Ukrainian Neurosurgical Journal

A Comprehensive assessment of surgical, clinical, and radiological outcomes in craniovertebral junction anomalies with basilar invagination and atlantoaxial dislocation: An initial experience of 5 cases

Dharmikkumar Velani — 2025-12-29

Objective: The craniovertebral junction (CVJ) plays a pivotal role in stabilizing and facilitating movement within the craniospinal axis. This study aimed to evaluate the clinical, radiological characteristics and surgical outcomes in patients with CVJ anomalies associated with basilar invagination and atlantoaxial dislocation.

Materials and methods: A retrospective analysis of five patients with CVJ anomalies, who underwent surgical management at Sardar Vallabhbhai Patel (SVP) Hospital, Ahmedabad, Gujarat, India. They were analyzed for clinical characteristics, radiological parameters and various surgical procedures. Patient's clinical and radiological status was assessed pre- and postoperatively at discharge and at 6 months of follow-up. Nurick grading system and Modified Japanese Orthopedic Association (mJOA) score was used. Radiological assessment was done by atlantodental interval (ADI), craniobasal angle, and craniometric lines.

Results: Most patients presented with neck pain, followed by motor weakness as the second most common symptom, while sensory deficits were the least frequent. Congenital atlantoaxial dislocation was the most prevalent CVJ anomaly observed. Clinically, significant postoperative improvements were observed in both Nurick grade and Modified Japanese Orthopedic Association (mJOA) score. Radiological findings showed a reduction in the atlanto-dens interval (ADI), a less acute clivus-canal angle, and downward movement of the odontoid process in the postoperative period. All cases had favorable postoperative outcomes, with no mortality reported at the one-year follow-up, and the condition of all patients stabilized.

Conclusion: Favorable outcomes were achieved through posterior fixation without anterior exposure in selected cases. The key to achieving excellent clinical and radiological outcomes with minimal complications lay in a thorough preoperative evaluation, timely surgical intervention, and the selection of an individualized surgical technique.

Low temporal muscle thickness is an independent poor prognostic factor in patients with brain metastases treated with radiosurgery

Kiril Z. Zhelev — 2025-12-29

Objective: The aim of this Bulgarian study was to determine the impact of temporal muscle thickness (TMT), a prognostic factor for sarcopenia, in patients with brain metastases (BMs) treated with radiosurgery.

Methods: A retrospective analysis was conducted using TMT values from planning brain magnetic resonance imaging (MRI) studies for 232 patients diagnosed with brain metastases originating from various histological solid tumors. These measurements were taken prior to their initial radiosurgery procedure, conducted between January 2021 and December 2022. The total TMT for both the left and right sides was calculated by summing them and then dividing by two to determine the average TMT. The cut-off value was determined for TMT based on the median of the measured values among all participants. Additionally, sarcopenia was assessed as an independent prognostic factor through Cox regression models that accounted for other relevant prognostic variables.

Results: In sarcopenia patients with a TMT below the cut-off values, specifically the median TMT (5.42 mm), the risk of death was significantly increased (HR = 6.310, 95% CI: 4.161–9.568, p < 0.001). In addition, sarcopenia was revealed to be an independent prognostic factor even after adjusting for gender, number of BMs, cancer type, and ECOG Performance Status (HR = 5.757, 95% CI: 3.717–8.915, p < 0.001). Patients with sarcopenia had a significantly shorter mean OS (5.46 months, 95% CI = 5.00–5.91) compared to those without sarcopenia (23.40 months, 95% CI = 20.62–26.18) (log-rank test P < 0.001).

Conclusions: In patients with BMs treated with radiosurgery, TMT from planning MRI studies serves as an independent prognostic marker and may help with patient stratification in future clinical trials.

Short-segment stabilization techniques for burst fractures of the thoracolumbar junction: a finite element study under lateral flexion

Oleksii S. Nekhlopochyn — 2025-12-29

Introduction: Burst fractures of the thoracolumbar junction (TLJ, T10–L2) are common spinal injuries associated with a high risk of neurological complications. Transpedicular fixation is one of the most effective treatment methods; however, the optimal choice of fixation configuration remains unresolved. This study aims to analyze the stress-strain state of various short-segment transpedicular fixation configurations for Th12 vertebra burst fractures under lateral flexion loading.

Materials and methods: A finite element model of the Th9–L5 spinal segment with a simulated Th12 burst fracture was created. Four fixation configurations were considered: M1 – short screws in Th11 and L1 (without intermediate screws), M2 – long screws in Th11 and L1 (without intermediate screws), M3 – short screws in Th11 and L1 with intermediate screws in Th12, and M4 – long screws in Th11 and L1 with intermediate screws in Th12.

The models were analyzed using CosmosM software, assessing equivalent von Mises stress at 18 control points. Loads simulated physiological lateral trunk bending.

