Romanian Neurosurgery https://journals.lapub.co.uk/index.php/roneurosurgery <p>Call for Papers - Vol. XXXV, No. 2 (June 2021)<br />Submission Deadline: May 1, 2021</p> London Academic Publishing en-US Romanian Neurosurgery 1220-8841 Overcoming vasospasm https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2645 <p>This article presents a case report detailing the endovascular management of severe vasospasm in a 55-year-old patient following the rupture of a right posterior communicating aneurysm. Initially presenting with a Fisher grade 4 subarachnoid haemorrhage, the patient underwent embolization treatment, which resulted in good condition. However, on the 9th day, the patient experienced a sudden deterioration, marked by severe vasospasm and neurological deficits.</p> <p>Diagnostic procedures, including cerebral angiography, revealed extensive vasospasm affecting multiple cerebral arteries. In response, endovascular therapy was initiated, consisting of the intra-arterial administration of Milrinone and Nimodipine. This intervention aimed to alleviate vasospasm and enhance cerebral perfusion. Angiographic imaging post-intervention demonstrated significant improvement in vascular perfusion, correlating with a rapid neurological response. Notably, the patient exhibited immediate improvement in motor deficits and dysarthria following treatment.</p> <p>This case underscores the critical importance of timely recognition and intervention in managing complications post-aneurysmal rupture, particularly severe vasospasm, which poses significant risks of neurological sequelae. The successful application of endovascular techniques, including chemical angioplasty, highlights the evolving landscape of neurointerventional procedures in addressing complex cerebrovascular pathology.</p> <p>The case further emphasizes the necessity of a multidisciplinary approach, involving collaboration between neurosurgery, interventional radiology, and neurocritical care, to optimize patient outcomes in cerebrovascular emergencies. Early detection, prompt intervention, and vigilant post-procedural monitoring remain pivotal in mitigating the risks associated with cerebral aneurysm rupture and its sequelae.</p> Monica Manisor Petru Coltea Cosmin-Nicodim Cindea Victor Tudor Vladimir Rosca Liliana Boca Vicentiu Saceleanu Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 9 14 Occipital intradiploic epidermoid cyst https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2591 <p>Intradiploic epidermoid cysts are rare intracranial tumours, with an estimated prevalence of less than 1% of all cranial tumours. Most of the intradiploic cysts are asymptomatic; however, clinical findings consist of headache and tenderness. We presented a case of a 21-year-old female who consulted the neurosurgery department for a period of three years about a mass in the occipital region, which was growing gradually. The patient was treated with surgical removal without complications. Intradiploic epidermoid cysts are infrequent intracranial tumours that primarily affect adults. This tumour has a wide spectrum of symptoms. Radiologic findings on computed tomography (CT) and magnetic resonance imaging (MR) are the cornerstone for the diagnosis, which is finally confirmed by histopathological studies. Surgical management with a complete resection of the cyst and capsule is the most commonly used treatment.</p> Daniela Arias Mariño Alejandro Rojas Urrea Lorena García Agudelo Angie Liseth Garzon Peñuela Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 15 17 Solitary intracerebral Langerhans cell histiocytosis https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2592 <p><strong>Background: </strong>Langerhans cell histiocytosis is an uncommon proliferative histiocytic disorder which can affect any organ. It is common in children and can rarely occur in adults. In the central nervous system, the hypothalamic-pituitary axis is most commonly involved. Brain parenchyma is rarely affected.</p> <p><strong>Case summary: </strong>We report a case of a 13-year-old male who presented with chief complaints of headache and swelling over the right frontal region. On imageology, a clinical diagnosis of meningioma was considered. The tumor was excised and on histopathological examination diagnosis of Langerhans cell histiocytosis was considered</p> <p><strong>Conclusion: </strong>Intracranial Langerhans cell histiocytosis is a rare condition which can mimic primary neoplasms of the central nervous system such as glioma, meningioma and metastatic deposits on imageology. Histopathology is the gold standard for diagnosis.