Background and Aim: Newborns with brachial plexus birth paralysis (BPBP) impose a heavy burden on their families. Given the importance of awareness of its incidence, our main goal was to assess changes in its trend. Also, this study aimed to evaluate the correlation between BPBP trends and the policy aiming at increasing rates of vaginal delivery (VD) (2018). Methods and Materials/Patients: This analytic cross-sectional study was conducted among patients with BPBP born at Al-Zahra Hospital, the Main Center of Obstetrics in Rasht City, Iran, between 2013 and 2023. Descriptive statistics were used to examine the patients’ demographic and clinical characteristics. The results were analyzed using SPSS software, version 26. Results: Over 11 years, 41617 live births occurred. Our study revealed a BPBP incidence of 1.54 cases per 1000 live births during this period. Of these, 33 newborns (51.6%) were male. In our study, the Joinpoint regression analysis showed that the incidence of BPBP increased throughout the study period (P<0.05). Also, there was no significant change in the rising trend of BPBP at the time the established policy aimed at increasing VD rates. In fact, the policy had no significant impact on the trend of BPBP. Moreover, there were no instrumental deliveries among the patients, despite the increasing trend of this injury. Only 10.9% of the patients with BPBP had a clavicle fracture after birth. There was no humerus fracture among all the patients. Also, only 11.5% of the cases had shoulder dystocia in our study. Conclusion: The findings indicate that the incidence of BPBP increased over the 11 years. Our study highlighted that the policy aimed at increasing VD rates did not significantly affect BPBP rate. Therefore, enhanced training for early-career obstetricians and improved preventive strategies are recommended.
Background and Importance: Spinal cord injury without radiographic abnormality (SCIWORA) is predominantly reported in pediatric populations, especially involving the cervical spine. In adults, particularly in the thoracic region, such injuries are exceedingly rare due to the biomechanical rigidity of the thoracic vertebrae. This case report presents an adult patient with a complete spinal cord transection at the T7–T8 level in the absence of any vertebral fracture or dislocation. Case Presentation: A 25-year-old male was admitted to the intensive care unit following a highenergy motor vehicle accident. Although the initial computed tomography (CT) of the thoracic spine showed no signs of vertebral injury, the patient developed complete paraplegia upon regaining consciousness. Magnetic resonance imaging (MRI) revealed a full-thickness transection of the spinal cord at the T7–T8 level. No surgical intervention was indicated due to the absence of compressive or unstable elements. Conclusion: Adult thoracic SCIWORA is an exceptionally rare clinical entity. In cases of severe neurological deficit with negative radiographs and CT scans, a prompt MRI is crucial for diagnosis. This case highlights the need for refined classification systems that incorporate MRI findings and biomechanical assessments to characterize such presentations better and inform clinical management.
Objectives: The neutrophil-to-lymphocyte ratio (NLR) in whole blood is an indicator of prognosis in several disorders, however its predictive value in the CSF of hydrocephalus patients has not been studied. This study aimed to determine the prognostic relevance of NLR at admission and its implications for clinical outcomes in patients with hydrocephalus treated with an external ventricular drain (EVD). Methods: This retrospective study examined consecutive individuals with hydrocephalus who were admitted to an adult ICU in a single center between 2020 and 2022. Patient demographics, clinical characteristics, laboratory data, and computed tomography (CT) scans were gathered. ROC curve analysis was used to identify the optimal NLR and clinical variable cutoff values for mortality. Univariate and multivariate logistic regression analysis was carried out to assess the independent impact of variables on mortality. Results: We included 40 patients with hydrocephaly in the present study. There were 24 males (60%) and 16 females (40%) patients, with an average age of 51.68 ± 16.34 years. NLR was considerably higher in the dead group than the alive (8.49 ± 6.53 vs 5.05 ± 3.78) (P=0.027). In a model of ROC analysis, NLR (AUC 0.702, 95% CI: 0.537 to 0.836; P = 0.0171), Age (AUC 0.674; 95% CI: 0.507 to 0.813; p= 0.0496), underlying disease (AUC 0.650; 95% CI: 0.483 to 0.794; p= 0.0126), and level of consciousness level (AUC 0.946; 95% CI: 0.825 to 0.993; p<0001) were significantly associated with mortality. The best predictive threshold of the NLR was 8.88 (sensitivity, 40%; specificity, 100%). Conclusion: In the current research, a high NLR (>8.88) in CSF was associated with an increased risk of mortality in individuals with hydrocephalus. When paired with a GSC score of <8, admission NLR > 8.88 considerably increases the accuracy of predicting outcomes following EVD.
