ABSTRACT
Metastatic spinal tumors are increasingly prevalent due to advancements in cancer treatment, leading to prolonged survival rates. This rising prevalence highlights the need for developing more effective therapeutic approaches to address this malignancy. Boron neutron capture therapy (BNCT) offers a promising solution by delivering targeted doses to tumors while minimizing damage to normal tissue. In this study, we evaluated the efficacy and safety of BNCT as a potential therapeutic option for spine metastases in mouse models induced by A549 human lung adenocarcinoma cells. The animal models were randomly allocated into three groups: untreated (n = 10), neutron irradiation only (n = 9), and BNCT (n = 10). Each mouse was administered 4-borono-L-phenylalanine (250 mg/kg) intravenously, followed by measurement of boron concentrations 2.5 h later. Overall survival, neurological function of the hindlimb, and any adverse events were assessed post irradiation. The tumor-to-normal spinal cord and blood boron concentration ratios were 3.6 and 2.9, respectively, with no significant difference observed between the normal and compressed spinal cord tissues. The BNCT group exhibited significantly prolonged survival rates compared with the other groups (vs. untreated, p = 0.0015; vs. neutron-only, p = 0.0104, log-rank test). Furthermore, the BNCT group demonstrated preserved neurological function relative to the other groups (vs. untreated, p = 0.0004; vs. neutron-only, p = 0.0051, multivariate analysis of variance). No adverse events were observed post irradiation. These findings indicate that BNCT holds promise as a novel treatment modality for metastatic spinal tumors.
Subject(s)
Boron Neutron Capture Therapy , Disease Models, Animal , Spinal Neoplasms , Boron Neutron Capture Therapy/methods , Animals , Mice , Humans , Spinal Neoplasms/radiotherapy , Spinal Neoplasms/secondary , Lung Neoplasms/radiotherapy , Lung Neoplasms/pathology , Phenylalanine/analogs & derivatives , Phenylalanine/therapeutic use , A549 Cells , Spinal Cord/radiation effects , Spinal Cord/pathology , Cell Line, Tumor , Boron/therapeutic use , FemaleABSTRACT
Objective: The double origin of the posterior inferior cerebellar artery (DOPICA) is a rare variant of PICA. Vertebral artery dissecting aneurysm (VADA) with DOPICA is an extremely rare occurrence. Herein, we report a case of VADA located between DOPICA that was successfully treated with endovascular internal trapping. Case Presentation: A 48-year-old male, found collapsed at his workplace, was admitted to our hospital for emergency medical assistance. Head CT revealed a subarachnoid hemorrhage (Fisher group 3), and cerebral angiography revealed right VADA with DOPICA. The VADA was located distal to the proximal component of the posterior inferior cerebellar artery (PCPICA) and just proximal to the hypoplastic distal component of PICA (DCPICA). Emergency endovascular internal trapping was performed using a total of 13 coils from the distal end of the VADA to just the distal of the branching point of PCPICA. VADA was not visualized, and antegrade flow through DOPICA to the basilar artery was confirmed. Head magnetic resonance angiography (MRA) showed antegrade flow via DOPICA, and the patient was discharged home on Day 46 with a modified Rankin Scale 0. Conclusion: Endovascular internal trapping for VADA with DOPICA was considered useful, especially when VADA is distal to PCPICA and proximal to DCPICA.
ABSTRACT
The azygos anterior cerebral artery (ACA) is a rare anatomical anomaly. Clipping surgery has been conducted in approximately 30 reported cases because it is frequently associated with aneurysms. However, few cases in which coil embolization was performed have been reported. We report three cases of coil embolization for distal ACA aneurysms with distal azygos ACA at our institution in 7 years. All patients were over 65-year-old women with saccular aneurysms larger than 7 mm; two with subarachnoid hemorrhage and one with an unruptured aneurysm. No patient had surgical complications associated with coil embolization. Coil embolization is also useful for large aneurysms in the distal azygos ACA, and its indication for treatment could be broadened.