</p> Shanthi Vissa Aruna Kumari Prayaga Swathi Bontha Rukmangadha Nandyala Ramesh Chandra VeeraSekhar Kattela Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 18 21 Neurosarcoidosis: overview of management and differentiation from fungal aetiologies https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2595 <p>Neurosarcoidosis, a rare inflammatory condition, poses a diagnostic challenge due to its various clinical presentations and potential mimics. This comprehensive review delves into the complexities of neurosarcoidosis, emphasizing the importance of a thorough diagnostic workup and the consideration of alternative conditions, such as fungal mimics. The study explores the intricacies of the diagnostic process, particularly the role of histopathology, imaging, and laboratory tests. The current state of neurosarcoidosis management is examined, such as the use of corticosteroids as well as novel therapies including Rituximab and JAK-STAT inhibitors. The clinical spectrum is described in detail for both the peripheral and central nervous systems, offering insights into the many presentations, which include ocular manifestations and syndromes like Heerfordt's syndrome. The complexities of neurosarcoidosis necessitate further research in its diagnosis, pharmacotherapy, and management. The inclusion of information on ongoing research and clinical trials underscores the need for tailored therapeutic approaches.</p> Shawn Khan Khushi Saigal Juan Varela Gabriel Flambert Parth Patel Arman Mahmood Brandon Lucke-Wold Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 22 34 Neurofibroma of C2 root https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2625 <p><strong>Background:</strong> Intra and extradural neurofibromas of C2 root is a challenging pathology, usually with indolent evolution, that is why the onset symptoms are neurologic deficit just like upper cervical myelopathy symptoms and explains the late diagnosis of giant tumours with severe spinal cord compression with involvement and distortion of great vessels anatomy. These facts make surgeries more difficult. The follow-up of this type of surgery must be very close because CSF fistula can often occur.</p> <p><strong>Case description</strong>: The present article reports a series of three cases of neurofibromas, two of them are giant dumbbell-shaped C2 neurofibromas and the third one is a case of neurofibromatosis type 1 of C2 roots bilaterally, C3 root unilateral with unusual postoperative course. Dural reconstruction was necessary in all cases.</p> <p><strong>Conclusions:</strong> The patients in this series were very symptomatic with good recovery. The surgical procedures were challenging, total tumour removal was possible, and the reconstruction of dural defects was needed in all cases. In the case of NF1, the postoperative period was practically just the follow-up of complications and addressing them. This fact stresses the importance of meticulous preoperative planning and close follow-up. Postoperative quality of life was better than preoperative in all the cases. The purpose of the surgical treatment is the decompression of the spinal cord, tumour removal and prophylaxis of CSF fistula by closing the dural defects. Overall, the surgical C2 root neurofibromas resection is a safe procedure and is associated with good clinical outcomes.</p> Marcel Sincari Andre Nunes Gabriel Pina Mark-Daniel Sincari Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 35 39 Microsurgical excision of intracranial arteriovenous malformation https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2588 <p><strong>Objectives: </strong>Brain Arteriovenous malformations are high-flow cerebrovascular lesions with dysplastic vascular nidus, fed by arteries and drained by veins without intervening capillaries. Prevalence is 0.2% and is an important cause of intracerebral haemorrhage in about 38% of young adults. The objective of this study is to analyze surgically managed Intracranial AV malformations with respect to their demographic features, varied clinical presentations, imaging features Spetzler Martin grading and outcome.</p> <p><strong>Methods:</strong> A study of 48 patients with Intracranial Arteriovenous malformations who underwent microsurgical excision at the Institute of Neurosurgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai over a period of 5 years from July 2018 to June 2022 and extracted their data including demographic characteristics, clinical presentations, Spetzler-Martin (SM) grades, complications and outcome were assessed.