Volume 11 · Issue 01 · 2025

Although stent-assisted coiling has become a standard approach for treating intracranial aneurysms (IAs), there are limited reports on its safety and effectiveness in parent artery less than 2.5 mm in diameter. This study evaluates the feasibility, safety, and short-term outcomes of using Neuroform Atlas stent-assisted coiling for IAs with small parent vessels.

This study reviewed and analyzed the clinical data of 50 IAs in 50 patients with a parent artery diameter of ≤ 2.5 mm, treated with Neuroform Atlas stent-assisted coiling at a single center between November 2020 and April 2024. Immediate postoperative angiographic outcomes were assessed using the modified Raymond-Roy classification. Follow-up imaging included computed tomographic angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA). Clinical outcomes were evaluated using the modified Rankin Scale (mRS).

The procedures achieved a 100% success rate. Immediately after treatment, 24 cases were classified as Raymond-Roy grade I, 11 as grade II, and 15 as grade III. Follow-up angiography in 28 cases revealed three instances of aneurysm recurrence, with a secondary procedure performed in one case. One patient reported poor neurological status, and two cases experienced procedure-related adverse events during telephone or clinical follow-up.

the Atlas stent demonstrated favorable outcomes in the treatment of aneurysms in small parent arteries (< 2.5 mm), with a low complication rate. The timely postoperative use of tirofiban may further reduce the risk of ischemic complications.

The extubation time is critical during the intensive care unit stay in aneurysmal subarachnoid hemorrhage (aSAH) patients. The current conventional parameters for predicting extubation failure (EF) and extubation time may not be suitable for this population. Here, we aimed to identify factors associated with EF in aSAH patients.

From a single-center observational study on aSAH patients with computed tomography angiography from 2019 to 2021, patients who received microsurgery were enrolled and divided into two groups according to whether EF occurred. Multivariable logistic regression was conducted to evaluate disease severity, medical history, and extubation time differences between patients with and without EF.

Of 335 patients included, EF occurred with a rate of 0.14. Delayed cerebral ischemia (67.4% vs. 13.5%) and acute hydrocephalus (6.5% vs. 1.4%) were frequently observed in patients with EF. Also, patients who develop EF presented higher disability (65.9% vs. 17.4%) and mortality (10.9% vs. 0.7%) rates. Multivariable analysis demonstrated that age (OR 1.038; 95% CI 1.004-1.073; P= 0.028), onset to admission time (OR 0.731; 95% CI 0.566-0.943; p = 0.016), WFNS grade > 3 (OR 4.309; 95% CI 1.639-11.330; p = 0.003), and extubation time < 24 h (OR 0.097; 95% CI 0.024-0.396; p= 0.001) were significantly associated with EF occurrence.

These data provide further evidence that older aSAH patients with onset to admission time < 2 days and WFNS grade > 3 have a high risk of developing EF, which is amplified by the ultra-early extubation. Moreover, in patients with two or more risk factors, a prolonged intubation recommendation requires consideration to avoid the EF.

Precise diagnosis and rapid treatment for acute complex intracranial hemorrhage (ICH) are crucial. The neurosurgical hybrid operating platform integrates traditional open neurosurgery operating room functionalities with endovascular therapy capabilities and is developing in the neurosurgical practice. However, its effect on the emergent complicated neurovascular cases needs pilot exploration.

In this prospective study, a total of 103 cases of both spontaneous and non-spontaneous ICH were consecutively recruited between June 2019 and June 2023. Demographic data, including age, gender distribution, and types of hemorrhage, were collected. Surgical interventions were tailored based on DSA, including spontaneous and non-spontaneous hemorrhages. Functional outcomes were assessed using the modified Rankin Scale (mRS) preoperatively and postoperatively.

Over the study period from June 2019 to June 2023, a cohort of 103 ICH cases underwent emergency hybrid surgical treatment utilizing the E-HOPE platform. Among these cases, 88 were classified as spontaneous ICH, while 15 were non-spontaneous. The mean age at diagnosis for the entire cohort was 54.0 ± 3.7 years, with a slight predominance of male patients. Spontaneous ICH encompassed a diverse spectrum of etiologies, including arteriovenous malformations, aneurysms, arteriovenous fistulas, cavernous malformations, moyamoya disease, and cryptogenic hemorrhages. Surgical interventions were tailored to address the specific pathology. Notably, improvements in mRS scores were observed in a majority of cases, with some patients experiencing stabilization or deterioration postoperatively. Non-spontaneous cases (n = 15) were primarily iatrogenic (n = 13) due to tumors adjacent to the internal carotid artery, necessitating stent graft deployment. Surgical approaches, including stent graft deployment and middle meningeal artery embolization, were effective in managing these cases. Postoperative functional outcomes varied depending on the nature of the hemorrhage, with a subset of patients demonstrating improvement in mRS scores while others showed no significant change.

