Multiple inflammatory pseudotumor formation after craniopharyngioma resection via an extended nasal endoscopic approach: A case report.

BACKGROUND: This report describes a case of intracranial multiple inflammatory pseudotumors (IP) after endoscopic resection of a craniopharyngioma, which is relatively rarely reported in the literature, and neurosurgeons should be aware of its existence. CASE SUMMARY: Herein, we report the case of a 56-year-old man who developed decreased visual acuity and blurred vision without obvious cause or inducement on April 27, 2020. To seek further treatment, he went to the Department of Neurosurgery, Clinical Medical College, Yangzhou University. After falling ill, there was no nausea, vomiting, limb convulsions, obvious disturbance of consciousness, speech disorders, cough, or persistent fever. The neurological examination findings were normal, and pituitary magnetic resonance imaging (MRI) revealed multiple nodules with abnormal signals in the sellar region. The diagnosis was craniopharyngioma. We performed total resection of the tumor via transnasal endoscopy, and the postoperative pathology suggested that the type of tumor was craniopharyngioma. Six months after the operation, the patient experienced sudden hearing loss in the right ear, tinnitus in both ears, and numbness on the right side of the face and head. Meanwhile, cranial MRI showed multiple IP. After steroid hormone and anti-inflammatory therapy, the above symptoms did not significantly improve. Finally, the patient's symptoms were well improved by surgery, and the postoperative pathological diagnosis was multiple IP. CONCLUSION: Intracranial inflammatory pseudotumor is a benign disease with slow progression, but the clinical symptoms and imaging findings are not typical, there are no pathological findings, and the diagnosis is relatively difficult. Most of the cases are treated by surgical resection, and the prognosis is good after surgery.

Contralateral seventh cervical nerve transfer for central spastic arm paralysis: a systematic review and meta-analysis.

Objectives: The specific benefits of a contralateral cervical 7 nerve transplant in people with spastic paralysis of the upper extremity caused by cerebral nerve injury are unclear. To evaluate the efficacy and safety of contralateral C7 nerve transfer for central spastic paralysis of the upper extremity, we conducted a comprehensive literature search and meta-analysis. Materials and methods: PRISMA guidelines were used to search the databases for papers comparing the efficacy of contralateral cervical 7 nerve transfer vs. rehabilitation treatment from January 2010 to August 2022. The finishing indications were expressed using SMD ± mean. A meta-analysis was used to assess the recovery of motor function in the paralyzed upper extremity. Results: The meta-analysis included three publications. One of the publications offers information about RCTs and non-RCTs. A total of 384 paralyzed patients were included, including 192 who underwent CC7 transfer and 192 who received rehabilitation. Results from all patients were combined and revealed that patients who had CC7 transfer may have regained greater motor function in the Fugl-Meyer score (SMD 3.52, 95% CI = 3.19-3.84, p < 0.00001) and had superior improvement in range of motion compared to the rehabilitation group (SMD 2.88, 95% CI = 2.47-3.29, p < 0.00001). In addition, the spasticity in the paralyzed upper extremity significantly improved in patients with CC7 transfer (SMD -1.42, 95% CI = -1.60 to -1.25, p < 0.00001). Conclusion: Our findings suggested that a contralateral C7 nerve transfer, which has no additional adverse effects on the healthy upper limb, is a preferable method to restore motor function.

Endovascular treatment achieves better outcomes than best medical management in patients with M2 occlusion and high stroke severity: a meta-analysis.

BACKGROUND: The lack of randomized evidence makes it difficult to establish reliable treatment recommendations for patients with M2 occlusion. This study aims to compare the efficacy and safety of endovascular treatment (EVT) with best medical management (BMM) in patients with M2 occlusion, and to investigate whether the optimal treatment varies according to stroke severity. METHODS: Comprehensive literature retrieval was conducted to identify studies that directly compared the outcomes of EVT and BMM. According to stroke severity, the study population were classified into those with moderate-severe stroke and those with mild stroke. National Institute of Health Stroke Scale (NIHSS) scores ≥ 6 was defined as moderate-severe stroke, and NIHSS scores 0-5 as mild stroke. Random-effects meta-analyses were performed to measure the symptomatic intracranial hemorrhage (sICH) within 72 h, and the modified Rankin Scale (mRS) scores 0-2 and the mortality at 90 days. RESULTS: Totally, 20 studies were identified, including 4358 patients. In the moderate-severe stroke population, the EVT had 82% higher odds for mRS scores 0-2 (OR 1.82, 95% CI 1.34-2.49) and a 43% lower odds for mortality (OR 0.57, 95% CI 0.39-0.82) compared with the BMM. However, no difference was found in the sICH rate (OR 0.88, 95% CI 0.44-1.77). In the mild stroke population, no differences were observed in the mRS scores 0-2 (OR 0.81, 95% CI 0.59-1.10) or mortality (OR 1.23, 95% CI 0.72-2.10) between EVT and BMM, whereas EVT was associated with higher sICH rate (OR 4.21, 95% CI 1.86-9.49). CONCLUSION: EVT may be only beneficial for patients with M2 occlusion and high stroke severity, but not for those with NIHSS scores 0-5.

