查看更多>>摘要：? 2022 Elsevier Inc.Background: Traumatic dural sinus injuries following penetrating brain injury are rare but are often associated with significant morbidity and mortality. The management of significant defects is operative and can be challenging. In modern civilian practice, patients with these injuries typically receive extensive preoperative investigation and advanced perioperative monitoring. Methods: We report a case of successful operative management in a frontline civilian field hospital of a 33-year-old man who sustained a shrapnel injury to the junction of the middle and posterior thirds of the superior sagittal sinus during the Syrian Civil War. Results: The injury was repaired successfully with a polytetrafluoroethylene graft. The postoperative course was uncomplicated. Anticoagulation was commenced 2 days postoperatively. The patient was discharged 5 days postoperatively with a GCS of 15 and mild weakness of the limbs bilaterally. Conclusions: Immediate repair of dural sinus injuries is feasible in the context of a low-resource wartime environment and should be attempted without delay. To our knowledge, this is the first case of successful use of a synthetic vascular graft for repair of a dural venous sinus injury in an ill-equipped hospital.
查看更多>>摘要：? 2022 Elsevier Inc.Arachnoid cysts are one of the benign spinal cystic lesions. Multiple nerve roots and spinal cord may be compressed by it, and operating is often recommended. Traditional surgical procedures often choose the posterior median approach, separating the paravertebral muscles, milling the lamina, fully exposing the cyst, partially or completely removing the cyst wall, looking for the leak, and then suturing and sealing. Here we present a case of giant spinal extradural arachnoid cyst in which a ultrafine flexible endoscope was used to visualize cystic spaces and identity the leaks. We repaired the leak after removing part of the cyst wall under the operating microscope, and the patient had an excellent recovery.
查看更多>>摘要：? 2022 Elsevier Inc.Sneezing is a poorly understood, protective reflex response. It's characterized by the following sequence: eye closure, inspiration, glottic closure, forced expiration with sudden glottic opening, and release of an elevated intrathoracic pressure creating a flow of explosive air through the nose.1 Studies have indicated an anatomic sneezing area of the brainstem corresponding to the central recipient zone of the nasal sensory neurons in the lateral medulla.2 The traditional pathophysiology of the sneeze is thought to begin by stimulation of the distal branches of the trigeminal nerve within the nasal mucosa. Afferent neural stimuli are transmitted to the trigeminal ganglion and then the lateral medulla. The efferent phase then begins, giving rise to the sneezing sequence described earlier.1 In addition to direct nasal irritation, sneezing has been shown to be triggered by several other causes (Table 1). This suggests that alternative mechanisms of sneeze induction other than direct nasal stimulation exist. We report a case of a 34-year-old man undergoing an awake craniotomy for a recurrent World Health Organization grade 2 oligodendroglioma (IDH-mutant, 1p19q-codeleted, ATRX preserved). During the operation we elicited a sneeze response on 3 occasions on stimulation of the olfactory nerve (Video 1). Although we cannot completely exclude costimulation of the sensory trigeminal terminations in the anterior fossa floor, the actual sneezing occurred during tumor peeling away from the arachnoid surface overlaying the olfactory nerve. This suggests a potential accessory route of sneeze stimulation involving the olfactory nerve distinct from the previously described trigemino-related, autonomic (sympathetic and parasympathetic systems) and psychogenic etiologies.
查看更多>>摘要：? 2021 Elsevier Inc.Background: The use of 5-aminolevulinic acid (5-ALA) for intraoperative protoporphyrin IX fluorescent imaging in the resection of malignant gliomas has been demonstrated to improve tumor visualization, increase the extent of resection, and extend progression-free survival. The current technique for visualization of 5-ALA consists of excitation and emission filters built into the operating microscope. However, there are notable limitations to this process, including low quantum yield, expense, and masking of surrounding anatomy. Methods: We present 3 cases in which 3 separate methods were employed for visualizing fluorescence. The devices reported are 1) a low-cost blue light flashlight, 2) a low-cost headlamp, and 3) the first reported case of the new Designs for Vision REVEAL Fluorescence-Guided Surgery (FGS) 5-ALA fluorescent headlight and loupes. The aim of the study is to provide confirmation that tumor fluorescence can be observed using commercially available products other than the microscope. Results: We demonstrate through 3 intraoperative cases that a variety of devices can produce visible fluorescence of the high-grade tumor and allow for simultaneous real-time visualization of the adjacent brain parenchyma and vasculature. The REVEAL FGS system appears to offer increased fluorescence emission compared with all other methods, including the microscope. Conclusions: Our study demonstrates the feasibility of using blue/ultraviolet light supplied by a commercially available, inexpensive flashlight or headlamp to visualize 5-ALA fluorescence in high-grade gliomas. We also provide the first documentation of the intraoperative use of the new Designs for Vision REVEAL FGS 5-ALA fluorescent headlight and loupes and report on the experience. Lack of an operative microscope capable of fluorescent illumination should not be a limiting factor in performing fluorescent-guided glioma resection.