Background and Importance: Decompressive craniectomy is an emergency neurosurgical procedure to reduce intracranial hypertension. Cranioplasty is an elective neurosurgical procedure to reconstruct the skull defect due to decompressive craniectomy. This study aims to review two different types of cranioplasty and comparecomputer-designed patientspecific titanium implant cranioplasty against titanium mesh with polymethyl methacrylate (PMMA) cranioplasty, regardingtheir complications and outcomes after the procedure. Case Presentation: This is a retrospective analysis of 150 patients who had undergone cranioplasty in PSG Institute of Medical Sciences and Research, Coimbatore, India from January 2014 to January 2023. A total of 46 patients underwent cranioplasty with a computerdesigned, patient-specific titanium implant, and 104 patients underwent cranioplasty with a titanium mesh and PMMA implant. The parameters compared between the two procedures included the timing of surgery, cosmetic satisfaction, duration of hospital stay, wound infection, wound gaping, implant exposure, and necessity of implant removal. Conclusion: Even though both procedures protect brain parenchyma from injuries due to direct trauma, patient-specific implant cranioplasty yielded shorter operating time, less wound infection, smaller wound gaping, reduced implant exposure, and better cosmetic appearance when compared with titanium mesh with PMMA implant cranioplasty.
Objective: Chronic subdural hematoma usually occurs in the 6th and 7th decades of people's lives and leads to severe permanent complications and even death. Today, the most appropriate treatment for this condition has not been determined, and although cases of spontaneous absorption of the hematoma have been reported, the best treatment is surgery. There are different methods of surgery for this disease, each of which has its unique advantages and disadvantages. The present study was a comparison of open and endoscopic methods in terms of postoperative neurological symptoms, residual hematoma, recurrence, and operation time of the patients. Material and Methods: In this clinical trial study, 32 patients were split into two groups using endoscopic and open techniques by simple random block method. The clinical examination of the patients and the CT Scan of the patients were reviewed and the necessary information was extracted from the patient's files. For follow-up, patients were followed up by phone after 6 months of discharge from the hospital. Results: After spending a day in the intensive care unit, all patients had been transferred to the ward. The average duration of hospitalization and bleeding of patients was significantly lower in the endoscopic group than in the non-endoscopic group(P<0.05). The duration of surgery did not differ significantly between the two groups. The frequency distribution of history of trauma, mortality, and neurological complications in the two groups of non-endoscopic and endoscopic patients was not significantly different from each other (P>0.05). The recurrence frequency distribution in the endoscopic group was significantly lower than in the non-endoscopic group (P=0.023). Conclusion: Compared to the non-endoscopic procedure, the endoscopic method's recurrence rate was significantly lower
Background and Aim: Glioblastoma multiforme (GBM) is a highly aggressive primary brain tumor with poor prognosis, largely driven by glioma stem-like cells (GSCs). Novel biomarkers that both characterize GSCs and predict patient survival are urgently needed. This study aims to identify GSCrelated genes with prognostic value in GBM through integrated bioinformatics analyses. Methods and Materials/Patients: Microarray data (GSE23806) comparing glioma cell lines and GSCs were downloaded via GEOquery in R and normalized. Differentially expressed genes (DEGs) were identified using the limma package (log₂ fold change ≥1, adjusted P<0.01). DEGs were crossreferenced with TCGA GBM tumor data via GEPIA2 to find common dysregulated genes. Kaplan– Meier survival analyses were performed using GEPIA2 to identify genes associated with survival. Protein–protein interaction (PPI) networks were built using GeneMANIA in cytoscape. Functional enrichment analyses (GO and KEGG) were conducted using clusterProfiler, with q<0.01. Results: A total of 1212 DEGs were i SMAD13 dentified in GSCs vs glioma cell lines and 5224 DEGs in GBM tumors vs normal tissues; 355 genes were commonly differentially expressed. Survival analysis revealed six genes (APLP1, CA14, PTPRN2, POR, ARMC10, and SMAD13) significantly associated with overall survival. Among these, CA14 and SMAD13 appeared protective (Hazzard ratio [R]~0.53–0.56), while APLP1, PTPRN2, POR, and ARMC10 were associated with risk (HR 1.6– 1.7). A PPI network with 26 nodes and 256 edges underscored extensive functional interactions. Enrichment analyses highlighted dysregulation in pathways including hypoxia response, metabolic processes, TGFβ signaling, and stem-like phenotypes. Conclusion: Our integrated bioinformatics framework identified six novel GSC-related genes with prognostic significance in GBM, representing diverse biological roles that range from tumor suppression to oncogenic signaling. These genes hold promise as diagnostic or therapeutic targets, but require experimental validation, including gene expression assays and functional studies to substantiate their roles in GBM pathogenesis and therapy resistance.
