Abstract Background Recently, endovascular electrocoagulation has been successfully used to treat ruptured aneurysms that cannot be catheterized with a microcatheter, but more research is needed to evaluate the efficacy of this technique. In this report, we present the first reported case of early aneurysm recurrence following electrocoagulation therapy and describe our experience of retreatment for this lesion. Case presentation A 51-year-old female presented with spontaneous subarachnoid hemorrhage, who was diagnosed with a rare tiny aneurysm arising from the A1 segment of anterior cerebral artery. Because of the sharp turning angle of parent artery and the extremely narrow aneurysm neck, attempts at catheterization of the aneurysm sac were unsuccessful. Thus, pure micro-guidewire electrocoagulation was selected as the salvage treatment approach. Initially, the aneurysm was successfully occluded by electrocoagulation, but follow-up angiography at 5 weeks postoperatively showed recanalization of the lesion. Eventually, the recurrent aneurysm was safely obliterated by surgical clipping, providing a direct view of the pathological changes following electrocoagulation therapy. Conclusions Endovascular electrocoagulation carries a risk of aneurysm recanalization despite initial success. Close angiographic follow-up is warranted to ensure the efficacy of this technique.
Gender dysphoria is characterized by a marked incongruence between an individual’s experienced gender and assigned sex at birth. The global prevalence of transgender individuals is increasing, leading to greater interaction with healthcare systems across multiple specialties, including neurosurgery. Gender-affirming hormone therapy (GAHT), a cornerstone of treatment, has several neurological and neurosurgical implications. Nevertheless, neurosurgeons often report limited confidence in managing transgender patients because of insufficient awareness and training. This review explores the growing evidence of the broad neurobiological basis of gender identity, which involves variations in neuroanatomy and its contribution to the pathophysiology of gender incongruence. Moreover, the understanding of the neurovascular and neuropsychiatric effects of GAHT has provided a broad picture of the conditions under which a transgender patient can present to the neurosurgical outpatient department or emergency department. The review also discusses a holistic neurosurgical care plan for transgender patients (including gender dysphoria), which involves making a safe and conducive environment for the patient to open up during consultation, a proper method to obtain informed consent on the basis of the WPATH SOC 8 guidelines, and the identification of general and specific risk factors during the perioperative period and the subsequent optimization. Furthermore, this review identifies the factors that may affect proper intraoperative care such as anesthetic and antiviral drug interactions with GAHT hormonal agents, patient positioning and preparation issues, and thromboprophylaxis. This review provides an outlook for optimum postoperative care involving comfortable patient recovery for proper wound healing, pain management, and mental health support. In conclusion, transgender patients present unique challenges in neurosurgical practice owing to the combined effects of GAHT and psychosocial determinants. There is a critical need for improved education, inclusive clinical practices, and multidisciplinary collaboration to optimize patient outcomes. Further large-scale studies are needed to strengthen the evidence base and guide standardized neurosurgical care for this population.
Abstract Background Epilepsy is a neurological disorder affecting over 50 million people worldwide, with a global incidence of 7.6 per 1,000 individuals. Mesial temporal lobe epilepsy (MTLE) is characterized by recurrent, unprovoked seizures originating in the temporal lobe. The standard surgical treatment is anterior temporal lobectomy; however, many patients are not suitable candidates due to the risk of adverse effects, including significant memory impairment, language deficits, bilateral temporal involvement, or reluctance to undergo resective surgery. This study aimed to evaluate the anticonvulsant effect of linear accelerator (LINAC)-based radiosurgery in patients with drug-resistant unilateral MTLE. Methods A prospective, single-center, exploratory pilot case series was conducted from March 1, 2017, to March 1, 2020, at the Hospital de Especialidades, Centro Médico Nacional de Occidente. Patients aged 18–65 years with a confirmed diagnosis of drug-resistant unilateral MTLE were enrolled. The primary outcome was defined as the achievement of complete freedom from disabling seizures (Engel Class I and ILAE Class 1) at 24 months post-radiosurgery. Secondary efficacy outcomes included achieving a ≥ 50% reduction in seizure frequency. The prescribed dose of 22 Gy was normalized to the 50% isodose line at the isocenter, ensuring ≥ 90% target coverage (V100 ≥ 90%) and a dose gradient < 10%, targeting the hippocampal head and anterior body. Results Seven patients were included. Median seizure frequency decreased from 12 seizures/month at baseline to 3.5 seizures/month at 24 months, corresponding to a median reduction of 75.6%.Longitudinal analysis demonstrated a significant reduction in seizure frequency over time (Friedman χ 2 = 14.62, p = 0.006), with significant differences between baseline and all follow-up periods (p = 0.018). No patient achieved seizure freedom. Kaplan–Meier analysis demonstrated that 71.4% of patients maintained a clinically meaningful seizure reduction (≥ 50% from baseline) throughout the 24-month follow-up. Patients with preoperative auras exhibited a median aura reduction of 60%, whereas de novo auras developed in three previously aura-free patients. Adverse events included visual field deficits in three patients (42.8%), psychiatric complications in two (28.6%), and clinically significant memory decline in one patient with pre-existing cognitive impairment. Conclusions LINAC-based stereotactic radiosurgery targeting the hippocampal head and anterior body achieved a clinically meaningful reduction in seizure frequency in selected patients with drug-resistant MTLE. However, complete seizure freedom was not achieved, and delayed adverse events were observed. Trial registration The study was approved by the ethics committee of the Hospital de Especialidades, Centro Médico Nacional de Occidente (approval number R-2017–1301-57).
