1
Review Surg Neurol Int
. 2020 Jun 20;11:160. doi: 10.25259/SNI_294_2020. eCollection 2020.
Diagnosis, and Treatment of Cervical Epidural Abscess and/or Cervical Vertebral Osteomyelitis With or Without Retropharyngeal Abscess; A Review
Nancy Epstein 1
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PMID: 32637213 PMCID: PMC7332491 DOI: 10.25259/SNI_294_2020
Free PMC article
Abstract
Background: Every year approximately 19.6 patients/100,000 per year are admitted to hospitals with spinal epidural abscesses (CSEA), 7.4/100,000 have vertebral osteomyelitis (VO)/100,000/year, while 4.1/100.000 children/year have cervical retropharyngeal abscesses (RPA) (i.e., data insufficient for adults).
Methods: Here we evaluated 11 individual case studies, 6 multiple patient series, and looked at 9 general review articles focusing on CSEA, and/or VO, with/without RPA.
Results: Of the 11 case studies involving 15 patients, 14 had cervical spinal epidural abscesses (CSEA: 10 CSEA/ VO/RPA, 2 CSEA/VO, 1 CSEA/TSEA, 1 CSEA/ TSEA/LSEA), 13 had cervical osteomyelitis (VO: 11 VO/CSEA, 2 VO/RPA), and 12 had cervical retropharyngeal abscesses (RPA: 10 RPA/CSEA/VO, 2 RPA/VO alone). When patients were treated surgically, they required 12 anterior, and 2 posterior approaches; 1 patient required no surgery. In the 6 larger cervical series involving 355 patients, 4 series involved CSEA (3 CSEA, 1 CSEA/VO), and 2 seires had cervical VO. Primary surgery was performed in 298 patients, while 57 were initially managed medically; 24 of these latter patients failed non-surgical therapy, and required delayed cervical surgery. Notably, all 17 clinical studies advocated early surgery where clinically appropriate for varying combinations of CSEA and/or VO with or without RPA. The 8 final articles reviewed all-levels of SEA and or VO, while also providing additional unique information regarding RPA.
Conclusion: We analyzed 11 case studies and 6 multiple case series regarding the diagnosis and treatment of combinations of cervical CSEA, and/or VO with or without RPA. We also reviewed 8 articles on the evaluation/ management of all-level SEAs and/or VOs, along with the unique features of RPAs.
Keywords: Cervical spine epidural abscesses; How to recognize failure of medical management; Retropharyngeal abscesses; Success of early surgery where appropriate for CSEA and/or VO with/without RPA; Vertebral osteomyelitis.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 27;11:167. doi: 10.25259/SNI_167_2020. eCollection 2020.
Outcome of Cranial Firearm Injuries in Civilian Population Based on a Novel Classification System
Farrukh Javeed 1, Asad Abbas 1, Lal Rehman 1, Syed Raza Khairat Rizvi 1, Ali Afzal 1, Hafiza Fatima Aziz 2
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PMID: 32637220 PMCID: PMC7332701 DOI: 10.25259/SNI_167_2020
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Abstract
Background: Cranial firearm injuries (CFAIs) are expected to be frequent during warfare; however, it is becoming increasingly common among civilian population in our part of the world. These injuries are associated with significant morbidity and mortality in addition to financial loss. The objective of our study is to evaluate the pattern of gunshot injuries to cranium and their outcome.
Methods: The study was conducted on 114 patients presenting with CFAIs to Jinnah Postgraduate Medical Centre, Karachi, Pakistan, between June 2015 and January 2019. Patients were evaluated with respect to age, gender, pattern of injury, Glasgow coma scale on arrival, radiological and clinical assessment, surgical intervention, and Glasgow outcome score measured at 6 months follow-up.
Results: Among patients with cranial gunshot, injuries most were males (76.3%). More than 50% patients aged between 18 and 35 years. About 46.5% of patients presented with moderate traumatic brain injury commonly involving the temporal lobe (36.8%). Of total 114 patients, 84.2% were managed conservatively but wound debridement was done in all patients. At 6 months, the overall mortality in our patients was 33.3%. Patients with good outcome (GOS 4 and 5) were 30.7% and 35.9% patients had bad outcome (GOS 2 and 3). Complication rate was 14.9% and the most common complication was disseminated intravascular coagulation in 5.2%.
Conclusion: Surgical intervention has no significant benefit over conservative management on long-term mortality and should be limited to patients with large intracranial hematomas and intraventricular hematomas causing hydrocephalus.
Keywords: Ballistics; Civilian population; Firearm injuries; Glasgow outcome score; Jinnah classification.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 27;11:172. doi: 10.25259/SNI_331_2020. eCollection 2020.
Combined Type 1 and 2 Split Cord Malformations, Kyphoscoliosis, Tethered Cord, and a Lipoma
Turki Elarjani 1, Sami Khairy 2, Wael Alshaya 2
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PMID: 32637225 PMCID: PMC7332706 DOI: 10.25259/SNI_331_2020
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Abstract
Background: Split cord malformations (SCMs) are uncommon congenital anomalies. They can be divided into Type 1 (bony septum and two separate dural sheaths) and Type 2 (fibrous septum and a single dural sheath).[1,2,4] Rarely,SCM can be associated with orthopedic anomalies (mostly seen in older children), such as scoliosis, followed by kyphosis, and/or both.[1-3] Conversely, patients with congenital scoliosis have 40% risk of congenital underlying neural deformities, with 16.3% attributed to SCM.[1,4] Those with thoracic or lumbosacral SCM may have congenital tethering lesions, predominantly consisting of intradural lipomas.[3,4] Surgery is optimally performed in two stages: first, removal of the spinal septum and untethering of the cord, and second, correction of the kyphosis, scoliosis, and/or both.[1-5].
Case description: In this video, a 44-year-old female initially presented after having progressively developed kyphoscoliosis since childhood. Three months before presentation, she had developed increased left lower extremity pain with hypoesthesia followed 1 month later by the onset of the left lower extremity monoplegia (0/5). The computed tomography and magnetic resonance imaging studies revealed a SCM at the L3 level with bony and membranous septum, accompanied by an intradural lipoma, and tethered cord. She underwent a two- stage procedure; first, removal of the bony and membranous septum, resection of the intradural lipoma, and untethering of the cord; second, she had correction of the kyphoscoliosis. Postoperatively, although the pain and sensory deficits improved, the left lower extremity monoplegia remained.
Conclusion: SCM is a rare cause of spinal deformity. If left untreated, the associated neurological deficits may progress. Treatment should include a two-staged approach; first, the bony and membranous septum should be removed followed by lipoma resection and untethering the cord with adequate cord decompression, while second, a fusion may be performed to address attendant kyphoscoliosis.
Keywords: Intradural lipoma, Kyphoscoliosis, Split cord malformation, Tethered cord.
Copyright: © 2020 Surgical Neurology International.
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4
Surg Neurol Int
. 2020 Jun 27;11:171. doi: 10.25259/SNI_242_2020. eCollection 2020.
Magnetic Resonance Imaging Findings in Intervertebral Disc Herniation: Comparison of Canal Compromise and Canal Size in Patients With and Without Cauda Equina Syndrome
Kalyan Kumar Varma Kalidindi 1, Sulaiman Sath 1, Gayatri Vishwakarma 2, Harvinder Singh Chhabra 1
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PMID: 32637224 PMCID: PMC7332702 DOI: 10.25259/SNI_242_2020
Free PMC article
Abstract
Background: Surgical decompressions are typically warranted in patients with magnetic resonance (MR) and clinical evidence of cauda equina syndromes (CESs). However, it is still unclear what MR findings best correlate with such CES. Here, we compared MR-documented canal size and level/extent of compromise in 52 patients with and 56 others without CES attributed to lumbar disc herniation.
Methods: This was a retrospective study of 52 patients with and 56 patients without CES attributed to MR- documented lumbar disc herniations (IDHs). The anteroposterior diameters of the spinal canal and the levels of maximal compression were documented and compared utilizing MR scans from both groups.
Results: The 52 patients with CES had more extensive narrowing of the canal diameters at the L4-L5 and L5- S1 levels and higher mean canal compression ratios versus 56 patients without CES. The mean percentage of compression in the CES group at L4-L5 and L5-S1 levels (70% and 67.5%, respectively) was less versus L2-L3 and L3-L4 levels (89.7% and 81.8%, respectively).
Conclusion: The 52 patients with CES due to IDH had greater canal compromise versus 56 without CES. Further, the percentage of canal compromise was less at L4-L5 and L5-S1 levels compared to other levels in patients with CES.
Keywords: Cauda equina syndrome; Diagnosis; Disc prolapse; Magnetic resonance imaging; Spinal canal.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 13;11:148. doi: 10.25259/SNI_35_2020. eCollection 2020.
Comparison of Two Different Titanium Cranioplasty Methods: Custom-made Titanium Prostheses Versus Precurved Titanium Mesh
Domenico Policicchio 1, Gina Casu 1, Giosuè Dipellegrini 1, Artan Doda 1, Giampiero Muggianu 1, Riccardo Boccaletti 1
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PMID: 32637201 PMCID: PMC7332511 DOI: 10.25259/SNI_35_2020
Free PMC article
Abstract
Background: The aim of this study was to compare the results of two different titanium cranioplasties for reconstructing skull defects: standard precurved mesh versus custom-made prostheses.
Methods: Retrospective analysis of 23 patients submitted to titanium cranioplasty between January 2014 and January 2019. Ten patients underwent delayed cranioplasty using custom-made prostheses; and 13 patients were treated using precurved titanium mesh (ten delayed cranioplasties, and three single-stage resection- reconstructions). Demographic, clinical, and radiological data were recorded. Results and complications of the two methods were compared, including duration of surgery, cosmetic results (visual analog scale for cosmesis [VASC]), and costs of the implants.
Results: Complications: one epidural hematoma in the custom-made group, one delayed failure in precurved group due to wound dehiscence with mesh exposure. There were no infections in either group. All custom-made prostheses perfectly fitted on the defect; eight of 13 precurved mesh prostheses incompletely covered the defect. Custom-made cranioplasty obtained better cosmetic results (average VASC 94 vs. 68), shorter surgical time (141min vs. 186min), and -fewer screws was needed to fix the prostheses in place (6 vs. 15). However, satisfactory results were obtained using precurved mesh in cases of small defects and in single-stage reconstruction. Precurved mesh was found to be cheaper (€1,500 vs. €5,500).
Conclusion: Custom-made cranioplasty obtained better results and we would suggest that this should be a first choice, particularly for young patients with a large cranial defect. Precurved mesh was cheaper and useful for single-stage resection-reconstruction. Depending on the individual conditions, both prostheses have their place in cranioplasty therapies.
Keywords: Cranioplasty; Custom-made cranioplasty; Decompressive craniectomy; Precurved mesh; Titanium mesh.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 13;11:147. doi: 10.25259/SNI_601_2019. eCollection 2020.
Analysis of Twisted Internal Carotid Arteries in Carotid Endarterectomy
Masaru Honda 1, Hajime Maeda 1
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PMID: 32637200 PMCID: PMC7332516 DOI: 10.25259/SNI_601_2019
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Abstract
Background: The twisted carotid artery is a variant, in which the internal carotid artery (ICA) courses medially to the external carotid artery. Due to the sparse descriptions in the literature, we, here, report our experience with cases of carotid endarterectomy (CEA) for twisted carotid artery and its clinical features.
Methods: Fifty-seven consecutive CEA-treated patients were evaluated, and the twist angle was measured on the source images of axial slices of computed tomography angiography (CTA).
Results: Eight male patients (14.2%) demonstrated a twisted right ICA (mean age, 77.0 ± 2.6 years; and mean stenosis, 66.9% ± 19.9%). The mean twist angle was 30.1° ± 17.9°, while the normal ICA is angled at -23.0° ± 12.3°. No statistical differences in the distribution of coexisting diseases were found between the normal and twisted ICA cases. CEA was successfully performed with the correction of the carotid position in all cases; however, significant position correction was not observed in the postoperative evaluation. Right-side dominancy (P = 0.045) and prolonged clamping time (P = 0.053) were observed in the twisted cases.
Conclusion: Twisted ICA was preferentially found in the right ICA and men. CEA of the twisted ICA was safely performed with appropriate head rotation and wider longitudinal skin incision than usual without a significant increase in the operative time. CTA is useful for preoperative evaluation. This specific variation should be considered by the neurosurgeon involved in the evaluation and treatment of carotid stenoses.
