Diagnostics

Research

19 pages, 2699 KiB

Open AccessArticle

Seizures Following Carotid Endarterectomy: A Comprehensive Meta-Analysis of 69,479 Patients and Evidence-Based Recommendations for Perioperative Care

by Kruthajn Rajesh, Helen Shen and Sonu M. M. Bhaskar

Diagnostics 2025, 15(1), 6; https://doi.org/10.3390/diagnostics15010006 - 24 Dec 2024

Viewed by 894

Abstract

Background: Seizures are a rare but potentially serious complication following carotid endarterectomy (CEA). Understanding their prevalence and associated factors is crucial for optimizing perioperative care and improving patient outcomes. This meta-analysis aimed to estimate the pooled prevalence of seizures following CEA and explore [...] Read more.

Background: Seizures are a rare but potentially serious complication following carotid endarterectomy (CEA). Understanding their prevalence and associated factors is crucial for optimizing perioperative care and improving patient outcomes. This meta-analysis aimed to estimate the pooled prevalence of seizures following CEA and explore clinical and procedural factors contributing to their occurrence. Methods: We conducted a systematic review and meta-analysis of studies reporting on seizures following CEA. A systematic search of PubMed, Embase, and Cochrane CENTRAL databases was performed, following PRISMA and MOOSE guidelines. Random-effects meta-analysis was used to calculate the pooled prevalence of postoperative seizures. Heterogeneity was assessed using the I² statistic. A total of 20 studies, encompassing 69,479 patients, were included. Results: The overall pooled prevalence of seizures following CEA was 1% (95% CI: 0–2%; p < 0.001), with significant heterogeneity (I² = 93.52%). Prospective studies reported a higher pooled prevalence (2%, 95% CI 0–4%; I² = 76.34%) compared to retrospective studies (0%, 95% CI 0–1%; I² = 91.51%). Male predominance was noted among patients who experienced seizures, and hypertension was the most common comorbidity. Cerebral hyperperfusion syndrome was identified as a key contributing factor to postoperative seizures. Data on long-term outcomes, including the development of epilepsy, were insufficient for further analysis. The methodological quality of the included studies varied, with most studies demonstrating a moderate risk of bias. Conclusions: Seizures occur in approximately 1% of patients following CEA, with higher rates observed in prospective studies. Cerebral hyperperfusion syndrome is an important contributor to this rare complication. We provide evidence-based specific recommendations for seizure management and introduce the SMART-CEA Checklist, a practical framework to guide perioperative care and reduce complications. Future research should focus on long-term outcomes, including epilepsy, and incorporate standardized methodologies to improve data reliability and guide clinical practice. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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16 pages, 707 KiB

Open AccessArticle

The Impact of Surgical Telementoring on Reducing the Complication Rate in Endoscopic Endonasal Surgery of the Skull Base

by Janez Ravnik, Hojka Rowbottom, Carl H. Snyderman, Paul A. Gardner, Tomaž Šmigoc, Matic Glavan, Urška Kšela, Nenad Kljaić and Boštjan Lanišnik

Diagnostics 2024, 14(17), 1874; https://doi.org/10.3390/diagnostics14171874 - 27 Aug 2024

Viewed by 1054

Abstract

Background: Pituitary adenomas represent the most common pituitary disorder, with an estimated prevalence as high as 20%, and they can manifest with hormone hypersecretion or deficiency, neurological symptoms from mass effect, or incidental findings on imaging. Transsphenoidal surgery, performed either microscopically or endoscopically, [...] Read more.

Background: Pituitary adenomas represent the most common pituitary disorder, with an estimated prevalence as high as 20%, and they can manifest with hormone hypersecretion or deficiency, neurological symptoms from mass effect, or incidental findings on imaging. Transsphenoidal surgery, performed either microscopically or endoscopically, allows for a better extent of resection while minimising the associated risk in comparison to the transcranial approach. Endoscopy allows for better visualisation and improvement in tumour resection with an improved working angle and less nasal morbidity, making it likely to become the preferred surgical treatment for pituitary neoplasms. The learning curve can be aided by telementoring. Methods: We retrospectively analysed the clinical records of 94 patients who underwent an endoscopic endonasal resection of a pituitary neoplasm between the years 2011 and 2023 at Maribor University Medical Centre in Slovenia. Remote surgical telementoring over 3 years assisted with the learning curve. Results: The proportion of complication-free patients significantly increased over the observed period (60% vs. 79%). A gradual but insignificant increase in the percentage of patients with improved endocrine function was observed. Patients’ vision improved significantly over the observed period. By gaining experience, the extent of gross total tumour resection increased insignificantly (67% vs. 79%). Conclusions: Telementoring for the endoscopic endonasal approach to pituitary neoplasms enables low-volume centres to achieve efficiency, decreasing rates of postoperative complications and increasing the extent of tumour resection. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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12 pages, 876 KiB

