Introduction Invasive intracranial neuromonitoring and early magnetic resonance imaging (MRI) inform treatment and prognosis in traumatic brain injury (TBI), but probes in situ raise MRI safety concerns. Research question How do neurocritical care clinicians handle MRI in patients with intracranial neuromonitoring probes? Materials and methods A cross-sectional open online survey was distributed via European and international neurosurgical and neurocritical care networks. It covered demographics, probe placement and MRI practices. Data were analyzed descriptively with 95% confidence intervals and exploratory Fisher's exact tests. Results Ninety clinicians from 29 countries participated, predominantly neurosurgeons (85.6%) practicing in Europe (71/84, 84.5%). Frontal placement was reported by 97.1% (66/68) and ipsilateral placement by 67.2% (43/64). Probes were inserted in the operating room by 51.5% and at the bedside by 48.5%; 61.8% used bolt systems (n = 68). Of 87 respondents, 51.7% kept all probes in situ during MRI, 29.9% removed all and 18.4% removed selected probes. Respondents removing probes (n = 41) most often cited absent MRI safety testing (46.3%) and thermal injury (41.5%); of those leaving probes in situ (n = 57), 66.7% reported no complications. MRI was performed on demand by 54.0% and within seven days by 37.9% (n = 87). No respondent characteristic was significantly associated with these practices. Discussion and conclusion Respondents broadly agreed on frontal placement, whereas lateralization, insertion technique and MRI-related probe handling varied considerably. These self-reported data from a predominantly European, neurosurgical sample cannot establish MRI safety with probes in situ. Device-specific MRI safety testing, prospective multicenter registries and multidisciplinary consensus are needed to standardize practice.
Introduction Chronic adhesive arachnoiditis (CAA) following obstetric neuraxial anesthesia is an exceptionally rare but potentially devastating complication. While the diagnosis and conservative management of post-epidural CAA have been described, the neurosurgical management of patients developing progressive ascending myelopathy over many years remains virtually undocumented. Research question What is the long-term neurosurgical decision-making process, and what are the outcomes, in a patient with post-epidural CAA developing progressive ascending myelopathy to the brainstem over a decade? Material and methods We report a single illustrative case with ten-year prospective follow-up and conducted a structured PubMed/MEDLINE search to identify previously published cases of post-neuraxial anesthesia CAA with ascending, holospinal, or surgically managed disease. Results A woman in her mid-twenties developed CAA following obstetric epidural analgesia complicated by postpartum meningitis. Over ten years she underwent eighteen neurosurgical procedures, including ventriculoperitoneal shunting, hemilaminectomy with ventral arachnoid cyst decompression, cystoperitoneal shunting, suboccipital decompression with C1 arch resection, Rickham reservoir implantation, and integration of fourth ventricular and cervical syrinx drainage into a dual-valve shunt system. Progressive ascending myelopathy ultimately reached the brainstem, necessitating tracheostomy and intermittent mechanical ventilation. Repeated short courses of high-dose corticosteroids were used adjunctively for acute exacerbations. Despite near-complete tetraplegia, the patient remained fully cognitively intact at ten-year follow-up – the longest reported for surgically managed post-epidural CAA. Discussion and conclusion Comparison with previously published cases suggests this represents the first documented progression of post-epidural CAA to permanent respiratory failure requiring tracheostomy; earlier reports describe brainstem involvement but not this degree of respiratory compromise. Stepwise neurosurgical intervention appeared to provide periods of stabilization, but could not halt the underlying fibrotic process. The goal of surgery in this disease is best framed as stabilization rather than cure. Clinicians should counsel patients that long-term progression cannot be excluded, and that surveillance imaging of the full neuraxis is warranted indefinitely.
Introduction The optimal management of neurologically stable acute subdural hematoma (aSDH) remains uncertain. Twist-drill-craniostomy with pressure-controlled-fibrinolytic irrigation (TDC-FIT) offers a minimally invasive approach, but its imaging effects remain poorly characterized. Research question To assess radiological, radiomic, and clinical outcomes after TDC-FIT. Material and methods This retrospective, single-center study included neurologically stable aSDH patients treated between July 2023 and June 2025. Pretreatment computed tomography (CT) scans and the first CT before irrigation discontinuation were assessed for hematoma volume, midline shift, attenuation in Hounsfield units (HU), skewness, and kurtosis. Paired nonparametric tests compared imaging measurements. Clinical outcomes, complications, and modified Rankin Scale (mRS) scores were recorded. Results Twenty-five patients were included (52% male; mean age, 83 years). Median hematoma volume decreased from 83.6 cm3 (IQR 62.4–111.0) to 21.0 cm3 (IQR 5.0–35.6; p < 0.0001), and midline shift from 6.0 to 0.0 mm (p = 0.00065). Median percentage volume reduction was 74.9% (IQR 63.3–93.1%). Mean intralesional attenuation decreased from a cohort median of 59.9 to 48.0 HU (p = 0.0025); skewness changed from −0.56 to −0.14 (p = 0.019). Median mRS was 2 premorbidly, 3 at discharge, and 2 at 3 months. Procedure-related complications comprised rebleeding requiring craniotomy in two patients (8%), symptomatic chronic SDH recurrence in two (8%), and device failure in one (4%). Both rebleeding scans preceded rescue craniotomy. Discussion and conclusion TDC-FIT was associated with hematoma reduction and changes in attenuation and skewness. These findings may reflect altered hematoma composition, but their biological significance remains uncertain. Prospective controlled studies are needed to establish safety and efficacy.
