Neurosurgery

Diffusion MRI (dMRI) tractography is currently the only imaging technique that allows for non-invasive delineation and visualisation of white matter (WM) tracts in vivo prompting rapid advances in related fields of brain MRI research in recent years. One of its major clinical applications is for pre-surgery planning and intraoperative image guidance in neurosurgery, where knowledge about the location of WM tracts nearby the surgical target can be helpful to guide surgical resection and optimise surgical outcomes...

BACKGROUND: Non-Epileptic Paroxysmal Events (NEPE) are common clinical manifestations in pediatric age presenting with dysfunction of motor and behavioral activity mimicking features of epileptic seizures. OBJECTIVE: To present and analyze number and clinical characteristic of a group of children/adolescents presenting with various types of NEPE; to compare clinical data of this group of NEPE affected children/adolescents with a group of children/adolescents affected by Epileptic Seizures (ES)...

Gordon Holmes syndrome (GHS) is an autosomal recessive disease characterized by cerebellar ataxia and hypogonadotropic hypogonadism. Among the genes associated with this syndrome, mutations in PNPLA6 have been detected and correlated with the phenotype of GHS. We report a case of a patient affected with GHS, confirmed by physical, neurological, laboratory and genetic analyses. Two compound heterozygous missense mutations on the PNPLA6 gene described as probably damaging/damaging in multiple in silico predictive tools have been detected with massive multigene sequencing...

BACKGROUND: Skull base meningiomas represent a challenge for neurosurgeons and the procedures are typically performed by experienced neurosurgeons, thus limiting resident training. A new simulation and rehearsal device can be used as an aid for senior surgeons during these operations and serve as a training tool for junior surgeons. METHODS: 40 patients harboring an anterior/middle fossa meningioma were recruited. Surgical Theater™, a rehearsal/simulation platform, was used for preoperative planning and intraoperative 3D navigation on 20 patients (CT-MADE group), while the remaining (control group) underwent a traditional navigation...

OBJECTIVES: To characterize patients with an acute traumatic spinal cord injury (ATSCI) above T6 who were admitted to the Intensive Care Unit (ICU) for ≥30 days, as well as their one-year mortality, in comparison with patients admitted for <30 days. METHODS: A retrospective, observational study was performed on 211 patients with an ATSCI above T6 who were admitted to an ICU of a Spanish hospital between 1998-2017. A multivariate logistic regression analysis was performed to determine the relationship between an ICU stay ≥30 days and post-ICU discharge mortality...

Cerebellar Mutism syndrome (CMS) is one the most disabling post-operative neurological complications following posterior fossa surgery in children. It is characterised by a transient mutism with a typical onset demonstrated within two days post-operatively accompanied by associated ataxia, hypotonia, irritability. Several hypotheses for anatomical basis of pathophysiology and risk factors have been suggested, however, a definitive theory and treatment protocols are yet to be determined. Animal histological and electrophysiological studies and more recent human imaging studies have demonstrated the existence of compartmentalised representation of cerebellar functions, the understanding of which may shed further light onto the pathophysiology...

BACKGROUND: Few central nervous systems (CNS) cases of actinomycetoma have been recorded in the literature, and most were reported in tropical and subtropical regions. The management of this invasive infection is difficult, especially when it affects the spine and the cranio-cervical regions. CASE: We report an unusual case of a cranio-cervical junction actinomycetoma, in a patient presenting a cerebellar syndrome from brainstem compression. The CT scan showed a compressive solid osteolytic lesion in the cranio-cervical junction...

BACKGROUND: The jugular foramen (JF) can be the site of several tumours. Paragangliomas, schwannomas and meningiomas are the most commonly reported. We describe a case of melanocytoma originating from the JF and presenting with an accessory nerve palsy. Illustrative case: A 48-year-old woman presented with a 6-month history of cervical and left shoulder pain with wasting and weakness of the left trapezius. A Magnetic Resonance Imaging (MRI) showed a T1-hyperintense, T2-isointense, heterogeneously enhancing lesion involving the left JF and extending into the cerebello-medullary and cerebello-pontine cisterns...

Chordomas are rare, slow-growing malignant tumors. Given the paucity of data of the disease, the treatment strategies are disputed. We collected clinical and survival information of patients with chordoma diagnosed between 1975 and 2016 from the Surveillance, Epidemiology, and End Results database. A total of 1797 patients were initially enrolled, including 762 (42.4%) cranial and 1035 (57.6%) spinal chordoma. A total of 1504 patients were further evaluated after screening. In the cranial group, the surgery (gross total resection (GTR): p = 0...

INTRODUCTION: Iatrogenic syringomyelia has previously been described preoperatively due to space occupying lesions and postoperatively predominantly postspinal CSF drainage. Iatrogenic syringomyelia after cranial surgery is a rare entity. The purpose of this study is to review the current literature for iatrogenic syringomyelia following cranial surgery in children. MATERIAL AND METHODS: We performed a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and meta-analyses) guidelines...