Open AccessArticle

Hypopituitarism, Diabetes Insipidus, and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Pituitary Macroadenoma Surgery with Indocyanine Green Dye

by Tomislav Felbabić, Tomaž Velnar and Tomaž Kocjan

Diagnostics 2024, 14(17), 1863; https://doi.org/10.3390/diagnostics14171863 - 26 Aug 2024

Cited by 1 | Viewed by 1275

Abstract

(1) Background: Pituitary adenomas are benign tumors comprising about 18% of all intracranial tumors, and they often require surgical intervention. Differentiating pituitary tissue from adenoma during surgery is crucial to minimize complications. We hypothesized that using ICG dye would reduce the hormonal complication [...] Read more.

(1) Background: Pituitary adenomas are benign tumors comprising about 18% of all intracranial tumors, and they often require surgical intervention. Differentiating pituitary tissue from adenoma during surgery is crucial to minimize complications. We hypothesized that using ICG dye would reduce the hormonal complication rates. (2) Methods: A prospective randomized study (February 2019–October 2023) included 34 patients with non-functional macroadenomas of the pituitary gland randomly assigned to receive intraoperative ICG or be in the control group. All underwent endoscopic endonasal transsphenoidal surgery. Pituitary function was assessed preoperatively, immediately postoperatively, and 3–6 months postoperatively. Adenohypophysis function was evaluated with hormonal tests (Cosyntropin stimulation test, TSH, fT3, fT4, prolactin, IGF-1, FSH, LH, and testosterone in men) and neurohypophysis function with fluid balance, plasma and urine osmolality, and serum and urinary sodium. (3) Results: Of the 34 patients (23 men, 11 women; average age 60.9 years), 5.9% in the ICG group developed diabetes insipidus postoperatively, compared to 23.5% in the control group. Adenohypophysis function worsened in 52.9% of the ICG group and in 35.3% of the control group. (4) Conclusions: Our study did not confirm the benefits of using ICG in these surgeries. Further research with a larger sample is needed. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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13 pages, 5011 KiB

Open AccessArticle

Results of Surgical Treatment of Occult Spinal Dysraphisms—A Single Centre Experience

by Peter Spazzapan, Tomaz Velnar, Nina Perosa, Andrej Porcnik and Borut Prestor

Diagnostics 2024, 14(7), 703; https://doi.org/10.3390/diagnostics14070703 - 27 Mar 2024

Viewed by 1399

Abstract

Occult spinal dysraphisms (OSDs) are caused by various defects in the embryogenesis of the spinal cord and represent an obstacle to the ascent of the conus, which allows the conus to pass from the lower levels of the spinal canal to the final [...] Read more.

Occult spinal dysraphisms (OSDs) are caused by various defects in the embryogenesis of the spinal cord and represent an obstacle to the ascent of the conus, which allows the conus to pass from the lower levels of the spinal canal to the final position between L1 and L2 during normal foetal life. When an OSD tethers the spinal cord at the lower levels, it can lead to neurological symptoms, better known as tethered cord syndrome. Surgical treatment of OSD is primarily aimed at untethering the spinal cord. In asymptomatic patients, this can protect against the long-term development of neurological deficits. In symptomatic patients, this can halt or limit the progression of existing symptoms. The aim of this study is to examine all paediatric and adult patients diagnosed with OSD and treated in the Department of Neurosurgery at the University Medical Centre Ljubljana during the 5-year period of 2016–2021. All patients diagnosed with OSD during this period were included in the study. Patient characteristics, treatment modalities and outcomes were studied with the aim of describing the differences between the paediatric and adult population and defining the rationality of treating these pathological conditions. We included in the study 52 patients with 64 occult dysraphic lesions. Adults (>18 years old) represented 15/52 (28.8%) of all patients, while 37/52 (71.8%) were children. The most common OSDs were conus lipomas, followed by dermal sinus tracts, filum terminale lipomas and split cord malformations. Surgical treatment was performed in 35/52 (67.3%) cases, while conservative management was chosen in 17/52 (32.6%) cases. The preoperative presence of symptoms was statistically higher in adults than in children (p = 0.0098). Surgery on complex spinal cord lipomas was statistically related to a higher rate of postoperative neurological complications (p = 0.0002). The treatment of OSD is complex and must be based on knowledge of the developmental anomalies of the spine and spinal cord. Successful surgical treatment relies on microsurgical techniques and the use of neuromonitoring. Successful treatment can prevent or limit the occurrence of neurological problems. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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10 pages, 6473 KiB