查看更多>>摘要：? 2022 Elsevier Inc.Delayed infection from an implanted device can be challenging to diagnose. Here, we report a case of a 56-year-old male patient with history of congenital hydrocephalus and previous placement of a ventriculoperitoneal (VP) shunt who presented with sepsis without any evidence of shunt infection at follow-up 3 years after his most recent shunt implantation. The VP shunt contained 2 residual ventricular catheters and 2 residual peritoneal catheters, as the patient has had multiple VP shunt revisions since childhood. The patient was unresponsive to multiple antibiotic regimens. Of note, 2-[18]-fluoro-2-deoxy-D-glucose?positron emission tomography scan revealed hypermetabolism at the distal end of the latest implanted abdominal catheter without any abnormality of migrated cerebral catheters, highlighting the advantageous use of 2-[18]-fluoro-2-deoxy-D-glucose?positron emission tomography to identify the infected catheter when multiple devices are involved. Removal of abdominal catheters confirmed the localized infection, and follow-up was uneventful after shunt replacement.
查看更多>>摘要：? 2022 Elsevier Inc.Corpus callosotomy is among the oldest surgeries performed for drug-resistant epilepsy. Since it was first performed in 1940, numerous studies have assessed its outcomes in various patient populations in addition to describing different extents of sectioning and emerging technologies (i.e., endoscopic, laser interstitial thermal therapy, and radiosurgery). To capture the current state and offer a reappraisal, we comprehensively review the origins of corpus callosotomy, efficacy for various seizure types, technical variations, complications, and indications and compare the procedure with vagus nerve stimulation therapy, which has similar indications. We consider corpus callosotomy to be a safe and efficacious procedure, which should be considered by clinicians when appropriate. Furthermore, it can play an important role in treating patients with drug-resistant epilepsy when appropriate in low-to-middle-income countries where resources are limited.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Pineal region metastases are rare but often cause severe neurologic deficits. Surgical resection and chemoradiotherapy can provide therapeutic benefit. We investigated the literature to analyze clinical characteristics, management strategies, and survival of adult patients with pineal region metastases. Methods: PubMed, Embase, Scopus, and Cochrane were searched following the PRISMA guidelines, including studies reporting clinical outcomes of patients with pineal region metastases. Clinical presentation, management, and survival were reviewed. Results: We included 31 studies comprising 47 patients. Lung cancer (29.8%) and carcinomas of unknown origin (14.9%) were the most frequent primary tumors. In 48.9% of patients, symptomatic pineal metastases preceded primary tumor diagnosis. Headache (67.4%) and confusion (46.5%) were the most common symptoms. Parinaud syndrome (46.5%) and hydrocephalus (87.2%) were noted. Biopsy (65.9%) was preferred over resection (34.1%), and shunting strategies used were endoscopic third ventriculostomy (43.9%) and ventriculoperitoneal (26.8%). Eleven patients (32.3%) received adjuvant chemotherapy and 32 (68%) received radiotherapy. Posttreatment improvement in symptoms (56.6%) and hydrocephalus (80.5%) were noted. In patients who received adjuvant chemotherapy/radiotherapy, significant improvement in posttreatment performance status occurred with both biopsy (P < 0.001) and resection (P = 0.007). No survival differences were reported between surgery and biopsy (P = 0.912) or between complete and partial resection (P = 0.220). Overall survival was neither influenced by surgical approach (P = 0.157) nor by shunting strategy (P = 0.822). Mean follow-up was 8 months and median overall survival 3 months. Only 2 cases (4.8%) of pineal metastasis showed recurrence. Conclusions: Pineal region metastases carry significant morbidity. Biopsy or surgical resection, combined with adjuvant chemotherapy/radiotherapy and/or shunting, may significantly improve performance status.