Background and Importance: Patient-specific polyetheretherketone (PEEK) implants are increasingly used in cranioplasty due to their biocompatibility, radiolucency, and favorable cosmetic outcomes. However, postoperative complications such as fluid collections remain a clinical concern. Case Presentation: We describe two male patients with severe traumatic brain injury who underwent bilateral decompressive craniectomy followed by delayed cranioplasty using custom-made PEEK implants. Both patients developed recurrent epidural and subgaleal effusions during follow-up. The first case was successfully managed conservatively with aspiration, corticosteroid therapy, and compressive bandaging. The second case developed progressive effusion resistant to conservative management, ultimately requiring implant removal and reconstruction with a titanium mesh, which resolved the complication. Although PEEK implants offer significant advantages in cranial reconstruction, they may be associated with recurrent effusion. Conservative management may be sufficient in some cases; however, persistent or refractory effusions may necessitate implant removal. Careful follow-up is essential for early detection and management of such complications. Conclusion: Although PEEK implants offer significant advantages in cranial reconstruction, they may be associated with recurrent effusion. Conservative management may be sufficient in some cases; however, persistent or refractory effusions may necessitate implant removal. Careful followup is essential for early detection and management of such complications.
Background and Aim: Defense mechanisms influence emotional expression and symptoms of social anxiety disorder, but this effect is unclear in people with spinal cord injury (SCI). This study investigated the role of coping mechanisms on emotional expressiveness and symptoms of social anxiety disorder in people with SCI. Methods and Materials/Patients: This study, entitled “Investigating the relationship between defense mechanisms, emotional expressiveness, and social anxiety disorder symptoms in individuals with SCI,” began in April 2023 and continued over 1 year. A total of 100 people with SCI were randomly selected from those referred to Tehran Welfare Center, Tehran City, Iran. Social anxiety, emotional expressiveness, and defensive styles questionnaires were used for data collection. The t-test was used for data analysis using SPSS software, version 22. Results: This study showed a relationship between defense mechanisms and emotional expressiveness in people with SCI (P<0.05). However, there is no relationship between defense mechanisms and social anxiety disorder in these people. There is no significant relationship between the demographic characteristics and either social phobia disorder or emotional expressiveness. However, a significant relationship was obtained between mature defense styles and being single (P<0.05). Conclusion: Individuals with SCI may use self-coping mechanisms to express their emotions. In people with SCI, efforts should be made to use appropriate coping mechanisms to express their excitement in proper ways.
Alzheimer’s disease (AD) is a major public health challenge. The exact cause of AD is unknown, but it is characterized by progressive impairment in cognitive and memory functions and pathological changes in the brain, such as aggregation of two main proteins, amyloid-beta (Aβ) and neurofibrillary tangles (NFTs) of tau. Nonetheless, the pathogenesis of AD appears to be complicated by vascular changes, neuroinflammation, synaptic loss, and impaired clearance of cellular waste products. Currently, the limited efficacy of available treatments underscores the need for alternative therapeutic strategies. The glymphatic system is a paravascular network in the central nervous system, responsible for the removal of cellular waste. The present review discusses the glymphatic system and its reconstructive surgery as a potential treatment approach for AD. Both experimental and human studies have demonstrated the role of the impaired glymphatic system in the pathogenesis of AD by increasing the accumulation of Aβ and tau proteins, thus holding potential as a new target for AD treatment. Moreover, glymphatic system dysfunction can lead to neurodegeneration, cognitive decline, and disease progression. Studies have also shown the potential role of microsurgical lymphatic reconstruction as a possible therapeutic target for AD treatment. Glymphatic system dysfunction may be a possible contributing factor to the pathogenesis and progression of AD. Moreover, glymphatic and meningeal reconstruction microsurgery may have the potential for the treatment of AD.