Safety and efficacy of tranexamic acid in spinal canal tumors: a retrospective cohort study.

Objective: The use of tranexamic acid (TXA) has become popular in spinal surgery, the purpose of this study is to investigate the effectiveness and safety of intraoperative TXA used to reduce surgical bleeding and transfusion requirements in spinal canal tumor resection.Methods: The data for patients with spinal canal tumors treated in our hospital from June 2014 to June 2017 were collected. The patients (≥18 years of age) were divided into a TXA group (group A, n = 30) and a non-TXA group (group B, n = 30). The TXA dose regimen in group A comprised a loading dose of 10 mg/kg 30 minutes before the operation, followed by a maintenance dose of 1 mg/kg per hour during the operation. Group B was not given TXA. The operation time, intraoperative blood loss, postoperative drainage, postoperative complications, coagulation function such as plasma thrombin time(PT), prothrombin time(TT), activated thromboplastin time(APTT), fibrinogen (Fib) were statistically analyzed.Results: The intraoperative blood loss and postoperative drainage volume were significant lower in group A than in group B (p<.05). There were no significant differences in the operation time, plasma thrombin time, prothrombin time, activated thromboplastin time, or fibrinogen between the two groups before and after the operation (p>.05), and no thrombotic complications occurred.Conclusion: TXA used during spinal tumor surgery can reduce the amount of intraoperative blood loss and postoperative drainage without increasing the risk of deep vein thrombosis and related complications.

Bilateral Chronic Subdural Hematoma Treated by YL-1 Type Hematoma Aspiration Needle Complicated by Hemorrhage of the Basal Ganglia and Brainstem.

BACKGROUND: A 72-year-old man with bilateral chronic subdural hematomas was admitted to our department and treated using a YL-1 type hematoma aspiration needle. The treatment was complicated by hemorrhage of the basal ganglia and brainstem. This patient had no history of hypertension. We evaluated the relevant literature to analyze the causes of cerebral hemorrhage in similar patients. CONCLUSIONS: This case report illustrates that the stability of the intracranial pressure should be closely monitored during the surgical treatment of chronic subdural hematomas, and large fluctuations in the cerebral perfusion pressure should be avoided during the operation. We also propose improvements in the technical details of the operative treatment of chronic subdural hematomas.

Neurologic Functional Outcomes of Decompressive Hemicraniectomy Versus Conventional Treatment for Malignant Middle Cerebral Artery Infarction: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aims of this study were to evaluate decompressive hemicraniectomy (DHC) versus conventional treatment (CT) for patients with malignant middle cerebral artery (MCA) infarction and to investigate the impact of age and surgical timing on neurologic function and mortality. METHODS: We searched English and Chinese databases for randomized controlled trials or observational studies published before August 2016. Outcomes included good functional outcome (GFO), mortality, and National Institutes of Health Stroke Scale and Barthel index scores. RESULTS: This meta-analysis included 25 studies (1727 patients). There were statistically significant differences between DHC and CT groups in terms of GFO (P < 0.0001), mortality (P < 0.00001), and National Institutes of Health Stroke Scale and Barthel index scores (P < 0.0001) at different follow-up points. Significant differences were observed between the groups in survival with moderately severe disability (P < 0.00001); no differences were observed in survival with severe disability. In the subgroup analysis, in the DHC group, GFO was less in patients >60 years old (9.65%) versus ≤60 years old (38.94%); more patients >60 years old had moderately severe or severe disability (55.27%) compared with patients ≤60 years old (44.21%). CONCLUSIONS: DHC could significantly improve GFO and reduces mortality of patients of all ages with malignant MCA infarction compared with CT, without increasing the number of patients surviving with severe disability. However, patients in the DHC group more frequently had moderately severe disability. Patients >60 years old with malignant MCA infarction had a higher risk of surviving with moderately severe or severe disability and less GFO.

Spontaneous acute hemorrhage of intraspinal canal cellular schwannoma with paraplegia: A case report.

Cellular schwannoma, an unusual histological subtype of schwannoma, is a benign hypercellular variant of a peripheral nerve sheath tumor. We report a 48-year-old woman with sudden onset of paraplegia. The complete surgical resection was achieved. This is the first report about intraspinal canal cellular schwannoma following spontaneous acute hemorrhage and paraplegia.

Primary extramedullary spinal melanoma mimicking spinal meningioma: A case report and literature review.