Keywords: Carotid endarterectomy; Clinical feature; Surgical feature; Twisted internal carotid artery.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 20;11:154. doi: 10.25259/SNI_576_2019. eCollection 2020.
Effect of Intravenous Lignocaine Infusion on the Quality of Emergence in Patients Undergoing Transsphenoidal Resection of Pituitary Tumors - A Prospective, Randomized Controlled Trial
Deepika Jain 1, Hemant Bhagat 1, Divya Jain 1
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PMID: 32637207 PMCID: PMC7332512 DOI: 10.25259/SNI_576_2019
Free PMC article
Abstract
Background: Emergence from anesthesia is a critical step in patients undergoing transsphenoidal pituitary surgery (TSS). The cough suppressant and anesthetic sparing properties of lignocaine makes it a favorable option for smooth extubation and maintaining stable hemodynamics intraoperatively. We aimed to evaluate the effect of lignocaine infusion on the quality of emergence (QOE) and intraoperative hemodynamics in patients undergoing transsphenoidal resection of pituitary tumors.
Methods: Fifty patients scheduled to undergo TSS were randomly divided into ligocaine group (n = 25), receiving 1.5 mg/kg bolus dose of lignocaine followed by continuous infusion of 1.5 mg/kg/h and saline group (n = 25). Patients assigned to the control group received equal volume of saline receiving equal volume of saline. The four emergence parameters (mean arterial pressure [MAP], heart rate (HR), cough, and agitation) were abbreviated into an aggregated score for QOE. Time to emergence and intraoperative hemodynamics were also recorded.
Results: The QOE was not found to be different between the two groups (P = 0.294). Lignocaine did not increase the time to emergence (P = 0.166). The intraoperative HR and MAP were comparable between the two groups. A lower minimum alveolar concentration of desflurane was required in lignocaine group during insertion of nasal speculum (P = 0.018) and at the time of seller ridge dissection (P = 0.043) compared to the saline group.
Conclusion: Intraoperative lignocaine infusion of 1.5 mg/kg/h did not significantly improve the QOE with respect to hemodynamics, cough, and emergence agitation in patients undergoing transsphenoidal resection of pituitary tumors.
Keywords: Lignocaine infusion; Quality of emergence; Transsphenoidal pituitary surgery.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 13;11:146. doi: 10.25259/SNI_565_2019. eCollection 2020.
Anterior Temporal Approach for Clipping of Ruptured Basilar Tip Aneurysms: Surgical Techniques and Treatment Outcomes
Somkiat Wongsuriyanan 1, Kitiporn Sriamornrattanakul 1
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PMID: 32637199 PMCID: PMC7332467 DOI: 10.25259/SNI_565_2019
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Abstract
Background: Basilar tip (BT) aneurysms are challenging to treat with microsurgical clipping, especially in subarachnoid hemorrhage cases. The anterior temporal approach is one of the surgical approaches for the treatment of aneurysms in this area. The majority of the previous reports on this approach have described unruptured cases. For the ruptured cases assessed in our study, the authors describe the surgical technique, patient characteristics, and surgical outcomes following the use of this technique.
Methods: Fourteen patients with ruptured BT aneurysms who received aneurysm clipping with an anterior temporal approach between December 2015 and August 2019 were retrospectively evaluated. The surgical techniques are described, an illustrative case is shown.
Results: The average patient age was 62.2 years (range: 46-78) for ten women and four men. Nine patients (64.3%) were classified as having a poor grade (World Federation of Neurosurgical Societies Grades 4 and 5) at the first presentation. All of the cases demonstrated complete aneurysm obliteration. Good outcomes (mRS 0 to 2) at 6 months were achieved in 58.3% of the patients and in 77.8% of the patients who had a good Glasgow Coma Score after resuscitation before surgery. Postoperative transient oculomotor nerve palsy and thalamic infarctions were detected in six patients (42.9%) and two patients (14.3%), respectively.
Conclusion: With appropriate case selection, the anterior temporal approach was effective and safe for the clipping of ruptured BT aneurysms.
Keywords: Anterior temporal approach; Basilar bifurcation aneurysm; Basilar tip aneurysm; Ruptured aneurysm.
Copyright: © 2020 Surgical Neurology International.
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There are no conflicts of interest. How to cite this article: Wongsuriyanan S, Sriamornrattanakul K. Anterior temporal approach for clipping of ruptured basilar tip aneurysms: Surgical techniques and treatment outcomes. Surg Neurol Int 2020;11:146.
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Case Reports Surg Neurol Int
. 2020 Jun 20;11:158. doi: 10.25259/SNI_204_2020. eCollection 2020.
Management of a Large Intraorbital Wooden Foreign Body: Case Report
John Nute Jabang 1, Lamin Dampha 1, Binta Sanyang 1, Charles Adeyemi Roberts 2, Bakary Ceesay 3
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PMID: 32637211 PMCID: PMC7332514 DOI: 10.25259/SNI_204_2020
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Abstract
Background: Intraorbital foreign bodies are a global injury and occur with a frequency of one in six orbital injuries; however, intraorbital wooden foreign bodies are uncommon. Intraorbital wooden foreign bodies predominantly affect the male population with a mean age ranging from 21 to 22 years. The diagnosis of intraorbital wooden foreign bodies depending on their size can be challenging on imaging and if not removed early the risk of infection is high.
Case description: A 23-year-old motorcyclist presented to the ER following a collision with a donkey cart carrying wood 3 h before presentation. Examination revealed an acutely ill-looking man in painful distress with a right supraorbital laceration associated with ipsilateral ptosis and periorbital edema. There was a retained intraorbital wooden foreign body. Computed tomography scan showed evidence of both an intraorbital bone fragment and a wooden foreign body. Surgery was done 3rd day of admission before which vision has declined with only perception to light. Only the wooden foreign body was removed. Evolution was favorable with recovery of vision and improvement of the ptosis.
Conclusion: The management of intraorbital wooden foreign bodies demands a multidisciplinary approach after a thorough history, examination, and imaging. Treatment of choice is timely and meticulous removal of the foreign body to avoid infection and other associated complications.
Keywords: Computer tomography scan; Intraorbital wooden foreign body; Magnetic resonance imaging; Orbital cellulitis; Orbital trauma; Visual acuity.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 13;11:153. doi: 10.25259/SNI_243_2020. eCollection 2020.
Unique Bone Suture Anchor Repair of Complex Lumbar Cerebrospinal Fluid Fistulas
Marc Agulnick 1, Benjamin R Cohen 2, Nancy E Epstein 2 3
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PMID: 32637206 PMCID: PMC7332496 DOI: 10.25259/SNI_243_2020
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Abstract
Background: Spine surgeons encounter occasional complex cerebrospinal fluid fistulas/dural tears (CSF/DT) during lumbar spinal surgery. In some cases, these leaks are found during the index procedure, but others may appear postoperatively, or in the course of successive procedures. Here we asked, whether these complex CSF fistulas/DT could be more readily repaired utilizing a "bone suture anchor" technique, particularly where there is no residual dural margin/remnant.
Methods: With the combined expertise of the orthopedist and neurosurgeon, mini/micro bone suture anchors, largely developed for hand surgery, facilitated repair of complex DT occurring during lumbar spine surgery. This technique was utilized to suture in place fascia, periosteal, or muscle grafts, and was followed by the application of microfibrillar collagen, and a fibrin sealant.
Results: This mini/micro suture anchor technique has now been utilized to repair multiple significant intraoperative and/or postoperative recurrent DT, largely avoiding the need to place lumbar drains and/or lumbo- peritoneal shunts.
Conclusions: Here, we reviewed how to directly suture dural grafts utilizing a mini/micro bone suture anchor technique to repair complex intraoperative primary/recurrent DT occurring during lumbar spine surgery. The major advantages of this technique, in addition to obtaining definitive occlusion of the DT, largely avoids the need to place lumbar drains and/or lumbo-peritoneal shunts with their attendant risks and complications.
Keywords: Complex Repair; Dural Leak; Lumbar; Massive; Patch Grafts; Suture Anchors.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 27;11:163. doi: 10.25259/SNI_42_2020. eCollection 2020.
Dynamic Assessment of Internal Carotid Artery and Elongated Styloid Process in a Case of Bilateral Carotid Artery Dissection
Yoshinobu Horio 1, Kenji Fukuda 1, Koichi Miki 1, Noriko Hirao 1, Mitsutoshi Iwaasa 1, Hiroshi Abe 1, Tooru Inoue 1
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PMID: 32637216 PMCID: PMC7332696 DOI: 10.25259/SNI_42_2020
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Abstract
Background: Vascular Eagle syndrome is that an elongated styloid process causes ischemic stroke due to internal carotid artery (ICA) dissection. Dynamic assessment using radiological imaging has not been well investigated. We assessed the change in the relative positional relationship between the elongated styloid process and the ICA using a cone-beam computed tomography (CBCT).
Case description: A 46-year-old female presenting with disturbance of consciousness, right hemiparesis, and aphasia was admitted to our hospital. Initial CT analysis showed a bilateral elongated styloid process. Magnetic resonance angiography (MRA) showed occlusion of the left ICA and a near occlusion of the right ICA. MRA also revealed the intimal flap and intramural hematoma in the bilateral ICA. Digital subtraction angiography showed bilateral ICA occlusion and carotid artery stenting was performed subsequently. After that, we visualized the movement of carotid stent with CBCT fusion methods. The stent moved forward and backward at the attachment point of the styloid process during head rotation, and there was a possibility that mechanical stress was emphasized at this point. Styloidectomy was performed after her rehabilitation. The patient did not experience a recurrence of stroke.
Conclusion: We showed that repeated attachment of the styloid process and ICA may trigger an ICA dissection during head rotation. This finding would be helpful for understanding the causes of vascular Eagle syndrome.
Keywords: Cone-beam computed tomography; Dissection; Eagle syndrome.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 13;11:151. doi: 10.25259/SNI_224_2020. eCollection 2020.
Isolated Neuroparacoccidioidomycosis as a Pseudotumoral Lesion in the Absence of Systemic Disease
Ricardo Salemi Riechelmann 1, Leonardo Henrique Rodrigues 1, Tiago Marques Avelar 1, Paulo Adolfo Xander 1, Guilherme Henrique da Costa 1, Luiz Fernando Cannoni 1, Guilherme Brasileiro de Aguiar 1, Jose Carlos Veiga 1
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PMID: 32637204 PMCID: PMC7332495 DOI: 10.25259/SNI_224_2020
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Abstract
Background: Paracoccidioidomycosis (PCM) is a systemic, progressive, noncontagious, and often chronic disease caused by the fungus Paracoccidioides brasiliensis that rarely affects the central nervous system (CNS). The condition is usually treated using antifungal drugs, and some cases may require surgery.
Case description: A 55-year-old man, a smoker, without known comorbidities, was referred to the neurosurgery team with a history of a single epileptic seizure a week before hospital admission followed by progressive right- sided hemiparesis. Head computed tomography and brain magnetic resonance imaging showed an intra-axial expansive lesion affecting the left parietal lobe, associated with extensive edema and a regional compressive effect producing slight subfalcine herniation that was initially managed as an abscess. After the failure of antibiotic treatment, the patient underwent a neurosurgical procedure for excision of the lesion. Histopathological analysis revealed that it was PCM and there was no evidence of impairment of other systems due to the disease.
Conclusion: PCM can be a serious, debilitating disease and is potentially fatal. Although isolated CNS involvement is rare, it must be considered, especially in endemic areas, as late diagnosis and treatment severely decreases good outcome rates.
Keywords: Central nervous system infections; Neurosurgical procedures; Paracoccidioidomycosis.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 27;11:170. doi: 10.25259/SNI_239_2020. eCollection 2020.
Optimum Concentration of Iodine Contrast Agent Injection for Best Stent Visualization Using Neuroform Atlas Stent During Stent-Assisted Coil Embolization: Case Reviews Based on in vitro Experiments
Shuta Aketa 1, Daisuke Wajima 1, Masayoshi Kiyomoto 1, Natsuhiko Izumi 1, Taiji Yonezawa 1
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PMID: 32637223 PMCID: PMC7332700 DOI: 10.25259/SNI_239_2020
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Abstract
Background: The present study aimed to evaluate the influence of contrast agent concentration (Conc) on the visibility of Neuroform Atlas in vitro and in clinical cases.
