查看更多>>摘要：? 2022 Elsevier Inc.Primary central nervous system lymphoma is a rare form of extranodal non-Hodgkin lymphoma. Few cases of primary central nervous system lymphoma involving bone and subcutaneous tissue invasion have been reported. Herein, we present the case of a 45-year-old man who experienced paroxysmal throbbing pain in the occipital area for more than 1 year, followed by progressive dysarthria and dyspnea for more than 4 days. Craniotomy and tumor removal were performed. Operative findings showed a posterior occipital soft tumor whose cells had invaded the skull and subcutaneous tissue.
Doria-Netto H.L.Campos Filho J.M.Chaddad-Neto F.Chang Mulato J.E....
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查看更多>>摘要：? 2022 Elsevier Inc.Cerebral arteriovenous malformations (AVMs) are dynamic neurovascular disorders that occur mainly in young adults, presenting an annual risk of rupture of 2% ? 4% per year.1 They can be asymptomatic, representing an incidental radiologic finding, or present with neurologic deficits according to their brain location, size, and presence or absence of bleeding.2,3 AVMs located in eloquent areas4 represent a great challenge for neurosurgeons, sometimes directed to alternatives therapies (e.g., embolization, radiotherapy) due to the difficulty in planning and surgical technique. Despite the complexity, we consider that there is benefit to removing these lesions; this can be done safely, as with the adequate microsurgical strategy and neuroanatomic knowledge. In Video 1, we show the case of a 55-year-old male patient with an AVM positioned over the right central sulcus. He presented with intermittent left-hand paresthesia followed by an episode of involuntary movements in the left arm without loss of consciousness and with spontaneous resolution. Angiography showed an AVM feed by branches of the middle cerebral artery and multiple venous drainage for the Trolard complex and superficial middle cerebral vein, with a 4-cm nidus, making it grade III in the Spetzler-Martin classification.4 The patient underwent surgery with total resection of the lesion without any complication or new neurologic deficits.
查看更多>>摘要：? 2022 Elsevier Inc.Selective dorsal rhizotomy (SDR) has been a well-established neurosurgical treatment option for ambulatory children with spastic diplegic cerebral palsy to reduce spasticity. Outcomes for SDR for spastic lower extremity hemiparesis has been less well described. In our experience, hemi-SDR has been an excellent intervention for children with suboptimal spasticity control despite maximizing pharmacologic and chemodenervation treatments. In Video 1, we demonstrate a focal segmental hemi-SDR at the L5-S1 level in a 7-year-old male patient with spastic hemiparesis secondary to a dysembryoplastic neuroepithelial tumor in the right inferior frontoparietal area. Rhizotomy was performed with identification and selective sectioning of dorsal nerve roots with abnormal stimulation patterns as determined by electrophysiology and clinical correlation. Dorsal nerve root fibers with unsustained discharges were spared. Postoperatively, the patient participated well in inpatient and outpatient therapies with significant progress in his mobility and activities of daily living. The patient showed improvement in gait velocity (51%), internal pressure ratio (+0.05), and step length (41% on the left and 27% on the right) 20 months after hemi-SDR. He also demonstrated a step length ratio closer to 1 (0.89) showing a more equal step length bilaterally and improved weight acceptance on the affected side. There were no changes observed on the left upper extremity. This positive outcome on spasticity control and function supports the need for further prospective studies for hemi-SDR as a treatment option for children with spastic hemiparesis.