Primary spinal melanoma is a rare lesion, which occurs throughout the cranial and spinal regions, however, is primarily observed in the middle or lower thoracic spine. The clinical features of primary spinal melanoma are complex and unspecific, resulting in a high misdiagnosis rate. In the present case report, a rare case of spinal melanoma exhibiting the dural tail sign and mimicking spinal meningioma is reported. The initial diagnosis, using magnetic resonance imaging (MRI), was unclear. Thus, melanin-containing tumors and spinal meningioma should have been considered in the differential diagnosis. The tumor was completely resected using a standard posterior midline approach, which was followed by chemotherapy. Subsequent to the surgery, the patient was discharged with improved motor capacity and a follow-up MRI scan showed no recurrence after six months. The present study demonstrates that it is critical for neurosurgeons to focus on increasing the accuracy of initial diagnoses in order to make informed decisions regarding the requirement for surgical resection. The present case report presents the clinical, radiological and pathological features of primary extramedullary spinal melanoma mimicking spinal meningioma to emphasize the importance of early identification and diagnosis.

Endoscopic evacuation of basal ganglia hemorrhage via keyhole approach using an adjustable cannula in comparison with craniotomy.

Neuroendoscopic (NE) surgery as a minimal invasive treatment for basal ganglia hemorrhage is a promising approach. The present study aims to evaluate the efficacy and safety of NE approach using an adjustable cannula to treat basal ganglia hemorrhage. In this study, we analysed the clinical and radiographic outcomes between NE group (21 cases) and craniotomy group (30 cases). The results indicated that NE surgery might be an effective and safe approach for basal ganglia haemorrhage, and it is also suggested that NE approach may improve good functional recovery. However, NE approach only suits the selected patient, and the usefulness of NE approach needs further randomized controlled trials (RCTs) to evaluate.

Primary carcinoma of the frontal sinus with extensive intracranial invasion: A case report and review of the literature.

Primary carcinoma of the frontal sinus is quite rare, with an incidence of 0.3-1.0% of all paranasal sinus carcinomas. The early diagnosis is often difficult and the condition is often mistakenly considered to involve mucoceles, pyoceles or osteomyelitis. The present study reports the case of a 66-year-old male with squamous cell carcinoma originating in the frontal sinus. The presenting symptoms were a cutaneous nodule on the left side of the forehead and a gradually progressive headache. Magnetic resonance imaging (MRI) demonstrated erosion of the ethmoid sinus, frontal lobe and orbit. The radical resection under frontal craniotomy was performed followed by post-operative radiotherapy. Six months after the surgery, the MRI examinations did not find any recurrence, and the patient currently lives symptom-free. The present study illustrates that frontal sinus cancer should be diagnosed early with caution. Total surgical resection followed by radiotherapy and chemotherapy, used singly or in combination, may result in favorable outcomes. The current study discusses the diagnosis, treatment and prognosis of the present case and reviews the associated literature to emphasize the importance of an early identification of this rare disease.

[Anatomic study on the design of far-lateral transcondylar transtubercular keyhole approach assisted by neuro-navigation].

OBJECTIVE: To design a new far-lateral transcondylar transtubercular keyhole approach assisted by neuro-navigation system according to the keyhole idea, and to explore the possibility of removing the occipital condyle and jugular tubercle precisely. METHODS: Navigation data were established on 8 cadaveric heads fixed by formalin and with their intracranial vessels perfused with colored silicone. Before the operation, circumscriptions of the occipital condyle and jugular tubercle were outlined with different colors in the navigation system in order to aid drilling them in operation. A 7 cm longitudinal "S" shaped skin incision was performed with its superior border 2 cm behind the middle point of mastoid and inferior margin at the level of C(2). After inverting the suboccipital muscles and exposing the far lateral part of the occipital bone, occipital condyle, hemilamina of C(1), vertebral artery and posterolateral portion of foramen magnum, a retro-condylar bone flap 3 cm in diameter was cut. Assisted by neuro-navigation, not only were the maximal angle of visual field measured before and after the 1/3 and 1/2 posteromedial occipital condyle removal respectively, but also the anatomic structures were observed and measured. RESULTS: The incision of the retro-condylar keyhole approach fully met the needs of the far-lateral transcondylar transtubercular keyhole approach; partial occipital condyle and jugular tubercle could be precisely drilled with the aid of neuro-navigation, thus avoiding the bewilder in drilling process; the maximal angles of visual field were 39.2 degrees +/- 3.29 degrees (before condyle drilled), 51.5 degrees +/- 2.45 degrees (1/3 condyle drilled) and 57.5 degrees +/- 2.66 degrees (1/2 condyle drilled) respectively, and there were significant difference among them (P < 0.01). CONCLUSION: It is feasible to perform the far-lateral trascondylar transtubercular keyhole approach; the maximal angle of visual field is obviously increased by drilling partial occipital condyle, and the middle clivus can be increasingly exposed through removal of jugular tubercle.