Open AccessArticle

The Impact of Magnetic Resonance Imaging Findings in Predicting Neurological Status Pre- and Post-Treatment of Spinal Dural Arteriovenous Fistulas: A 22-Year Experience in a Neurovascular and Spine Center

by Andreas Filis, Kay Engellandt, Sergio M. F. Romualdo, Ibrahim El-Battrawy, Dino Podlesek, Tareq A. Juratli, Ilker Y. Eyüpoglu and Mido Max Hijazi

Diagnostics 2024, 14(6), 581; https://doi.org/10.3390/diagnostics14060581 - 8 Mar 2024

Viewed by 1330

Abstract

Background: Successful treatment of spinal dural arteriovenous fistulas (SDAVF) requires prompt diagnosis with definitive fistula localization and non-delayed treatment. Magnetic resonance imaging (MRI) is used for the screening and follow-up of SDAVF, although the value of MRI signs such as myelopathy and flow [...] Read more.

Background: Successful treatment of spinal dural arteriovenous fistulas (SDAVF) requires prompt diagnosis with definitive fistula localization and non-delayed treatment. Magnetic resonance imaging (MRI) is used for the screening and follow-up of SDAVF, although the value of MRI signs such as myelopathy and flow voids is controversial. Therefore, we investigated the predictive value of MRI signs pre- and post-treatment and their correlation with the neurological status of SDAVF patients. Methods: We retrospectively analyzed the clinical records of 81 patients who underwent surgical or endovascular treatment for SDAVF at our hospital between 2002 and 2023. A total of 41 SDAVF patients with follow-up MRI of 4.6 [2.9–6.5] months (median [interquartile range]) post-treatment and clinical follow-up of 3, 6, and 12 months were included. Results: The extent of pretreatment myelopathy was seven [6–8] vertebral levels, with follow-up MRI showing no myelopathy in 70.7% of cases. The pretreatment flow voids extended over seven [4.5–10] vertebral levels and completely disappeared on follow-up MRI in 100% of cases. The modified Aminoff–Logue scale of disability (mALS) was four [2–7] pretreatment and two [0–4.5] at the third follow-up, with improvement in 65.9% of patients. The American Spinal Injury Association motor score (ASIA-MS) was 97 [88–100] pretreatment and 100 [95–100] at the third follow-up assessment, with 78% of patients improving. Pretreatment ASIA-MS correlated with the extent of myelopathy at admission (R²: 0.179; 95% CI: −0.185, −0.033; p = 0.006) but not with flow voids at admission, while pretreatment mALS showed no correlation with either MRI signs. The improvement in ASIA-MS and mALS between admission and the last follow-up showed no correlation with the extent of pretreatment myelopathy and flow voids or with pos-treatment MRI changes. The diagnostic sensitivity of magnetic resonance angiography (MRA) for localization of the fistula was 68.3% (28/41). Conclusions: The severity of the clinical condition in SDAVF patients has a multifactorial cause, whereby the ASIA-MS correlates with the extent of myelopathy pretreatment. MRI changes after treatment showed no correlation with the clinical outcome and cannot be used as a prognostic factor. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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Review

Jump to: Research, Other

18 pages, 2559 KiB

Open AccessReview

Isolated Sagittal Craniosynostosis: A Comprehensive Review

by Peter Spazzapan and Tomaz Velnar

Diagnostics 2024, 14(4), 435; https://doi.org/10.3390/diagnostics14040435 - 16 Feb 2024

Cited by 8 | Viewed by 4275

Abstract

Sagittal craniosynostosis, a rare but fascinating craniofacial anomaly, presents a unique challenge for both diagnosis and treatment. This condition involves premature fusion of the sagittal suture, which alters the normal growth pattern of the skull and can affect neurological development. Sagittal craniosynostosis is [...] Read more.

