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Zhonghua Yi Xue Za Zhi Dec 2023To investigate the surgical efficacy of neurosurgery robot deep brain stimulation(DBS) in the treatment of elderly Parkinson's disease(PD). The clinical data of...
To investigate the surgical efficacy of neurosurgery robot deep brain stimulation(DBS) in the treatment of elderly Parkinson's disease(PD). The clinical data of elderly patients (≥75 years) with PD who underwent neurosurgical robot-assisted DBS surgery in the Department of Neurosurgery of the General Hospital of Northern Theater Command from September 2016 to September 2022 were collected retrospectively. Operation time, electrode implantation duration, postoperative pneumocephalus volume, electrode implantation accuracy, the Tao's DBS surgery scale, perioperative complications were analyzed.The unified Parkinson's disease rating scales (UPDRS), UPDRS-Ⅲ, tremor, rigidity, bradykinesia, axial, Barthel Activities of Daily Living (ADL-Barthel), Levodopa Equivalent Daily Dose (LEDD), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores and mortality were assessed respectively before operation, 6, 12 and 24 months after operation and last follow-up. A total of 25 elderly patients were enrolled, including 14 males and 11 females, aged(78.3±3.2) years. Nine patients had underlying diseases. Nine patients (36%) underwent bilateral Globus Pallidus pars Interna deep brain stimulation (GPi-DBS) and 16 patients (64%) underwent bilateral subthalamic nucleus deep brain stimulation (STN-DBS).The operation time was (1.56±0.19) hours, the electrode implantation duration was (1.01±0.19) hours, the pneumocephalus volume was 9.8(4.7, 23.3) cm, and the electrode implantation accuracy was (0.84±0.24) mm, the Tao's DBS surgery scale was (80.2±6.2).The follow-up time [(, )] was 57.3(27.9, 75.7) months. No serious complications such as intracranial hemorrhage, infection or poor wound healing occurred during the perioperative period. The improvement rate of UPDRS, UPDRS-Ⅲ, rigidity, bradykinesia, and LEDD at 6 months after surgery was significantly higher than that at 24 months after surgery and at the last follow-up (all <0.05); the improvement rate of axial symptoms, ADL-Barthel score, and MoCA score at 6 months after surgery was significantly higher than that at the last follow-up (<0.05). HAMD and HAMA scores showed no significant improvement during follow-up after surgery (both >0.05). At the last follow-up, 12 patients died, with death time of (35.1±20.2) months after operation, and the death age of [(, )] 80(79, 83)years. Robot-assisted DBS surgery for elderly patients with PD is accurate and safe, and the postoperative symptoms are significantly improved, and they can benefit from neuromodulation for long term, and the risks are controllable.
Topics: Aged; Male; Female; Humans; Parkinson Disease; Robotics; Retrospective Studies; Activities of Daily Living; Hypokinesia; Pneumocephalus; Treatment Outcome; Deep Brain Stimulation; Levodopa
PubMed: 38123222
DOI: 10.3760/cma.j.cn112137-20231006-00642 -
Journal of Neurosurgery. Case Lessons Dec 2023Epidermoid cyst tumors can arise as intradiploic tumors in the frontal skull bones around the fontanel in childhood but are mostly found at the frontal or frontotemporal...
BACKGROUND
Epidermoid cyst tumors can arise as intradiploic tumors in the frontal skull bones around the fontanel in childhood but are mostly found at the frontal or frontotemporal base of the brain or in the cerebellopontine angle. Therefore, finding a symptomatic intradiploic lesion in the convexity in late adulthood is uncommon. Intradiploic epidermoids can cause complications as they grow, by eroding and perforating their surroundings, and in cases of destruction of the wall of a pneumatized sinus, they can cause pneumocephalus.
OBSERVATIONS
In the present case, a female patient presented with a skull lesion that had grown progressively over 64 years, resulting in spontaneous pneumocephalus. Surgery with subsequent cranioplasty was performed. The histological examination confirmed the presence of an intradiploic epidermoid.
LESSONS
This case highlights that complete resection of the lesion with subsequent cranioplasty is recommended before symptoms and reconstructive challenges due to the enormous size of the defect. This case serves as a reminder that intradiploic epidermoids, although uncommon, will expand throughout life and can cause significant complications such as pneumocephalus after decades. Timely surgical interventions after diagnosis are recommended to prevent further complications and to achieve a successful outcome in terms of complete resection and reconstruction.
PubMed: 38109733
DOI: 10.3171/CASE23614 -
Otology & Neurotology : Official... Jan 2024
Topics: Humans; Pneumocephalus; Air Travel; Mastoid; Ear, Middle
PubMed: 38085769
DOI: 10.1097/MAO.0000000000004054 -
European Journal of Case Reports in... 2023A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental...