Background and Aim: Subarachnoid hemorrhage (SAH) resulting from ruptured intracranial aneurysms is associated with high mortality rates and presents a significant clinical challenge. The primary interventions to mitigate the risk of rebleeding and improve patient outcomes are neurosurgical clipping and endovascular coiling. While neurosurgical clipping has historically been the gold standard, endovascular coiling offers a less invasive alternative. Accordingly, this study compares the efficacy and outcomes of these two interventions in patients with aneurysmal SAH. Methods and Materials/Patients: A total of 65 consecutive patients with aneurysmal SAH, treated either with neurosurgical clipping or endovascular coiling, were included in the retrospective cohort study. Functional outcomes were assessed using the modified Rankin score, and the complications were evaluated. Results: No significant differences were found in functional outcomes between neurosurgical clipping and endovascular coiling groups (P=0.92); however, patients undergoing endovascular coiling had shorter lengths of in-hospital and in-intensive care unit stays compared to those treated with neurosurgical clipping (P=0.02). Conversely, endovascular coiling was associated with higher intervention costs (P<0.01). Subgroup analyses based on disease severity revealed small differences in functional outcomes between the two groups. Conclusion: While both neurosurgical clipping and endovascular coiling demonstrate comparable efficacy in preventing rebleeding and improving functional outcomes, they present distinct advantages and considerations. Future studies should be performed to improve treatment algorithms and patient outcomes in this complex clinical situation. Additionally, larger prospective studies are needed to validate these findings and provide stronger evidence for guiding clinical decision-making.
Background and Aim: Chronic subdural hematoma (cSDH), particularly its septated subtype (sCSDH), poses significant therapeutic challenges due to its propensity for recurrence and resistance to conventional surgical interventions. Septated cSDH is characterized by fibrin membranes that compartmentalize the hematoma, impeding complete drainage and perpetuating inflammationdriven neovascularization. Current management strategies including burr-hole craniostomy (BHC), craniotomy, and pharmacotherapy exhibit recurrence rates of 20–30% in septated cases, underscoring the need for alternative approaches. Methods and Materials/Patients: A targeted narrative review was conducted by searching PubMed, Scopus, and Web of Science (January 2000–July 2025) and peer-reviewed human studies meeting predefined inclusion criteria were reviewed. This review synthesizes existing literature to evaluate MMAE’s efficacy in septated cSDH. Results: Key findings highlight MMAE’s ability to reduce recurrence rates (3.1% vs 23.4% in nonembolized septated cases) when used adjunctively with surgery or as monotherapy, particularly in high-risk or recurrent patients. Technical considerations, such as transradial access (TRA) and embolic agent selection (e.g. polyvinyl alcohol, gelatin sponge), further enhance procedural safety and outcomes. Emerging evidence supports MMAE’s role in disrupting the angiogenicinflammatory cycle unique to septated cSDH, offering a paradigm shift in management. Conclusion: Despite promising results, challenges persist, including the need for specialized expertise and limited long-term data. However, prospective randomized trials are warranted to optimize protocols and solidify its position in clinical guidelines. This review underscores MMAE as a transformative adjunctive strategy for septated cSDH, bridging gaps in traditional therapies while advocating for further research to refine its application.