Results: Models with long screws (M2, M4) demonstrated lower maximum stresses in connecting rods (315.5–321.0 MPa) compared to short screws (324.8–324.9 MPa). The inclusion of intermediate screws (M3, M4) significantly reduced stress in the fractured Th12 vertebra (by up to 28%), in adjacent vertebral endplates (by 18–25%), and at screw entry points into vertebral arches (up to 28%). The lowest fixation screw stresses were observed in the model with long and intermediate screws (up to 38% lower compared to the baseline model M1). However, intermediate screws minimally influenced stresses in the connecting rods (up to 1.2%).

Conclusions: The optimal short-segment transpedicular fixation configuration is the use of long screws in adjacent vertebrae combined with intermediate fixation in the fractured vertebra (M4). This approach provides optimal load distribution, reduces the risk of construct failure, and preserves mobility of adjacent segments. Long screws improve overall system stiffness, while intermediate screws effectively stabilize the damaged segment and significantly unload critical areas of the construct and adjacent anatomical structures.

External ventricular drainage for spontaneous intracerebral hemorrhage with intraventricular hemorrhage: mortality and outcomes in Mali

Youssouf Sogoba — 2025-12-29

Introduction: Intracerebral hemorrhage (ICH) with intraventricular hemorrhage (IVH) is a serious condition associated with high morbidity and mortality. External ventricular drainage (EVD) is a major tool in the treatment of IVH to manage elevated intracranial pressure and may reduce short-term mortality.

The aim of this study was to determine the impact of EVD placement in the acute phase on mortality and short-term neurologic outcomes in patients with spontaneous ICH associated with IVH.

Materials and methods: We conducted a prospective observational study including adult patients admitted to Gabriel Toure University Hospital over a five year period between January 2019 and December 2023. Demographic, clinical and radiographic characteristics of patients were recorded. All patients who underwent EVD for primary diagnosis of ICH and radiographic evidence of IVH were included. The Graeb score was used to assess the severity of IVH. Outcomes were evaluated using the Glasgow Coma Scale (GCS) and the modified Rankin score (mRS). Statistical analysis was performed to determine independent predictor factors of 30-day mortality using Wilcoxon rank sum test and Fisher’s exact test. P value ≤ 0.05 was considered statistically significant.

Results: During the study period, a total of 63 patients were admitted for spontaneous ICH and IVH was associated in 24 (38.1%) patients. Among them, EVDs were placed in 17 patients. The mean age was 49 years with range of 27 to 66 years. There were 11 males and 6 females. The main risk factors of stroke were hypertension in 13 patients and diabetes in 7 patients. The initial GCS ranged from 5 and 8. Unilateral pupillary dilatation was found in 8 patients. The duration of EVD ranged from 1 to 8 days. The short term mortality rate was 70.5 % at 30 days. The functional outcomes were poor in 4 patients with mRS score of 4 and 5. The independent predictor factors for 30-day mortality were poor GCS (p=0.319), Mydriasis (p=0.245) and poor Graeb score (p=0.004).

Conclusion: The placement of EVD in patient with IVH remains controversial. Our study reveals the high mortality rate in patients with ICH despite this procedure, raising questions about the usefulness of this procedure in our setting. Although our study demonstrated a high mortality rate, patients with appropriate indications undoubtedly require EVD. Complementary and randomized studies are necessary in the future.

Status and prognostic impact of IDH1 in adult grade 4 diffuse gliomas

Mouna Zghal — 2025-12-29

Background and objectives: The fifth edition of the WHO Classification of Tumors of the Central Nervous System divides grade 4 diffuse glioma based on IDH1 mutation in grade 4 astrocytoma, IDH-mutant and glioblastoma, IDH-wild type tumors. This study aimed to evaluate the IDH1 status in grade 4 diffuse glioma as well as its correlation with clinicopathological features and patient survival. To our knowledge, no Tunisian studies on the molecular profile of diffuse glioma have yet been published.

Methods: This is a retrospective study including all cases of adult, grade 4 diffuse glioma collected in the pathology department of Habib Bourguiba hospital.

Results: A total of 67 patients were included in the final analysis. The expression of IDH1 was positive in 22 cases (32%). IDH1-positive tumors were classified as grade 4 astrocytoma, IDH1-mutant while, 45 IDH1-negative tumors were classified as glioblastoma, IDH1-wild type tumors (68%). IDH1 expression was correlated with younger age (≤ 40 years old), frontal location, complete surgical resection and well-defined borders. IDH1-positive tumors were associated significantly with better prognosis. The 1-year overall survival (OS) for grade 4 astrocytoma, IDH1-mutant was 86% compared with 8% in glioblastoma, IDH1-wild type (p=0.008).

