Cranioplasty Outcomes from a Tertiary Hospital in a Developing Country.

BACKGROUND: Decompressive craniectomy (DC) is a surgical procedure to treat refractory increase in intracranial pressure. DC is frequently succeeded by cranioplasty (CP), a reconstructive procedure to protect the underlying brain and maintain cerebrospinal fluid flow dynamics. However, complications such as seizures, fluid collections, infections, and hydrocephalus can arise from CP. Our aim is to investigate these complications and their possible risk factors and to discuss whether early or late CP has any effect on the outcome. MATERIALS AND METHODS: A single-center retrospective cohort study was performed, including patients who underwent CP after DC between January 2014 and January 2022. Relevant information was collected such as demographics, type of brain injury, materials used in CP, timing between DC and CP, and postoperative complications. Ultimately, 63 patients were included in our study. We also compared the complication rate between patients who underwent late CP after DC (>90 days) against patients who underwent early CP (<90 days). RESULTS: Most patients were male (78%). The sample median age was 29 years, with pediatric patients, accounting for 36% of the samples. Overall complication rate was 57% and they were seizure/epilepsy in 50% of the patients, fluid collection (28%), infections (25%), posttraumatic hydrocephalus (17%), and bone defect/resorption (3%). Twenty-two percent of patients with complications required reoperation and underwent a second CP. The median (interquartile range) duration between the craniotomy and the CP was 56 (27-102) days, with an early (≤3 months) percentage of 68%. We found no significant difference between early (≤3 months) and late (>3 months) CP regarding complication rates. CONCLUSION: Despite CP being a simple procedure, it has a considerable rate of complications. Therefore, it is important that surgeons possess adequate knowledge about such complications to navigate these challenges more effectively.

Résumé Contexte:La craniectomie décompressive (DC) est une intervention chirurgicale destinée à traiter l'augmentation réfractaire de la pression intracrânienne. La DC est fréquemment remplacée par une cranioplastie (CP), une procédure reconstructive visant à protéger le cerveau sous-jacent et à maintenir la dynamique du flux du liquide céphalo-rachidien. Cependant, des complications telles que des convulsions, des collections de liquides, des infections et une hydrocéphalie peuvent survenir en raison de la CP. Notre objectif est d'étudier ces complications et leurs facteurs de risque possibles et de discuter si une CP précoce ou tardive a un effet sur le résultat.Matériels et méthodes:Une étude de cohorte rétrospective monocentrique a été réalisée, incluant des patients ayant subi une PC après une DC entre janvier 2014 et janvier 2022. Des informations pertinentes ont été collectées telles que les données démographiques, le type de lésion cérébrale, les matériaux utilisés dans la PC, le timing entre la DC et CP et complications postopératoires. Au final, 63 patients ont été inclus dans notre étude. Nous avons également comparé le taux de complications entre les patients ayant subi une CP tardive après une DC (> 90 jours) et ceux ayant subi une CP précoce (<90 jours).Résultats:La plupart des patients étaient des hommes (78 %). L'âge médian de l'échantillon était de 29 ans, les patients pédiatriques représentant 36 % des échantillons. Le taux global de complications était de 57 % et il s'agissait de convulsions/épilepsie chez 50 % des patients, d'accumulation de liquide (28 %), d'infections (25 %), d'hydrocéphalie post-traumatique (17 %) et de défauts/résorptions osseuses (3 %). Vingt­deux pour cent des patients présentant des complications ont dû être réopérés et ont subi une deuxième CP. La durée médiane (intervalle interquartile) entre la craniotomie et la CP était de 56 (27 à 102) jours, avec un pourcentage précoce (≤ 3 mois) de 68 %. Nous n'avons trouvé aucune différence significative entre la PC précoce (≤ 3 mois) et tardive (> 3 mois) en ce qui concerne les taux de complications.Conclusion:Bien que la CP soit une procédure simple, elle entraîne un taux de complications considérable. Il est donc important que les chirurgiens possèdent des connaissances adéquates sur ces complications pour relever ces défis plus efficacement.

Long term clinical and radiological outcomes following surgical treatment of symptomatic cranial arachnoid cyst: A population based consecutive cohort study.

