Delayed brain reexpansion in schizophrenic patient affected by trabecular type chronic subdural hematoma

Background: Chronic subdural hematoma (cSDH) represents a complex and unpredictable disease, characterized by high morbidity and mortality, especially in elderly patients. Factors affecting the postoperative brain reexpansion along to cSDH recurrence have not been yet adequately investigated. The authors presented the case of a schizophrenic patient affected by trabecular type cSDH that presented a delayed brain reexpansion despite a craniotomy and membranotomy. Case Description: A 51-year-old female patient with diagnosis of schizophrenia was admitted to the emergency department with GCS score of 5/15 and right anisocoria. An urgent brain CT revealed a trabecular right cSDH (35 mm in maxi…

Letter to the Editor Regarding “First Report of Extraspinal Lead Migration Along a Thoracic Spinal Nerve After Spinal Cord Stimulation”

Largest neurosurgical social media group and its impact on communication and research

Item does not contain fulltext BACKGROUND: The use of social media to communicate and disseminate knowledge has increased exponentially, especially in the field of neurosurgery. 'Neurosurgery cocktail' (NC) was developed by a group of young neurosurgeons as a means of sharing didactic materials and clinical experiences via social media. It connects 35.000 neurosurgeons worldwide on multiple platforms, primarily Facebook and Twitter. Given the rising utilization of social media in neurosurgery, the popularity of NC has also increased since its inception. In this study, the authors surveyed the social media analytics of NC for both Facebook and Twitter. Besides, we reviewed the literature on …

Multimodal Simulation of a Novel Device for a Safe and Effective External Ventricular Drain Placement

BackgroundExternal ventricular drain (EVD) placement is mandatory for several pathologies. The misplacement rate of the EVD varies widely in literature, ranging from 12.3 to 60%. The purpose of this simulation study is to provide preliminary data about the possibility of increasing the safety of one of the most common life-saving procedures in neurosurgery by testing a new device for EVD placement.MethodsWe used a novel guide for positioning the ventricular catheter (patent RM2014A000376). The trajectory was assessed using 25 anonymized head CT scans. The data sets were used to conduct three-dimensional computer-based and combined navigation and augmented reality-based simulations using pla…

Acrometastases to the Hand: A Systematic Review

Background and Objectives: The term acrometastases (AM) refers to secondary lesions sited distally to the elbow and knee, representing 0.1% of all bony metastases. By frequency, pulmonary cancer and gastrointestinal and genitourinary tract neoplasms are the most responsible for the reported AM. Improvements in oncologic patient care favor an increase in the incidence of such rare cases. We performed a systematic review of acrometastases to the hand to provide further insight into the management of these fragile patients. We also present a peculiar case of simultaneous acrometastasis to the ring finger and pathological vertebral fracture. Material and Methods: A literature search according t…

Neuroendoscopic Navigated One-Step Removal of Crossed Ventricular Catheter Fragments: Technical Note

Abstract Introduction Neuroendoscopy plays an important role in minimally invasive neurosurgery. The authors reported an interesting case of a pediatric patient with multiple ventriculoperitoneal shunt (VPS) revision surgeries, presenting with VPS infection and with two crossed intraventricular floating catheter fragments, successfully removed through a neuroendoscopic navigated one-step procedure. A literature review regarding this exceedingly rare condition has also been discussed. Case Description An 11-year-old female patient with a history of congenital hydrocephalus was admitted to the emergency department with symptoms of intracranial hypertension, psychomotor agitation, and tetrapar…

Primary Extracranial Meningiomas of the Head and Neck

Meningiomas represent the most common benign histological tumor of the central nervous system. Usually, meningiomas are intracranial, showing a typical dural tail sign on brain MRI with Gadolinium, but occasionally they can infiltrate the skull or be sited extracranially. We present a systematic review of the literature on extracranial meningiomas of the head and neck, along with an emblematic case of primary extracranial meningioma (PEM), which provides further insights into PEM management. A literature search according to the PRISMA statement was conducted from 1979 to June 2021 using PubMed, Web of Science, Google Scholar, and Scopus databases, searching for relevant Mesh terms (primary …

All that glitters is not gold: A spinal epidural empyema following epidural steroid injection