查看更多>>摘要：? 2022 Elsevier Inc.Objective: To present and evaluate the section concerning head wounds in Kitāb al-Taysīr (Liber Teisir) by Ibn Zuhr (Avenzoar). Methods: In this study, 4 different versions of Avenzoar's work were analyzed. The first 2 versions are in Arabic and titled Kitāb al-Taysīr fī al-Mudāwāt wa al-Tadbīr; one was edited by Michel Khouri and printed in Damascus in 1983, and the other was edited by Mu?ammad b. ?Abd Allah al-Rūdānī and printed in Rabat in 1991. The third and fourth versions are in Latin; one was translated by Paravicius, edited by Hieronymus Surianus, and printed in Venice in 1530, and the other was a manuscript in Bibliothèque interuniversitaire de santé, MS 5119 in Paris and was translated by John of Capua. Results: The titles of the sections are “Wounds due to iron objects” and “Wounds due to stones” in Arabic and “On head injuries from external factors such as blow” and “On head wounds from iron or stone or wood” in Latin. The chapter written by Avenzoar on head wounds is divided into 2 parts. First, he explained the treatment, and subsequently he described his views and related experiences. Conclusions: The information provided by Avenzoar on head injuries technically reflects the medical and surgical comprehension of his era. In the section that is the focus of this study, he first provided technical information related to head injuries and then offered his opinions on the controversial and problematic issues in treatment such as phlebotomy. This study revealed that Avenzoar approached the subject differently than his predecessors.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Chronic subdural hematomas (CSDHs) with narrow or multilayered hematomas must be accurately localized for burr hole drainage. We present a simple alternative localization method using conventional computed tomography (CT) scans acquired for the initial diagnosis and a commercially available carpenter's square (CS). Methods: Using our novel method, we localized 77 narrow or multilayered CSDHs. A single burr hole site on the thickest portion of narrow hematomas or on the site allowing access to both the isolated superficial layer and the deep layer of multilayered hematomas was identified on axial CT images; the image was parallel to the orbitomeatal line (OML). On the target CT slice, the level from the OML and from the surface of the forehead to the intended burr hole (sagittal distance) was measured. The OML and the level of the CT target slice were marked using the CS. Then, the CS was placed at the marked target level; the 2 edges of the CS were situated on the frontal and temporal scalp and parallel to the OML and the sagittal line. The sagittal distance was then marked. Results: All burr holes reached the CSDHs. The mean deviation of the burr holes was 4.7 mm inferior and 1.4 mm anterior to the intended site. In 65 instances (84.4%), a deviation within 10 mm was observed in both the superoinferior and the anteroposterior directions. Conclusions: Our simple and inexpensive method can localize narrow or multilayered CSDHs with acceptable accuracy and increases the efficiency of routine clinical work.
查看更多>>摘要：? 2022 Elsevier Inc.Objective: To conduct a bibliometric review of literature on posterior ligamentous complex (PLC) injury in thoracolumbar trauma to guide future research. Methods: A keyword-based search was conducted from January 2000 to September 2021 using the Scopus database. Relevant publications were analyzed for year of publication, authorship, publishing journal, institution and country of origin, subject matter, and article type. Content analysis of clinical articles was also performed, analyzed for sample size, retrospective versus prospective study design, single-center versus multicenter study, and level of evidence. Results: The search yielded 262 publications published in 61 journals by 537 authors from 162 institutions and 29 countries. Thomas Jefferson University, University of Calgary, and University of Toronto had the largest number of publications related to posterior ligamentous complex injury. Authors from the United States, Canada, and China were the most frequent contributors in terms of the number of publications. Spine was the most prolific and top-cited journal, and A.R. Vaccaro was the most prolific author. The most cited publication was “A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status” by Vaccaro et al. Most of the publications were case studies, with diagnostic accuracy being the most frequently discussed topic. The sample size for a large portion of the case series was <50. Most case series were retrospective studies conducted at a single center. Conclusions: Our review provides an extensive list of the most historically significant thoracolumbar PLC injury articles, acknowledging key contributions made to the advancement of this research area.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Undergraduate neurosurgery conferences are acknowledged to play an important role in bridging the gap between a limited exposure to neurosurgery within medical schools and a highly competitive application process. Hands-on workshops are attractive for any conference but can be prohibitively expensive, especially for student societies. Methods: We describe our method to manufacture a low-cost skull model, which we used for a hands-on intracranial pressure (ICP) monitoring workshop station at 2 international neurosurgical conferences. We describe the workflow for our ICP monitoring workshop using these models. Results: Our model acts as an appropriate substitute for more professional simulators while adequately mimicking the sensation of skull drilling, dural puncture, and intraparenchymal ICP bolt and probe insertion. All tools and resources are accessible from local markets and can be sourced online. A total of GB￡100 was spent making 5 skull models and took 2 hours to manufacture by 3 individuals. The ICP monitoring workshop was carried out 3 times over 40 minutes, with each session accommodating 18 or 19 delegates (N = 55). Conclusions: These workshop models have been praised by medical students for increasing exposure and awareness toward neurosurgical procedures and the sophistication of investigations used by the specialty. Consultant neurosurgeons have praised the simulation provided by these models as closely mimicking the procedure in reality.