</p> <p><strong>Results:</strong> Of the 48 patients treated with microsurgery, the most common 51% belongs to the age group between 21 to 40years, left-sided is slightly more common with headache major symptom, involving Parietooccipital lobe 33% commonly, 28 (62.2%) patients initially presented with haemorrhage.</p> <p>Anterior circulation artery feeders was common 68.8% and mostly drainage involving superficial venous drainage system. Based on the Spetzler-Martin (SM) grading system, the patients were graded as follows: 6(13 %) Grade I, 10(21%) Grade II, 25(52%) Grade III, 3 (6%) Grade IV and 4(8%) Grade V. Overall, 35(73%) patients had a favorable outcome, most commonly seen in Grade I, II and Grade III. Almost complete obliteration of the AVMs were achieved in all favorable outcome cases.</p> <p><strong>Conclusion</strong>: Microsurgical excision is the gold standard treatment of choice for low grade AVMs and certain high-grade AVMs with increased risk of rupture. The Spetzler-Martin grading system is a simple and effective method to estimate the risk of surgery and to evaluate the prognosis. Proper patient selection combined with appropriate preoperative evaluation, meticulous surgical technique and postoperative care all lead to reduced mortality and morbidity.</p> Mathan S. Sankar Dhanasekar A. Raghavendran R. Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 35 39 Comparative study of thoracolumbar fractures posterior fixations between long segment and short segment involving the fractured vertebra https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2628 <p><strong>Background. </strong> Thoracolumbar fractures are among the most common and unstable traumatic injuries to the spine. They require a rigid fixation. However, there are controversies in the choice of fixation types. This study aimed to compare long-segment posterior fixation (LSPF) bridging the injured vertebra and short-segment fixation with screws in the fractured vertebra (SSFFV).</p> <p><strong>Methods.</strong> This was an analytical study of 22 patients admitted to the Kinshasa University Teaching Hospital from 2020 to 2023 with thoraco-lumbar fractures. Variables of interest included: sex, age, occupation, cause of fracture, ASIA score, injured vertebra, Magerl fracture types, Sagittal Cobb angle (SCA), and level of fixation. Data were analysed using SPSS 26 software.</p> <p><strong>Results</strong>. Ten patients (45.4%) had SSFFV and 12 (54.6%) had LSPF. Overall, the sex ratio was 4.5 and, the mean age was 35.27±9.88 years. Road accidents accounted for 72.7% of causes, fracture of L1 (50%), ASIA A (41%) and Magerl B (54,5%). Pre-operative features did not show a difference between the two fixations. No difference was observed in function values before surgery (p=0.863) and at one year postoperatively (p=0.914). The mean SCA was 15.57 ± 5.90° before surgery, and 12.60±5.94° one year after surgery showing a significant correction of local kyphosis of 3° (P &lt;0.001). There was no significant difference in the degrees of correction of local kyphosis immediately postoperatively (p=0.591) and at one year postoperative (p=0.819) and also in the degrees of loss of local kyphosis (p=0.870) between SSFFV and LSPF.</p> <p><strong>Conclusion</strong>. This study did not show a significant difference in functional recovery, reduction and loss of correction of traumatic kyphosis between the two fixations. The SSFFV therefore appears to be an effective alternative to LSPF.</p> Antoine Beltchika Israël Maoneo Glennie Ntsambi Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 46 53 Evaluation of vertebral artery variations and arterial dominance in cervical CT angiographic images in Iranian population https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2587 <p><strong>Purpose: </strong>The aim of the present study was to determine the characteristics and variations in the origin of vertebral arteries (VA), its level of entry into the transverse foramen, VA diameter, Length of VA, and VA dominance.</p> <p><strong>Methods: </strong>A total of 250 adult patients (143 males and 107 females) were enrolled (Mean age: 60.92±13.44) and scanned with Computerized Tomography angiography (CTA).