Background: Therapeutic epidural spinal injections (ESIs) of steroids are one of the most common nonsurgical management modalities employed for alleviating pain due to chronic persistent lumbar spinal disease. However, it is well documented that they have significant risks and complications without any long-term efficacy. ESI may result in epidural empyema which may be difficult to diagnose with delays resulting in significant permanent neurological sequelae. Case Description: A 45-year-old female presented with a lumbar spinal epidural empyema after receiving ESI for low back and right leg pain due to a lumbar disc herniation. Laboratory studies showed elevations of multiple inflammatory …

Dural splitting reconstruction in retethering after lipomeningocele repair: Technical note

Background: Tethered spinal cord syndrome (TCS) can occur after the surgical repair of lipomeningoceles (LMCs). In these cases, the tethering results from postoperative adhesions between the spinal cord and the overlying repaired dura. A watertight dural closure using the residual dura and/or the surrounding tissues does not always provide enough space for the spinal cord and risks retethering. Here, we report a 16-year-old patient with secondary TCS following lipomeningocele repair who successfully underwent release of the tethered filum terminale utilizing a novel dural splitting reconstructive technique to attain a water-tight closure without the need for a duroplasty. Methods: A 16-yea…

Thoracic dumbbell spinal chordoma mimicking a schwannoma

Background: Epidural dumbbell-shaped chordomas are localized slow growing, and malignant/aggressive neoplasms. Here, we present a 62-year-old male with a T3-T4 dumbbell-shaped chordoma and reviewed the appropriate literature. Case Description: A 62-year-old male presented with a three-month history of thoracic pain. When the thoracolumbar magnetic resonance (MR) showed a T3-T4 dumbbell-shaped intracanalicular/extradural tumor, he underwent tumor removal. After the histological examination proved the lesion was a spinal chordoma, he underwent a secondary radical transthoracic tumor resection. Postoperatively, the patient was able to walk without assistance, and at 6-month follow-up, was neu…

Diamond-Shaped Mini-Craniotomy: A New Concept in Neurosurgery

Abstract Background We describe, step by step, a modified, less invasive, diamond-shaped mini-craniotomy that optimizes dural opening and can be performed in elderly patients affected by acute subdural or intracerebral hematomas, in therapy with antiplatelets or anticoagulants. Methods We retrospectively analyzed the clinical records of 67 patients (mean age of 78.5 years) treated in our institution, during a period of 10 years, with this novel diamond-shaped craniotomy. Seventeen patients were treated for intracerebral hemorrhage and 50 patients for acute subdural hematomas. All the patients were in therapy with antiplatelets or anticoagulants. Results Approach-related complications were n…

Repair of a spinal pseudomeningocele in a delayed postsurgical cerebrospinal fluid leak using titanium U-clips: Technical note

Abstract Introduction Chronic cerebrospinal fluid leak (CCFL) represents a possible event following spine surgery, with an incidence rate ranging from 5 to 18%. In literature have been reported few modification techniques that involved the use of titanium U-clips with the aim to reduce dural traumatism during its closure but only after non-accidental durotomy. Case illustration We report the case of a 47-year-old female with history of L5-S1 microsurgical discectomy. After one year the patient was admitted to our unit because she presented progressive skin swelling in the lumbar region, intermittent headache and recurrent episodes of lipothymia. One-year MRI showed a voluminous subcutaneous…

Pediatric Trigeminal Schwannoma: From a “Minimally Invasive” to a Combined Endovascular and Surgical Management

Traumatic lumbar disc extrusion mimicking spinal epidural hematoma: Case report and literature review

Background: Because the neurological presentation of spinal epidural hematomas (SEH) is often not specific, they may be misdiagnosed as acute lumbar disk herniations. Here, we present a case in which a traumatic disc extrusion mimicked an epidural hematoma and reviewed the appropriate literature. Case Description: A 27-year-old male sustained a high-energy fall. The lumbar MRI scan showed a L4-S1 ventral medium/high signal intensity mass on the T1- and high signal intensity lesion on T2-weighted images; the original diagnosis was spinal epidural hematoma. However, at surgery, consisting of a left L4 and L5 hemilaminectomy with L4-L5 and L5-S1 laminotomy, an extruded lumbar disc was encount…

The triad hsp60-mirnas-extracellular vesicles in brain tumors: Assessing its components for understanding tumorigenesis and monitoring patients

