Retained wood penetrating the inferior orbital fissure removed after several months from injury: A case report and a comprehensive literature review.

Background: Intraorbital wooden foreign bodies (IOWFBs) constitute a relatively rare ocular trauma. Clinically, it can be difficult to diagnose them due to their wide variety of clinical manifestations. In addition, radiologic diagnosis of IOWFBs is always uncertain and challenging since their low density and low intensity on initial images are identical to air and fat. Therefore, IOWFBs are commonly missed and may not be confirmed for days or months after the initial injury. This article endeavors to contribute to the existing literature on IOWFBs by adding a case of an unusual occurrence of retained wood penetrating the inferior orbital fissure (IOF). To date, there have been no documented instances of a similar occurrence in this particular anatomical location. Case Description: A 58-year-old female with a history of trauma sustained by a slipping accident 10 months before her referral to our hospital. She underwent multiple surgeries and was referred to us due to persistent right eye pain, periorbital swelling, recurrent eye discharge, and inferior orbital paresthesia. The imaging revealed a retained foreign body located in the right orbital floor inferior to the inferior rectus muscle extending to the sub-temporal fossa through the IOF. The residue was successfully removed without complications. Conclusion: A history of trauma followed by persistent symptoms should raise the suspicion of a retained foreign body, regardless of the severity of trauma or the time between trauma and clinical presentation. Appropriate and timely imaging, followed by surgical removal, remains the cornerstone of treatment with a favorable prognosis.

"Brain Biopsy Revolution: Unveiling the Core Syringe Technique with Clinical Insights".

OBJECTIVES: Obtaining a definitive pathological diagnosis from brain tissue sampling was challenging due to the small, non-representative sample. This study introduced a novel syringe technique for brain biopsy aimed at enhancing diagnostic accuracy by obtaining core tissue samples that better represent the targeted tissue. METHODS: The ten patients with atypical brain lesions underwent the syringe biopsy. After meticulous preoperative planning with neuronavigation, a minimally invasive approach was used: a 3 cm skin incision and a 14 mm burr hole were created. A modified 3-cc syringe was used to create negative pressure and cannulate the brain tissue. The desired sample size (24 cm³) was obtained by controlling the syringe depth and withdrawal. Medical records were reviewed to assess sample analysis results and any complications RESULTS: The syringe technique successfully yielded adequate tissue samples in 9 out of 10 patients. In one case, the desired tissue could not be retrieved and required a microsurgical approach for removal. In all ten cases, a correct diagnosis was made without significant complications. CONCLUSION: The preliminary findings suggest that the syringe technique is both safe and effective for obtaining substantial volumes of brain tissue, facilitating accurate pathological evaluation in cases of complex neurological disorders.

A Prospective Comparison Between Soft Tissue Dissection Techniques in Pterional Craniotomy: Functional, Radiological, and Aesthetic Outcomes.

BACKGROUND AND OBJECTIVES: Given the complex anatomy of the operative region and individual surgeon preferences, some techniques for soft tissue dissection before pterional craniotomy have gained more popularity than others. This prospective study used subjective and objective measurements to compare the functional, radiological, and aesthetic outcomes of 3 such dissection techniques. METHODS: This multicenter prospective cohort study included all patients who underwent elective pterional craniotomy between 2018 and 2020 at 3 centers in Riyadh, Saudi Arabia. All patients underwent 1 of 3 soft tissue dissection techniques: myocutaneous flap, interfascial, and subfascial dissection techniques. Clinical and radiological assessments were performed upon discharge and at the 3- and 6-month follow-ups. RESULTS: We included 78 patients, with a mean age of 44.9 ± 16.3 years. Myocutaneous flap, interfascial, and subfascial dissections were performed in 34 (43%), 24 (30%), and 20 patients (25%), respectively. The myocutaneous flap method had the shortest opening ( P = .001) and closure ( P = .005) times; tenderness was more evident in this group than in the others ( P = .05). The frontalis muscle was most affected in the interfascial dissection group ( P = .05). The frontalis nerve function was similar in all groups after 6 months ( P = .54). The incidence of temporomandibular joint dysfunction was highest in the myocutaneous flap group (29%). Decreased temporalis muscle thickness at the 6-month postoperative follow-up was most severe in the subfascial dissection group (12.6%), followed by the myocutaneous flap (11.9%) and interfascial dissection (9.9%) groups, with no significant difference ( P = .85). Temporal hollowing was more prominent in the myocutaneous flap group ( P = .03). Cosmetic satisfaction was highest in the interfascial dissection group, with no significant difference ( P = .4). CONCLUSION: This study provides important information for neurosurgeons in weighing the benefits and risks of each technique for their patients.

Neurenteric cyst of the dorsal craniocervical junction in an adult: A case report and operative video.

Background: Neurenteric cysts (NCs) are rarely located in the dorsal craniocervical junction (CCJ). Case Description: Here, we present a case and show the surgical video of a 24-year-old man with a history of neck pain, progressive hemiparesis, and difficulty swallowing. Radiological images revealed an intradural extramedullary lesion at the dorsal CCJ. Posterior approach with C1-C2 laminectomy for resection of the lesion was performed with significant improvement in symptoms postoperatively. Histopathological examination confirmed the diagnosis of NC. Conclusion: This case demonstrates a rare location of a NC in an adult patient. Complete excision of the cyst wall and its content is the recommended treatment option.