查看更多>>摘要：? 2021 Elsevier Inc.Background: The goal of this study was to examine neurosurgical scientific publications and change in the trends in major neurosurgical journals during the last 10 years. Methods: The peer-reviewed articles published in 12 prominent neurosurgical journals over the last 10 years were analyzed. The journals were grouped into 2 groups based on the number of articles published in a journal in a year (≥500 or <500). Results: The total number of peer-reviewed articles published in 10 years in these 12 journals was 48,957. The number of peer-reviewed articles published in a year increased from 3441 to 7316 over this time. The maximum number of peer-reviewed articles were published in 2019 in Group A (n = 7170) and in 2018 in Group B journals (n = 615). The commonest article types were Original Articles and Case Reports in both the groups, but the proportion of Original Articles published was greater in Group A journals (54.0%) as compared with Group B journals (44.5%). Review Articles were more commonly published in Group B journals. The proportion of articles published in Group A and B journals from the United States was 48.0% and 31.7%, respectively, whereas the proportion of articles from Europe was 21.4% and 36.2%, respectively. Conclusions: Neurosurgical publications are continuously increasing, with a parallel growth in the number of authors and citations all over the world. There are significant differences in the scientometric indices of major neurosurgical journals based on their yearly articles published.
查看更多>>摘要：? 2021 Elsevier Inc.Objective: To conduct a comprehensive systematic review and meta-analysis of current retrospective cohort studies to identify significant preoperative risk factors for prolonged postoperative opioid use following spine surgery. Methods: Studies were identified according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses through a search of PubMed, Google Scholar, Scopus, and Cochrane databases. Unique articles were screened by 2 independent reviewers. Primary research articles reporting odds ratios of risk factors for prolonged opioid use following spine surgery were included. Prolonged opioid use was defined as continued use ≥3 months following surgery, and study quality was evaluated using the Newcastle-Ottawa Scale. Random-effects meta-analysis was performed to calculate pooled odds ratios and confidence intervals. Results: The initial search yielded 648 studies. Following duplicate removal, 492 titles and abstracts were screened. After full-text review of 68 studies, 19 final studies including 168,961 patients were eligible for meta-analysis. Newcastle-Ottawa Scale scores ranged from 6 to 9. Meta-analysis assessed 17 risk factors for long-term opioid use. Preoperative opioid use, depression, depression and/or anxiety, drug abuse or dependency, female gender, fibromyalgia, lower back pain, tobacco use, and chronic pulmonary disease were found to be statistically significant risk factors for prolonged opioid use. Conclusions: Several patient-level factors may play a role in the tendency to persistently use opioids after spine surgery. By preoperatively identifying these characteristics, clinicians may be better able to identify patients who are at risk and employ methods to mitigate potential long-term opioid use.
查看更多>>摘要：? 2021 Elsevier Inc.Background: The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the outcomes of surgical neuro-oncology patients worldwide. We aimed to review the practice patterns in surgical neuro-oncology in low- and middle-income countries (LMICs). We also present a situational report from our own country. Methods: A scoping review was performed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: Twelve studies were included in the review. Most of the studies were from Asia (India, China, Iran, and Turkey), and 1 was from Brazil. Quantitative reports showed a decrease in the number of surgical neuro-oncology operations between pre-COVID-19 and post-COVID-19 time frames, but similar proportions of neuro-oncology procedures. Qualitative review showed similar practice patterns between LMICs and high-income countries, except for limitations in resources such as negative-pressure operating rooms and intensive care units, and maintenance of face-to-face consults despite the adoption of telemedicine. Limited data on adjuvant therapy were available in LMICs. Conclusions: In our review, we found that the practice patterns in surgical neuro-oncology in LMICs during the COVID-19 pandemic are similar to those in high-income countries, except for a few modifications because of resource limitation and patient preferences.
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