Methods: A plastic tube was filled with several Conc. in saline (experiment 1) and blood (experiment 2). Thereafter, the Neuroform Atlas was placed around the plastic tube in an acrylic shield case. In experiment 3, the Neuroform Atlas was placed in the internal carotid artery of the endo vascular evaluator endovascular training system with an injection of several Conc in saline. Five slices of the axial images obtained using the 3D-cone-beam computed tomography (3D-CBCT) with the digital subtraction angiography system were evaluated. A 1-cm2 circular center, which showed the contrast agent in saline or blood, was determined as the region of interest, and its pixels were evaluated.
Results: Radiation density (Rd) was directly proportional to the contrast agent in saline and blood (experiment 1: (Rd (pixel)) = 6.8495 × (concentration (%)) + 152.72 (R2 = 0.99), experiment 2: (Rd (pixel)) = 6.2485 × (concentration (%)) + 167.42 (R2 = 0.9966), experiment 3: (Rd (pixel)) = 10.287 × (concentration (%)) + 108.26 (R2 = 0.993)]. Rd calculated similarly in our cases (concentration varied from 5% to 8%) was between the range of "Rd of experiment 2" and "Rd of experiment 3."
Conclusion: Based on our in vitro experiments, with 5-8% concentration, Neuroform Atlas stent deployment with complete neck coverage by the bulging stent and wall apposition was visualized on 3D-CBCT.
Keywords: Coil embolization; Iodine contrast; Neuroform Atlas stent; Optimum; Stent visualization.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 20;11:161. doi: 10.25259/SNI_508_2019. eCollection 2020.
Intracerebral Steal Phenomenon Induced Focal Reversible Vasogenic Edema and Decrease in Cerebral Blood Flow After Carotid Endarterectomy
Yu Shimizu 1, Katsuhiro Tsuchiya 1, Norihiro Fujisawa 1
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PMID: 32637214 PMCID: PMC7332508 DOI: 10.25259/SNI_508_2019
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Abstract
Background: Intracerebral steal phenomenon (ISP) is a rare complication following surgical treatment of carotid stenosis. However, the factors responsible remain unknown. We described the rear case of the ISP who had vasogenic edema and cerebral blood flow (CBF) decline and presented with hemiparesis after carotid endarterectomy (CEA).
Case description: A 72-year-old male with stenosis of the bilateral carotid artery (NASCET right 90% and left 70%) presented with cerebral hypoperfusion manifesting as right hemiparesis, after left CEA. Fluid-attenuated inversion recovery images showed edema of the motor area around an old infarction and a decrease in CBF. This lesion was an area of vasogenic edema caused by ISP and focal cerebral hypoperfusion. CBF of the contralateral cerebral hemispheres had increased. The treatment with an intravenous infusion of a free radical scavenger and glycerol improved the patient's symptoms and brain edema. Magnetic resonance imaging showed a gradual decline in the brain edema, which completely disappeared 2 weeks after CEA. He was discharged with no neurological deficit.
Conclusion: In this report, we described the case of a patient with ISP who had vasogenic edema induced by CBF decline and presented with hemiparesis following CEA. This is the first report of progressing focal vasogenic edema caused by ISP after endarterectomy.
Keywords: Cerebral blood flow; Endarterectomy; Intracerebral steal phenomenon; Single-photon emission computed tomography; Vasogenic edema.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 20;11:155. doi: 10.25259/SNI_584_2019. eCollection 2020.
Atypical Sellar Cyst: A Rare Case
Nimrah Ali 1, Areesha Shakeel 2, Yousuf Shaikh 3, Salman Sharif 4, Atif Hashmi 5
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PMID: 32637208 PMCID: PMC7332488 DOI: 10.25259/SNI_584_2019
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Abstract
Background: Sellar cysts are common in neurosurgery. Around 90% of these are diagnosed as pituitary adenomas. The other 10% are nonadenomatous, inflammatory, infective, metastatic, or cystic in nature. Some rare cysts include dermoid, epidermoid, colloid, and arachnoid. They all have different histological features. The case we present demonstrates a unique cyst with features that are not previously documented.
Case description: A 60-year-old female presented to the neurosurgical department complaining of blurring of vision and severe headache for more than ½ year. Imaging was done which revealed a bony erosive lesion in the region of sella. Magnetic resonance imaging with contrast showed high signals with no contrast enhancement. A clear diagnosis could not be made based on radiology. Surgery was done and sample was sent for histopathology. Based on histopathological report findings, a diagnosis of benign atypical sellar cyst was made. Post procedure, the patient recovered and was discharged.
Conclusion: Sellar cysts present similarly. They are differentiated based on their histological features. The sellar cyst we encountered had features different from the ones already described in the literature.
Keywords: Benign epithelial cyst; Endoscopy; Sellar cyst.
Copyright: © 2020 Surgical Neurology International.
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16
Surg Neurol Int
. 2020 Jun 27;11:169. doi: 10.25259/SNI_199_2020. eCollection 2020.
Comparative Metrics of Neurosurgical Scientific Journals: What Do They Mean to Readers?
James I Ausman 1 2, Nancy Epstein 3, James L West 1
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PMID: 32637222 PMCID: PMC7332697 DOI: 10.25259/SNI_199_2020
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Abstract
Background: In regard to scientific information, are we effectively reaching the universe of physicians in the 21st century, all of whom have different backgrounds, practice environments, educational experiences, and varying degrees of research knowledge?
Methods: A comparison of the top nine neurosurgery journals based on various popular citation indices and also on the digital metric, Readers (Users)/month, was compiled from available metrics and from internet sources.
Results: Major differences in the ranking of the Readers (Users)/month metrics compared to ranking of the various citation indices were found. It is obvious that the citation indices do not measure the number of readers of a publication. Which metric should be used in judging the value of a scientific paper? The answer to that question relates to what the interest of the reader has in the scientific information. It appears that the academic scientist may have a different reason for reading a scientific publication than a physician caring for a patient.
Conclusions: There needs to be more than one type of metric that measures the value and "Impact" of a scientific paper based on how physicians learn.
Keywords: Citation indices; Comparison publication metrics; How do physicians learn? Readers (Users) month.
Copyright: © 2020 Surgical Neurology International.
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17
Surg Neurol Int
. 2020 Jun 20;11:159. doi: 10.25259/SNI_287_2020. eCollection 2020.
Isolated Painless Scoliosis in Lumbar Disc Herniation
Ali Akhaddar 1, Hafid Arabi 2
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PMID: 32637212 PMCID: PMC7332515 DOI: 10.25259/SNI_287_2020
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18
Surg Neurol Int
. 2020 May 9;11:103. doi: 10.25259/SNI_143_2020. eCollection 2020.
Neurosurgery in Iraq at the Time of Corona
Samer S Hoz 1, Zahraa F Al-Sharshahi 1, Saja A Albanaa 2
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PMID: 32574275 PMCID: PMC7265420 DOI: 10.25259/SNI_143_2020
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19
Case Reports Surg Neurol Int
. 2020 Jun 20;11:156. doi: 10.25259/SNI_66_2020. eCollection 2020.
Risk of Fatal Sinus Arrest Induced by Low-Grade Subarachnoid Hemorrhage: A Case of a Young Patient With Obstructive Sleep Apnea
Naoki Wakuta 1, Satoshi Yamamoto 2
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PMID: 32637209 PMCID: PMC7332489 DOI: 10.25259/SNI_66_2020
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Abstract
Background: Sleep apnea syndrome (SAS) and subarachnoid hemorrhage (SAH) are both considered possible causes of secondary arrhythmias. However, there are limited reports on the increased risk of bradyarrhythmia for arrhythmia-free SAS patients with SAH.
Case description: A 31-year-old woman with SAS developed low-grade SAH and underwent coil embolization on postbleed day 1. Following a coiling procedure, she experienced worsening episodes of sinus arrest lasting up to 12 s and required a temporary pacemaker. Frequent episodes of sinus arrest were detected for the next 4 days. Thereafter, all types of arrhythmias gradually decreased, and she eventually recovered to be arrhythmia free.
Conclusion: Acceleration of sympathetic nervous activity caused by acute SAH may predispose patients to bradyarrhythmia with SAS and elicit asystole. The coexistence of SAS and SAH should be recognized as a cause of life-threatening sinus arrest, even if the severity of SAH is low grade.
Keywords: Endovascular surgery; Sinus arrest; Sleep apnea syndrome; Subarachnoid hemorrhage.
Copyright: © 2020 Surgical Neurology International.
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20
Case Reports Surg Neurol Int
. 2020 Jun 20;11:157. doi: 10.25259/SNI_161_2020. eCollection 2020.
A Spontaneous Cervical Epidural Hematoma Mimicking a Stroke - A Case Report
Pedro Teles 1, Joaquim Pedro Correia 1, Lia Pappamikail 1, Artur Lourenço 1, Clara Romero 1, Fátima Lopes 1, Gonçalo Neto Almeida 1, Pedro Abreu 1
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PMID: 32637210 PMCID: PMC7332487 DOI: 10.25259/SNI_161_2020
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Abstract
Background: A spontaneous cervical epidural hematoma (SCEH) is a rare occurrence. It usually presents with quadriparesis, but it may present with hemiparesis or hemiplegia and can easily be misdiagnosed as stroke. We present a case of stroke mimicking SCEH with hemiparesis worsened after tissue plasminogen activator therapy (tPA) followed by emergency cervical decompression laminectomy.
Case description: A 63-year-old female presented to the emergency department with sudden onset of posterior neck and left shoulder pain with the right side hemiparesis. On neurological examination, the patient had motor power of the right upper and lower limb of 2/5 Medical Research Council, and her whole left extremities were intact. Her medical history was unremarkable for trauma, hemorrhagic diathesis, or anticoagulation therapy. A head computed tomography was ordered ruling out intracranial hemorrhage. Assuming an acute ischemic stroke as the most likely diagnosis, alteplase (tPA) was administered 3 h after symptoms onset, however without any improvement in patient symptoms. A cervical magnetic resonance was performed revealing a right paramedian epidural mass-like lesion between C3-C6. The patient underwent cervical laminectomy C3-C6 with evacuation of epidural hematoma with significant clinical status improvement after surgery.
Conclusion: tPA treatment is frequently used as first-line therapy for acute ischemic stroke. Therefore, physicians should be aware of the potential for the SCEH in patients presenting with hemiparesis, as tPA administration may increase cervical hematoma leading to clinical deterioration. With this case, we intended to warn about SCEH as a rare but possible entity, since its early recognition and prompt clinical intervention may improve neurological outcomes.
Keywords: Cervical epidural hematoma; Stroke; Thrombolysis.
Copyright: © 2020 Surgical Neurology International.
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21
Case Reports Surg Neurol Int
. 2020 Jun 27;11:165. doi: 10.25259/SNI_97_2020. eCollection 2020.
A Sellar Neuroblastoma Showing Rapid Growth and Causing Syndrome of Inappropriate Secretion of Antidiuretic Hormone: A Case Report
Muhammad Kamil 1, Nayuta Higa 1, Hajime Yonezawa 1, Shingo Fujio 1, Jun Sugata 1, Tomoko Takajo 1, Tsubasa Hiraki 2, Junko Hirato 3, Kazunori Arita 1, Koji Yoshimoto 1
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PMID: 32637218 PMCID: PMC7332709 DOI: 10.25259/SNI_97_2020
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Abstract
Background: Sellar neuroblastoma is a very rare entity. We report a rare case of arginine vasopressin (AVP)- producing sellar neuroblastoma presumed to have originated from the lower part of sellar turcica, which grew very rapidly.
Case description: A 33-year-old woman was found to have a sellar lesion with a diameter of 18 mm invading into the bilateral cavernous sinus on magnetic resonance imaging (MRI) performed for dizziness. Six years later, when she visited the clinic due to bilateral visual disturbance, MRI showed a rapid growth of the tumor, with a maximal diameter of 56 mm at the current state, strongly compressing the optic nerve and chiasm. Transsphenoidal decompression of the optic chiasm revealed an intact pituitary gland on the top of the tumor. The tumor was composed of neoplastic cells that were immunohistochemically positive for neuronal markers and arginine vasopressin (AVP), but negative for all anterior pituitary hormones, glial fibrillary acidic protein, or thyroid transcription factor-1; these findings were suggestive of sellar neuroblastoma. She underwent 50-Gy radiation therapy, which has controlled the growth for the past 3 years.