Sagittal craniosynostosis, a rare but fascinating craniofacial anomaly, presents a unique challenge for both diagnosis and treatment. This condition involves premature fusion of the sagittal suture, which alters the normal growth pattern of the skull and can affect neurological development. Sagittal craniosynostosis is characterised by a pronounced head shape, often referred to as scaphocephaly. Asymmetry of the face and head, protrusion of the fontanel, and increased intracranial pressure are common clinical manifestations. Early recognition of these features is crucial for early intervention, and understanding the aetiology is, therefore, essential. Although the exact cause remains unclear, genetic factors are thought to play an important role. Mutations in genes such as FGFR2 and FGFR3, which disrupt the normal development of the skull, are suspected. Environmental factors and various insults during pregnancy can also contribute to the occurrence of the disease. An accurate diagnosis is crucial for treatment. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and three-dimensional reconstructions play a crucial role in visualising the prematurely fused sagittal suture. Clinicians also rely on a physical examination and medical history to confirm the diagnosis. Early detection allows for quick intervention and better treatment outcomes. The treatment of sagittal craniosynostosis requires a multidisciplinary approach that includes neurosurgery, craniofacial surgery, and paediatric care. Traditional treatment consists of an open reconstruction of the cranial vault, where the fused suture is surgically released to allow normal growth of the skull. However, advances in minimally invasive techniques, such as endoscopic strip craniectomy, are becoming increasingly popular due to their lower morbidity and shorter recovery times. This review aims to provide a comprehensive overview of sagittal craniosynostosis, highlighting the aetiology, clinical presentation, diagnostic methods, and current treatment options. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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Other

Jump to: Research, Review

23 pages, 4489 KiB

Open AccessSystematic Review

The Value of Cerebral Blood Volume Derived from Dynamic Susceptibility Contrast Perfusion MRI in Predicting IDH Mutation Status of Brain Gliomas—A Systematic Review and Meta-Analysis

by José Pablo Martínez Barbero, Francisco Javier Pérez García, Paula María Jiménez Gutiérrez, Marta García Cerezo, David López Cornejo, Gonzalo Olivares Granados, José Manuel Benítez and Antonio Jesús Láinez Ramos-Bossini

Diagnostics 2025, 15(7), 896; https://doi.org/10.3390/diagnostics15070896 - 1 Apr 2025

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Abstract

Background: Dynamic susceptibility contrast perfusion MRI (DSC-MRI) is a promising non-invasive examination to predict histological and molecular characteristics of brain gliomas. However, the diagnostic accuracy of relative cerebral blood volume (rCBV) is heterogeneously reported in the literature. This systematic review and meta-analysis aims [...] Read more.

Background: Dynamic susceptibility contrast perfusion MRI (DSC-MRI) is a promising non-invasive examination to predict histological and molecular characteristics of brain gliomas. However, the diagnostic accuracy of relative cerebral blood volume (rCBV) is heterogeneously reported in the literature. This systematic review and meta-analysis aims to assess the diagnostic accuracy of mean rCBV derived from DSC-MRI in differentiating Isocitrate Dehydrogenase (IDH)-mutant from IDH-wildtype gliomas. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, and EMBASE up to January 2025, following PRISMA guidelines. Eligible studies reported mean CBV values in treatment-naïve gliomas with histologically confirmed IDH status. Pooled estimates of standardized mean differences (SMDs), diagnostic odds ratios (DOR), and area under the receiver-operating characteristic curve (AUC) were computed using a random-effects model. Heterogeneity was assessed via I² statistic. Meta-regression analyses were also performed. Results: An analysis of 18 studies (n = 1733) showed that mean rCBV is significantly lower in IDH-mutant gliomas (SMD = −0.86; p < 0.0001). The pooled AUC was 0.80 (95% CI, 0.75–0.90), with moderate sensitivity and specificity. Meta-regression revealed no significant influence of DSC-MRI acquisition parameters, although a flip angle showed a trend toward significance (p = 0.055). Conclusions: Mean rCBV is a reliable imaging biomarker for IDH mutation status in gliomas, demonstrating good diagnostic performance. However, heterogeneity in acquisition parameters and post-processing methods limits generalizability of results. Future research should focus on standardizing DSC-MRI protocols. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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10 pages, 1853 KiB