To descriptively evaluate short-term (48–72 h postoperatively) neurological functional outcomes in patients undergoing awake craniotomy for intracranial lesions located within eloquent brain areas, and conduct univariate exploratory analyses of clinical factors correlated with acute postoperative neurological deterioration. Secondary exploratory survival analyses are included solely for hypothesis generation; all survival-related findings carry no definitive clinical prognostic interpretation given the study’s critical limitations of small sample size, pathological heterogeneity, absent long-term functional follow-up, and missing key perioperative covariates. A single-center descriptive retrospective analysis was performed on 30 patients who received awake craniotomy between January 2019 and November 2024. The primary predefined endpoint was new or exacerbated neurological deficits within 48–72 h after surgery, quantified via Karnofsky Performance Status (KPS), Glasgow Coma Scale (GCS), Mini-Mental State Examination (MMSE), and manual muscle strength testing. Early postoperative dysfunction was categorized into three distinct phenotypes: transient global systemic functional decline, focal motor neurological deficits, and isolated language impairment (aphasia). Secondary exploratory endpoints included overall survival and all-cause mortality, with follow-up completed by February 28, 2025. Univariate logistic regression screened correlates of acute neurological decline; Kaplan–Meier survival curves, log-rank subgroup comparisons, and Cox proportional hazards regression were applied for exploratory survival modeling. All survival analyses are interpreted as purely descriptive and hypothesis-generating, with no confirmatory clinical value; the specific constraints are addressed in the Limitations section. The cohort contained 30 patients, with an awake craniotomy intraoperative mapping completion rate of 90.0
Background Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Agitation is a common complication after moderate to severe TBI and managing it in the acute hospital setting can be challenging. Aim Currently, there are no standardised interventions to manage agitation in TBI. This review aims to evaluate contemporary research over the past 10 years which addresses pharmacological and non-pharmacological strategies for managing agitation post-TBI. Method A scoping review literature search was conducted using PRISMA guidelines. The protocol was pre-registered on PROSPERO (ID 1295903). The literature search used Mesh and Boolean keywords ‘traumatic brain injury and ‘agitation management’ in PubMed, and a free-text search of ‘traumatic brain injury and agitation management’ with ‘map term to subject heading’ in Embase (Ovid) and Cochrane, covering studies from 01 January 2015 to 09 March 2026. Findings were analysed and discussed between two reviewers. Results A total of 65 studies were identified, and after careful review, 13 papers were selected from PubMed and Embase for our Scoping Review. Non-pharmacological strategies highlighted the importance of orienting the patient and the supportive role of family during the acute recovery period. Pharmacological strategies included found that the antipsychotic olanzapine was helpful in managing agitation in moderate to severe TBI. Valproic acid in a small male sample [1] and a separate study using dextromethorphan and quinidine [2] found that these medications were also helpful in managing agitation in TBI. Discussion and conclusion Clinicians and health professionals reported that treating the patient holistically, with the medical, social, and psychiatric history was of benefit. Antipsychotic Olanzapine and Valproic acid may have their uses in the short-term, interim acute setting under supervision. Future research with larger sample sizes further investigating these medications would be useful, along with personalisation of medications to the patient’s medical history. Most of the studies included in the review are observational and reviews, rather than randomised controlled trials, with a lack of primary evidence which may be a limitation. Systematic review registration PROSPERO CRD 1295903