Conclusion: Awareness of rare sellar neuroblastomas will allow the accumulation of clinicopathologic information that may facilitate the understanding of their origin, clinical features, neuroimaging characteristics, and pertinent adjuvant treatment.
Keywords: Neuroblastoma; Rapid growth; Sellar; Syndrome of inappropriate antidiuretic hormone secretion.
Copyright: © 2020 Surgical Neurology International.
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22
Surg Neurol Int
. 2020 Jun 20;11:162. doi: 10.25259/SNI_284_2019. eCollection 2020.
Technical Note: In Mexico, the Majority of 147 Traumatic Spinal Cord Injuries Occurred in the Thoracic Spine for Young Males
César Adán Almendárez-Sánchez 1, Thalía Sotelo-Popoca 2, Abrahan Alfonso Tafur-Grandett 1, Raúl Huato-Reyes 1
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PMID: 32637215 PMCID: PMC7332513 DOI: 10.25259/SNI_284_2019
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Abstract
Background: Traumatic spinal cord injury (TSCI) is a devastating problem typically associated with multi-organ disorders. Studies regarding TSCI and their attendant comorbidities are scarce from developing countries.
Methods: The electronic files of 147 patients with TSCI (2017-2018) were reviewed; 78% of patients were males averaging 38 years of age. The following variables associated with the TSCI included age, sex, etiology of trauma, vertebral level, fracture classification, Frankel grade, treatment, complications, and mortality.
Results: Of interest, most cases involved thoracic injuries with attendant chest trauma resulting from falls from substantial heights.
Conclusion: In Mexico, the majority of TSCI occur in young males (average age 38) who have sustained falls from significant heights resulting in thoracic fractures with a high frequency of chest injuries. By providing such information for developing countries, we may develop future strategies to TSCI in vulnerable populations.
Keywords: Epidemiology; Incidence; México; Spinal cord injury; Traumatic.
Copyright: © 2020 Surgical Neurology International.
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23
Case Reports Surg Neurol Int
. 2020 Jun 13;11:149. doi: 10.25259/SNI_105_2020. eCollection 2020.
Report of Intradural Aneurysm in the Cavernous Segment of the Internal Carotid Artery Presented With Subarachnoid Hemorrhage and Oculomotor Palsy
Charles Alfred Pedrozo 1, Guilherme Brasileiro de Aguiar 1, Jose Carlos Esteves Veiga 1
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PMID: 32637202 PMCID: PMC7332490 DOI: 10.25259/SNI_105_2020
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Abstract
Background: Aneurysms of the cavernous segment of the internal carotid artery (ICA) do not usually cause subarachnoid hemorrhage (SAH). We report a patient who presented with this condition due to a ruptured aneurysm located on the posterior genu of the cavernous segment, raising the question of what factors could have led to such evolution.
Case description: A 55-year-old male patient presented with sudden, intense thunderstorm headache, associated with complete palsy of the left oculomotor nerve and neck stiffness. Cranial computed tomography (CT) showed no SAH, but showed an expansive process in the sella turcica, consistent with a pituitary macroadenoma. After that, SAH was confirmed by lumbar puncture (Fisher I). Cranial angio-CT revealed an intradural saccular aneurysm in the cavernous segment of the left ICA. The patient underwent cranial microsurgery for cerebral aneurysm clipping. Unlike the normal anatomic pattern, the cavernous segment of the carotid artery in this patient was located in the intradural compartment.
Conclusion: Intradural rupture of proximal cavernous segment carotid aneurysms is rare. We review the literate for such cases and discuss the possible causes.
Keywords: Aneurysms; Ophthalmoparesis; Pituitary adenoma; Subarachnoid hemorrhage.
Copyright: © 2020 Surgical Neurology International.
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12 references6 figures
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24
Surg Neurol Int
. 2020 May 23;11:125. doi: 10.25259/SNI_250_2020. eCollection 2020.
A Canadian Perspective on Coronavirus disease-19 and Neurosurgical Residency Training
Erika D Leck 1, Mark A MacLean 1, Jacob Alant 1
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PMID: 32574276 PMCID: PMC7265415 DOI: 10.25259/SNI_250_2020
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25
Case Reports Surg Neurol Int
. 2020 Jun 13;11:152. doi: 10.25259/SNI_259_2020. eCollection 2020.
Intramedullary Craniovertebral Junction Metastasis Leading to the Diagnosis of Underlying Renal Cell Carcinoma
Giancarlo Ponzo 1, Giuseppe Emmanuele Umana 2, Massimiliano Giuffrida 1, Massimo Furnari 1, Giovanni Federico Nicoletti 1, Gianluca Scalia 1
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PMID: 32637205 PMCID: PMC7332509 DOI: 10.25259/SNI_259_2020
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Abstract
Background: Intramedullary spinal cord metastases represent 4-8.5% of the central nervous system metastases and affect only 0.1-0.4% of all patients. Those originating from renal cell carcinoma (RCC) are extremely rare. Of the eight patients described in the literature with metastatic RCC and intramedullary cord lesion, only five were found in the cervical spine. Here, the authors add a 6th case involving an RCC intramedullary metastasis at the C1-C2 level.
Case description: A 78-year-old male patient presented with intermittent cervicalgia of 5 months duration accompanied by few weeks of a progressive severe right hemiparesis, up to hemiplegia. The magnetic resonance imaging (MRI) examination revealed an intramedullary expansive lesion measuring 10 mm×15 mm at the C1-C2 level; it readily enhanced with contrast. A total body computed tomography (CT) scan documented an 85 mm mass involving the right kidney, extending to the ipsilateral adrenal gland, and posteriorly infiltrating the ipsilateral psoas muscle. The subsequent CT-guided fine-needle biopsy confirmed the diagnosis of an RCC (Stage IV). The patient next underwent total surgical total removal of the C1-C2 intramedullary mass, following which he exhibited a slight motor improvement, with the right hemiparesis (2/5). He died after 14 months due to global RCC tumor progression.
Conclusion: The present case highlights that a patient without a prior known diagnosis of RCC may present with an intramedullary C1-C2 metastasis. In such cases, global staging is critical to determine whether primary lesion resection versus excision of metastases (e.g., in this case, the C1-C2 intramedullary tumor) are warranted.
Keywords: Craniovertebral junction; Intramedullary; Metastasis; Myelotomy; Renal cell carcinoma.
Copyright: © 2020 Surgical Neurology International.
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26
Case Reports Surg Neurol Int
. 2020 Jun 27;11:166. doi: 10.25259/SNI_170_2020. eCollection 2020.
Primary Myxoid Temporal Bone Tumor: A Rare Neurosurgical Manifestation of Carney Complex?
Tobechi Nwankwo Mbadugha 1, Kohei Kanaya 2, Tetsuyoshi Horiuchi 2, Mai Iwaya 3, Samuel Chukwunonyerem Ohaegbulam 1, Kazuhiro Hongo 2
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PMID: 32637219 PMCID: PMC7332703 DOI: 10.25259/SNI_170_2020
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Abstract
Background: Carney complex (CNC) is a rare autosomal dominant syndrome, manifesting mainly with cardiac, cutaneous, and mucosal myxomas. Osteochondromyxoma is known as an extremely rare bone lesion of CNC which usually appears early in life; however, there were no reports of primary bone myxoma of the skull in the patients with CNC. We present the first case of primary myxoid skull tumor in the patient with CNC.
Case description: We report the left temporal bone tumor with significant intracranial mass effect in a 58-year- old woman already diagnosed with CNC. Complete resection of the tumor with skull bone reconstruction was carried out. Pathological diagnosis was labeled the lesion as an atypical myxoid spindle cell neoplasm. The features were different from atrial myxoma and osteochondromyxoma which has been described in CNC. There have been no signs of recurrence in 9 years follow-up.
Conclusion: To the best of our knowledge, there have been no reports of the primary myxoid tumors in the skull in the patients with CNC. This paper highlighted a possible important association between CNC and primary intracranial myxoid tumors.
Keywords: Carney complex; Myxoid tumor; Skull.
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27
Case Reports Surg Neurol Int
. 2020 Jun 27;11:168. doi: 10.25259/SNI_257_2020. eCollection 2020.
Symptomatic Cerebral Vasospasm in the Setting of Carmustine Wafer Placement for Glioblastoma: A Case Presentation and Review of Literature
Maheen Qamar Khan 1, Cristian Cirjan 1, Nabiha Quadri 1, Georgios Alexopoulos 1, Jeroen Coppens 1
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PMID: 32637221 PMCID: PMC7332710 DOI: 10.25259/SNI_257_2020
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Abstract
Background: Gliadel placement in glioblastoma resection, particularly with concurrent chemoradiation, has demonstrated an improvement in survival. There have been several reported adverse effects, some of which lend to significantly increased morbidity and mortality. With only two other cases described in literature, cerebral vasospasm secondary to carmustine-impregnated wafers is an extremely rare side effect.
Case description: We report the case of a 51-year-old female who presented with the left lower limb paresis 8 days after high-grade glioma resection provoked by carmustine wafer placement.
Conclusion: We urge surgeons to reconsider placement of carmustine wafers in nations where the surgical resection cavity includes exposed large cerebral vasculature. We also propose the early identification of this devastating complication in the postoperative period by maintaining a high clinical suspicion and prompt utilization of computed tomography and digital subtraction angiography in the management and treatment of these patients accordingly.
Keywords: Carmustine wafer; Cerebral vasospasm; Glial tumor; Glioma; Tumor resection.
Copyright: © 2020 Surgical Neurology International.
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28
Case Reports Surg Neurol Int
. 2020 Jun 27;11:164. doi: 10.25259/SNI_47_2020. eCollection 2020.
Paramedian Thalamic Infarction Caused by Cisternal Drain Placement in Open Clipping for Aneurysmal Subarachnoid Hemorrhage: Two Case Reports
Sho Tsunoda 1, Tomohiro Inoue 1, Hideaki Ono 2, Kazuaki Naemura 1, Atsuya Akabane 1
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PMID: 32637217 PMCID: PMC7332699 DOI: 10.25259/SNI_47_2020
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Abstract
Background: Some complications associated with cisternal drainage have been reported; however, there are few reports on direct vascular injury caused by cisternal drain. We experienced two rare cases of thalamic infarction caused by cisternal drain placement during open clipping for a ruptured anterior communicating artery (AcomA) aneurysm through an anterior interhemispheric approach.
Case description: Two cases of ruptured AcomA aneurysm were treated by surgical clipping through an anterior interhemispheric approach, and then a cisternal drain was inserted from opticocarotid space toward prepontine cistern. Postoperatively, the magnetic resonance imaging showed unilateral anterior-medial thalamic infarction in both two cases. By reviewing the postoperative computed tomography and digital subtraction angiography, it was suspected that the cisternal drain, which was inserted slightly deep, obstructed the P1 perforator because of an anatomical variation involving a lowered basilar bifurcation and caused postoperative unilateral paramedian thalamic infarction.
Conclusion: To avoid these complications, neurosurgeons should consider the potential for P1 perforator injury related to cisternal drain placement.
Keywords: Cisternal drainage; Complication; Subarachnoid hemorrhage; Thalamic infarction.
Copyright: © 2020 Surgical Neurology International.
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29
Case Reports Surg Neurol Int
. 2020 Jun 13;11:150. doi: 10.25259/SNI_189_2020. eCollection 2020.
A Case of Dual Three-Column Thoracic Spinal Fractures Following Traumatic Injury
Taylor Waitt 1, Vamsi Reddy 1, Dayton Grogan 1, Pearce Lane 2, Joseph Kilianski 1, John DeVine 2, Alexander Post 1
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PMID: 32637203 PMCID: PMC7332507 DOI: 10.25259/SNI_189_2020
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Abstract
Background: Thoracic spine fracture-dislocations due to motor vehicle accidents (MVAs) rarely involve double- level, noncontiguous lesions.
Case description: A 19-year-old male following an MVA was paraplegic; he exhibited full motor/sensory loss below the T4 level (i.e., ASIA scale Grade A). The chest X-ray, magnetic resonance, and computed tomography studies confirmed T3-T5 and T11-12 fractures, warranting T3-L3 thoracolumbar decompression and fusion. Despite surgical intervention, the patient's neurological status remained unchanged.
Conclusion: This case illustrates the rare presentation of noncontiguous, posttraumatic thoracic spinal lesions requiring simultaneous decompression/fixation.
