Giant Ganglioneuroma of the Lumbar Spine: A Rare Cause of Radiculopathy.

Background: Ganglioneuroma (GN) is a rare, benign tumor that originates from neural crest cells and can potentially affect any anatomical site within the sympathetic nervous system. Typically, GNs are more frequently reported in children and young adults, with a slightly higher prevalence in females. We are reporting a rare case of a giant lumbar spine ganglioneuroma by outlining the clinical presentation, radiological finding, management, and outcome. Case Description. A 37-year-old female presented with low back pain radiating to the right lower limb for few years. Neurological examination revealed bilateral lower limb hyperreflexia (+3). Lumbar spine CT and MRI revealed a right paravertebral soft tissue lesion with heterogeneous signal intensity and enhancement at L1 to L3. The patient underwent complete resection of the lesion via a retroperitoneal approach. The surgery was uneventful. The histopathological sections were suggestive of mature ganglioneuroma. She was discharged in stable condition with follow-up at neurosurgery clinic. Conclusion: Giant ganglioneuromas are rare, benign tumors of sympathetic neurons. Complete surgical resection is the most effective therapeutic option for ganglioneuroma to avoid recurrence. Given the benign nature of ganglioneuroma, chemotherapy and radiotherapy tend to have a limited role following surgical resection.

Surgical resection of pericallosal tuberculoma through contralateral approach: A case report.

Background: Pericallosal tuberculoma, a rare form of intracranial tuberculoma, affects the corpus callosum and results from tuberculosis (TB), a bacterial infection that can cause a myriad of symptoms. Diagnosing this condition can be challenging but can be confirmed through imaging studies and biopsy. Treatment involves a combination of antitubercular medications and surgical removal of the lesion if it is in a critical location or causing significant symptoms. This article describes the surgical management and imaging characteristics approach to a patient with intracranial tuberculoma. Case Description: A 17-year-old female with a history of TB meningitis nine years ago presented with one week of recurrent seizures and mild third nerve palsy, later diagnosed as a tuberculoma of the corpus callosum through radiological imaging and biopsies. A total surgical resection of the lesion was performed using a contralateral interhemispheric frontal parasagittal approach. The patient went under observation and suitable follow-up plans. Conclusion: Surgical management can effectively treat cerebral granulomas and improve neurological deficits in patients with recurring TB. Despite the possibility of complications, the benefits of such measures are highlighted in this case, suggesting that surgical intervention can be a viable option for achieving optimal outcomes in these patients.

Methods of Hemostasis in Cranial Neurosurgery: An Anatomy-Based Stepwise Review.

BACKGROUND: Hemostasis is crucial in preventing hemorrhage during cranial neurosurgical procedures and maintaining visualization of the surgical field. There is significant variation in the availability of hemostatic methods across different settings and hemostatic techniques are being continuously developed over the decades of practicing neurosurgery. The aim of this article is to provide an outline of the potential methods to achieve hemostasis based on the sequential operative anatomy of a cranial operation. METHODS: A systematic review was conducted following the PRISMA guidelines. The PubMed database was searched from inception of the database to July 18, 2023. A total of 64 studies were identified fulfilling predefined inclusion criteria, and the risk of bias was assessed using the Joanna Briggs Institute checklists. RESULTS: Seventy-one hemostatic agents, techniques, tools, and devices were identified, which were then categorized according to the operative phase for which they are indicated. Nine operative anatomic targets were addressed in the sequence in which they are involved during a cranial procedure. For each anatomic target, the following number of hemostatic techniques/agents were identified: 11 for scalp, 3 for periosteum, 10 for skull bone, 11 for dura mater, 9 for venous sinuses, 5 for arteries, 6 for veins, 12 for brain parenchyma, and 4 for cerebral ventricles. CONCLUSIONS: Depending on the phase of the surgery and the anatomic structure involved, the selection of the appropriate hemostatic method is determined by the source of bleeding. Surgeon awareness of all the potential techniques that can be applied to achieve hemostasis is paramount, especially when faced with operative nuances and difficult-to-control bleeding during cranial neurosurgical procedures.