UNLABELLED
A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental status. There was placement of a ventriculoperitoneal shunt in 1970 complicated by meningitis, leading to removal of the material and ventriculociternostomy as definitive treatment in 2004. About one month previously, she had undergone a laparoscopic cholecystectomy complicated by an intra-abdominal collection. Clinical examination at the emergency department revealed a Glasgow score of 8 (E3 V1 M4). In the emergency department the patient presented a tonic-clonic seizure before a cerebral CT scan was performed showing a massive compressive pneumocephalus, then a second seizure. The patient was finally admitted to the neurosurgery department and underwent surgery.
LEARNING POINTS
Changes in mental status in a patient with a history of chronic hydrocephalus should alert clinicians to a possible complication.This case reflects the delayed diagnosis of a critically ill patient in the emergency department.
PubMed: 38077697
DOI: 10.12890/2023_004160 -
SA Journal of Radiology 2023Imaging evaluation of the brain and cranium after cranial surgery is a routine and significant part of the workflow of a radiology department. Various normal expected... (Review)
Review
UNLABELLED
Imaging evaluation of the brain and cranium after cranial surgery is a routine and significant part of the workflow of a radiology department. Various normal expected findings and early and late complications are associated with the post-operative cranium. In this pictorial review, the authors describe the typical imaging features of the spectrum of various conditions associated with cranial surgery with illustrative cases.
CONTRIBUTION
A good knowledge and understanding of the spectrum of imaging appearances in the post-operative cranium is vital for the radiologist to accurately diagnose potential complications and distinguish them from normal post-operative findings, improving patient outcomes and guiding further treatment.
PubMed: 38059119
DOI: 10.4102/sajr.v27i1.2684 -
IJID Regions Dec 2023Few cases of disease by have been reported, some in immunocompetent patients but mainly in immunocompromised. The current case report describes a 28-year-old female...
Few cases of disease by have been reported, some in immunocompetent patients but mainly in immunocompromised. The current case report describes a 28-year-old female with an initial diagnosis of pituitary macroadenoma. After the initial surgery, the patient was readmitted due to tension pneumocephalus and cerebrospinal fluid (CSF) fistula. Cultures showed in the CSF and Candida albicans in the urine. The patient died after multiple complications. This is the first case of neuroinfection by in the American continent as reviewed. It was not determined as the main cause of death due to the sudden herniation, however, with active infection derived from the identification in two different samples, for this reason, we consider that it could be useful to take it as a cause of disease and a probable cause when the studies for detection of the most common pathogens have been negative.
PubMed: 38020184
DOI: 10.1016/j.ijregi.2023.10.006 -
Neurocritical Care Jun 2024Intracranial multimodal monitoring (iMMM) is increasingly used for neurocritical care. However, concerns arise regarding iMMM invasiveness considering limited evidence... (Meta-Analysis)
Meta-Analysis Review
Intracranial multimodal monitoring (iMMM) is increasingly used for neurocritical care. However, concerns arise regarding iMMM invasiveness considering limited evidence in its clinical significance and safety profile. We conducted a synthesis of evidence regarding complications associated with iMMM to delineate its safety profile. We performed a systematic review and meta-analysis (PROSPERO Registration Number: CRD42021225951) according to the Preferred Reporting Items for Systematic Review and Meta-Analysis and Peer Review of Electronic Search Strategies guidelines to retrieve evidence from studies reporting iMMM use in humans that mention related complications. We assessed risk of bias using the Newcastle-Ottawa Scale and funnel plots. The primary outcomes were iMMM complications. The secondary outcomes were putative risk factors. Of the 366 screened articles, 60 met the initial criteria and were further assessed by full-text reading. We included 22 studies involving 1206 patients and 1434 iMMM placements. Most investigators used a bolt system (85.9%) and a three-lumen device (68.8%), mainly inserting iMMM into the most injured hemisphere (77.9%). A total of 54 postoperative intracranial hemorrhages (pooled rate of 4%; 95% confidence interval [CI] 0-10%; I 86%, p < 0.01 [random-effects model]) was reported, along with 46 misplacements (pooled rate of 6%; 95% CI 1-12%; I 78%, p < 0.01) and 16 central nervous system infections (pooled rate of 0.43%; 95% CI 0-2%; I 64%, p < 0.01). We found 6 system breakings, 18 intracranial bone fragments, and 5 cases of pneumocephalus. Currently, iMMM systems present a similar safety profile as intracranial devices commonly used in neurocritical care. Long-term outcomes of prospective studies will complete the benefit-risk assessment of iMMM in neurocritical care. Consensus-based reporting guidelines on iMMM use are needed to bolster future collaborative efforts.