</p> <p><strong>Results: </strong>The VA entered the C6 transverse foramen in 97.8% of specimens. Abnormal entrance of VA was observed in 4.4% of specimens. The mean length of prevertebral (V1) right and left VA was 81.38±14.38 mm and 82.49±14.16 mm. The mean length of the intraforaminal segment (V2) of the right and left VA was 81.38±14.375mm and 82.49±14.162mm and showed sexual dimorphism. The mean diameter of the right and left VA was 3.297±0.85 and 3.676±0.88, respectively. We found 1(0.4%) left and 1(0.4%) right VA emerging from the aortic arch. The mean right and left VA diameters were 3.28 ± 0.83 mm and 3.6±0.88mm, respectively. A total of 90(0.36) patients were right dominant and 160(0.64) patients were left-dominant. The right VA of aortic arch origin entered the 4th cervical transverse foramina, whereas the left VA entered the 7th cervical transverse foramina. We found that 22(8.8%) of the right and 1 (0.4%) of the left vertebral arteries had distal origin. The results did not show any relationship between gender and origin of VA, diameter of VA, and level of entry. A significant relationship was observed between gender and VA length (P=0.0001).</p> <p><strong>Discussion:</strong> The present study confirms the presence of anomalous in the VA route. Knowledge of such anatomical variations is important in interpreting CTA and may reduce the risk of intraoperative VA injury.</p> Mohammad Mehrpouyan Mozhgan Sametzadeh Mohamad Momen Garibvand Ali Reza Eftekhari Moghadam Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 54 60 Cerebral hydatid cyst masquerading as multiple cystic metastases https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2600 <p>Hydatid disease is caused by encysted larvae of the dog tapeworm Echinococcus granulosus. Cerebral hydatidosis is a rare central nervous system larval infection affecting approximately 2–3% of patients. CT and MRI scans of the boy, described in our case, showed multiple cystic areas. Total surgical extirpation is the therapeutic approach, emphasizing the importance of early diagnosis for a favourable prognosis. Recurrence and unfavourable outcomes are commonly associated with incomplete excision and surgical rupture, necessitating careful removal to prevent anaphylaxis and widespread infection. Dowling's technique is the preferred surgical approach and postoperatively, patients are administered antiparasitic drugs such as Albendazole or Mebendazole for 6–12 months in most cases, with doses ranging from 10-15mg/kg in divided doses. The results of pharmacological treatment vary across series, with response rates ranging from 43.5 to 80%. Early diagnosis significantly contributes to a favourable prognosis by preventing neurological consequences.</p> Areeba Tariq Muhammad Maskoob Talib Manzar Huseyn Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 61 63 Spinal thoracic tuberculoma in neurofibromatosis type-1 https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2510 <p>The clinical manifestations of neurofibromatosis type-1 have in common the presence of neurofibromas, schwannomas and cafe`-au-lait macules, which can potentially appear within any organ system of the body, involving primarily the skeleton, skin and soft tissues. The spinal thoracic tuberculoma in neurofibromatosis is exceptional.</p> <p>We report here, the case of a 31-year-old male with neurofibromatosis type-1 who presented a year agoa spinal thoracic pain. The evolution was marked by the appearance of a dorsal para-vertebral mass, progressively increasing in volume for 03 months.</p> <p>Neurological Examination revealed normal muscle bulk and tone, and power was grade 5/5. Deep tendon reflexes were brisk and the Babinski sign was present. The sensory deficit was present below the D<sub>9</sub> level. The remainder of the examination found a voluminous dorsal para vertebral mass ovoid, renitent, and adhering to the superficial and the deep planes. There were also "café-au-lait" spots disseminated on his body. The imagery showed a formation with respect to D<sub>11</sub>-D<sub>12</sub>, isointense on T<sub>1</sub> and T<sub>2</sub>, heterogeneously enhanced after contrast with central necrosis, with a foraminal starting point measuring 85x78x66 mm, with external canal extension. Laminectomy D<sub>11</sub>-D<sub>12</sub> was performed with incomplete excision of the lesion. The histological examination showed casein-follicular vertebral tuberculosis, with secondary abdominal changes. Then the patient was put on anti-bacillary drugs. The evolution was marked two weeks later by the reappearance of the back pain and the back mass. On the 42<sup>nd</sup> day of treatment, the patient had a febrile consciousness disorder with a GCS of 8, right mydriasis and meningeal stiffness. Paraclinic investigations revealed tuberculosis meningoencephalitis, responsible for an active ventricular hydrocephalus associated with a left temporoparietal extrudal hematoma. An external ventricular shunt was performed as well as a left temporo-parietal extrudal hematoma evacuation. The patient died 7 days later in a poly visceral failure chart.