Subject(s)
Anterior Cerebral Artery , Embolization, Therapeutic , Intracranial Aneurysm , Humans , Female , Embolization, Therapeutic/methods , Intracranial Aneurysm/therapy , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Aged , Anterior Cerebral Artery/surgery , Anterior Cerebral Artery/diagnostic imaging , Cerebral Angiography , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/surgery , Subarachnoid Hemorrhage/etiology , Treatment OutcomeABSTRACT
Airway complications that occur after anterior cervical spine surgery pose a life-threatening risk, which encompasses complications including prolonged intubation, unplanned reintubation, and/or necessity of tracheostomy. The present study aimed to identify the surgical risks associated with postoperative airway complications in neurosurgical training institutes. A retrospective, multicenter, observational review of data from 365 patients, who underwent anterior cervical spine surgery between 2018 and 2022, at three such institutes was carried out. Postoperative airway complication was defined as either the need for prolonged intubation on the day of surgery or the need for unplanned reintubation. The perioperative medical information was obtained from their medical records. The average age of the cohort was over 60 years, with males comprising approximately 70%. Almost all surgeries predominantly involved anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion, with most surgeries occurring at the level of C5/6. In total, 363 of 365 patients (99.5%) were extubated immediately after surgery, and the remaining two patients were kept under intubation because of the risk of airway complications. Of the 363 patients who underwent extubation immediately after surgery, two (0.55%) required reintubation because of postoperative airway complications. Patients who experienced airway complications were notably older and exhibited a significantly lower body mass index. The results of this study suggested that older and frailer individuals are at an elevated risk for postoperative airway complications, with immediate postoperative extubation generally being safe but requiring careful judgment in specific cases.
Subject(s)
Airway Management , Cervical Vertebrae , Postoperative Complications , Humans , Male , Retrospective Studies , Middle Aged , Cervical Vertebrae/surgery , Female , Postoperative Complications/etiology , Aged , Spinal Fusion/adverse effects , Adult , Neurosurgical Procedures/adverse effects , Intubation, Intratracheal/adverse effects , Diskectomy/adverse effects , Aged, 80 and overABSTRACT
Preoperative simulation images creates an accurate visualization of a surgical field. The anatomical relationship of the cranial nerves, arteries, brainstem, and related bony protrusions is important in skull base surgery. However, an operator's intention is unclear for a less experienced neurosurgeon. Three-dimensional(3D)fusion images of computed tomography and magnetic resonance imaging created using a workstation aids precise surgical planning and safety management. Since the simulation images allows to perform virtual surgery, a déjà vu effect for the surgeon can be obtained. Additionally, since 3D surgical images can be used for preoperative consideration and postoperative verification, discussion among the team members is effective from the perspective of surgical education for residents and medical students. Significance of preoperative simulation images will increase eventually.
Subject(s)
Skull Base Neoplasms , Skull Base , Humans , Skull Base/diagnostic imaging , Skull Base/surgery , Skull Base/pathology , Imaging, Three-Dimensional/methods , Skull Base Neoplasms/surgery , Tomography, X-Ray Computed/methods , Neurosurgical Procedures/methods , Magnetic Resonance Imaging/methodsABSTRACT
BACKGROUND: Preoperative embolization for meningiomas is controversial regarding its effectiveness in reducing intraoperative blood loss and operative time. In contrast, some reports have documented improved surgical outcomes in large meningiomas. In this study, we retrospectively compared the outcomes of craniotomy for meningiomas with/without preoperative embolization with diluted N-butyl-2-cyanoacrylate (NBCA) primarily in a single institution. METHODS: Data (World Health Organization grade, Simpson grade, maximum tumor diameter, intraoperative bleeding, operative time, history of hypertension, and time from embolization to craniotomy) of patients with initial intracranial meningiomas were compared with or without preoperative embolization from January 2015 to April 2022. RESULTS: The embolization group consisted of 56 patients and the nonembolization group included 76 patients. Diluted NBCA (13% concentration for all patients) was used in 51 of 56 patients (91.1%) who underwent transarterial embolization. Permanent neurological complications occurred in 2 (3.6%) patients. Intraoperative bleeding was significantly lower in the embolization group for a maximum tumor diameter ≥40â¯mm (155 vs. 305â¯ml, respectively, p < 0.01). In the nonembolization group, for a maximum tumor diameter ≥30â¯mm, patients with hypertension had more intraoperative bleeding than non-hypertensive ones. CONCLUSIONS: Despite its limitations, the present results showed that, under certain conditions, preoperative embolization for intracranial meningiomas caused less intraoperative bleeding. The safety of treatment was comparable with that reported in the Japan Registry of NeuroEndovascular Therapy 3 (JR-NET3) with a complication rate of 3.7% for preoperative embolization of meningiomas, despite the treatment focused on the liquid embolization material.
