± 740 mL, p < 0.01). Incidence of hypotension was lower in the PPV group (4 [11.1%] vs. 0 [0%], p = 0.04). Brain relaxation scores, serum lactate levels, periorbital and conjunctival edema, and incidence of postoperative nausea and vomiting were comparable between the groups. Conclusion The requirement for intraoperative fluids was less in PPV-guided fluid management with better hemodynamic stability, adequate brain conditions, and no compromise of perfusion.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract A reduction in fluid absorption or an obstruction of normal outflow is a common cause of hydrocephalus. It typically requires medical attention, which frequently entails the placement of a ventriculoperitoneal shunt (VPS) to lower intracranial pressure. We intend to list the few, documented examples of neurological impairments resulting from the installation of a VPS in this systematic study. Two search engines (PubMed and Cochrane) were used to conduct a systematic review from 1975 to December 12, 2021. The following search terms were employed: neurological deficits or neurological injury or palsies or thalamus or tract or longitudinal fasciculus or somatotropy or fasciculus or hearing loss or hemisensory or cortico AND ventriculoperitoneal shunt or VPS AND hydrocephalus. The inclusion criteria included VPS, neurological deficits, and human participants. The exclusion criteria included ventriculoarterial shunt, lumboperitoneal shunt, nonhuman subjects, and infection. Twenty trials in total, including a total of 25 patients, were included. There were 17 case report studies. A total of 35/785 patients (4.46%) experienced neurological impairments. In 9/25 (36%) of shunt cases had one of the three recognized causes: trapped fourth ventricle, dandy walker, or syringomyelia. Most of the patients developed VI, VII nerve palsies 11/25 (44%) followed by weakness, cerebellar symptoms, and VI nerve palsy. The brainstem was seen to be the most often injured structure (15/25; 60%), followed by deep brain structures (thalamus, basal ganglia, and white matter tracts; 20%). Even though ventriculoperitoneal shunting is a routine and straightforward treatment, issues can still arise. Although rare, there have been reports of cranial nerve impairments, therefore care should be taken.
{"title":"Systemic Review: Neurological Deficits following Ventriculoperitoneal Shunt (VPS) Insertion","authors":"Rana Moshref, Rafaa Ahmed Algethmi","doi":"10.1055/s-0043-1771329","DOIUrl":"https://doi.org/10.1055/s-0043-1771329","url":null,"abstract":"Abstract A reduction in fluid absorption or an obstruction of normal outflow is a common cause of hydrocephalus. It typically requires medical attention, which frequently entails the placement of a ventriculoperitoneal shunt (VPS) to lower intracranial pressure. We intend to list the few, documented examples of neurological impairments resulting from the installation of a VPS in this systematic study. Two search engines (PubMed and Cochrane) were used to conduct a systematic review from 1975 to December 12, 2021. The following search terms were employed: neurological deficits or neurological injury or palsies or thalamus or tract or longitudinal fasciculus or somatotropy or fasciculus or hearing loss or hemisensory or cortico AND ventriculoperitoneal shunt or VPS AND hydrocephalus. The inclusion criteria included VPS, neurological deficits, and human participants. The exclusion criteria included ventriculoarterial shunt, lumboperitoneal shunt, nonhuman subjects, and infection. Twenty trials in total, including a total of 25 patients, were included. There were 17 case report studies. A total of 35/785 patients (4.46%) experienced neurological impairments. In 9/25 (36%) of shunt cases had one of the three recognized causes: trapped fourth ventricle, dandy walker, or syringomyelia. Most of the patients developed VI, VII nerve palsies 11/25 (44%) followed by weakness, cerebellar symptoms, and VI nerve palsy. The brainstem was seen to be the most often injured structure (15/25; 60%), followed by deep brain structures (thalamus, basal ganglia, and white matter tracts; 20%). Even though ventriculoperitoneal shunting is a routine and straightforward treatment, issues can still arise. Although rare, there have been reports of cranial nerve impairments, therefore care should be taken.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cervical myelopathy secondary to congenital anomalies involving the posterior elements of the axis (C2) is extremely rare.[1] We present a case of deeply invaginated unfused C2 laminae into the spinal canal with associated ossified posterior longitudinal ligament (OPLL) at the C2-C3 level presenting with myelopathy symptoms.