</p> J. Geoffrey Nedekha Diallo Moussa Félix K.K. Ségbédji Tokpa Valentin Diallo Mamadou Mohamed Benzagmout Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 64 68 Characteristics and surgical management of spinal meningiomas in the Himalayan region https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2629 <p><strong>Background:</strong> Spinal meningiomas, originating from arachnoid cap cells, primarily manifest in the intradural extramedullary region, commonly favouring the thoracic area, albeit occurrences in the cervical, lumbar, and exceptionally rare sacral regions have been noted. Among tumours in this location, meningiomas, neurofibromas, and schwannomas prevail. MRI serves as the preferred imaging modality due to its ability to often reveal the distinctive dural origin of meningiomas. Microdissection and resection stand as the established gold standard for treating spinal meningiomas.</p> <p><strong>Materials and methods:</strong> This study, conducted at the Sheri-Kashmir Institute of Medical Sciences Soura Srinagar in Jammu and Kashmir, India, spanned approximately 10 years from August 2009 to July 2017 retrospectively and August 2017 to July 2019 prospectively. It encompassed patients diagnosed with spinal meningiomas, evaluated through comprehensive history-taking, clinical examinations, biochemical assessments, and radiological studies. Surgical interventions predominantly involved laminectomy, aiming for gross total or subtotal tumour resection using a posterior approach. Postoperative complications, such as CSF leaks and wound infections, were monitored, and the duration of hospitalization was recorded from the surgery date to discharge.</p> <p><strong>Results:</strong> The results showed a mean patient age of 44 years, with the youngest being 16 years old and the eldest 70 years old. Most patients (40.90%) fell within the 41-50 age group, with 22.72% in the 51-60 age bracket. Among the 22 patients, females comprised 68.18%, resulting in a female-to-male ratio of 2.1:1. The most prevalent symptoms were pain (77%) and weakness (63%), followed by bladder dysfunction (27%). Tumors were primarily located in the thoracic region (68%), with other occurrences in the cervicothoracic (18%), thoracolumbar (9%), and cervical (4.54%) areas. Posterior surgical approaches were utilized in 91% of cases, with the remaining 9% employing an anterior approach. Tumour sizes varied, with 22.72% smaller than 2 cm and 77.27% larger, having a mean greatest diameter of 2.9 cm. Postoperative complications were observed in 9.09% of patients, with CSF leaks and wound infections being the major concerns, while 91% experienced no complications.</p> <p><strong>Conclusions:</strong> In conclusion, this study illustrates spinal meningiomas as slow-growing tumors with a subtle onset, typically appearing in the 4th to 5th decade, and exhibiting a female predominance with a 2:1 ratio. Pain emerges as the most prevalent presenting symptom. Surgery stands as the primary treatment, albeit accompanied by potential postoperative complications such as wound infections, CSF leaks, or bowel and bladder dysfunctions. Adjuvant radiotherapy might be considered for recurrent or advanced disease to offer palliative relief.</p> Aizul Khursheed Mohsin Fayaz Mubashir Gani Abdul Rashid Bhat Abdul Haseeb Wani Zafirah Zahir Khurram Khan Gianluca Scalia Bipin Chaurasia Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 69 77 Gravitational bullet injuries https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2557 <p>Gravitational bullet injuries, prevalent in the Middle East, particularly in Iraq, are a critical public health concern, often resulting from celebratory gunfire. In our Neurosurgery Teaching Hospital in Baghdad, we've observed that these injuries differ significantly from high-velocity gunshot wounds, characterized by lower velocity and energy due to air resistance and gravity. Unlike high-velocity bullets, gravitational bullets cause less bone fragmentation and radial brain damage. These bullets often end up on the tentorium or within the skull base, rarely transgressing the cerebellar tentorium on a vertical trajectory. We've also noticed that the pediatric population, particularly younger children, are more susceptible to these injuries due to their thinner cranial vertex, leading to more penetrating injuries and aggressive brain bleeding. Our observations underline the need for focused studies, awareness, regulation, and tailored management strategies to combat this overlooked issue.