Background and Aim: In lumbar spine fusion surgeries, spinal anesthesia (SA) can enhance comfort and reduce postoperative pain compared to general anesthesia (GA). This study aimed to compare the preoperative and postoperative outcomes of the two approaches, given their unique advantages and disadvantages. Methods and Materials/Patients: This randomized, single-blind clinical trial involved 48 patients aged 18-65, classified as American society of anesthesiologists (ASA) I or II, who were candidates for spinal fusion surgery. Participants were divided into two groups: General and spinal anesthesia (GSA, n=24) and GA (n=24). The primary outcome was hemodynamic changes, while the secondary outcomes focused on pain intensity and side effects, such as postoperative nausea, vomiting, and shivering. The key variables included vital signs, intraoperative blood loss, propofol and midazolam doses, and surgical duration from operating room entry to discharge from recovery. Results: No significant differences in demographics or medical history were observed between the groups. The operative time was shorter in the GSA group (P=0.048). No notable differences were observed in terms of bleeding, nausea/vomiting, or shivering between the two methods. However, the median postoperative heart rate was significantly lower in the GSA group (P=0.007), and pain levels were also significantly reduced in both groups, with lower scores observed in the GSA group compared to GA (P=0.005). Hemoglobin levels decreased in both groups post-surgery (P<0.001). Repeated-measures analysis of variance (ANOVA) indicated significant effects on blood pressure, with GSA consistently showing lower readings than GA throughout the observation period. Conclusion: Evidence from clinical trials indicates that combining GSA leads to shorter operative times, improved postoperative cardiac regulation, more stable intraoperative blood pressure, and better immediate pain control. These benefits promote the use of spinal anesthetic adjuvants in suitable surgical groups, ensuring hemodynamic stability without affecting recovery time or increasing bleeding risk. These findings are crucial for enhancing anesthetic practices and optimizing patient outcomes.
Background and Aim: Pituitary adenomas commonly require endoscopic transsphenoidal surgery (ETSS). Although ETSS is minimally invasive, intraoperative cerebrospinal fluid (CSF) leaks occur in up to 50% of cases and can lead to meningitis or pneumocephalus if not well repaired. Autologous fat grafting from the periumbilical region is effective for dural reconstruction but carries donor-site morbidity and surgical-site infection (SSI). Buccal fat harvested intraorally reduces abdominal morbidity but risks contamination from oral flora. We evaluated a novel endonasal nasal-aperture approach to buccal fat harvest, hypothesizing comparable efficacy with fewer donor-site complications. Methods and Materials/Patients: In a single-center, single-blinded, nonrandomized trial at Alzahra Hospital (affiliated with Isfahan University of Medical Sciences, Isfahan City, Iran, 2024–2025), 30 patients with macroadenomas undergoing ETSS were allocated 1:1 to nasal-aperture buccal fat harvest (n=15) or standard periumbilical abdominal fat harvest (n=15). The same surgeon used consistent anesthesia and postoperative protocols. The primary outcome was postoperative CSF leak. Secondary outcomes included operative time, length of stay, postoperative bleeding, SSI, donor-site pain, facial numbness, and cosmetic sequelae. Follow-up visits occurred at 2 weeks, 1, 2, 4 months, and 1 year. Statistical comparisons used the t-test, Mann-Whitney U test, and chi-square test (α=0.05). Results: Groups were demographically similar (mean age 48.2±3 years; 56.7% male; mean BMI 25.4±1.2 kg/m²). Operative time (116.7±3.2 vs 115.9±3.8 min, P=0.54) and hospital stay (4.6±0.5 vs 4.5±0.5 days, P=0.67) did not differ between study groups. Both groups achieved 100% CSFleak closure without graft failure. The nasal-aperture group had significantly lower postoperative bleeding (20% vs 66.7%, P=0.01) and SSI (6.7% vs 33.3%, P=0.04). Transient facial numbness occurred in 6.7% of the nasal-aperture group; one immediate asymmetry resolved within 24 hours. No persistent donor-site complications or neurologic deficits were observed. Conclusion: Endonasal nasal-aperture buccal fat harvest during ETSS provides equivalent CSFleak prevention to abdominal fat grafting while reducing bleeding, infection risk, and donor-site morbidity, and improving cosmetic outcomes. Larger randomized, multicenter trials with longer follow-up and patient-reported outcomes are warranted.