{"title":"Concomitant Occurrence of the Ossified Posterior Longitudinal Ligament with a Posterior C2 Defect","authors":"Manikandan Thandapani, Sudheer Kumar Pothu, Ramachandran Govindasamy, Satish Rudrappa, Balaji Vaithialingam","doi":"10.1055/s-0043-1771321","DOIUrl":"https://doi.org/10.1055/s-0043-1771321","url":null,"abstract":"Cervical myelopathy secondary to congenital anomalies involving the posterior elements of the axis (C2) is extremely rare.[1] We present a case of deeply invaginated unfused C2 laminae into the spinal canal with associated ossified posterior longitudinal ligament (OPLL) at the C2-C3 level presenting with myelopathy symptoms.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Felipe Ramirez Velandia, David Camilo Gomez Cristancho, Andres Urrego Nieto, Isabel Marquez, Alejandra Restrepo Martinez, Jaime Eduardo Becerra Ospina, Juan Carlos Pérez Rodriguez
Abstract Surgical treatment of high-grade spondylolisthesis is controversial and aims at restoring the spinopelvic sagittal balance through complete or partial reduction of the listhesis. Nerve decompression and interbody fusion are necessary for patients presenting with neurological deficit, severe pain, lower limb asymmetry, or deformities. We present the case and the results of a patient with high-grade spondylolisthesis, in whom minimally invasive management was performed. A narrative review in this topic is also provided. We performed a literature review of high-grade spondylolisthesis to compare our technique to current surgical alternatives. We included articles from PubMed, Embase, Scopus, Ovid, and Science Direct published between 1963 and 2022 that were written in English, German, and Spanish. The terms used were the following: “high grade spondylolisthesis,” “spondyloptosis,” “surgical management,” “interbody fusion,” and “arthrodesis.” In all, 485 articles were displayed, from which we filtered 112 by title and abstract. At the end, 75 references were selected for the review. Different interbody fusion techniques can be used to correct the lumbosacral kyphosis and restore the spinopelvic parameters. A complete reduction of the listhesis is not always required. The surgical procedure carried out in our patient corresponds to the first known case of minimally invasive circumferential arthrodesis with iliac screws and sacral fixation in a high-grade dysplastic spondylolisthesis. This approach guarantees the correction of the lumbosacral kyphosis and a complete reduction of the listhesis. Further studies are required to determine whether the results of this case can be extrapolated to other patients with high-grade spondylolisthesis.
{"title":"Minimally Invasive Surgery for Managing Grade IV and V Spondylolisthesis","authors":"Felipe Ramirez Velandia, David Camilo Gomez Cristancho, Andres Urrego Nieto, Isabel Marquez, Alejandra Restrepo Martinez, Jaime Eduardo Becerra Ospina, Juan Carlos Pérez Rodriguez","doi":"10.1055/s-0043-1771317","DOIUrl":"https://doi.org/10.1055/s-0043-1771317","url":null,"abstract":"Abstract Surgical treatment of high-grade spondylolisthesis is controversial and aims at restoring the spinopelvic sagittal balance through complete or partial reduction of the listhesis. Nerve decompression and interbody fusion are necessary for patients presenting with neurological deficit, severe pain, lower limb asymmetry, or deformities. We present the case and the results of a patient with high-grade spondylolisthesis, in whom minimally invasive management was performed. A narrative review in this topic is also provided. We performed a literature review of high-grade spondylolisthesis to compare our technique to current surgical alternatives. We included articles from PubMed, Embase, Scopus, Ovid, and Science Direct published between 1963 and 2022 that were written in English, German, and Spanish. The terms used were the following: “high grade spondylolisthesis,” “spondyloptosis,” “surgical management,” “interbody fusion,” and “arthrodesis.” In all, 485 articles were displayed, from which we filtered 112 by title and abstract. At the end, 75 references were selected for the review. Different interbody fusion techniques can be used to correct the lumbosacral kyphosis and restore the spinopelvic parameters. A complete reduction of the listhesis is not always required. The surgical procedure carried out in our patient corresponds to the first known case of minimally invasive circumferential arthrodesis with iliac screws and sacral fixation in a high-grade dysplastic spondylolisthesis. This approach guarantees the correction of the lumbosacral kyphosis and a complete reduction of the listhesis. Further studies are required to determine whether the results of this case can be extrapolated to other patients with high-grade spondylolisthesis.","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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