Asian Journal of Neurosurgery

Contrast-induced encephalopathy (CIE) is a rare neurological complication that occurs after the use of contrast medium in various angiographic procedures. Symptoms can be different, from headache to severe neurological deficit and coma. In the articles published to date, symptoms appeared immediately after application of contrast agent or within 24 hours. Here we present two cases of patients in whom CIE developed delayed after endovascular treatment.

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Background  Middle cerebral artery (MCA) anomalies are a rare finding and may be associated with vascular changes, such as intracranial aneurysms. Among them, the rete MCA aneurysm is very rare, with only 22 cases reported to date. Case Description  A 50-year-old woman presented with subarachnoid, intraventricular, and intracerebral hemorrhage secondary to a ruptured aneurysm of rete MCA from an anomalous collateral artery of the anterior cerebral artery, treated successfully by microsurgical clipping...

No abstract text is available yet for this article.

Medulloblastoma is the most common malignant pediatric brain tumor. Histological subclassification and adjuvant therapy have improved prognostication and outcome. Extraneural metastasis remains a poor prognostic factor and subcutaneous seeding is rarely encountered and reported in the pediatric population. We report a 3-year-old child who rapidly presented with subcutaneous seeding a month following gross total resection of his tumor.

Orbital arteriovenous fistula (AVF) is a rare disease, and its standard therapeutic strategy has not been established. A 70-year-old male consulted an ophthalmologist due to a visual field defect in his left eye. Neurological findings showed visual impairment but no symptoms such as exophthalmos, conjunctival congestion, or diplopia. Magnetic resonance imaging showed marked dilation of the left superior ophthalmic vein (SOV). Cerebral angiography revealed an AVF that was limited to the left orbit. The feeder was a branch of the ophthalmic artery that originated from the first portion, and the drainer was the SOV, which was meandering and significantly dilated...

Objective  Pterion is an "H" shaped formation of sutures located in the temporal fossa of the skull. It is an important anatomical landmark and a craniometric point. The thinness of the skull and its inner relation with the middle meningeal artery make this anatomical landmark clinically significant. Variations in the pterion are imperative, especially for neurosurgeons in order to have the most suitable craniometric point to be minimally invasive. Materials and Methods  One hundred pterions were studied to report the variations in the type and location of the pterion...

Objective  In recent years, endovascular methods have been developed to treat intracranial aneurysms. To date, results of endovascular treatment (EVT) for anterior communicating aneurysms (ACoAs) have never been investigated in Iran. Thus, we sought to assess the mid-term angiographic and clinical outcomes of patients with ACoAs who underwent EVT in a tertiary center. Materials and Methods  Electronic health documents of patients with ACoAs who underwent EVT from March 2019 to July 2021 were retrospectively reviewed...

Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) are surgical methods for treating obstructive hydrocephalus. However, there is still disagreement regarding the most effective technique, in terms of both operative success and postoperative complications. Therefore, we performed a systematic review and meta-analysis to compare the efficacy and safety of these two methods in patients with obstructive hydrocephalus. We performed a systematic search of the PubMed, Scopus, and Cochrane Library databases...

Rudimentary meningoceles of the spine with dural extension are very rare and warrant surgical excision to prevent infection and long-term neurological deficits in pediatric patients. We present the case of a 5-month-old infant with a tethered spinal cord secondary to a rudimentary meningocele. The patient presented shortly after birth with a midline cervical dimple that was evaluated for a suspected dermal sinus tract. Magnetic resonance imaging scan of the spine showed a sinus tract with intradural extension to C2-3 and external opening at the level of spinous process C5...

Objective  The purpose of this study is to assess demographic, clinical, and unique morphological characteristics of distal anterior cerebral artery (DACA) aneurysm. The relation of outcome included Glasgow Outcome Scale (GOS) using various independent variables, Hunt and Hess clinical grade (H&H), Miller Fischer grade, intraoperative rupture, and comparison of outcomes at discharge and last follow-up. Methods  Demographic data, aneurysm characteristics, and treatment outcomes were evaluated in 28 ruptured DACA aneurysms operated over a period of 13 years...