Topics: Humans; Critical Care; Neurophysiological Monitoring; Intracranial Hemorrhages; Postoperative Complications
PubMed: 37991675
DOI: 10.1007/s12028-023-01885-0 -
Medicine Nov 2023We report on a 45-year-old woman who has a ventriculoperitoneal shunt (VPS), experienced drowsy mental status, with hypesthesia and hemiplegia on the left side. Ten days... (Review)
Review
INTRODUCTION AND PATIENT CONCERNS
We report on a 45-year-old woman who has a ventriculoperitoneal shunt (VPS), experienced drowsy mental status, with hypesthesia and hemiplegia on the left side. Ten days ago she underwent laparoscopic cholecystectomy (LC). Computed tomography revealed tension pneumocephalus, with severe compression on the right side of the brain.
INTERVENTIONS AND DIAGNOSIS
She underwent 2 surgeries, the first surgery was to place a subdural drainage catheter, however, the pneumocephalus relapsed after withdrawing the catheter, and the later surgery was to replace the new VPS.
OUTCOMES
After replacing the VPS, the patient recovers completely after 10 weeks of follow-up.
CONCLUSION
To our knowledge, this is the first report of LC-induced tension pneumocephalus in a patient with VPS. The purpose of this study is to share our experience, with the hypothesized mechanism being the retrograde air through the VPS valve because of high abdominal pressurization. We recommend noting the existence of the VPS when the LC or any abdominal laparoscopy is performed. The VPS should be clamped during any laparoscopic procedure until complete depressurization. Furthermore, all patients with VPS who have neurological deterioration after abdominal laparoscopy should be treated as having the diagnosis of a tension pneumocephalus. These patients need emergency surgery to replace VPS and set the valve for high-pressure, which can result in a quick and complete recovery.
Topics: Female; Humans; Middle Aged; Cholecystectomy, Laparoscopic; Head; Hydrocephalus; Laparoscopy; Pneumocephalus; Ventriculoperitoneal Shunt
PubMed: 37960800
DOI: 10.1097/MD.0000000000035967 -
Magnetic Resonance in Medical Sciences... Nov 2023Postsurgery intracranial air usually diminishes, presumably merging with cerebrospinal fluid (CSF) and venous circulation. Our study presents two transsphenoidal surgery...
Postsurgery intracranial air usually diminishes, presumably merging with cerebrospinal fluid (CSF) and venous circulation. Our study presents two transsphenoidal surgery cases, highlighting potential air absorption by arachnoid granulation (AG)-an underexplored phenomenon. AG has long been deemed pivotal for CSF absorption, but recent perspectives suggest a significant role in waste clearance, neuroinflammation, and neuroimmunity. These cases may stimulate renewed research on the multifaceted role of AG in neurofluid dynamics and potentially elucidate further AG functions.
PubMed: 37952943
DOI: 10.2463/mrms.bc.2023-0122 -
Orbit (Amsterdam, Netherlands) Nov 2023To review the literature on the location of the anterior ethmoidal foramen (AEF) and trauma during transconjunctival medial wall decompression. (Review)
Review
PURPOSE
To review the literature on the location of the anterior ethmoidal foramen (AEF) and trauma during transconjunctival medial wall decompression.
METHODS
A comprehensive literature search was conducted using the PubMed, Embase, and Scopus databases, combining the terms "olfactory fossa" and "fovea ethmoidalis" with "trauma," "cerebrospinal fluid leak," "pneumocephalus," "orbital decompression," and "anterior ethmoidal artery" (AEA). All cases of cranial base trauma during medial orbital decompression and the anatomical studies on the location of the AEF and the course of the AEA were reviewed.
RESULTS
Ninety-four articles were identified, of which 37 were related to the AEF, 41 reported the course of the AEA, and 16 to reported cases of cranial base trauma. Out of these cases, 10 were related to transconjunctival medial orbital decompression, affecting 11 patients. Most AEFs are situated at the frontoethmoidal suture, but up to 38.15% of AEFs are located above the suture on the frontal bone. Most AEFs are adjacent to the roof of the ethmoidal sinus. The distance of the AEF to the cranial base increases in the presence of supraorbital ethmoidal cells (SOEC).
CONCLUSIONS
The position of the AEF is variable and should not be considered a safe landmark for all patients.
PubMed: 37942625
DOI: 10.1080/01676830.2023.2274866