Background and Aim: Chronic subdural hematomas (CSDH) are a common neurosurgical issue characterized by the accumulation of blood between the brain and its outermost protective membrane. The pathogenesis of CSDH involves a cycle of recurrent hemorrhage, fibrinolysis, inflammation, and angiogenesis. D-dimer, a marker of fibrinolysis, has been investigated in CSDH. This study explores the correlation between D-dimer levels, computed tomography (CT) findings, and recurrence of CSDH. Methods and Materials/Patients: This prospective study included 80 patients with CSDH who underwent surgical evacuation between 2018 and 2020. The CSDHs were classified based on CT scan appearance, and D-dimer levels were measured in the hematoma fluid and peripheral blood samples. The statistical analysis was performed to identify correlations between D-dimer levels, CT subtypes, and recurrence rates. Results: The mean D-dimer value in the Hypodense group was 454.2 mg/L while the value in the isodense group was 777.74 mg/L. The highest mean value was observed in the mixed subgroup, at 2370 mg/L. The layered group had a mean value of 1146.85 mg/L. The mean D-dimer value in the homogenous group was 622.48 mg/L while the mean in the heterogenous group was 2014.57 mg/L. There was a statistically significant correlation between the imaging subtypes and the D-dimer values (P=0.01). Conclusion: The mean D-dimer values were highest in the mixed subtype of CSDH, followed by the layered subtype, while the hypo- and isodense subtypes had lower D-dimer levels. There was a significant correlation between the imaging subtypes and D-dimer values. Additionally, a higher rate of recurrence was observed in the mixed subtype group, which also had higher D-dimer values. Steroid administration after surgery showed a statistically significant negative correlation with recurrence rates.
Background and Aim: The stability of the cervical spine is essential for treating spinal pathologies, including trauma, malformations, and tumors. Surgical stabilization, especially in the subaxial cervical vertebrae, often needs the use of lateral mass screws, laminar screws, and transpedicular screw fixation (TPSF). Due to the complex anatomy of the cervical spine and its variations among different ethnicities, as well as the high risks of surgical complications, it is crucial to understand its morphometric characteristics for more effective and safer surgical interventions. This study evaluates the feasibility of placing transpedicular, translaminar, and lateral mass screws (LMS) in the subaxial cervical vertebrae in the Iranian population by analyzing morphometric data obtained from cervical computed tomography (CT) scans. Methods and Materials/Patients: A cross-sectional study was conducted using cervical CT scan imaging of 100 patients from Rajayee Hospital in Qazvin City, Iran. Specific measurements of the pedicle, lamina, and lateral mass were recorded. Statistical analysis was performed using SPSS software, version 19, with a focus on descriptive statistics and tests for differences between genders. Results: The study presents detailed morphometric measurements of the subaxial cervical vertebrae in the Iranian population, including data from various cervical levels. Particularly, parameters, such as pedicle transverse angle, translaminar thickness, height, sagittal diagonal, and various lateral mass measurements, were analyzed, showing notable differences at each cervical level. Conclusion: Comparing the data from the present study to similar studies of different ethnicities provides valuable insights into the morphometry of the subaxial cervical vertebrae in the Iranian population. The findings emphasize the importance of considering ethnic-specific anatomical variations in surgical planning, eventually leading to safer and less complicated surgical outcomes in spine surgeries.
Background and Aim: Spinal stenosis is a common condition in the elderly and is characterized by the narrowing of the spinal canal, leading to significant neurological symptoms. Traditional imaging methods, such as magnetic resonance imaging (MRI) and computed tomography (CT), have limitations, including interpretation and time consumption variability. Integrating artificial intelligence (AI), particularly deep-learning algorithms, into MRI analysis shows promise for enhancing diagnostic accuracy and efficiency. This narrative review aims to explore AI’s application in diagnosing spinal stenosis and its implications for treatment planning and patient outcomes in neurosurgery practice. Methods and Materials/Patients: A literature search was conducted using Google Scholar, MEDLINE, and PubMed to identify original studies on AI in diagnosing lumbar and cervical spinal stenosis. Relevant studies were included after screening. Data extraction was performed using a structured spreadsheet, and findings were analyzed thematically to identify trends in AI applications for diagnostic accuracy. Results: Integrating AI into the diagnostic process for lumbar and cervical spinal stenosis has significantly improved accuracy and efficiency. By employing advanced deep learning (DL) algorithms, particularly convolutional neural networks (CNNs), AI systems can analyze imaging data more effectively and identify subtle patterns indicative of stenosis that human clinicians may overlook. This capability enhances diagnostic precision and facilitates earlier interventions, ultimately improving patient outcomes. As research continues to advance in this field, the role of AI is expected to expand, further transforming the landscape of spinal stenosis diagnoses. Conclusion: AI has shown significant promise in enhancing the diagnosis of cervical and lumbar spinal stenosis. By utilizing deep-learning algorithms, AI can analyze imaging data more accurately and efficiently, identifying subtle patterns indicative of stenosis that human observers may miss. This can ultimately facilitate earlier interventions and improve patient outcomes.