Emergency hybrid surgical treatment utilizing the E-HOPE platform offers promising outcomes for ICH patients. Tailored surgical approaches result in favorable postoperative functional outcomes, highlighting the importance of a multidisciplinary approach in managing these complex cases.

Surgical management of giant and irregular pituitary neuroendocrine tumors (GIPitNETs) presents a significant challenge in neurosurgery. While endoscopic endonasal surgery (EES) is a widely used approach for PitNETs, GIPitNETs with extensive intracranial extension pose challenges for purely EES. We use simultaneous combined endoscopic endonasal and transcranial surgery (CECS) for the treatment of this type of tumor. Currently, there is limited research comparing CECS to EES for GIPitNETs. This study aims to compare the efficacy and short outcome of CECS and purely EES in the management of GIPitNETs to better understand the advantages and limitations of each surgical approach.

The data of GIPitNETs patients who underwent surgery between March 2018 and May 2023 at a single center were retrospectively reviewed. All included cases were divided into CECS and EES groups according to the treatment modality received. The baseline characteristics and tumor imaging features of patients were compared between the groups, as well as surgical results, perioperative complications, and last follow-up outcomes.

A total of 50 patients met the inclusion criteria, with 27 undergoing CECS and 23 EES. CECS achieved a significantly higher GTR rate compared to EES (66.7% vs. 13.0%, p < 0.0001). CECS had longer operation times and hospital stays, but both approaches had similar rates of complications, including intracranial infection, CSF leakage, new pituitary dysfunction, postoperative diabetes insipidus, and vascular infarction. CECS reduces the risk of postoperative bleeding. Tumor recurrence and reoperation were significantly more common in the EES group.

CECS is a safe and effective surgical approach for GIPitNETs, leading to higher rates of GTR, comparable complication rates, and reduced risk of postoperative bleeding when compared to purely EES. EES was associated with more tumor recurrence. Further long-term follow-up data is needed to validate these findings.

To assess the clinical effects of hybrid surgery, which includes spinal angiography-assisted microsurgery, in the treatment of spinal dural arteriovenous fistulas (SDAVF).

We retrospectively reviewed 45 patients who underwent hybrid Spinal dural arteriovenous fistula (SDAVF) resection between September 2019 and June 2022. The hybrid surgery involved intraoperative digital subtraction angiography (DSA) of the spinal vessels to determine the source of the blood-supplying artery, location of the fistula and draining vein, indocyanine green fluorescence (ICG)-assisted microsurgical resection of the fistula, and postoperative DSA to verify therapeutic efficacy. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Visual Analog Scale (VAS), Barthel score, modified Rankin Scale (mRS) and modified Aminoff-Logue score (key indicator) were used to assess the clinical effects of SDAVF resection.

A series of 45 patients with SDAVF were successfully treated with hybrid surgery without fistula recurrence. There were no intraoperative complications related to spinal angiography, and none of the patients died. Postoperatively, two patients experienced clinical deterioration of spinal cord function, which manifested as bilateral lower extremity paralysis and bladder sphincter dysfunction. Postoperatively, improvement in mALS scores was observed in 16 cases (35.6%) within 1-2 days, 12 cases (26.7%) at 1 week, and 7 cases (15.6%) at 6 months. No SDAVF recurrence was detected in the spinal MRA examination 6 months after surgery. When compared with preoperative mALS scores, 35 cases (77.8%) showed significant improvement in symptoms, 8 cases (17.8%), remained unchanged, and 2 cases (4.4%) deteriorated. Compared with the preoperative scores, the postoperative mALS score was significantly decreased [postoperative vs. preoperative: 2(1,3) vs. 3(2,4)], HAMD score [(12.2 ± 5.5) vs. (19.6 ± 6.3)], HAMA score [(15.6 ± 5.5) vs. (20.5 ± 6.5)], and VAS score [3(2,5) vs. 5(4,8)]. Conversely, Barthel scoresshowed significant increase [(74.6 ± 8.7) vs. (67.8 ± 9.2)] (P < 0.05). However, the mRS scores were lower than preoperatively [1(1,2) vs. 2(1,2.5)], but the difference was not statistically significant (P > 0.05). There was a significant increase in "good" neurological outcomes at follow-up compared with preoperative function (62.2% vs. 33.3%) (P= 0.023).