Keywords: Noncontiguous spinal injury; Spondyloptosis; Thoracic spinal injury; Trauma.
Copyright: © 2020 Surgical Neurology International.
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Review Surg Neurol Int
. 2020 Jun 20;11:160. doi: 10.25259/SNI_294_2020. eCollection 2020.
Diagnosis, and Treatment of Cervical Epidural Abscess and/or Cervical Vertebral Osteomyelitis With or Without Retropharyngeal Abscess; A Review
Nancy Epstein 1
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PMID: 32637213 PMCID: PMC7332491 DOI: 10.25259/SNI_294_2020
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Abstract
Background: Every year approximately 19.6 patients/100,000 per year are admitted to hospitals with spinal epidural abscesses (CSEA), 7.4/100,000 have vertebral osteomyelitis (VO)/100,000/year, while 4.1/100.000 children/year have cervical retropharyngeal abscesses (RPA) (i.e., data insufficient for adults).
Methods: Here we evaluated 11 individual case studies, 6 multiple patient series, and looked at 9 general review articles focusing on CSEA, and/or VO, with/without RPA.
Results: Of the 11 case studies involving 15 patients, 14 had cervical spinal epidural abscesses (CSEA: 10 CSEA/ VO/RPA, 2 CSEA/VO, 1 CSEA/TSEA, 1 CSEA/ TSEA/LSEA), 13 had cervical osteomyelitis (VO: 11 VO/CSEA, 2 VO/RPA), and 12 had cervical retropharyngeal abscesses (RPA: 10 RPA/CSEA/VO, 2 RPA/VO alone). When patients were treated surgically, they required 12 anterior, and 2 posterior approaches; 1 patient required no surgery. In the 6 larger cervical series involving 355 patients, 4 series involved CSEA (3 CSEA, 1 CSEA/VO), and 2 seires had cervical VO. Primary surgery was performed in 298 patients, while 57 were initially managed medically; 24 of these latter patients failed non-surgical therapy, and required delayed cervical surgery. Notably, all 17 clinical studies advocated early surgery where clinically appropriate for varying combinations of CSEA and/or VO with or without RPA. The 8 final articles reviewed all-levels of SEA and or VO, while also providing additional unique information regarding RPA.
Conclusion: We analyzed 11 case studies and 6 multiple case series regarding the diagnosis and treatment of combinations of cervical CSEA, and/or VO with or without RPA. We also reviewed 8 articles on the evaluation/ management of all-level SEAs and/or VOs, along with the unique features of RPAs.
Keywords: Cervical spine epidural abscesses; How to recognize failure of medical management; Retropharyngeal abscesses; Success of early surgery where appropriate for CSEA and/or VO with/without RPA; Vertebral osteomyelitis.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 27;11:167. doi: 10.25259/SNI_167_2020. eCollection 2020.
Outcome of Cranial Firearm Injuries in Civilian Population Based on a Novel Classification System
Farrukh Javeed 1, Asad Abbas 1, Lal Rehman 1, Syed Raza Khairat Rizvi 1, Ali Afzal 1, Hafiza Fatima Aziz 2
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PMID: 32637220 PMCID: PMC7332701 DOI: 10.25259/SNI_167_2020
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Abstract
Background: Cranial firearm injuries (CFAIs) are expected to be frequent during warfare; however, it is becoming increasingly common among civilian population in our part of the world. These injuries are associated with significant morbidity and mortality in addition to financial loss. The objective of our study is to evaluate the pattern of gunshot injuries to cranium and their outcome.
Methods: The study was conducted on 114 patients presenting with CFAIs to Jinnah Postgraduate Medical Centre, Karachi, Pakistan, between June 2015 and January 2019. Patients were evaluated with respect to age, gender, pattern of injury, Glasgow coma scale on arrival, radiological and clinical assessment, surgical intervention, and Glasgow outcome score measured at 6 months follow-up.
Results: Among patients with cranial gunshot, injuries most were males (76.3%). More than 50% patients aged between 18 and 35 years. About 46.5% of patients presented with moderate traumatic brain injury commonly involving the temporal lobe (36.8%). Of total 114 patients, 84.2% were managed conservatively but wound debridement was done in all patients. At 6 months, the overall mortality in our patients was 33.3%. Patients with good outcome (GOS 4 and 5) were 30.7% and 35.9% patients had bad outcome (GOS 2 and 3). Complication rate was 14.9% and the most common complication was disseminated intravascular coagulation in 5.2%.
Conclusion: Surgical intervention has no significant benefit over conservative management on long-term mortality and should be limited to patients with large intracranial hematomas and intraventricular hematomas causing hydrocephalus.
Keywords: Ballistics; Civilian population; Firearm injuries; Glasgow outcome score; Jinnah classification.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 27;11:172. doi: 10.25259/SNI_331_2020. eCollection 2020.
Combined Type 1 and 2 Split Cord Malformations, Kyphoscoliosis, Tethered Cord, and a Lipoma
Turki Elarjani 1, Sami Khairy 2, Wael Alshaya 2
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PMID: 32637225 PMCID: PMC7332706 DOI: 10.25259/SNI_331_2020
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Abstract
Background: Split cord malformations (SCMs) are uncommon congenital anomalies. They can be divided into Type 1 (bony septum and two separate dural sheaths) and Type 2 (fibrous septum and a single dural sheath).[1,2,4] Rarely,SCM can be associated with orthopedic anomalies (mostly seen in older children), such as scoliosis, followed by kyphosis, and/or both.[1-3] Conversely, patients with congenital scoliosis have 40% risk of congenital underlying neural deformities, with 16.3% attributed to SCM.[1,4] Those with thoracic or lumbosacral SCM may have congenital tethering lesions, predominantly consisting of intradural lipomas.[3,4] Surgery is optimally performed in two stages: first, removal of the spinal septum and untethering of the cord, and second, correction of the kyphosis, scoliosis, and/or both.[1-5].
Case description: In this video, a 44-year-old female initially presented after having progressively developed kyphoscoliosis since childhood. Three months before presentation, she had developed increased left lower extremity pain with hypoesthesia followed 1 month later by the onset of the left lower extremity monoplegia (0/5). The computed tomography and magnetic resonance imaging studies revealed a SCM at the L3 level with bony and membranous septum, accompanied by an intradural lipoma, and tethered cord. She underwent a two- stage procedure; first, removal of the bony and membranous septum, resection of the intradural lipoma, and untethering of the cord; second, she had correction of the kyphoscoliosis. Postoperatively, although the pain and sensory deficits improved, the left lower extremity monoplegia remained.
Conclusion: SCM is a rare cause of spinal deformity. If left untreated, the associated neurological deficits may progress. Treatment should include a two-staged approach; first, the bony and membranous septum should be removed followed by lipoma resection and untethering the cord with adequate cord decompression, while second, a fusion may be performed to address attendant kyphoscoliosis.
Keywords: Intradural lipoma, Kyphoscoliosis, Split cord malformation, Tethered cord.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 27;11:171. doi: 10.25259/SNI_242_2020. eCollection 2020.
Magnetic Resonance Imaging Findings in Intervertebral Disc Herniation: Comparison of Canal Compromise and Canal Size in Patients With and Without Cauda Equina Syndrome
Kalyan Kumar Varma Kalidindi 1, Sulaiman Sath 1, Gayatri Vishwakarma 2, Harvinder Singh Chhabra 1
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PMID: 32637224 PMCID: PMC7332702 DOI: 10.25259/SNI_242_2020
Free PMC article
Abstract
Background: Surgical decompressions are typically warranted in patients with magnetic resonance (MR) and clinical evidence of cauda equina syndromes (CESs). However, it is still unclear what MR findings best correlate with such CES. Here, we compared MR-documented canal size and level/extent of compromise in 52 patients with and 56 others without CES attributed to lumbar disc herniation.
Methods: This was a retrospective study of 52 patients with and 56 patients without CES attributed to MR- documented lumbar disc herniations (IDHs). The anteroposterior diameters of the spinal canal and the levels of maximal compression were documented and compared utilizing MR scans from both groups.
Results: The 52 patients with CES had more extensive narrowing of the canal diameters at the L4-L5 and L5- S1 levels and higher mean canal compression ratios versus 56 patients without CES. The mean percentage of compression in the CES group at L4-L5 and L5-S1 levels (70% and 67.5%, respectively) was less versus L2-L3 and L3-L4 levels (89.7% and 81.8%, respectively).
Conclusion: The 52 patients with CES due to IDH had greater canal compromise versus 56 without CES. Further, the percentage of canal compromise was less at L4-L5 and L5-S1 levels compared to other levels in patients with CES.
Keywords: Cauda equina syndrome; Diagnosis; Disc prolapse; Magnetic resonance imaging; Spinal canal.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 13;11:148. doi: 10.25259/SNI_35_2020. eCollection 2020.
Comparison of Two Different Titanium Cranioplasty Methods: Custom-made Titanium Prostheses Versus Precurved Titanium Mesh
Domenico Policicchio 1, Gina Casu 1, Giosuè Dipellegrini 1, Artan Doda 1, Giampiero Muggianu 1, Riccardo Boccaletti 1
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PMID: 32637201 PMCID: PMC7332511 DOI: 10.25259/SNI_35_2020
Free PMC article
Abstract
Background: The aim of this study was to compare the results of two different titanium cranioplasties for reconstructing skull defects: standard precurved mesh versus custom-made prostheses.
Methods: Retrospective analysis of 23 patients submitted to titanium cranioplasty between January 2014 and January 2019. Ten patients underwent delayed cranioplasty using custom-made prostheses; and 13 patients were treated using precurved titanium mesh (ten delayed cranioplasties, and three single-stage resection- reconstructions). Demographic, clinical, and radiological data were recorded. Results and complications of the two methods were compared, including duration of surgery, cosmetic results (visual analog scale for cosmesis [VASC]), and costs of the implants.
Results: Complications: one epidural hematoma in the custom-made group, one delayed failure in precurved group due to wound dehiscence with mesh exposure. There were no infections in either group. All custom-made prostheses perfectly fitted on the defect; eight of 13 precurved mesh prostheses incompletely covered the defect. Custom-made cranioplasty obtained better cosmetic results (average VASC 94 vs. 68), shorter surgical time (141min vs. 186min), and -fewer screws was needed to fix the prostheses in place (6 vs. 15). However, satisfactory results were obtained using precurved mesh in cases of small defects and in single-stage reconstruction. Precurved mesh was found to be cheaper (€1,500 vs. €5,500).
Conclusion: Custom-made cranioplasty obtained better results and we would suggest that this should be a first choice, particularly for young patients with a large cranial defect. Precurved mesh was cheaper and useful for single-stage resection-reconstruction. Depending on the individual conditions, both prostheses have their place in cranioplasty therapies.
Keywords: Cranioplasty; Custom-made cranioplasty; Decompressive craniectomy; Precurved mesh; Titanium mesh.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 13;11:147. doi: 10.25259/SNI_601_2019. eCollection 2020.
Analysis of Twisted Internal Carotid Arteries in Carotid Endarterectomy
Masaru Honda 1, Hajime Maeda 1
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PMID: 32637200 PMCID: PMC7332516 DOI: 10.25259/SNI_601_2019
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Abstract
Background: The twisted carotid artery is a variant, in which the internal carotid artery (ICA) courses medially to the external carotid artery. Due to the sparse descriptions in the literature, we, here, report our experience with cases of carotid endarterectomy (CEA) for twisted carotid artery and its clinical features.
Methods: Fifty-seven consecutive CEA-treated patients were evaluated, and the twist angle was measured on the source images of axial slices of computed tomography angiography (CTA).
Results: Eight male patients (14.2%) demonstrated a twisted right ICA (mean age, 77.0 ± 2.6 years; and mean stenosis, 66.9% ± 19.9%). The mean twist angle was 30.1° ± 17.9°, while the normal ICA is angled at -23.0° ± 12.3°. No statistical differences in the distribution of coexisting diseases were found between the normal and twisted ICA cases. CEA was successfully performed with the correction of the carotid position in all cases; however, significant position correction was not observed in the postoperative evaluation. Right-side dominancy (P = 0.045) and prolonged clamping time (P = 0.053) were observed in the twisted cases.
Conclusion: Twisted ICA was preferentially found in the right ICA and men. CEA of the twisted ICA was safely performed with appropriate head rotation and wider longitudinal skin incision than usual without a significant increase in the operative time. CTA is useful for preoperative evaluation. This specific variation should be considered by the neurosurgeon involved in the evaluation and treatment of carotid stenoses.