Risk Factors for Mortality in Patients With Cerebral Palsy: A Systematic Review and Meta-Analysis.

Cerebral palsy (CP) is a developmental and physical disorder with different degrees of severity. Since CP manifests itself in early childhood, numerous research studies have concentrated on children with CP. Patients with CP encounter different severity of motor impairments attributed to the damage or disturbance to the fetal or infant developing brain, which begins in early childhood and persists through adulthood. Patients with CP are more prone to mortality compared to the general population. This systematic review and meta-analysis aimed to assess the risk factors that predict and influence mortality in patients with CP. Systematic search for studies assessing the risk factors for mortality in CP patients that were conducted from 2000 to 2023 in Google Scholar, PubMed, and Cochrane Library was performed. R-One Group Proportion was used for statistical analysis and Newcastle-Ottawa Quality Assessment Scale (NOS) for quality appraisal. Of the 1791 total database searches, nine studies were included. Based on the NOS tool for quality appraisal, seven studies were of moderate quality, and two studies were rated as of high quality. The risk factors included pneumonia and other respiratory infections, neurological disorders, circulatory diseases, gastrointestinal infections, and accidents. Pneumonia (OR = 0.40, 95% CI = 0.31 - 0.51), neurological disorders (OR = 0.11, 95% CI = 0.08 - 0.16), respiratory infections (OR = 0.36, 95% CI = 0.31 - 0.51), cardiovascular and circulatory diseases (OR = 0.11, 95% CI = 0.04 - 0.27), gastrointestinal and metabolic causes (OR = 0.12, 95% CI = 0.06 - 0.22), and accidents (OR = 0.05, 95% CI = 0.04 - 0.07) were the risk factors assessed. It was concluded that multiple factors predict the risk of mortality in patients with CP. Pneumonia and other respiratory infections are associated with a high risk of mortality. Cardiovascular and circulatory diseases, gastrointestinal and metabolic disorders, and accidents are strongly linked to mortality in CP patients.

Intramuscular Versus Intravenous Treatment of Status Epilepticus: A Systematic Review.

Status epilepticus is a neurological emergency associated with high morbidity and mortality with fatal outcomes if not treated well. The goal of this study was to compare the intramuscular and intravenous treatment of individuals with status epilepticus. A search was performed on Scopus, PubMed, Embase, and Web of Science databases for articles published in the English language in peer-reviewed publications up to March 1, 2023. Studies were included if the treatment of status epileptics was compared either directly or indirectly between intramuscular and intravenous methods. In addition, relevant papers were manually screened for in the reference lists of the included studies. Non-duplicate articles were identified. Finally, five articles were included in the analysis, of which four were randomized controlled trials and one was a retrospective cohort study. The intramuscular midazolam group's time until the first seizure stopped was significantly shorter than the intravenous diazepam group's time (7.8 versus 11.2 minutes, respectively; p = 0.047). Moreover, the percentage of patients admitted was significantly lower in the intramuscular group than in the intravenous group (p = 0.01), but the lengths of stay in the intensive care unit and the hospital did not differ significantly between the groups. Regarding seizure recurrence, the intramuscular group had fewer incidences of recurrent seizures. Finally, there were no appreciable differences in safety outcomes between the two treatment arms. During the analysis, different outcomes reported after the use of intramuscular and intravenous treatments in managing patients with status epilepticus were categorized. This categorization led to a clear view of the efficacy and safety of intramuscular versus intravenous treatments in managing status epilepticus patients. The information at hand indicates that intramuscular therapy is just as successful as intravenous therapy in treating people with status epilepticus. The availability, adverse effect profile, logistics of administration, cost, and whether it is included in hospital formularies are some of the factors to be taken into consideration when choosing the drug administration technique.

Regional and seasonal variations in functional abdominal pain and functional constipation prevalence among Saudi children.