Subject(s)
Embolization, Therapeutic , Enbucrilate , Hypertension , Meningeal Neoplasms , Meningioma , Humans , Meningioma/diagnostic imaging , Meningioma/surgery , Enbucrilate/therapeutic use , Meningeal Neoplasms/surgery , Meningeal Neoplasms/pathology , Retrospective Studies , Treatment Outcome , Embolization, Therapeutic/methods , Hypertension/etiologyABSTRACT
AIM: To report mechanical thrombectomy (MT) for internal carotid artery (ICA) occlusion with cross-flow through the communicating artery ("with" group), and to compare it with ICA or middle cerebral artery occlusion without cross-flow ("without" group). MATERIAL AND METHODS: This study included 10 and 57 cases of the "with" and "without" groups, respectively. Cases analyzed by rapid processing of perfusion and diffusion (RAPID) since October 2020 were included. RESULTS: Puncture-to-reperfusion time was 78.5 and 39 min (p=0.0155), the National Institutes of Health Stroke Scale score at discharge was 10.5 and 4 (p=0.0166), decline from pre to post Diffusion-Weighted Image-Alberta Stroke Program Early computed tomography (CT) Score was 0.5 and 0 (p=0.0495), and the modified Rankin Scale score at 90 days was 4 and 2 (p=0.0195) in the "with" and "without" groups, respectively. Furthermore, Tmax values of > 6 s (50 cc vs. 164 cc; p=0.0277) and Tmax > 4 s/Tmax > 6 s ratio (3.23 vs. 1.55) (p=0.0074) were significantly different between the "with" and "without" groups. CONCLUSION: The "with" group may have been affected by the longer treatment time and being at high risk of distal migration of thrombus due to poor prognosis. Although the region with a Tmax of > 6 s tends to be small in patients of the "with" group, it indicates a low-perfusion state that can lead to cerebral infarction, and MT should be performed.
Subject(s)
Carotid Artery Diseases , Stroke , Thrombosis , Humans , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/surgery , Thrombectomy/methods , Cerebral Angiography/methods , Treatment Outcome , Stroke/diagnostic imaging , Stroke/etiology , Stroke/surgery , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/surgery , Retrospective StudiesABSTRACT
Background: In the cervical nerve sheath tumor (NST) surgery with dumbbell extension of Eden type 2 or 3, selection of anterior, posterior, or combined approach remains controversial. Objectives: This technical note aimed to propose possible advantages of the posterior unilateral approach (PUA). Methods: Six patients who underwent the surgical treatment of cervical NSTs with dumbbell extension of Eden type 2 or 3 were included. The critical surgical steps included (1) complete separation of extradural and intradural procedures, (2) careful peeling of the neural membranes (epineurium and perineurium) from the tumor surface in the extradural procedure, (3) complete removal of the extradural tumor within the neural membranes, (4) intradural disconnection of tumor origin, and (5) intentional tumor removal up to the vertebral artery (VA), i.e., the VA line. Results: The tumor location of dumbbell extension was Eden types 2 and 3 in two and four patients. Gross total resection was achieved in two patients and intentional posterior removal of the tumor to the VA line was achieved in the remaining four patients. No vascular or neural injuries associated with surgical procedures occurred. Postoperative neurological assessment revealed no symptomatic aggravation in all patients. No secondary surgery was performed during the study period. Conclusion: PUA was safe and less invasive for functional recovery and tumor resection, if the anatomical relationship between the tumor and VA is clearly understood. The VA line is an important anatomical landmark to limit the extent of tumor resection.