</p> Mustafa Ismail Wamedh E. Matti Hussain J. Kadhum Ahmed M. Taha Maher Khashea Mustafa Samer S. Hoz Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 78 80 Posterior auricular artery https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2556 <p><strong>Introduction</strong>: The posterior auricular artery (PAA) is the preterminal branch of the external carotid artery (ECA), arising superiorly to the occipital artery (OA). The PAA has quite a few anatomical variations and established neurosurgical applications. We conducted this study as an overview to illustrate all neurosurgical aspects regarding this artery, its reconstructive uses, and anatomical variation.</p> <p><strong>Method</strong>: We performed a literature review in Google Scholar and PubMed medical databases for studies discussing the PAA, its anatomical variations, and neurosurgical applications.</p> <p><strong>Results</strong>: We identified 30 articles that discuss the anatomical variations and neurosurgical applications of the PAA. While reviewing the available articles and original works regarding PAA.</p> <p><strong>Conclusion</strong>: The PAA has considerable anatomical variations regarding its origin, course, branches, and length. The related neurosurgical applications of PAA include bypass, embolization, aneurysm, AVM, and reconstruction flaps.</p> Zahraa A. Alsubaihawi Ahmed Muthana Zahraa M. Kareem Fatimah Oday Ahmed Hagar A. Algburi Younus M. Al-Khazaal Oday Atallah Mustafa Ismail Samer S. Hoz Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 81 86 Potential psychological responses in patients who underwent MRI scanning https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2554 <p>This paper explores the potential impact of magnetic resonance imaging (MRI) on patients' psychological states, focusing on reported mood changes post-procedure. Factors influencing the psychological state during an MRI, including claustrophobia, noise, scan duration, and fear of the unknown, are discussed. We also draw parallels with darkness therapy, a stress and depression management technique, due to the similar environment. Notably, a subset of patients reported transient improvement in depressive symptoms following an MRI, suggesting a need for further research. The paper underscores the necessity for rigorous scientific exploration of these observations to validate them and better inform patients about possible mood alterations post-MRI.</p> Zainab A. Alaraji Oday Atallah Zinah A. Alaraji Sajjad G. Al-Badri Mustafa Ismail Samer S Hoz Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 87 89 Supratrochlear artery https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2555 <p><strong>Introduction.</strong> The supratrochlear artery (STA) is a small vessel with a relatively tiny and quite constant course. The literature describing the STA fails to provide a collective description of the anatomy and neurosurgical applications of the STA. Therefore, we are here to present an overview of anatomy, anatomical variability, and the clinical application of STA.</p> <p><strong>Method.</strong> We conducted a literature review in Google Scholar and PubMed medical databases to review the existing studies on STA regarding its anatomy and neurosurgical applications.</p> <p><strong>Results.</strong> We identified 18 articles that discuss the anatomical variations and neurosurgical applications of the STA. Certain parameters are used to describe the surgical anatomy of STA, including origin, course, diameter, branches, depth, and distance in relation to the midline and vertical glabellar line. We also discussed certain applications of STA and its importance in neurosurgical reconstruction flaps and the diagnosis of carotid artery disease.</p> <p><strong>Conclusion. </strong>Comparable to the supraorbital artery (SOA), the STA is less variable in its anatomical course, and exhibits a more superficial course. The STA has certain important neurosurgical applications through its involvement in reconstruction flaps for the skull base and plays an important role in the diagnosis of carotid artery disease.</p> Ruqayah Al-Baider Ahmed Muthana Sarah F. Hassan Fatimah Oday Ahmed Rania Thamir Hadi Oday Atallah Mustafa Ismail Samer S. Hoz Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 90 93 The impact of rehabilitation programs on patients postoperative recovery after spine surgery https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2586 <p>Spine surgery is a common intervention aimed at improving the lives of individuals with various spinal conditions, and the success of this procedure extends beyond the operating room to the postoperative recovery phase. This research paper explores the impact of rehabilitation programs on postoperative recovery in spine surgery patients. By delving into the multidisciplinary approach of rehabilitation, including physical therapy, occupational therapy, pain management, and patient education, the study aims to provide a comprehensive understanding of how these programs optimize outcomes and restore functional abilities.