Hybrid surgery is a safe and effective treatment for patients with SAVF, which is beneficial for improving anxiety, depression, spinal cord, and neurological function, and relieving pain. However, the treatment of patients with SDAVF is a complex, long-term process requiring further multidisciplinary interventions, including clinical care, psychosocial interventions, and neurorehabilitation.

Chronic traumatic Encephalopathy (CTE) has been linked to an increase in the mortality of contact sport athletes in the USA, most especially in the early 2000s due to limited information on its existence. The lack of understanding of its existence resulted in delayed diagnosis and inadequate treatment of the disease for affected individuals.

Africa faces a similar gap as awareness and research on CTE remain limited in the region where active participation in contact sports is rising. If no drastic action is taken to mitigate the gap, the region may face similar health consequences in the future.

Various challenges responsible for the gap can be attributed to limited infrastructure, limited funding opportunities, and sociocultural factors. To address these challenges, a multifaceted approach is necessary through increasing funding, integrating CTE education into the medical curriculum, improving infrastructure, and resolving sociocultural myths about organ donation.

A nonadjustable state of the programmable shunt valve is a rare phenomenon. This case report aims to explore the cause of pressure adjustment dysfunction in a programmable shunt valve in a middle cranial fossa arachnoid cyst-peritoneal shunt patient and to underscore this dysfunction as an indicator of shunt valve obstruction.

A child with a ruptured giant arachnoid cyst in the left middle cranial fossa presented with acute intracranial hypertension following head trauma. The initial cysto-peritoneal shunt surgery rapidly alleviated symptoms, including headaches, vomiting, and left cranial nerve palsy, stabilizing the clinical condition. However, between 20 and 24 months after the initial shunt surgery, the patient developed intermittent shunt dysfunction, experiencing recurrent headaches and vomiting, during which the programmable valve’s pressure setting had become fixed and was no longer adjustable. A second surgery was then performed to remove the existing shunt, excise the fibrotic cyst wall, fenestrate the basal cistern, and establish temporary subdural drainage. During this operation, extensive fibrosis of the cyst wall in the subdural space was discovered, forming a tough and hypertrophic fibrotic membrane that encased the cerebral hemispheres. This fibrotic material nearly filled the shunt valve chamber, causing valve obstruction and immobilizing the pressure control rod, resulting in pressure adjustment dysfunction. As the patient could not maintain stability without continuous drainage, a third surgery was ultimately necessary to place a subdural-peritoneal shunt. Five years of follow-up revealed no significant clinical symptoms, and the patient has maintained a normal life.

Shunt valve obstruction is an underestimated cause of shunt system failure, with no current definitive method for early diagnosis. Fibrotic deposition is a primary mechanism underlying shunt valve obstruction. Pressure adjustment dysfunction in a programmable shunt valve serves as a reliable indicator of shunt valve obstruction. Further research should prioritize the treatment and prevention of shunt valve obstructions to improve outcomes in neurosurgical practice.

Delayed radiation-induced complications after stereotactic radiosurgery (SRS) for arteriovenous malformations (AVM) have scarcely been described in the literature, and their incidence, pathophysiology, and treatment remain unclear. Additionally, the literature regarding these complications is confusing. The authors present a well-documented case report describing these late complications, adding evidence to the possible common pathophysiological mechanism underlying them, and illustrating an effective treatment modality when they occur.

A case of a 28-year-old male with an increasing cyst formation (CF) appearing 10 years after SRS for AVM is presented. Despite surgical treatment, due to the incomplete resection of the angiomatous nodule, recurrence as a chronic encapsulated expanding hematoma (CEEH) occurred. This relapse required a second treatment, which could have been avoided if aggressive surgical treatment had been performed initially.

This case highlights the continuum between CF and CEEH, challenging existing confusion in the literature. Complete resection of the angiomatous nodule associated with CF is imperative for achieving resolution and preventing recurrence.