Brain tumors have a poor prognosis and progress must be made for developing efficacious treatments, but for this to occur their biology and interaction with the host must be elucidated beyond current knowledge. What has been learned from other tumors may be applied to study brain tumors, for example, the role of Hsp60, miRNAs, and extracellular vesicles (EVs) in the mechanisms of cell proliferation and dissemination, and resistance to immune attack and anticancer drugs. It has been established that Hsp60 increases in cancer cells, in which it occurs not only in the mitochondria but also in the cytosol and plasma-cell membrane and it is released in EVs into the extracellular space and in cir…

Spontaneous anterior cervicothoracic spinal epidural hematoma extending to clivus in SARS-CoV-2 infection

Background: The treatment of spontaneous spinal epidural hematomas (SSEHs), depending on the lesion size and myeloradicular involvement, can be surgical or conservative. Here, we present a 55-year-old patient who sustained a SSEH several months following a systemic SARS-CoV-2 infection. Case Description: A 55-year-old immunocompromised female (i.e., history 17 years ago of Hodgkin’s lymphoma, nodular sclerosis variant) recently developed a SARS-CoV-2 infection treated with nonsteroidal anti-inflammatory agents. She then reported the sudden onset of cervicodorsalgia after a slight cervical flexion/extension maneuver. The brain and cervicothoracic spine MRI studies documented a clival anteri…

Women in Neurosurgery: From a Matter of Fortuitous Occasions Toward a Conscious Choice.

Background Medicine has made progress toward gender equality and has achieved almost equal distribution between men and women among graduates. However, more still needs to be done because most surgical subspecialties are still lacking adequate female representation and this persisting gender gap is particularly evident in both practical neurosurgery and the academic world. Gradual advancements have enabled a few women to pursue a successful career in neurologic surgery, pairing clinical practice with mentoring and involvement in academic research. These efforts show that more needs to be done to bridge the historic and current gap, which has recently aroused increasing interest among the ne…

Navigated Transcranial Magnetic Stimulation Motor Mapping Usefulness in the Surgical Management of Patients Affected by Brain Tumors in Eloquent Areas: A Systematic Review and Meta-Analysis

Background: The surgical strategy for brain glioma has changed, shifting from tumor debulking to a more careful tumor dissection with the aim of a gross-total resection, extended beyond the contrast-enhancement MRI, including the hyperintensity on FLAIR MR images and defined as supratotal resection. It is possible to pursue this goal thanks to the refinement of several technological tools for pre and intraoperative planning including intraoperative neurophysiological monitoring (IONM), cortico-subcortical mapping, functional MRI (fMRI), navigated transcranial magnetic stimulation (nTMS), intraoperative CT or MRI (iCT, iMR), and intraoperative contrast-enhanced ultrasound. This systematic re…

A new tool to improve pedicle screw placement accuracy in navigated spine surgery: A monocentric study

Objective Navigated instrumented spine surgery is burden by a low but significant screw mispositioning risks, respectively, for the 2D imaging system from 15 to 40% and, for the 3D imaging system, ranging from 4.1 to 11.5%. The primary objective of this study was to demonstrate the efficacy of a new "screw-like" tool in order to further decrease pedicle screws mispositioning rate during vertebral navigated spine surgery. Materials and methods Between January and June 2019 an initial case series of 18 patients were enrolled. All patients underwent a pedicle screw fixation, both in thoracic (Th10-Th12) and lumbosacral (L1-S1) spine, using O-arm (Medtronic Navigation, Louisville, Colorado) and…

In Reply to the Letter to the Editor Regarding “Females in Neurosurgery: from a Matter of Fortuitous Occasions Towards a Conscious Choice”

The role of hemostatic devices in neurosurgery. A systematic review.