</p> <p>Rehabilitation programs play a vital role in managing postoperative pain, restoring mobility, promoting muscle strength, and enhancing overall functional abilities. The paper investigates the specific interventions involved, such as physical therapy exercises, manual therapy, pain management strategies, and patient education, highlighting their collective contribution to a holistic recovery process. The benefits of rehabilitation programs extend beyond physical aspects to address the psychological and emotional well-being of patients, providing a supportive environment through counselling and stress management techniques.</p> <p>Factors influencing the effectiveness of rehabilitation programs, including patient-specific factors, surgical complexity, timing, and patient compliance, are examined. The study draws upon a comprehensive literature review, presenting evidence from research studies, randomized controlled trials, and prospective cohort studies that consistently demonstrate the positive impact of rehabilitation programs on pain management, functional outcomes, and quality of life.</p> <p>Challenges in implementing rehabilitation programs, such as resource constraints and patient education, are acknowledged, and potential strategies for improvement are proposed. These include the integration of technology, collaboration among healthcare professionals, and a focus on patient education and engagement to enhance accessibility and effectiveness.</p> <p>In conclusion, this research underscores the critical role of rehabilitation programs in optimizing postoperative recovery for spine surgery patients. The findings have implications for clinical practice, emphasizing the need for comprehensive, tailored rehabilitation approaches, collaboration among healthcare professionals, and the integration of technology to further improve patient outcomes. Future research should explore the optimal timing and duration of rehabilitation interventions, comparative studies of different approaches, and long-term outcomes to inform clinical decision-making in the field of spine surgery recovery.</p> Muhammad Jehanzeb Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 94 101 The future of spine surgery: technological innovations and advancements https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2584 <p>Spine surgery has witnessed remarkable advancements in technology, techniques, and patient outcomes. The future of spine surgery holds even greater promise as technological innovations continue to shape the field. This comprehensive review explores the role of various technological advancements in the future of spine surgery, focusing on robotic-assisted surgery, augmented reality and virtual reality, 3D printing and custom implants, artificial intelligence and predictive analytics, biomaterials and tissue engineering, nanotechnology, and telemedicine.</p> <p>Robotic-assisted surgery offers enhanced precision and improved outcomes through real-time guidance and surgical manoeuvre assistance. Augmented reality and virtual reality technologies provide valuable tools for preoperative planning, intra-operative navigation, and surgeon training. 3D printing and custom implants enable personalised treatment approaches with improved fit and alignment. Artificial intelligence and predictive analytics offer decision support, precise diagnostics, and real-time monitoring. Biomaterials and tissue engineering approaches facilitate tissue regeneration and targeted drug delivery. Nanotechnology holds promise for precise diagnostics, real-time monitoring, and targeted therapies. Telemedicine and remote monitoring enhance postoperative care and improve accessibility to specialised care.</p> <p>These technological advancements have the potential to revolutionise spine surgery by improving surgical outcomes, enhancing patient experiences, increasing accessibility to specialised care, and optimising healthcare delivery. However, challenges such as cost, training, regulatory approvals, privacy, and ethical considerations must be addressed for successful implementation.