Objectives: This study aimed to evaluate functional abdominal pain disorders and functional constipation prevalence in the central region of Saudi Arabia, and compare it to that of the western region. Methods: This was a cross-sectional study using online questionnaires targeting the general population of Riyadh region of Saudi Arabia. Subjects were randomly selected by sharing links on social media groups. Any parent with a 3-18-year-old child was included, and children with chronic medical illnesses or symptoms of organic GI disorders were excluded. Results: Three hundred nineteen subjects were included in the final analysis; the prevalence of functional abdominal pain disorders overall was 6.2% and the prevalence of functional constipation was 8.1%. Conclusions: Functional constipation diagnosis seems to be affected by life stressors or a previous viral illness. Seasonal variations had minimal effect on functional abdominal pain disorder and functional constipation symptom frequency and severity.

Outcome measures in neurosurgery: Is a unified approach better? A literature review.

Background: Accurate assessment and evaluation of health interventions are crucial to evidence-based care. The use of outcome measures in neurosurgery grew with the introduction of the Glasgow Coma Scale. Since then, various outcome measures have appeared, some of which are disease-specific and others more generally. This article aims to address the most widely used outcome measures in three major neurosurgery subspecialties, "vascular, traumatic, and oncologic," focusing on the potential, advantages, and drawbacks of a unified approach to these outcome measures. Methods: A literature review search was conducted by using PubMed MEDLINE and Google scholar Databases. Data for the three most common outcome measures, The Modified Rankin Scale (mRS), The Glasgow Outcome Scale (GOS), and The Karnofsky Performance Scale (KPS), were extracted and analyzed. Results: The original objective of establishing a standardized, common language for the accurate categorization, quantification, and evaluation of patients' outcomes has been eroded. The KPS, in particular, may provide a common ground for initiating a unified approach to outcome measures. With clinical testing and modification, it may offer a simple, internationally standardized approach to outcome measures in neurosurgery and elsewhere. Based on our analysis, Karnofsky's Performance Scale may provide a basis of reaching a unified global outcome measure. Conclusion: Outcome measures in neurosurgery, including mRS, GOS, and KPS, are widely utilized assessment tools for patients' outcomes in various neurosurgical specialties. A unified global measure may offer solutions with ease of use and application; however, there are limitations.

Cardiovascular complications and outcomes among athletes with COVID-19 disease: a systematic review.

BACKGROUND: Current evidence still emerging regarding the risk of cardiovascular (CV) sequel associated with coronavirus disease 2019 (COVID-19) infection, and considerable replicated studies are needed to ensure safe return-to-play. Therefore, we aimed in this systematic review to measure the prevalence of CV complications suffered by COVID-19 athletic patients, explore the outcomes, optimal approaches to diagnoses, and safe return-to-play considerations. METHODS: A systematic search on post COVID-19 infection quantitative studies among athletes was conducted following MeSH terms in Medline, Cochrane Library, Ovid, Embase and Scopus (through 15 January 2022). We included peer-reviewed studies reported athletes' CV complications and the outcomes post COVID-19 infection. Editorials, letters, commentaries, and clinical guidelines, as well as duplicate studies were excluded. Studies involving non-athletic patients were also excluded. Quality assessment was performed using Newcastle-Ottawa Scale. RESULTS: We included 15 eligible articles with a total of 6229 athletes, of whom 1023 were elite or professional athletes. The prevalence of myocarditis ranged between 0.4% and 15.4%, pericarditis 0.06% and 2.2%, and pericardial effusion between 0.27% and 58%. Five studies reported elevated troponin levels (0.9-6.9%). CONCLUSIONS: This study provides a low prevalence of CV complications secondary to COVID-19 infection in short-term follow-up. Early recognition and continuous assessment of cardiac abnormality in competitive athletes are imperative to prevent cardiac complications. Establishing a stepwise evaluation approach is critical with an emphasis on imaging techniques for proper diagnosis and risk assessment for a safe return to play.