查看更多>>摘要：? 2022 Elsevier Inc.Intracranial aneurysms are a common asymptomatic vascular pathology, the rupture of which is a devastating event with a significant risk of morbidity and mortality. Aneurysm detection and risk stratification before rupture events are, therefore, imperative to guide prophylactic measures. Artificial intelligence has shown great promise in the management pathway of aneurysms, through automated detection, the prediction of rupture risk, and outcome prediction after treatment. The complementary use of these programs, in addition to clinical practice, has demonstrated high diagnostic and prognostic accuracy, with the potential to improve patient outcomes. In the present review, we explored the role and limitations of deep learning, a subfield of artificial intelligence, in the aneurysm patient journey. We have also briefly summarized the application of deep learning models in automated detection and prediction in cerebral arteriovenous malformations and Moyamoya disease.
查看更多>>摘要：? 2022 Elsevier Inc.Background: Dr. Nathan Rifkinson (1912–2010) was an influential neurosurgeon who dedicated his entire career to the people of Puerto Rico. In 1948, he became the first formally trained neurosurgeon to practice in Puerto Rico. Driven by incredible tenacity and with the help of several other neurosurgery professors, he created a world-class neurosurgery residency training center. Methods: This article presents the history of neurosurgery in Puerto Rico taken from publications and personal stories recorded by a neurosurgeon who has been part of the neurosurgery program of the University of Puerto Rico for 34 years. The establishment and development of the residency training program during the last 50 years are documented. Results: This recollection of events presents the history of neurosurgery in Puerto Rico and emphasizes the creation of a neurosurgery training program at the University of Puerto Rico. The University of Puerto Rico has the only residency program on the Island, preparing neurosurgeons for the last 50 years. The notable contributions of the professors in the University over the past 50 years, with special mention of Dr. Nathan Rifkinson, are described. Conclusions: In Puerto Rico, Dr. Rifkinson discovered a new niche that helped him grow to a unique iconic figure, advising physicians and government leaders on the Island. Together with all the other neurosurgery pillars and their extraordinary dedication, our professors have established an incredible legacy. Without the extreme goodness of our neurosurgery professors, neurosurgery in Puerto Rico would not be what it is now.
查看更多>>摘要：? 2022 Elsevier Inc.Metastatic glioblastoma to the vertebral spine is rarely encountered. The decision to intervene surgically must consider the poor prognosis in these patients. Here we report the case of a 46-year-old woman who presented with sudden weakness of the lower extremities 10 months after diagnosis of a left parietal glioblastoma. Imaging revealed osseous metastases to the thoracic and lumbosacral vertebral bodies. She initially underwent vertebroplasty with symptomatic improvement, but the progression of disease precluded further surgical interventions, and the patient was referred for chemotherapy and radiotherapy. The case illustrates that the choice of treatment modality varies throughout the time course of the disease—patients with spinal instability or few solitary metastases may benefit from intervention, but as the disease burden increases, palliative radiotherapy and chemotherapy may offer greater benefit.
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