Open AccessCase Report

The Impact of Class III Obesity on Outcomes for Vestibular Schwannoma Surgery: A Case Report

by Tomaž Šmigoc, Hojka Rowbottom and Janez Ravnik

Diagnostics 2025, 15(7), 888; https://doi.org/10.3390/diagnostics15070888 - 1 Apr 2025

Viewed by 364

Abstract

Background and Clinical Significance: Vestibular schwannomas (VS) are benign tumors arising from Schwann cells of the eighth cranial nerve. They represent approximately 8% of all intracranial tumors and have an increasing incidence. Larger VS can cause brainstem compression and hydrocephalus, and magnetic [...] Read more.

Background and Clinical Significance: Vestibular schwannomas (VS) are benign tumors arising from Schwann cells of the eighth cranial nerve. They represent approximately 8% of all intracranial tumors and have an increasing incidence. Larger VS can cause brainstem compression and hydrocephalus, and magnetic resonance imaging (MRI) is the diagnostic modality of choice. Individuals with VS and an elevated body mass index (BMI) can have more postoperative complications due to their weight, which can also negatively impact the preoperative diagnostic process and planning, as well as the surgery itself, as compromises must be made since optimal positioning of the patient is often not feasible. Increased BMI is a recognized risk factor for cerebrospinal fluid (CSF) leak after microscopic resection of a VS. Case Presentation: This report presents a case of a patient with class III obesity who had to undergo a right VS resection with preexisting hydrocephalus and the obstacles encountered by the surgical team throughout the diagnostics process since MRI could not be performed and preoperative planning had to be based on computed tomography (CT) scan; operative treatment, where suboptimal patient placement was achieved for a planned retrosigmoid approach to the pontocerebellar angle (PCA) and postoperative rehabilitation, which was hindered by his high BMI (55 kg/m²) with several complications, such as CSF leak, due to his extreme weight. Conclusions: Despite barriers, optimal tumor resection was obtained with a long neurorehabilitation process, with a favorable outcome, emphasizing the role of a multidisciplinary team. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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10 pages, 2853 KiB

Open AccessCase Report

Neck Schwannoma Masking as Thyroid Tumour: Into the Deep of Diagnostics and Anatomy

by Serghei Covantsev, Anna Bumbu, Anna Sukhotko, Evghenii Zakurdaev, Ivan Kuts and Andrey Evsikov

Diagnostics 2024, 14(20), 2332; https://doi.org/10.3390/diagnostics14202332 - 19 Oct 2024

Cited by 1 | Viewed by 1367

Abstract

Schwannomas are benign nerve sheath tumours that exhibit a slow rate of growth. In the vast majority of cases, schwannomas manifest as asymptomatic masses. The presence of symptomatic lesions may necessitate surgical removal. The incidence of schwannomas ranges from 4.4 to 5.23 cases [...] Read more.

Schwannomas are benign nerve sheath tumours that exhibit a slow rate of growth. In the vast majority of cases, schwannomas manifest as asymptomatic masses. The presence of symptomatic lesions may necessitate surgical removal. The incidence of schwannomas ranges from 4.4 to 5.23 cases per 100,000 population, accounting for approximately 7% of all primary tumours in the central nervous system. There is a limited number of case reports describing schwannomas outside the central nervous system. In rare instances, schwannomas may originate at the level of the thyroid gland. In such cases, incidental neck schwannomas may be mistaken for thyroid or parathyroid tumours. The increasing incidence of thyroid cancer draws more attention to all thyroid nodules, both benign and malignant. Thyroid nodules are detected in up to 65% of autopsies, with only 4–6.5% being malignant. Thyroid tumours are typically diagnosed by USG; however, they are often revealed incidentally during neck CT or MRI for other conditions. To rule out malignancy, tumour verification is required. The modern diagnosis of thyroid cancer is based on fine-needle aspiration (FNA) biopsy and cytology, which is classified according to the Bethesda classification system. However, not all FNAs are informative, and the differential diagnosis and treatment strategies in cases of unsatisfactory results are not standardized, leading to potential intraoperative challenges. We present a case study of a patient with a thyroid nodule that was ultimately diagnosed with a schwannoma of the neck according to core-needle biopsy. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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9 pages, 618 KiB