Keywords: Carotid endarterectomy; Clinical feature; Surgical feature; Twisted internal carotid artery.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 20;11:154. doi: 10.25259/SNI_576_2019. eCollection 2020.
Effect of Intravenous Lignocaine Infusion on the Quality of Emergence in Patients Undergoing Transsphenoidal Resection of Pituitary Tumors - A Prospective, Randomized Controlled Trial
Deepika Jain 1, Hemant Bhagat 1, Divya Jain 1
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PMID: 32637207 PMCID: PMC7332512 DOI: 10.25259/SNI_576_2019
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Abstract
Background: Emergence from anesthesia is a critical step in patients undergoing transsphenoidal pituitary surgery (TSS). The cough suppressant and anesthetic sparing properties of lignocaine makes it a favorable option for smooth extubation and maintaining stable hemodynamics intraoperatively. We aimed to evaluate the effect of lignocaine infusion on the quality of emergence (QOE) and intraoperative hemodynamics in patients undergoing transsphenoidal resection of pituitary tumors.
Methods: Fifty patients scheduled to undergo TSS were randomly divided into ligocaine group (n = 25), receiving 1.5 mg/kg bolus dose of lignocaine followed by continuous infusion of 1.5 mg/kg/h and saline group (n = 25). Patients assigned to the control group received equal volume of saline receiving equal volume of saline. The four emergence parameters (mean arterial pressure [MAP], heart rate (HR), cough, and agitation) were abbreviated into an aggregated score for QOE. Time to emergence and intraoperative hemodynamics were also recorded.
Results: The QOE was not found to be different between the two groups (P = 0.294). Lignocaine did not increase the time to emergence (P = 0.166). The intraoperative HR and MAP were comparable between the two groups. A lower minimum alveolar concentration of desflurane was required in lignocaine group during insertion of nasal speculum (P = 0.018) and at the time of seller ridge dissection (P = 0.043) compared to the saline group.
Conclusion: Intraoperative lignocaine infusion of 1.5 mg/kg/h did not significantly improve the QOE with respect to hemodynamics, cough, and emergence agitation in patients undergoing transsphenoidal resection of pituitary tumors.
Keywords: Lignocaine infusion; Quality of emergence; Transsphenoidal pituitary surgery.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 13;11:146. doi: 10.25259/SNI_565_2019. eCollection 2020.
Anterior Temporal Approach for Clipping of Ruptured Basilar Tip Aneurysms: Surgical Techniques and Treatment Outcomes
Somkiat Wongsuriyanan 1, Kitiporn Sriamornrattanakul 1
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PMID: 32637199 PMCID: PMC7332467 DOI: 10.25259/SNI_565_2019
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Abstract
Background: Basilar tip (BT) aneurysms are challenging to treat with microsurgical clipping, especially in subarachnoid hemorrhage cases. The anterior temporal approach is one of the surgical approaches for the treatment of aneurysms in this area. The majority of the previous reports on this approach have described unruptured cases. For the ruptured cases assessed in our study, the authors describe the surgical technique, patient characteristics, and surgical outcomes following the use of this technique.
Methods: Fourteen patients with ruptured BT aneurysms who received aneurysm clipping with an anterior temporal approach between December 2015 and August 2019 were retrospectively evaluated. The surgical techniques are described, an illustrative case is shown.
Results: The average patient age was 62.2 years (range: 46-78) for ten women and four men. Nine patients (64.3%) were classified as having a poor grade (World Federation of Neurosurgical Societies Grades 4 and 5) at the first presentation. All of the cases demonstrated complete aneurysm obliteration. Good outcomes (mRS 0 to 2) at 6 months were achieved in 58.3% of the patients and in 77.8% of the patients who had a good Glasgow Coma Score after resuscitation before surgery. Postoperative transient oculomotor nerve palsy and thalamic infarctions were detected in six patients (42.9%) and two patients (14.3%), respectively.
Conclusion: With appropriate case selection, the anterior temporal approach was effective and safe for the clipping of ruptured BT aneurysms.
Keywords: Anterior temporal approach; Basilar bifurcation aneurysm; Basilar tip aneurysm; Ruptured aneurysm.
Copyright: © 2020 Surgical Neurology International.
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There are no conflicts of interest. How to cite this article: Wongsuriyanan S, Sriamornrattanakul K. Anterior temporal approach for clipping of ruptured basilar tip aneurysms: Surgical techniques and treatment outcomes. Surg Neurol Int 2020;11:146.
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Case Reports Surg Neurol Int
. 2020 Jun 20;11:158. doi: 10.25259/SNI_204_2020. eCollection 2020.
Management of a Large Intraorbital Wooden Foreign Body: Case Report
John Nute Jabang 1, Lamin Dampha 1, Binta Sanyang 1, Charles Adeyemi Roberts 2, Bakary Ceesay 3
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PMID: 32637211 PMCID: PMC7332514 DOI: 10.25259/SNI_204_2020
Free PMC article
Abstract
Background: Intraorbital foreign bodies are a global injury and occur with a frequency of one in six orbital injuries; however, intraorbital wooden foreign bodies are uncommon. Intraorbital wooden foreign bodies predominantly affect the male population with a mean age ranging from 21 to 22 years. The diagnosis of intraorbital wooden foreign bodies depending on their size can be challenging on imaging and if not removed early the risk of infection is high.
Case description: A 23-year-old motorcyclist presented to the ER following a collision with a donkey cart carrying wood 3 h before presentation. Examination revealed an acutely ill-looking man in painful distress with a right supraorbital laceration associated with ipsilateral ptosis and periorbital edema. There was a retained intraorbital wooden foreign body. Computed tomography scan showed evidence of both an intraorbital bone fragment and a wooden foreign body. Surgery was done 3rd day of admission before which vision has declined with only perception to light. Only the wooden foreign body was removed. Evolution was favorable with recovery of vision and improvement of the ptosis.
Conclusion: The management of intraorbital wooden foreign bodies demands a multidisciplinary approach after a thorough history, examination, and imaging. Treatment of choice is timely and meticulous removal of the foreign body to avoid infection and other associated complications.
Keywords: Computer tomography scan; Intraorbital wooden foreign body; Magnetic resonance imaging; Orbital cellulitis; Orbital trauma; Visual acuity.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 13;11:153. doi: 10.25259/SNI_243_2020. eCollection 2020.
Unique Bone Suture Anchor Repair of Complex Lumbar Cerebrospinal Fluid Fistulas
Marc Agulnick 1, Benjamin R Cohen 2, Nancy E Epstein 2 3
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PMID: 32637206 PMCID: PMC7332496 DOI: 10.25259/SNI_243_2020
Free PMC article
Abstract
Background: Spine surgeons encounter occasional complex cerebrospinal fluid fistulas/dural tears (CSF/DT) during lumbar spinal surgery. In some cases, these leaks are found during the index procedure, but others may appear postoperatively, or in the course of successive procedures. Here we asked, whether these complex CSF fistulas/DT could be more readily repaired utilizing a "bone suture anchor" technique, particularly where there is no residual dural margin/remnant.
Methods: With the combined expertise of the orthopedist and neurosurgeon, mini/micro bone suture anchors, largely developed for hand surgery, facilitated repair of complex DT occurring during lumbar spine surgery. This technique was utilized to suture in place fascia, periosteal, or muscle grafts, and was followed by the application of microfibrillar collagen, and a fibrin sealant.
Results: This mini/micro suture anchor technique has now been utilized to repair multiple significant intraoperative and/or postoperative recurrent DT, largely avoiding the need to place lumbar drains and/or lumbo- peritoneal shunts.
Conclusions: Here, we reviewed how to directly suture dural grafts utilizing a mini/micro bone suture anchor technique to repair complex intraoperative primary/recurrent DT occurring during lumbar spine surgery. The major advantages of this technique, in addition to obtaining definitive occlusion of the DT, largely avoids the need to place lumbar drains and/or lumbo-peritoneal shunts with their attendant risks and complications.
Keywords: Complex Repair; Dural Leak; Lumbar; Massive; Patch Grafts; Suture Anchors.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 27;11:163. doi: 10.25259/SNI_42_2020. eCollection 2020.
Dynamic Assessment of Internal Carotid Artery and Elongated Styloid Process in a Case of Bilateral Carotid Artery Dissection
Yoshinobu Horio 1, Kenji Fukuda 1, Koichi Miki 1, Noriko Hirao 1, Mitsutoshi Iwaasa 1, Hiroshi Abe 1, Tooru Inoue 1
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PMID: 32637216 PMCID: PMC7332696 DOI: 10.25259/SNI_42_2020
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Abstract
Background: Vascular Eagle syndrome is that an elongated styloid process causes ischemic stroke due to internal carotid artery (ICA) dissection. Dynamic assessment using radiological imaging has not been well investigated. We assessed the change in the relative positional relationship between the elongated styloid process and the ICA using a cone-beam computed tomography (CBCT).
Case description: A 46-year-old female presenting with disturbance of consciousness, right hemiparesis, and aphasia was admitted to our hospital. Initial CT analysis showed a bilateral elongated styloid process. Magnetic resonance angiography (MRA) showed occlusion of the left ICA and a near occlusion of the right ICA. MRA also revealed the intimal flap and intramural hematoma in the bilateral ICA. Digital subtraction angiography showed bilateral ICA occlusion and carotid artery stenting was performed subsequently. After that, we visualized the movement of carotid stent with CBCT fusion methods. The stent moved forward and backward at the attachment point of the styloid process during head rotation, and there was a possibility that mechanical stress was emphasized at this point. Styloidectomy was performed after her rehabilitation. The patient did not experience a recurrence of stroke.
Conclusion: We showed that repeated attachment of the styloid process and ICA may trigger an ICA dissection during head rotation. This finding would be helpful for understanding the causes of vascular Eagle syndrome.
Keywords: Cone-beam computed tomography; Dissection; Eagle syndrome.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 13;11:151. doi: 10.25259/SNI_224_2020. eCollection 2020.
Isolated Neuroparacoccidioidomycosis as a Pseudotumoral Lesion in the Absence of Systemic Disease
Ricardo Salemi Riechelmann 1, Leonardo Henrique Rodrigues 1, Tiago Marques Avelar 1, Paulo Adolfo Xander 1, Guilherme Henrique da Costa 1, Luiz Fernando Cannoni 1, Guilherme Brasileiro de Aguiar 1, Jose Carlos Veiga 1
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PMID: 32637204 PMCID: PMC7332495 DOI: 10.25259/SNI_224_2020
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Abstract
Background: Paracoccidioidomycosis (PCM) is a systemic, progressive, noncontagious, and often chronic disease caused by the fungus Paracoccidioides brasiliensis that rarely affects the central nervous system (CNS). The condition is usually treated using antifungal drugs, and some cases may require surgery.
Case description: A 55-year-old man, a smoker, without known comorbidities, was referred to the neurosurgery team with a history of a single epileptic seizure a week before hospital admission followed by progressive right- sided hemiparesis. Head computed tomography and brain magnetic resonance imaging showed an intra-axial expansive lesion affecting the left parietal lobe, associated with extensive edema and a regional compressive effect producing slight subfalcine herniation that was initially managed as an abscess. After the failure of antibiotic treatment, the patient underwent a neurosurgical procedure for excision of the lesion. Histopathological analysis revealed that it was PCM and there was no evidence of impairment of other systems due to the disease.
Conclusion: PCM can be a serious, debilitating disease and is potentially fatal. Although isolated CNS involvement is rare, it must be considered, especially in endemic areas, as late diagnosis and treatment severely decreases good outcome rates.
Keywords: Central nervous system infections; Neurosurgical procedures; Paracoccidioidomycosis.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 27;11:170. doi: 10.25259/SNI_239_2020. eCollection 2020.
Optimum Concentration of Iodine Contrast Agent Injection for Best Stent Visualization Using Neuroform Atlas Stent During Stent-Assisted Coil Embolization: Case Reviews Based on in vitro Experiments
Shuta Aketa 1, Daisuke Wajima 1, Masayoshi Kiyomoto 1, Natsuhiko Izumi 1, Taiji Yonezawa 1
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PMID: 32637223 PMCID: PMC7332700 DOI: 10.25259/SNI_239_2020
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Abstract
Background: The present study aimed to evaluate the influence of contrast agent concentration (Conc) on the visibility of Neuroform Atlas in vitro and in clinical cases.