This review is devoted to the modern method of monitoring of pupil diameter and reactivity in patients with acute brain injury. The authors present complete data on diagnostic and prognostic capabilities of automated infrared pupillometry, which should take its rightful place in comprehensive assessment of functional brain state in ICU patients. In authors' opinion, clinical introduction of pupillometry will improve prediction of outcomes following acute brain injury and quality of neurological monitoring in patients with cerebral edema and intracranial hypertension...

Cavernous malformations (CMs) of central nervous system are vascular malformations usually localized in the brain and rarely in the spinal cord. To date, these malformations are well studied. However, some problems of the management of this pathology are still unresolved. This is due to rare localization of intramedullary CMs in the spinal cord and difficult treatment of spinal pathology per se. To date, about 1000 cases of spinal CM are described in the literature. This review is devoted to natural course of disease and postoperative outcomes...

BACKGROUND: Retropleural and/or retrodiaphragmatic approach is one of the options for anterolateral access to the thoracic spine and thoracolumbar region. This technique has no disadvantages associated with thoracotomy or extensive tissue dissection following posterolateral approaches. OBJECTIVE: Systematic analysis of foreign and national researches devoted to the possibility, safety and effectiveness of lateral retropleural approach to the thoracic spine and meta-analysis of the most common complications associated with this approach...

The authors report a patient with recurrent bifocal germinoma of the optical nerves and chiasm after previous combined treatment. The tumor resulted progressive visual acuity loss despite subsequent therapy (glucocorticoid therapy, chemo- and radiotherapy). Differential diagnosis between tumor progression and consequences of radiotherapy was complicated by MRI negative pattern. Subsequent development of the process, signs of anterior visual pathway damage and tumor spread throughout the ventricular system and subarachnoid spaces according to neuroimaging data indicated recurrence of disease...

The authors report resection of anaplastic convexital meningioma in a middle-aged woman complicated by expected massive blood loss. The most intense bleeding occurred at the final stage of resection and it was impossible to stop it with traditional approaches. The surgeon pressed a standard tachocomb plate moistened with a diluted solution of recombinant activated factor VII (coagil, Russia) to the most bleeding area for 5 minutes. Subsequently, surgeon replaced finger pressure with a permanent napkin. Hemostatic effect of recombinant activated factor VII following its systemic administration is well known and convincingly proven in many surgical areas including neurosurgery...

Venous thromboembolic events (VTE) can significantly complicate postoperative period in neurosurgical patients. It is known that patients with brain tumors are especially susceptible to VTE. OBJECTIVE: To determine the incidence and risk factors of VTE in patients with various brain tumors. MATERIAL AND METHODS: All patients with brain tumors underwent surgery in 2019 ( n =610). They were divided into the groups depending on tumor type: sellar region, intracerebral, extracerebral neoplasms and metastases...

BACKGROUND: The risk and benefits of early neurosurgical intervention in patients with non-traumatic intracerebral hematoma (NICH) are still unclear. OBJECTIVE: To evaluate an effectiveness of early surgery in patients with NICH compared to primary conservative therapy. MATERIAL AND METHODS: There were 115 patients with indications for surgery. The indications were supratentorial NICH over 30 cm3 and GCS score >7 points. All patients were divided into 2 groups: the main group ( n =59) - NICH removal within 24 hours; the control group ( n =56) - conservative treatment only...

BACKGROUND: Aneurysms of vertebral artery confluence and proximal parts of basilar artery are extremely rare. They are usually combined with proximal fenestration of basilar artery. No timely surgical treatment of these aneurysms is associated with high risk of adverse outcomes, and their treatment is a challenge for neurosurgeons. MATERIAL AND METHODS: We analyzed postoperative outcomes in 17 patients with 21 aneurysms of vertebral artery confluence and proximal parts of basilar artery...

OBJECTIVE: To evaluate the correlation of trigeminal radiculopathy with anatomical relationships of trigeminal nerve root, brainstem, tumors and vessels in patients with vestibular schwannomas. MATERIAL AND METHODS: A retrospective analysis included 153 patients (106 females and 47 males aged 22-82 years) with vestibular schwannomas who underwent surgery via retromastoid approach. Preoperative trigeminal radiculopathy (facial pain and sensory disturbances) was examined after microsurgical resection...

Surgical treatment of spine and spinal cord diseases is one of important objectives in modern neurosurgery. Patient safety is a priority in spine and spinal cord surgery. Intraoperative imaging ensures efficacy and safe surgery with and without stabilization, preoperative marking, control of decompression and correct implant placement. Surgical C-arms and intraoperative cone-beam CT scanners are the most widespread in everyday practice. The latest achievement was intraoperative spiral computed tomography. C-arms and CT scanners with intraoperative navigation increase the efficiency and safety of surgical interventions...