Percutaneous full-endoscopic bullet removal from the C2 vertebra in a pediatric patient.

Gunshot injuries (GSIs) to the spine constitute approximately 17% to 21% of all traumatic spinal injuries, with the cervical spine being the second most frequently affected region. There is a lack of approved algorithms for patients with GSIs to the spine. Surgical intervention is controversial; however, it is generally considered in cases involving neurological deterioration with incomplete deficit, externalized liquor fistula, instability, installed toxicity, and risk of migration. Detailed information on pediatric patients is limited, primarily due to the predominance of adult patients. This study presents the full-endoscopic removal of a bullet in the C2 vertebra of a pediatric patient. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23230.

Middle Cerebral Artery Ischemic Complications After Flow Diverter Deployment from Internal Carotid Artery Extending into M1 Segment.

AIM: To gain a better understanding of ischemia risk related to in-stent stenosis (ISS) or in-stent thrombosis (IST) of the middle cerebral artery (MCA) and lenticulostriate arteries after flow-diverting devices (FDD) deployment from the internal carotid artery (ICA) to proximal middle cerebral artery (M1). MATERIAL AND METHODS: Using data from a prospectively maintained database, we retrospectively evaluated patients who were treated with FDD between January 2015 and 2020 at a single academic center. Only patients with unruptured ICA aneurysms where the FDD was extended into M1 were included. RESULTS: In total, 89 patients with 94 ICA aneurysms were treated with FDD. A total of 34 patients with 36 aneurysms had FDD extending into M1. Of the 34 patients, four experienced MCA, and lenticulostriate territory ischemia. Three patients had in-stent thrombosis (IST), and one patient had severe in-stent stenosis (ISS). The overall ischemic complication rate was 17.6%, which resulted in a permanent neurological deficit in 11.7% of the patients. CONCLUSION: If the distance of the distal neck of the aneurysm to the ICA terminus (ICAT) is ≤5 mm, or if the aneurysm is located directly at the ICAT, FDD should be considered only as a last option when other treatment modalities are not suitable. In addition, in the treatment of distal ICA aneurysms, extra effort should be exerted during the procedure to deploy the FDD without extending into M1. However, when traditional microsurgical clipping and other endovascular procedures are not suitable, the use of FDD is effective in terms of high aneurysm occlusion rates and preventing aneurysm rupture.

Comparison of Subthalamic Nucleus vs. Globus Pallidus Interna Deep Brain Stimulation in Terms of Gait and Balance; A Two Year Follow-Up Study.

AIM: To compare the effects of subthalamic nucleus (STN) and globus pallidus interna (GPi) deep brain stimulation (DBS) on the motor outcome, gait and balance function, fall risk (FR), and non-motor symptoms in patients with advanced Parkinson's disease (PD). MATERIAL AND METHODS: We randomized patients with advanced PD with the indication of DBS to undergo either STN or GPi DBS and followed them for 2 years. We collected data at baseline and postoperative 6, 12, and 24 months. We compared changes in the Unified Parkinson's Disease Rating Scale (UPDRS) score, timed gait tests, posturography, non-motor symptom questionnaire (NMSQuest), hospital anxiety and depression (HAD) scale, and levodopa equivalent dose (LED). RESULTS: We enrolled and randomized 12 patients to receive either STN (n = 6) or GPi (n = 6) DBS. Postoperative motor outcomes were significantly improved in both groups (p < 0.05). In both groups, timed gait tests exhibited better performance in mobility; however, patients receiving GPi DBS performed better than those receiving STN DBS in the timed gait tests (p < 0.05). Furthermore, the posturographic evaluation demonstrated a significant elevation in the FR in the STN group (p < 0.05). CONCLUSION: Both STN and GPi DBS are equally effective in alleviating disabling motor complications. However, seemingly, STN DBS could cause more gait and balance problems; hence, a tailored approach seems to be more appropriate in the target selection.

Melanotic neuroectodermal tumor of infancy in the skull: a case report.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rarely occurring neoplasm of neural crest origin, appearing in children during the first year of life. MNTI is a benign tumor but is nonetheless locally aggressive; it usually originates from the maxilla and the mandible. Recognition of the diagnostic features of MNTI is important, so that it may be differentiated from benign lesions (dermoid or epidermoid cysts, vascular lesions) as well as from malignant lesions such as small round cell tumors. We present a case of a 2-month-old infant who developed right retroauricular swelling with extension through the calvarium and into the central nervous system. The tumor was totally resected. Aggressive benign or malignant lesions of the calvarium may entail dural infiltration and brain involvement, as in our case. Early diagnosis and surgery are thus mandatory for benign or malignant tumors of the calvarium.

Spontaneous recovery of post-traumatic cerebrospinal fluid rhinorrhea following meningitis: A case report.

The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication. A 26-year-old male patient who had a traffic accident one week ago was sent to our clinic because of his rhinorrhea persisting for 4 days. On cranial computed tomography, fracture of the left frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding in the vicinity of the frontal sinus, subarachnoidal bleeding and left temporal extradural hematoma were detected. Then he underwent sinus wall repair and extradural hematoma was drained through bifrontal craniotomy. However, rhinorrhea persisted which resulted a deterioration in consciousness and he entered into a deep somnolent state. When his symptoms of meningitis became apparent, rhinorrhea of the patient disappeared. The patient transferred in intensive care unit and re-connected to a lumbar drainage system. On cerebral magnetic resonance imaging, regression of contrast-enhanced lesions localized in the left anterotemporal and frontal and in the regions lateral to the right trigon and medial to the right thalamus and in the right posteroparietal regions was observed. Despite repair of the anterior cranial fracture and lumbar drainage, rhinorrhea may persist. Herein, development of meningitis caused disappearing of rhinorrhea symptoms without any need for surgical intervention.

Reuse of internal pulse generator in cases of infection after deep brain stimulation surgery.

BACKGROUND: Hardware-related infection after deep brain stimulation (DBS) is one of the most serious complications and may need additional interventions. OBJECTIVES: To reuse the internal pulse generator (IPG) after DBS infection and to reduce the economic costs. METHODS: A database of 102 patients who underwent DBS surgery was used in the study. The incidence, clinical characteristics and management of infections while reusing the IPG after DBS-related infection were analyzed and reported. RESULTS: The overall infection rate was 5.9% (6 of 102 patients). Management consisted of total hardware removal followed by intravenous antibiotics. The IPG was at first kept in a solution, then rinsed with water and dried following sterilization with ethylene oxide gas at 38 °C for 18 h. When the treatment of the infection was finished, we reused the IPG and reimplanted the DBS. No hardware-related infection or other complications were observed after reimplantation. CONCLUSIONS: Management of hardware-related infections can be challenging. The medical and economic costs associated with these infections are enormous. The IPG can often be saved in infected patients. Thus, a significant cost burden is eliminated. Properly executed, reuse of IPG should markedly reduce the costs of these devices.