</p> <p>Future research directions include further exploration of robotic-assisted surgery, advancement of augmented reality and virtual reality technologies, development of advanced biomaterials and tissue engineering strategies, exploration of nano-materials, and ongoing evaluation of telemedicine and remote monitoring. Collaboration among surgeons, engineers, and scientists is crucial to advancing these technologies and optimising their clinical applications.</p> <p>In conclusion, the future of spine surgery is shaped by technological advancements that offer improved precision, personalised treatment approaches, and enhanced patient outcomes. While challenges exist, ongoing research and innovation will drive the field forward, improving patient care and advancing the field of spine surgery as a whole.</p> Muhammad Jehanzeb Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 102 108 The extended post spinal surgery syndrome (EPSS) https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2599 <p>Pain can occur after any spinal surgery. Despite this, there are other many signs and symptoms of neurological deficits that can occur in patients with varying severity. Our aim is to find some of the main neurological deficits that can occur after any spinal surgery. We searched the literature based on some of the important keywords like neurological deficits after spine surgery, foot drops, cauda equina syndrome, epidural hematoma, and nerve and dural injury. Based on this we analyzed the most important and widely read articles. The problems associated with spine surgery have been published in the literature but are much more than the failed back surgery syndrome and cause more discomfort to patients with varying degrees of neurological deficits. We have coined a new term “Extended Post-spinal Surgery Syndrome (EPSS)” for these conditions. We propose this to include the other complications after lumbar surgery including nerve injury, dural injury, cauda equina syndrome and epidural haematoma. </p> Ramnarayan R. Bipin Chaurasia Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 109 116 The status of nanoneusurgery investigated https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2596 <p>Nanoneurosurgery, introduced in 2003, aims to revolutionize neurosurgery using nanotechnology. Despite early excitement, its development has been slower than expected. The field encompasses various neurosurgical domains, utilizing advanced technologies like femtosecond laser and nanoparticle-enhanced stem cell therapies. However, challenges such as diagnostic limitations, nanoparticle toxicity, and ethical issues have impeded progress. Recent trends show a decline in research activity, suggesting a need for more interdisciplinary approaches and practical applications. The field remains distant from fully integrating nanotechnology, indicating that its future impact might be indirect and gradual. Continued research and collaboration are essential for realizing its potential.</p> Mustafa Ismail Abdullah K. Al-Qaraghuli Sajjad G. Al-Badri Samer S. Hoz Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 117 120 Decompressive craniectomy for dural venous sinus thrombosis https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/2582 <p>A rare event, dural sinus thrombosis occurs more frequently in young adults and children. Generally, medical treatment is the preferred option for this condition; however, if no improvement is observed with medical treatment, decompressive craniectomy is suggested as the preferred surgical intervention. A non-systematic literature search was conducted in PubMed and SCOPUS databases until June 2023, using keywords such as "Decompressive craniectomy," "Dural venous sinus thrombosis," and "Traumatic Brain Injury," along with their synonyms in both English and Spanish. The search revealed that genetic or acquired thrombophilia and the use of oral contraceptives were the most common risk factors, explaining the female predominance of this condition. Patients with dural sinus thrombosis commonly experience headaches, the intensity of which is not yet considered pathognomonic for the condition, ranging from mild to severe. Other nonspecific symptoms include nausea, vomiting, and papilledema. Thrombolytic agents are utilized to rapidly dissolve the clot, supported by interventional neuroradiology techniques to administer the agent directly at the thrombosis site. Studies have reported the effectiveness of emergent decompressive craniectomy in patients with recent onset of dural sinus thrombosis, leading to good results, especially in cases where cerebral hernia is present.</p> Álvaro Campero Roberto González Méndez Matias Baldoncini Michael Gregorio Ortega Sierra Copyright (c) 2024 Romanian Neurosurgery 2024-03-15 2024-03-15 121 126