Hemostasis represents a fundamental step in every surgical procedure. During neurosurgical procedures, proper and robust hemostasis into confined spaces can significantly reduce the odds of perioperative complications. Over the decades, multiple methods have been applied, and several medical devices have been developed to promote and guarantee proper hemostasis. This study presents a systematic review of the most used intraoperative hemostatic methods and devices in neurosurgery. Insightful research was performed on the PubMed database according to the PRISMA guidelines. This comprehensive review of scientific literature represents a synoptic panel where the most used intraoperative hemosta…

Spinal epidural abscess due to acute pyelonephritis

Background: Spinal epidural abscesses are rare and are misdiagnosed in up to 75% of cases. Fever, back pain, and neurological deficits are part of the classical triad. Here, the authors report a patient with a L2–L5 spinal epidural abscess with the left paravertebral extension attributed to acute pyelonephritis. Case Description: A 54-year-old female presented with persistent low back pain and lower extremity weakness accompanied by paresthesias. Previously, she had been hospitalized with the left acute pyelonephritis. The lumbosacral MRI documented a T12/L5 anterior epidural abscess with ring enhancement on the contrast study; the maximum diameter of the abscess at the L2–L3 level contrib…

Letter to the Editor Regarding “Central Neurocytoma: Rare Presentation in Fourth Ventricle and Review of Literature”

Surgical Back Risk Syndrome and Spinal Cord Stimulation: Better Safe Than Sorry.

Background Recurrent and chronic low back pain, caused by degenerative lumbar spondylosis, commonly affects elderly patients, even those with no previous low back surgery. These patients, like those affected by failed back surgery syndrome (FBSS), may become unresponsive to medical conservative treatment and their quality of life could be easily compromised. Moreover, general comorbidities, obesity, and other typical conditions of the elderly may make surgery under general anesthesia riskier than the natural history of the disease. These patients could be considered affected by surgical back risk syndrome (SBRS). Methods In this article, we report our preliminary observational prospective s…

Primary spinal Burkitt’s lymphoma: Case report and literature review

Background:Burkitt’s lymphoma is a non-Hodgkin B-cell lymphoma, occurring mostly in Equatorial Africa. According to the WHO, classification is three different variants: sporadic, endemic, and immunodeficient-associated. Here, we present a patient with “sporadic” primary epidural Burkitt’s lymphoma resulting in chronic low back pain (LBP).Case Description:A 63-year-old female presented with a 2-month history of LBP and the left lower extremity sciatica. The thoracolumbar MRI showed a L5 irregular, osteolytic epidural lesion that was hypointense on T1-weighted images, hyperintense on STIR studies, and inhomogeneously enhanced with contrast. Additional hypointense lesions were also seen at the…

Thoracic spinal extradural arachnoid cyst: A case report and literature review

Background: Spinal extradural arachnoid cysts (SEDACs) are rare and are variously attributed to congenital, traumatic, or inflammatory etiologies. Here, we report a 70-year-old male who presented with a T11-T12 SEDAC and an incidental craniovertebral junction (CVJ) meningioma. Case Description: A 70-year-old male presented with progressive bilateral lower limb weakness and paresthesias. The thoracic MRI identified an extradural arachnoid cystic lesion at the T11-T12 level. In addition, the brain/ cervical MR documented an incidental meningioma at the CVJ. The patient underwent T11-T12 laminectomy for fenestration/removal of the extradural arachnoid cyst resulting in immediate cord decompre…

Letter: Image-Guided Navigation and Robotics in Spine Surgery.

The Boundless World of Cranioplasty: A Multicenter Retrospective Study and Therapeutic Flow-Chart Patient-Specific Based.

Background Cranioplasty is both a functional and aesthetical therapeutic option. In the clinical scenario every cranioplasty's material is potentially qualified to achieve the goal of calvarian reconstruction but there is a lack of agreement about the optimum choice, especially between the heterologous ones. The choice of cranioplasty widely depends on surgeon's personal preferences. In this retrospective multicentric study a comparative analysis of hydroxyapatite or titanium cranioplasties was carried on analyzing the main factors considered by the surgeon to choose a material rather than another one. Our results and data were compared with those reported in the scientific literature and a…

Neurosurgical post-operative complications with incidental life-saving findings

Abstract Neurosurgery is one of the most complex disciplines, requiring skillfulness and ability to try to cure nervous pathologies. Despite the role of this surgery in the inviolability of life, complications are relatively likely. Complications are frustrating and they contribute to produce a wrong but physiologic guilty conscience. However, sometimes they can have a sense over the rationale. In our study, we present two examples of post-operative complications of common neurosurgical pathologies. We compared our experience with the complications reported in literature and analyzed the importance of seeing the patients in their entirety, so encouraging a mindful approach in our medical da…