Background and Aim: Ankylosing spondylitis (AS) increases the risk of spinal fractures, often after minor trauma, due to fragile and rigid spinal anatomy. Lumbar fractures in AS patients are rare, and optimal management strategies are not well established. This study presents a case of traumatic lumbar spine fracture in an AS patient and reviews the current literature on diagnosis and management. Methods and Materials/Patients: A 48-year-old male with longstanding AS presented with a traumatic L2-L3 AO type C fracture and neurological deficits following a motorcycle accident. He underwent staged surgical management: First, multilevel posterior fixation, followed by anterior column reconstruction with cage placement. A literature review was conducted to collect evidence-based recommendations for managing such fractures. Results: The patient’s neurological function improved substantially following surgery, with progressive recovery of motor function and bladder control by three months. Literature review suggests that surgical intervention is generally preferred for unstable fractures in AS, with special attention required for anatomical challenges and perioperative risks. Conclusion: Lumbar spine fractures in AS often result from low-energy trauma and can present with subtle symptoms. Prompt diagnosis and individualized surgical management can lead to favorable outcomes, emphasizing the importance of careful perioperative planning in this unique patient population.
Background and Importance: Lumbosacral spinal stenosis (LSS) is a disease in elderly cases and, in it's advanced forms, gives rise to intractable leg pain and, in many cases various degrees of bladder dysfunction. In LSS, bladder dysfunction can occur following compression of lumbar nerve roots or cauda equine. Urological manifestations of LSS, such as bladder dysfunction and lower urinary tract complaints (LUTC), including urinary incontinence, detrusor hyperactivity and hypoactivity, and recurrent urinary tract infections, are rare and reviewed in this narrative study. Methods: This is a narrative study about the neuro-uro-genital aspects of LSS. To provide up-to-date information on this topic in neurosurgery, we precisely reviewed articles about neuro-urological manifestations of LSS. Using the keywords lumbar stenosis, neurogenic bladder, surgical decompression, and urodynamic study, all the corresponding surveys were held on Google Scholar, and PubMed Medline and precisely studied. Results: Urological presentations of LSS are rare; however, many patients present with various degrees of bladder malfunction. Urodynamic study (UDS) is crucial in detecting neurogenic bladder malfunction, preventing renal function aggravation, and evaluating the neuro-urological effects of LSS surgery. Conclusion: LSS may present with genitourinary symptoms. In contrast to conservative therapy, surgical decompression yields an adequate improvement in the neurourological aspects of LSS, with no significant relationship between the operation for LSS and the resolution of the upper urinary tract lesions (UUTL). Therefore , more conclusive studies with a long follow-up period and a large case population are required to explore the final treatment results.
Background and Importance: Cerebral micro-arteriovenous malformations (micro-AVMs), defined as occult nidus smaller than 1 cm, pose diagnostic challenges on conventional imaging and complicate treatment due to their small size and risk of hemorrhage. Advanced imaging modalities, such as intra-arterial cone-beam computed tomography angiography (CBCT-A), have shown promise in enhancing diagnostic accuracy and treatment planning. Case Presentation: We report the case of a 58-year-old woman who presented with intracerebral hemorrhage (ICH) without a history of hypertension. Initial computed tomography (CT) and magnetic resonance imaging (MRI) failed to identify the underlying vascular anomaly, necessitating catheter-based intra-arterial digital subtraction angiography (DSA), which revealed a small, low-flow nidus indicative of an AVM. Selective CBCT-A provided a detailed angioarchitectural evaluation, enabling precise catheterization and effective nidus occlusion with Onyx 18. Conclusion: This case highlights the critical role of combining digital subtraction angiography (DSA) and CBCT-A in the management of AVMs, particularly when traditional imaging is inconclusive. These modalities are crucial for managing AVMs, especially in patients with atypical presentations or those without common cerebrovascular risk factors.