Open AccessCase Report

Hybrid Positron Emission Tomography and Magnetic Resonance Imaging Guided Microsurgical Management of Glial Tumors: Case Series and Review of the Literature

by Yusuf Sukru Caglar, Murat Buyuktepe, Emre Yagiz Sayaci, Ihsan Dogan, Melih Bozkurt, Elif Peker, Cigdem Soydal, Elgin Ozkan and Nuriye Ozlem Kucuk

Diagnostics 2024, 14(14), 1551; https://doi.org/10.3390/diagnostics14141551 - 18 Jul 2024

Cited by 2 | Viewed by 1376

Abstract

In this case series, we aimed to report our clinical experience with hybrid positron emission tomography (PET) and magnetic resonance imaging (MRI) navigation in the management of recurrent glial brain tumors. Consecutive recurrent neuroglial brain tumor patients who underwent PET/MRI at preoperative or [...] Read more.

In this case series, we aimed to report our clinical experience with hybrid positron emission tomography (PET) and magnetic resonance imaging (MRI) navigation in the management of recurrent glial brain tumors. Consecutive recurrent neuroglial brain tumor patients who underwent PET/MRI at preoperative or intraoperative periods were included, whereas patients with non-glial intracranial tumors including metastasis, lymphoma and meningioma were excluded from the study. A total of eight patients (mean age 50.1 ± 11.0 years) with suspicion of recurrent glioma tumor were evaluated. Gross total tumor resection of the PET/MRI-positive area was achieved in seven patients, whereas one patient was diagnosed with radiation necrosis, and surgery was avoided. All patients survived at 1-year follow-up. Five (71.4%) of the recurrent patients remained free of recurrence for the entire follow-up period. Two patients with glioblastoma had tumor recurrence at the postoperative sixth and eighth months. According to our results, hybrid PET/MRI provides reliable and accurate information to distinguish recurrent glial tumor from radiation necrosis. With the help of this differential diagnosis, hybrid imaging may provide the gross total resection of recurrent tumors without harming eloquent brain areas. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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8 pages, 766 KiB

Open AccessBrief Report

Captive Bolt Gun-Related Vascular Injury: A Single Center Experience

by Jure Pešak, Andrej Porčnik and Borut Prestor

Diagnostics 2024, 14(10), 977; https://doi.org/10.3390/diagnostics14100977 - 8 May 2024

Viewed by 1231

Abstract

This article investigates the clinical and radiological characteristics of captive bolt gun head injuries, a rare form of low-velocity penetrating brain injury. Eleven consecutive patients were included in the study. Vascular injuries and the rate of infection were systematically analyzed. Radiological findings reveal [...] Read more.

This article investigates the clinical and radiological characteristics of captive bolt gun head injuries, a rare form of low-velocity penetrating brain injury. Eleven consecutive patients were included in the study. Vascular injuries and the rate of infection were systematically analyzed. Radiological findings reveal common bolt trajectories in the anterior cranial fossa, with identified risk factors for a poor outcome including trajectory crossing midline, hematocephalus, and paranasal sinus involvement. Only one patient had a good outcome. Despite meticulous microsurgical techniques, this study highlights often unfavorable clinical outcomes in captive bolt gun injuries, with vascular injury identified as a potential contributing risk factor for a poor outcome. Knowledge of variant vascular tree anatomy and corresponding vascular territory is important. To avoid potential vascular injuries, a complete removal of bone fragments was not always performed and it did not increase the rate of infection, challenging the conventional wisdom advocating for the complete removal of bone fragments. These findings contribute novel insights into captive bolt gun-related injuries, paving the way for further research. Full article

(This article belongs to the Special Issue New Advances in Neurosurgery: Clinical Diagnosis, Treatment and Prognosis)

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