Methods: A plastic tube was filled with several Conc. in saline (experiment 1) and blood (experiment 2). Thereafter, the Neuroform Atlas was placed around the plastic tube in an acrylic shield case. In experiment 3, the Neuroform Atlas was placed in the internal carotid artery of the endo vascular evaluator endovascular training system with an injection of several Conc in saline. Five slices of the axial images obtained using the 3D-cone-beam computed tomography (3D-CBCT) with the digital subtraction angiography system were evaluated. A 1-cm2 circular center, which showed the contrast agent in saline or blood, was determined as the region of interest, and its pixels were evaluated.
Results: Radiation density (Rd) was directly proportional to the contrast agent in saline and blood (experiment 1: (Rd (pixel)) = 6.8495 × (concentration (%)) + 152.72 (R2 = 0.99), experiment 2: (Rd (pixel)) = 6.2485 × (concentration (%)) + 167.42 (R2 = 0.9966), experiment 3: (Rd (pixel)) = 10.287 × (concentration (%)) + 108.26 (R2 = 0.993)]. Rd calculated similarly in our cases (concentration varied from 5% to 8%) was between the range of "Rd of experiment 2" and "Rd of experiment 3."
Conclusion: Based on our in vitro experiments, with 5-8% concentration, Neuroform Atlas stent deployment with complete neck coverage by the bulging stent and wall apposition was visualized on 3D-CBCT.
Keywords: Coil embolization; Iodine contrast; Neuroform Atlas stent; Optimum; Stent visualization.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 20;11:161. doi: 10.25259/SNI_508_2019. eCollection 2020.
Intracerebral Steal Phenomenon Induced Focal Reversible Vasogenic Edema and Decrease in Cerebral Blood Flow After Carotid Endarterectomy
Yu Shimizu 1, Katsuhiro Tsuchiya 1, Norihiro Fujisawa 1
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PMID: 32637214 PMCID: PMC7332508 DOI: 10.25259/SNI_508_2019
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Abstract
Background: Intracerebral steal phenomenon (ISP) is a rare complication following surgical treatment of carotid stenosis. However, the factors responsible remain unknown. We described the rear case of the ISP who had vasogenic edema and cerebral blood flow (CBF) decline and presented with hemiparesis after carotid endarterectomy (CEA).
Case description: A 72-year-old male with stenosis of the bilateral carotid artery (NASCET right 90% and left 70%) presented with cerebral hypoperfusion manifesting as right hemiparesis, after left CEA. Fluid-attenuated inversion recovery images showed edema of the motor area around an old infarction and a decrease in CBF. This lesion was an area of vasogenic edema caused by ISP and focal cerebral hypoperfusion. CBF of the contralateral cerebral hemispheres had increased. The treatment with an intravenous infusion of a free radical scavenger and glycerol improved the patient's symptoms and brain edema. Magnetic resonance imaging showed a gradual decline in the brain edema, which completely disappeared 2 weeks after CEA. He was discharged with no neurological deficit.
Conclusion: In this report, we described the case of a patient with ISP who had vasogenic edema induced by CBF decline and presented with hemiparesis following CEA. This is the first report of progressing focal vasogenic edema caused by ISP after endarterectomy.
Keywords: Cerebral blood flow; Endarterectomy; Intracerebral steal phenomenon; Single-photon emission computed tomography; Vasogenic edema.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 20;11:155. doi: 10.25259/SNI_584_2019. eCollection 2020.
Atypical Sellar Cyst: A Rare Case
Nimrah Ali 1, Areesha Shakeel 2, Yousuf Shaikh 3, Salman Sharif 4, Atif Hashmi 5
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PMID: 32637208 PMCID: PMC7332488 DOI: 10.25259/SNI_584_2019
Free PMC article
Abstract
Background: Sellar cysts are common in neurosurgery. Around 90% of these are diagnosed as pituitary adenomas. The other 10% are nonadenomatous, inflammatory, infective, metastatic, or cystic in nature. Some rare cysts include dermoid, epidermoid, colloid, and arachnoid. They all have different histological features. The case we present demonstrates a unique cyst with features that are not previously documented.
Case description: A 60-year-old female presented to the neurosurgical department complaining of blurring of vision and severe headache for more than ½ year. Imaging was done which revealed a bony erosive lesion in the region of sella. Magnetic resonance imaging with contrast showed high signals with no contrast enhancement. A clear diagnosis could not be made based on radiology. Surgery was done and sample was sent for histopathology. Based on histopathological report findings, a diagnosis of benign atypical sellar cyst was made. Post procedure, the patient recovered and was discharged.
Conclusion: Sellar cysts present similarly. They are differentiated based on their histological features. The sellar cyst we encountered had features different from the ones already described in the literature.
Keywords: Benign epithelial cyst; Endoscopy; Sellar cyst.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 27;11:169. doi: 10.25259/SNI_199_2020. eCollection 2020.
Comparative Metrics of Neurosurgical Scientific Journals: What Do They Mean to Readers?
James I Ausman 1 2, Nancy Epstein 3, James L West 1
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PMID: 32637222 PMCID: PMC7332697 DOI: 10.25259/SNI_199_2020
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Abstract
Background: In regard to scientific information, are we effectively reaching the universe of physicians in the 21st century, all of whom have different backgrounds, practice environments, educational experiences, and varying degrees of research knowledge?
Methods: A comparison of the top nine neurosurgery journals based on various popular citation indices and also on the digital metric, Readers (Users)/month, was compiled from available metrics and from internet sources.
Results: Major differences in the ranking of the Readers (Users)/month metrics compared to ranking of the various citation indices were found. It is obvious that the citation indices do not measure the number of readers of a publication. Which metric should be used in judging the value of a scientific paper? The answer to that question relates to what the interest of the reader has in the scientific information. It appears that the academic scientist may have a different reason for reading a scientific publication than a physician caring for a patient.
Conclusions: There needs to be more than one type of metric that measures the value and "Impact" of a scientific paper based on how physicians learn.
Keywords: Citation indices; Comparison publication metrics; How do physicians learn? Readers (Users) month.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 20;11:159. doi: 10.25259/SNI_287_2020. eCollection 2020.
Isolated Painless Scoliosis in Lumbar Disc Herniation
Ali Akhaddar 1, Hafid Arabi 2
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PMID: 32637212 PMCID: PMC7332515 DOI: 10.25259/SNI_287_2020
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Surg Neurol Int
. 2020 May 9;11:103. doi: 10.25259/SNI_143_2020. eCollection 2020.
Neurosurgery in Iraq at the Time of Corona
Samer S Hoz 1, Zahraa F Al-Sharshahi 1, Saja A Albanaa 2
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PMID: 32574275 PMCID: PMC7265420 DOI: 10.25259/SNI_143_2020
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Case Reports Surg Neurol Int
. 2020 Jun 20;11:156. doi: 10.25259/SNI_66_2020. eCollection 2020.
Risk of Fatal Sinus Arrest Induced by Low-Grade Subarachnoid Hemorrhage: A Case of a Young Patient With Obstructive Sleep Apnea
Naoki Wakuta 1, Satoshi Yamamoto 2
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PMID: 32637209 PMCID: PMC7332489 DOI: 10.25259/SNI_66_2020
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Abstract
Background: Sleep apnea syndrome (SAS) and subarachnoid hemorrhage (SAH) are both considered possible causes of secondary arrhythmias. However, there are limited reports on the increased risk of bradyarrhythmia for arrhythmia-free SAS patients with SAH.
Case description: A 31-year-old woman with SAS developed low-grade SAH and underwent coil embolization on postbleed day 1. Following a coiling procedure, she experienced worsening episodes of sinus arrest lasting up to 12 s and required a temporary pacemaker. Frequent episodes of sinus arrest were detected for the next 4 days. Thereafter, all types of arrhythmias gradually decreased, and she eventually recovered to be arrhythmia free.
Conclusion: Acceleration of sympathetic nervous activity caused by acute SAH may predispose patients to bradyarrhythmia with SAS and elicit asystole. The coexistence of SAS and SAH should be recognized as a cause of life-threatening sinus arrest, even if the severity of SAH is low grade.
Keywords: Endovascular surgery; Sinus arrest; Sleep apnea syndrome; Subarachnoid hemorrhage.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 20;11:157. doi: 10.25259/SNI_161_2020. eCollection 2020.
A Spontaneous Cervical Epidural Hematoma Mimicking a Stroke - A Case Report
Pedro Teles 1, Joaquim Pedro Correia 1, Lia Pappamikail 1, Artur Lourenço 1, Clara Romero 1, Fátima Lopes 1, Gonçalo Neto Almeida 1, Pedro Abreu 1
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PMID: 32637210 PMCID: PMC7332487 DOI: 10.25259/SNI_161_2020
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Abstract
Background: A spontaneous cervical epidural hematoma (SCEH) is a rare occurrence. It usually presents with quadriparesis, but it may present with hemiparesis or hemiplegia and can easily be misdiagnosed as stroke. We present a case of stroke mimicking SCEH with hemiparesis worsened after tissue plasminogen activator therapy (tPA) followed by emergency cervical decompression laminectomy.
Case description: A 63-year-old female presented to the emergency department with sudden onset of posterior neck and left shoulder pain with the right side hemiparesis. On neurological examination, the patient had motor power of the right upper and lower limb of 2/5 Medical Research Council, and her whole left extremities were intact. Her medical history was unremarkable for trauma, hemorrhagic diathesis, or anticoagulation therapy. A head computed tomography was ordered ruling out intracranial hemorrhage. Assuming an acute ischemic stroke as the most likely diagnosis, alteplase (tPA) was administered 3 h after symptoms onset, however without any improvement in patient symptoms. A cervical magnetic resonance was performed revealing a right paramedian epidural mass-like lesion between C3-C6. The patient underwent cervical laminectomy C3-C6 with evacuation of epidural hematoma with significant clinical status improvement after surgery.
Conclusion: tPA treatment is frequently used as first-line therapy for acute ischemic stroke. Therefore, physicians should be aware of the potential for the SCEH in patients presenting with hemiparesis, as tPA administration may increase cervical hematoma leading to clinical deterioration. With this case, we intended to warn about SCEH as a rare but possible entity, since its early recognition and prompt clinical intervention may improve neurological outcomes.
Keywords: Cervical epidural hematoma; Stroke; Thrombolysis.
Copyright: © 2020 Surgical Neurology International.
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21
Case Reports Surg Neurol Int
. 2020 Jun 27;11:165. doi: 10.25259/SNI_97_2020. eCollection 2020.
A Sellar Neuroblastoma Showing Rapid Growth and Causing Syndrome of Inappropriate Secretion of Antidiuretic Hormone: A Case Report
Muhammad Kamil 1, Nayuta Higa 1, Hajime Yonezawa 1, Shingo Fujio 1, Jun Sugata 1, Tomoko Takajo 1, Tsubasa Hiraki 2, Junko Hirato 3, Kazunori Arita 1, Koji Yoshimoto 1
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PMID: 32637218 PMCID: PMC7332709 DOI: 10.25259/SNI_97_2020
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Abstract
Background: Sellar neuroblastoma is a very rare entity. We report a rare case of arginine vasopressin (AVP)- producing sellar neuroblastoma presumed to have originated from the lower part of sellar turcica, which grew very rapidly.
Case description: A 33-year-old woman was found to have a sellar lesion with a diameter of 18 mm invading into the bilateral cavernous sinus on magnetic resonance imaging (MRI) performed for dizziness. Six years later, when she visited the clinic due to bilateral visual disturbance, MRI showed a rapid growth of the tumor, with a maximal diameter of 56 mm at the current state, strongly compressing the optic nerve and chiasm. Transsphenoidal decompression of the optic chiasm revealed an intact pituitary gland on the top of the tumor. The tumor was composed of neoplastic cells that were immunohistochemically positive for neuronal markers and arginine vasopressin (AVP), but negative for all anterior pituitary hormones, glial fibrillary acidic protein, or thyroid transcription factor-1; these findings were suggestive of sellar neuroblastoma. She underwent 50-Gy radiation therapy, which has controlled the growth for the past 3 years.
Conclusion: Awareness of rare sellar neuroblastomas will allow the accumulation of clinicopathologic information that may facilitate the understanding of their origin, clinical features, neuroimaging characteristics, and pertinent adjuvant treatment.
