Journal of Neurological Surgery. Part A, Central European Neurosurgery

BACKGROUND: Surgical approaches to the anterior cranial fossa have great risk of damaging the olfactory tract and bulb. The goal of this study was to describe the outer arachnoid envelope around the olfactory bulb which plays significant role in the approach-related injury of the nerve. MATERIAL AND METHODS: A total of 20 fresh human cadaveric heads were examined as a following: 5 cadaveric heads were used to describe a gross overview of the topographic anatomy of the outer arachnoid cover of the olfactory bulb...

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BACKGROUND:  Insular gliomas (INGs) remain a surgically intimidating glioma subgroup encased by eloquent cortical parcels and white matter language tracts, and traversed by multiple middle cerebral artery branches. The predictive power of prognostic factors affecting overall survival (OS), progression-free survival (PFS), and resectability of INGs remain disputed. This comprehensive systematic review analyses prognostic factors and resectability predictors of INGs substantiating pragmatic management options...

BACKGROUND:  Postoperative intracranial hypotension-associated venous congestion (PIHV) is a rare event. The authors report the case of a patient presenting with PIHV after spinal surgery following the sudden loss of cerebrospinal fluid (CSF) induced by suction drainage. METHODS:  A 69-year-old patient underwent uneventful revision surgery for wound dehiscence after lumbar surgery with placement of a subfascial suction drain. RESULTS:  Postoperatively, the patient presented with fluctuating consciousness and a generalized tonic-clonic seizure...

Bilateral thalamic stroke is usually due to compromised artery of Percheron, an anatomical variation of the vascular supply of the thalamus. The stroke in this area is very uncommon, and is mainly due to top of the basilar syndrome. Other causes are extremely rare. We describe the case of a patient with a pituitary adenoma who underwent surgery and later presented with a bilateral thalamic infarct, suggesting compromise of the artery of Percheron. This would be the third case published in the literature about this complication...

BACKGROUND:  Chiari malformations, usually congenital, can rarely be associated with arteriovenous (AV) fistulas. We present the first case involving a type IV dural AV fistula with a Chiari type I malformation. METHODS:  Retrospective chart review was performed to obtain pertinent details regarding history and examination, pathologic findings, and treatment course. RESULTS:  A 63-year-old woman with a 2-year history of migraines presented with 5 months of occipital, right-sided headaches and neck pain exacerbated by Valsalva maneuvers...

BACKGROUND:  Human immunodeficiency virus (HIV) associated vasculopathy can cause ischemic cerebral stroke; however, there is limited evidence on optimal management. Herein, we report a case of acute ischemic stroke due to progressive internal carotid artery (ICA) stenosis in an HIV-positive patient. Superficial temporal artery to middle cerebral artery (STA-MCA) bypass, in addition to the best medical treatments, prevented stroke progression. CLINICAL DESCRIPTION:  A 39-year-old man with HIV infection presented with a sudden onset of aphasia and right hemiparesis...

AIM: Neurogenic pulmonary edema (NPE) following subarachnoid hemorrhage (SAH) is still one of the most catastrophic complications with its high morbidity and mortality rate. Systemic sympathetic hyperactivity has been considered in the pathogenesis, but it has not been clarified. In this study, the relationship between the degeneration of Th3 dorsal root ganglion (DRG) and developing NPE following spinal SAH was investigated. METHODS: The study was conducted on 23 rabbits...

INTRODUCTION: It remains controversial whether primary pontine hemorrhage (PPH) should be managed conservatively or treated promptly via surgical evacuation of the hematoma. The purpose of this study was to assess the therapeutic effect of robotic frameless stereotactic aspiration with thrombolysis in the treatment of PPH. METHODS: A total of 39 patients with PPH between January 2012 and November 2016 were included in the study. Sixteen patients with frameless stereotactic surgical treatment (ST group) and twenty-three patients with conservative treatment (CT group)...

OBJECTIVE: The study aimed to evaluate the safety and feasibility of transpedicular instrumentation for the C2 vertebra and to establish the precise anatomical parameters and boundaries within which this procedure can be safely and effectively performed. MATERIALS AND METHODS: This retrospective study analyzed 66 patients who underwent C2 transpedicular screw fixation. Preoperative and postoperative axial, sagittal, and coronal cervical computed tomography (CT) scans were examined...