OBJECTIVE: Symptomatic intracranial arachnoid cysts are treated mainly through surgical resection, endoscopic fenestration, or by implanting cystoperitoneal (CP) shunt. However, the use of a specific technique remains controversial. The purpose of this study is to discuss these surgical modalities in symptomatic patients with intracranial arachnoid cysts (ACs) and investigate which has better outcomes and less complications by comparing variable preoperative and postoperative parameters. METHODS: An analysis of thirty-nine symptomatic patients who underwent intracranial arachnoid cyst surgery in the department of neurosurgery between 2009 and 2023 was performed. Patients were retrospectively compared based on age group, gender, anatomical location, laterality, type of intervention, clinical and volumetric changes, postoperative complications and outcome. RESULTS: Of the 39 patients, 20 patients (51.28 %) received CP shunt. Eleven patients (28.2 %) underwent endoscopic fenestration, and 8 patients (20.5 %) had surgical resection. The age at the time of first operation ranged from 1 month to 59.9 years (mean age: 16.8 years), and the pediatric patients were 25 (64.1 %). The most common initial symptom was headache which was observed in 19 patients (48.7 %), followed by seizure in 12 patients (30.8 %), vomiting in 11 patients (28.2 %), visual dysfunction in 8 patients (20.5 %), drowsiness in 8 patients (20.5 %), visual symptoms in 8 patients (20.5 %), cognitive impairment in 4 patients (10.3 %), focal neurological deficits in 3 patients (7.7 %), and cranial nerve involvement in 1 patient (2.6 %). 24 patients (61.5 %) showed improvement while in 15 patients (38.5 %) the symptoms persisted or worsened. Postoperatively, patients were followed up for an average of one year. The highest improvement rate was noted in endoscopic fenestration with 9 improved patients (81.8 %), followed by surgical resection with 5 symptom-free patients (62.5 %). The worst outcomes were seen in cystoperitoneal shunt with only half of the patients were relieved (50 %). Complications developed in 2 patients (25 %) who underwent surgical resection, 5 patients (45.5 %) who had endoscopic fenestration, and 13 patients (65 %) who had cystoperitoneal shunting. CONCLUSION: Endoscopic fenestration has the highest improvement rate, the lowest serious complications along with being the least invasive technique. These features make it the optimal modality in treatment of ACs. Surgical resection or cystoperitoneal shunt can be considered as secondary techniques when patients report unchanged or worsening symptoms.

Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5- C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, whichmay be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.

Primary cervical glioblastoma multiforme as a presentation of constitutional mismatch repair deficiency: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Primary Glioblastoma Multiforme(GBM) of cervical spinal cord represent an extremely rare type of tumors in the pediatric age group. Constitutional mismatch repair deficiency (CMMRD) patients are known to develop uni- or multiple synchronous-high grade gliomas in the brain. CASE PRESENTATION: The authors report a 23 month old child presented with bilateral upper limb weakness for 7 days with imaging evidence of intramedullary mass lesion that extends from the level of the C3 to C7. The patient underwent excisional biopsy from C3 to C7 and laminoplasty. Immunohistology confirmed primary cervical GBM. CLINICAL DISCUSSION: Constitutional mismatch repair deficiency is cancer tendent syndrome associated with broad spectrum of malignancies. Screening for CMMRD is not a daily practice in oncology and thus prevalence might be underestimated. To authors' knowledge, no prior primary cervical GBM in CMMRD syndrome. CONCLUSION: This report highlights the challenges of CMMRD polymorphic presentations, diagnosis, complications, management and surveillance.

Paraparesis As a Rare First Presentation Of Primary Hyperparathyroidism-Related Brown Tumor in The Thoracic Spine: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Brown tumor (BT) is defined as osteolytic lesion of an underlying state of hyperparathyroidism. Hyperparathyroidism will activate osteoclasts which initiate active bone resorption foci of lytic-cysts with hemosiderin depositions that pigment it with its characteristic brown pathologic gross appearance. Devastating fractures and injuries can occur to affected bones and surrounding tissue that require emergent intervention and correction. CASE PRESENTATION: We present a case of a medically free 31-year-old female patient, who presented complaining of unsteadiness and progressive lower limbs weakness over 40 days of duration. Subsequent lab tests showed elevated PTH levels, along with 3.5 × 1.8 cm heterogeneous soft tissue mass involving the right pedicle on T7 level compressing the corresponding level of the spinal cord. Surgical management aimed to decompress the spinal cord and to obtain a biopsy for histopathologic examination which revealed a brown tumor. Neck ultrasound and Sestamibi scan indicated the presence of hyperactive and hyperplastic parathyroid tissue most suggestive of parathyroid adenoma. CLINICAL DISCUSSION: Various presentations of Brown Tumor depend on the bone affected, despite the rarity of spinal involvement, yet expanding tumors can manifest either with back pain, radicular pain, paresthesia, weakness, paralysis, or incontinence. The highest incidence rates of spinal brown tumors affect adults over the age of 40. Management goals are to decompress the neuronal tissue emergently and to prevent further bony lytic deterioration. CONCLUSION: The objective of this study is to provide an overview of primary hyperparathyroidism-related spinal brown tumors, presentation, and summary of previously reported similar cases in the literature.