Keywords: Neuroblastoma; Rapid growth; Sellar; Syndrome of inappropriate antidiuretic hormone secretion.
Copyright: © 2020 Surgical Neurology International.
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20 references6 figures
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22
Surg Neurol Int
. 2020 Jun 20;11:162. doi: 10.25259/SNI_284_2019. eCollection 2020.
Technical Note: In Mexico, the Majority of 147 Traumatic Spinal Cord Injuries Occurred in the Thoracic Spine for Young Males
César Adán Almendárez-Sánchez 1, Thalía Sotelo-Popoca 2, Abrahan Alfonso Tafur-Grandett 1, Raúl Huato-Reyes 1
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PMID: 32637215 PMCID: PMC7332513 DOI: 10.25259/SNI_284_2019
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Abstract
Background: Traumatic spinal cord injury (TSCI) is a devastating problem typically associated with multi-organ disorders. Studies regarding TSCI and their attendant comorbidities are scarce from developing countries.
Methods: The electronic files of 147 patients with TSCI (2017-2018) were reviewed; 78% of patients were males averaging 38 years of age. The following variables associated with the TSCI included age, sex, etiology of trauma, vertebral level, fracture classification, Frankel grade, treatment, complications, and mortality.
Results: Of interest, most cases involved thoracic injuries with attendant chest trauma resulting from falls from substantial heights.
Conclusion: In Mexico, the majority of TSCI occur in young males (average age 38) who have sustained falls from significant heights resulting in thoracic fractures with a high frequency of chest injuries. By providing such information for developing countries, we may develop future strategies to TSCI in vulnerable populations.
Keywords: Epidemiology; Incidence; México; Spinal cord injury; Traumatic.
Copyright: © 2020 Surgical Neurology International.
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23
Case Reports Surg Neurol Int
. 2020 Jun 13;11:149. doi: 10.25259/SNI_105_2020. eCollection 2020.
Report of Intradural Aneurysm in the Cavernous Segment of the Internal Carotid Artery Presented With Subarachnoid Hemorrhage and Oculomotor Palsy
Charles Alfred Pedrozo 1, Guilherme Brasileiro de Aguiar 1, Jose Carlos Esteves Veiga 1
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PMID: 32637202 PMCID: PMC7332490 DOI: 10.25259/SNI_105_2020
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Abstract
Background: Aneurysms of the cavernous segment of the internal carotid artery (ICA) do not usually cause subarachnoid hemorrhage (SAH). We report a patient who presented with this condition due to a ruptured aneurysm located on the posterior genu of the cavernous segment, raising the question of what factors could have led to such evolution.
Case description: A 55-year-old male patient presented with sudden, intense thunderstorm headache, associated with complete palsy of the left oculomotor nerve and neck stiffness. Cranial computed tomography (CT) showed no SAH, but showed an expansive process in the sella turcica, consistent with a pituitary macroadenoma. After that, SAH was confirmed by lumbar puncture (Fisher I). Cranial angio-CT revealed an intradural saccular aneurysm in the cavernous segment of the left ICA. The patient underwent cranial microsurgery for cerebral aneurysm clipping. Unlike the normal anatomic pattern, the cavernous segment of the carotid artery in this patient was located in the intradural compartment.
Conclusion: Intradural rupture of proximal cavernous segment carotid aneurysms is rare. We review the literate for such cases and discuss the possible causes.
Keywords: Aneurysms; Ophthalmoparesis; Pituitary adenoma; Subarachnoid hemorrhage.
Copyright: © 2020 Surgical Neurology International.
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12 references6 figures
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24
Surg Neurol Int
. 2020 May 23;11:125. doi: 10.25259/SNI_250_2020. eCollection 2020.
A Canadian Perspective on Coronavirus disease-19 and Neurosurgical Residency Training
Erika D Leck 1, Mark A MacLean 1, Jacob Alant 1
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PMID: 32574276 PMCID: PMC7265415 DOI: 10.25259/SNI_250_2020
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25
Case Reports Surg Neurol Int
. 2020 Jun 13;11:152. doi: 10.25259/SNI_259_2020. eCollection 2020.
Intramedullary Craniovertebral Junction Metastasis Leading to the Diagnosis of Underlying Renal Cell Carcinoma
Giancarlo Ponzo 1, Giuseppe Emmanuele Umana 2, Massimiliano Giuffrida 1, Massimo Furnari 1, Giovanni Federico Nicoletti 1, Gianluca Scalia 1
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PMID: 32637205 PMCID: PMC7332509 DOI: 10.25259/SNI_259_2020
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Abstract
Background: Intramedullary spinal cord metastases represent 4-8.5% of the central nervous system metastases and affect only 0.1-0.4% of all patients. Those originating from renal cell carcinoma (RCC) are extremely rare. Of the eight patients described in the literature with metastatic RCC and intramedullary cord lesion, only five were found in the cervical spine. Here, the authors add a 6th case involving an RCC intramedullary metastasis at the C1-C2 level.
Case description: A 78-year-old male patient presented with intermittent cervicalgia of 5 months duration accompanied by few weeks of a progressive severe right hemiparesis, up to hemiplegia. The magnetic resonance imaging (MRI) examination revealed an intramedullary expansive lesion measuring 10 mm×15 mm at the C1-C2 level; it readily enhanced with contrast. A total body computed tomography (CT) scan documented an 85 mm mass involving the right kidney, extending to the ipsilateral adrenal gland, and posteriorly infiltrating the ipsilateral psoas muscle. The subsequent CT-guided fine-needle biopsy confirmed the diagnosis of an RCC (Stage IV). The patient next underwent total surgical total removal of the C1-C2 intramedullary mass, following which he exhibited a slight motor improvement, with the right hemiparesis (2/5). He died after 14 months due to global RCC tumor progression.
Conclusion: The present case highlights that a patient without a prior known diagnosis of RCC may present with an intramedullary C1-C2 metastasis. In such cases, global staging is critical to determine whether primary lesion resection versus excision of metastases (e.g., in this case, the C1-C2 intramedullary tumor) are warranted.
Keywords: Craniovertebral junction; Intramedullary; Metastasis; Myelotomy; Renal cell carcinoma.
Copyright: © 2020 Surgical Neurology International.
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26
Case Reports Surg Neurol Int
. 2020 Jun 27;11:166. doi: 10.25259/SNI_170_2020. eCollection 2020.
Primary Myxoid Temporal Bone Tumor: A Rare Neurosurgical Manifestation of Carney Complex?
Tobechi Nwankwo Mbadugha 1, Kohei Kanaya 2, Tetsuyoshi Horiuchi 2, Mai Iwaya 3, Samuel Chukwunonyerem Ohaegbulam 1, Kazuhiro Hongo 2
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PMID: 32637219 PMCID: PMC7332703 DOI: 10.25259/SNI_170_2020
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Abstract
Background: Carney complex (CNC) is a rare autosomal dominant syndrome, manifesting mainly with cardiac, cutaneous, and mucosal myxomas. Osteochondromyxoma is known as an extremely rare bone lesion of CNC which usually appears early in life; however, there were no reports of primary bone myxoma of the skull in the patients with CNC. We present the first case of primary myxoid skull tumor in the patient with CNC.
Case description: We report the left temporal bone tumor with significant intracranial mass effect in a 58-year- old woman already diagnosed with CNC. Complete resection of the tumor with skull bone reconstruction was carried out. Pathological diagnosis was labeled the lesion as an atypical myxoid spindle cell neoplasm. The features were different from atrial myxoma and osteochondromyxoma which has been described in CNC. There have been no signs of recurrence in 9 years follow-up.
Conclusion: To the best of our knowledge, there have been no reports of the primary myxoid tumors in the skull in the patients with CNC. This paper highlighted a possible important association between CNC and primary intracranial myxoid tumors.
Keywords: Carney complex; Myxoid tumor; Skull.
Copyright: © 2020 Surgical Neurology International.
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27
Case Reports Surg Neurol Int
. 2020 Jun 27;11:168. doi: 10.25259/SNI_257_2020. eCollection 2020.
Symptomatic Cerebral Vasospasm in the Setting of Carmustine Wafer Placement for Glioblastoma: A Case Presentation and Review of Literature
Maheen Qamar Khan 1, Cristian Cirjan 1, Nabiha Quadri 1, Georgios Alexopoulos 1, Jeroen Coppens 1
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PMID: 32637221 PMCID: PMC7332710 DOI: 10.25259/SNI_257_2020
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Abstract
Background: Gliadel placement in glioblastoma resection, particularly with concurrent chemoradiation, has demonstrated an improvement in survival. There have been several reported adverse effects, some of which lend to significantly increased morbidity and mortality. With only two other cases described in literature, cerebral vasospasm secondary to carmustine-impregnated wafers is an extremely rare side effect.
Case description: We report the case of a 51-year-old female who presented with the left lower limb paresis 8 days after high-grade glioma resection provoked by carmustine wafer placement.
Conclusion: We urge surgeons to reconsider placement of carmustine wafers in nations where the surgical resection cavity includes exposed large cerebral vasculature. We also propose the early identification of this devastating complication in the postoperative period by maintaining a high clinical suspicion and prompt utilization of computed tomography and digital subtraction angiography in the management and treatment of these patients accordingly.
Keywords: Carmustine wafer; Cerebral vasospasm; Glial tumor; Glioma; Tumor resection.
Copyright: © 2020 Surgical Neurology International.
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35 references3 figures
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28
Case Reports Surg Neurol Int
. 2020 Jun 27;11:164. doi: 10.25259/SNI_47_2020. eCollection 2020.
Paramedian Thalamic Infarction Caused by Cisternal Drain Placement in Open Clipping for Aneurysmal Subarachnoid Hemorrhage: Two Case Reports
Sho Tsunoda 1, Tomohiro Inoue 1, Hideaki Ono 2, Kazuaki Naemura 1, Atsuya Akabane 1
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PMID: 32637217 PMCID: PMC7332699 DOI: 10.25259/SNI_47_2020
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Abstract
Background: Some complications associated with cisternal drainage have been reported; however, there are few reports on direct vascular injury caused by cisternal drain. We experienced two rare cases of thalamic infarction caused by cisternal drain placement during open clipping for a ruptured anterior communicating artery (AcomA) aneurysm through an anterior interhemispheric approach.
Case description: Two cases of ruptured AcomA aneurysm were treated by surgical clipping through an anterior interhemispheric approach, and then a cisternal drain was inserted from opticocarotid space toward prepontine cistern. Postoperatively, the magnetic resonance imaging showed unilateral anterior-medial thalamic infarction in both two cases. By reviewing the postoperative computed tomography and digital subtraction angiography, it was suspected that the cisternal drain, which was inserted slightly deep, obstructed the P1 perforator because of an anatomical variation involving a lowered basilar bifurcation and caused postoperative unilateral paramedian thalamic infarction.
Conclusion: To avoid these complications, neurosurgeons should consider the potential for P1 perforator injury related to cisternal drain placement.
Keywords: Cisternal drainage; Complication; Subarachnoid hemorrhage; Thalamic infarction.
Copyright: © 2020 Surgical Neurology International.
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18 references7 figures
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29
Case Reports Surg Neurol Int
. 2020 Jun 13;11:150. doi: 10.25259/SNI_189_2020. eCollection 2020.
A Case of Dual Three-Column Thoracic Spinal Fractures Following Traumatic Injury
Taylor Waitt 1, Vamsi Reddy 1, Dayton Grogan 1, Pearce Lane 2, Joseph Kilianski 1, John DeVine 2, Alexander Post 1
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PMID: 32637203 PMCID: PMC7332507 DOI: 10.25259/SNI_189_2020
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Abstract
Background: Thoracic spine fracture-dislocations due to motor vehicle accidents (MVAs) rarely involve double- level, noncontiguous lesions.
Case description: A 19-year-old male following an MVA was paraplegic; he exhibited full motor/sensory loss below the T4 level (i.e., ASIA scale Grade A). The chest X-ray, magnetic resonance, and computed tomography studies confirmed T3-T5 and T11-12 fractures, warranting T3-L3 thoracolumbar decompression and fusion. Despite surgical intervention, the patient's neurological status remained unchanged.
Conclusion: This case illustrates the rare presentation of noncontiguous, posttraumatic thoracic spinal lesions requiring simultaneous decompression/fixation.
Keywords: Noncontiguous spinal injury; Spondyloptosis; Thoracic spinal injury; Trauma.
Copyright: © 2020 Surgical Neurology International.
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