To the Editor, We appreciate the insightful comments made by the authors of the letter regarding our article, "The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with PELD" 1. Thank you for taking the time to assess our manuscript and for the opportunity to respond to your comments.

BACKGROUND:  The ideal surgical treatment of lumbar canal stenosis remains controversial. Although decompressive open surgery has been widely used with good clinical outcome, minimally invasive indirect decompression techniques have been developed to avoid the complications associated with open approaches. The purpose of this study was to evaluate the radiologic outcome and safety of the indirect decompression achieved with stand-alone percutaneous pedicle screw fixation in the surgical treatment of lumbar degenerative pathologies...

BACKGROUND:  Spinal cord hemangioblastomas are rare benign and highly vascular tumors that develop either sporadically or as part of von Hippel-Lindau (VHL) disease. Generally, complete resection without significant neurologic deficit remains considerably challenging due to the risk of massive bleeding. The current study therefore aimed to describe en bloc resection of spinal cord hemangioblastomas according to the typical anatomical structures of peripheral lesions and evaluate the neurofunctional prognosis of this technique...

INTRODUCTION: Between individual patients with lumbar disc prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with non-tolerable pain after at least 8-12 weeks of conservative management, or significant neurological deficit. Channelling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiscectomy...

BACKGROUND: In general, sufficient anchoring of screws in the bone material ensures the intended primary stability. METHODS: Shape memory materials offers the option of using temperature-associated deformation energy in a targeted manner in order to do justice to the special situation of osteoporotic bones or the potential lack of anchoring. An expansion screw was developed that takes this possibility and these requirements into account. Using finite element analysis, the variability of screw configuration and actuator was assessed from shape memory...

Letter: We have read the recent article published by Zhang et al titled "The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Percutaneous Endoscopic Interlaminar Diskectomy: A Retrospective Study". In this retrospective study, authors performed interlaminar endoscopic lumbar discectomy (IELD) for L5-S1 disc herniations, categorizing patients into two groups. One group underwent IELD with saline irrigation fluid containing 0.33 gm of tranexamic acid (TXA) per 1L of saline, while the other group received only saline irrigation fluid...

Background High Frequency Oscillations (HFOs) are spontaneous EEG events that occur with in the frequency range of 80 to 500 Hz and consist of at least four distinct oscillations that stand out from the background activity. They can be further classified into "Ripples" (80-250 Hz) and "Fast Ripples" (FR, 250-500 Hz) based on different frequency bands. Studies have indicated that HFOs may serve as important markers for identifying epileptogenic regions and networks in patients with refractory epilepsy. Furthermore, a higher extent of removal of brain regions generating HFOs could potentially lead to improved prognosis...

BACKGROUND: Pituitary adenoma (PA) is a common intracranial endocrine cancer, but no precise target has been found for the effective prediction and treatment of PA. METHODS: qRT‒PCR analysis showed that circMFN2 could affect the expression of miR-146a-3p in PA samples. Moreover, we used Western blotting to evaluate the expression levels of TRAF6 and NF-κB markers. The EdU assay, scratch wound-healing assay, and matrigel invasion assay were performed to assess the potential function of this pathway in PA cells...

BACKGROUND: Intracranial hypertension is a life-threatening condition that can be treated by decompressive craniectomy (DC), which involves removing part of the skull and intracranial lesions. However, DC has many complications and requires a second surgery to repair the skull. Decompressive bone flap replacement (DBFR) or decompressive cranioplasty is a novel technique that replaces the bone flap with a titanium mesh, providing both decompression and skull integrity. METHODS: The materials and methods of DBFR are described in detail...

BACKGROUND: Augmented reality is a new technology that, when applied to spinal surgery, offers the potential for efficient, safe, and accurate placement of pedicle screws. This study investigated whether augmented reality combined with a guide board improved the safety and accuracy of pedicle screw placement compared to traditional free-hand screw placement. METHODS: Four trainers were divided into augmented reality navigation and free-hand groups. Each group consisted of a novice and an experienced spine surgeon...