A Bibliometric Analysis of the Most-Cited Articles on Craniospinal Epidural Hematoma.

AIM: To analyze the most-cited articles on cranial and spinal epidural hematomas (EDHs). MATERIAL AND METHODS: A title-specific search was performed on the Scopus database using the term ?epidural hematoma? in June 2020, with no publication date restrictions. The top 100 most-cited articles were collected, reviewed, and analyzed. RESULTS: A total of 2165 articles were published on EDH from 1949 to 2020, and the top 100 most-cited ones were published between 1966 and 2014, receiving an average citation of 84.7 per paper. Most papers were published in Neurosurgery and Journal of Neurosurgery (JNS). 48% of the most-cited articles on EDH originated from the United States of America (USA). Notably, studies on spinal EDH represented 75% of the most-cited articles in our review. The most-cited article on EDH was published by Lawton et al. in 1995, receiving a total of 412 citations at an annual citation rate of 16.4%. CONCLUSION: This report identifies the most influential publications on EDH as well as the publications trends over the last 70 years. Recognition of the most impactful work is an important tool for clinicians and researchers as it can reflect the enormous changes in the clinical practice. This report can serve as a guide for developing evidence-based practices and identifying areas of research inadequacy.

Chiari I malformation with neurogenic hypertension after suboccipital decompression.

Patients with Chiari I malformations have a spectrum of symptoms related to craniocervical structural compression. Neurogenic hypertension has been reported in some patients with this disorder, with resolution of hypertension after suboccipital decompressions in some cases. The pathophysiology of neurogenic hypertension in these patients is thought to be related to ventrolateral medullary compression. The important role of the ventrolateral medulla in blood pressure control has been studied extensively. In this report, we present the case of a pediatric patient diagnosed with a Chiari I malformation who developed hypertension after a suboccipital decompression. We believe that this case demonstrates the important role of the ventrolateral medulla in neurogenic hypertension.

Preoperative trans-arterial embolization of a giant scalp congenital hemangioma associated with cardiac failure in a premature newborn.

Scalp congenital hemangiomas are a rare, but well-known, vascular malformation in infants. These hemangiomas are usually benign, but occasionally these are associated with cardiac complications and disfigurement. Giant hemangiomas that are associated with high-output heart failure require intervention because they have a high mortality rate and do not respond to medical therapy. We report here a case of a premature newborn who was diagnosed with a giant scalp hemangioma associated with cardiac failure. The newborn underwent successful arterial feeder embolization of the superficial temporal artery. He then underwent surgical excision 14 days after embolization. We believe that preoperative embolization of a giant scalp hemangioma in newborns is a safe measure for alleviating underlying cardiac failure and minimizing the risk of intraoperative bleeding.

High-grade spheno-orbital meningioma in patients with systemic lupus erythematosus: Two case reports and literature review.

BACKGROUND: Spheno-orbital meningiomas (SOMs) are often benign. The association of meningioma and systemic lupus erythematosus (SLE) is rarely discussed in the literature. Here, we report two patients with high-grade, SOMs with a prolonged history of SLE and review the literature. CASE DESCRIPTION: The first case is a 52-year-old female patient with a 15-year history of SLE diagnosis who was referred to our center with a 1-year history of proptosis and excessive tearing of the left eye. This patient was operated for the left SOM with histopathological diagnosis of the World Health Organization (WHO) Grade III rhabdoid meningioma. The second case is a 36-year-old female patient with a 12-year history of SLE diagnosis who presented to our clinic with a 5-year-history of progressive right eye proptosis and occasional headaches. She was operated for the right SOM with histopathological diagnosis of the WHO Grade II chordoid meningioma. CONCLUSION: Rhabdoid and chordoid SOMs are uncommon and no previous report discussed their occurrence in patients with SLE. The association of high-grade meningiomas and SLE deserves further exploration.

Diabetes Insipidus following Endoscopic Transsphenoidal Surgery for Pituitary Adenoma.

Objectives Pituitary adenoma (PA), among the most commonly encountered sellar pathologies, accounts for 10% of primary intracranial tumors. The reported incidence of postoperative diabetes insipidus (DI) is highly variable. In this study, we report our experience with DI following endoscopic transsphenoidal surgery (TSS) for PAs, elucidating the risk factors of postoperative DI, the likelihood of long-term DI, and the impact of DI on the length of stay (LOS). Methods The study included 178 patients who underwent endoscopic resection of PAs. Early DI was defined as that occurring within the first postoperative week. The mean follow-up was 36 months. Long-term DI was considered as DI apparent in the last follow-up visit. Results Of the 178 patients included in the study, 77% of the tumors were macroadenomas. Forty-seven patients (26%) developed early DI. Long-term DI was observed in 18 (10.1%) of the full cohort. Age younger than 50 years was significantly associated with a higher incidence of long-term DI ( p = 0.02). Macroadenoma and gross total resection were significantly associated with higher incidence of early DI ( p = 0.05 and p = 0.04, respectively). The mean LOS was 4 days for patients with early postoperative DI and 3 days for those without it. Conclusion The reported incidence of postoperative DI is significantly variable. We identified age younger than 50 years a risk factor for developing long-term postoperative DI. Gross total surgical resection and tumor size (> 1 cm) were associated with development of early DI. Early DI increased the LOS on average by 1 day.