Objectives  Representing approximately 22% of cervical spine injuries, upper cervical spine injuries are becoming more frequent with the increase in road traffic accidents. The purpose of our study is to evaluate the results of our surgical series and to compare them with the literature. Materials and Methods  In this monocentric retrospective study of over three years (June 2019-May 2022), all the patients with traumatic injuries of the upper cervical spine with a surgical treatment and a minimum of 12 months follow-up were included...

A spinal arachnoid cyst is a rare entity representing only 1 to 3% of spinal canal lesions. Very few of them are reported to be symptomatic. Moreover, occurrence in multiples is even rarer. Extradural type is more common than intradural. In the spine, it is rare in the sacral region. Other common pathologies, such as a dermoid or epidermoid cyst, are often considered at presentation. Even magnetic resonance imaging can miss the diagnosis sometimes. We report a case with symptoms of paraparesis and incontinence at presentation, initially misdiagnosed as a dermoid cyst, later found to be multiple intradural arachnoid cysts located in the sacral region...

Objective  Plaque induction through intimal injury using a balloon catheter in small animals and by artificial ligation of the carotid artery in large animals have been reported. However, these reports have not yet succeeded in inducing stable plaques nor creating a high degree of intimal thickening to be used as animal models. We have previously developed a plaque induction model in rats but have failed to obtain a plaque incidence frequency that can be used as a model. Thus, in the current study, we aimed to create a versatile disease model to examine the pharmacokinetics of drug administration, determine the efficacy of treatment, and examine the process of intimal thickening...

Objectives  Total intravenous anesthesia (TIVA) is used during surgery with intraoperative neurophysiological monitoring. Addition of adjuvant may minimize suppression of potentials by reducing doses of propofol. We studied the effect of addition of ketamine or dexmedetomidine to propofol-fentanyl-based TIVA on corticobulbar motor evoked potential (CoMEP) in patients undergoing posterior fossa surgeries. Materials and Methods  Forty-two patients were assigned to three groups ( n  = 14 each), Group S-saline, Group D-dexmedetomidine (0...

Background  Postoperative surgical site infections are a recognized complication following craniotomies with an associated increase in morbidity and mortality. Several studies have attempted to identify bundles of care to reduce the incidence of infections. Our study aims to clarify which perioperative measures play a role in reducing surgical infection rates further. Methods  This study is a retrospective audit of all elective craniotomies in years 2018 to 2019. The primary endpoint was the surgical site infection rate at 30 days and 4 months after the procedure...

Objective  Trigeminal neuralgia (TN) is a neurological disorder that often presents as severe toothache. The majority of TN patients visit dental clinics first, so TN represents a potential pitfall for dental practitioners. This report describes the development of a trigeminal neuralgia questionnaire (TNQ), assessing 10 characteristics of TN, to assist dentists in screening for TN in dental clinics, and evaluates the effectiveness of TNQ. Materials and Methods  Fifty-three patients who visited the TN outpatient department in our institute and completed the TNQ were included in this study...

Objectives  The 2021 WHO Classification of Central Nervous System Tumors taxonomy laid further stress on molecular classification and prognostication of glial tumors in comparison to histopathological grading. Research shows that low-grade gliomas (LGGs) can go through malignant differentiation and lead to severe disability and death. Data from various populations will be necessary to ascertain the exact interplay between genotypic predictors of LGG and outcomes. Materials and Methods  To assess the molecular pathology for glial tumors in the Pakistani population, the Shaukat Khanum Memorial Cancer Hospital carried out a retrospective chart review of electronic health records from 2008 to 2018, with immunohistochemistry analysis findings from 2010 to 2018...

Currently, awake craniotomy (AC) is one of the most often employed procedures to map and resect tumors in eloquent brain areas, avoiding the use of general anesthesia (GA) and thereby reducing anesthesia-related complications and cost of surgery. Resource limitations are one of the basic reasons for avoiding AC in low- and middle-income countries (LMICs). The aim of this study is to describe the simplified protocol of awake brain surgery that can be implemented in a limited financial setting in LMICs and to share our first experience...

Objective  There are a large number of prospective studies that use diffusion tensor imaging (DTI) to show the relationship between intracranial tumors and white matter (WM) fibers. We studied the role of DTI in supratentorial intra-axial (ST-IA) tumors of the brain in deciding the surgical approach with maximal resection and minimal or no deficit and in predicting the histological characterization of the tumor and the neurological outcome. Methods  A total of 91 cases of ST-IA tumors were included in our study...