Conclusion: Our study investigated IDH1 expression in grade 4 diffuse glioma and proved that grade 4 astrocytoma, IDH1 positive tumors displayed different characteristics with a more favorable outcome compared to glioblastoma, IDH1 negative. Thus, evaluation of IDH1 mutation should be standardized routinely not only as diagnostic marker but also to refine the prognostic classification of these tumors.

Phalen’s test. Classic or modern?

Irakli B. Goginava — 2025-12-29

Objective: to compare the sensitivity and specificity of the classic and modified Phalen test and to give recommendations on the expediency of using the tests in the diagnosis of carpal tunnel syndrome (CTS).

Materials and methods. The experimental group included 21 women (15 right and 14 left hands) with signs of idiopathic carpal tunnel syndrome. The control group also included 21 women (15 right and 14 left hands) without characteristic clinical manifestations of carpal tunnel syndrome. The mean age of the participants in both groups averaged 52 years.

Twenty-one women in the experimental and, respectively, in the control groups were randomized to perform both the classical and modified Phalen tests on 29 hands. In the classic Phalen test, the subject places her flexed elbows on the table so that the forearms are in a vertical position. The hands under the action of gravity are flexed as far as possible, the fingers remain in extension. When performing the modified Phalen test, the subject is asked to connect the dorsal surfaces of both hands, relax the upper limbs and, while maintaining this relaxed state, lower the elbows below the horizontal line.

Results. The sensitivity of the classic Phalen test was 93%, and that of the modified test was 96%. The specificity of the classical Phalen test was 96%, modified - 93%. The positive predictive value (PPV) of the classic Phalen test was 96%, the negative predictive value (NPV) was 93%. The PPV and NPV of the modified test were 93% and 96%, respectively.

Conclusion. The sensitivity of the classic Phalen test (93%) was slightly lower than the sensitivity of the modified test (96%), and the specificity of the classic test (96%) was higher than that of the modified test (93%). Due to high specificity and sensitivity, both tests have significant diagnostic value and can be successfully used in the diagnosis of carpal tunnel syndrome.

Changes in the neuro-glial-vascular interface in metabolic intoxications in children (based on acetonemic syndrome and hyperammonemia)

Yaroslav D. Bondarenko — 2025-12-29

Objective: To investigate morphofunctional changes of the neuro-glial-vascular interface in children with metabolic intoxications, particularly in acetonemic syndrome and hyperammonemia.

Materials and methods: A systematic literature review with elements of narrative analysis was conducted following PRISMA guidelines. Literature search was performed in PubMed/MEDLINE, Web of Science Core Collection, Scopus, and Cochrane Library for the period 1990-2024. Included studies involved children from birth to 18 years and investigated neurotoxic effects of acetonemic syndrome and hyperammonemia. Study quality was assessed using Newcastle-Ottawa Scale, AMSTAR-2, and SYRCLE tools.

Results: Key morphofunctional disorders of the neuro-glial-vascular interface were identified: cytotoxic astrocytic swelling due to glutamine accumulation during ammonia detoxification; blood-brain barrier disruption with decreased expression of tight junction proteins (claudin-5, occludin, ZO-1); impaired energy metabolism due to glycolysis inhibition and mitochondrial dysfunction; excitotoxicity resulting from glutamate-glutamine cycle disruption; microglial activation with increased expression of CD68, Iba1, MHC II, and pro-inflammatory cytokine secretion.

Conclusions: Morphofunctional changes of the neuro-glial-vascular interface with acetonemic syndrome and hyperammonemia are characterized by complex disruptions of blood-brain barrier (BBB) structure and function, energy metabolism, neurotransmitter balance, and neuroinflammatory processes. A personalized approach to diagnosis and treatment using biomarkers of BBB damage and neuroinflammation is necessary.

Platelet-rich plasma in discogenic pain: therapeutic potential of multifactorial action

Mykhailo V. Khyzhnyak — 2025-12-29

Intervertebral disc degeneration (IVDD) is one of the leading causes of chronic low back pain and disability. The key pathogenetic mechanism of IVDD is chronic inflammation, which leads to extracellular matrix catabolism and the death of disc cells. It has been established that these changes are based on the activation of pro-inflammatory signaling cascades, particularly NF-κB, MAPK, and JAK/STAT pathways, as well as the induction of caspase-dependent apoptosis.

Objective: To summarize current understanding of the molecular signaling pathways involved in degenerative processes within the intervertebral disc, and to elucidate the mechanisms of action of platelet-rich plasma (PRP) components capable of modulating these pathways.

Materials and methods: A comprehensive analysis of contemporary experimental and clinical studies was performed to evaluate the effects of the main growth factors present in PRP (TGF-β, PDGF, IGF-1, FGF, CTGF, EGF, HGF) on signaling pathways in intervertebral disc cells associated with catabolism, apoptosis, and inflammation.

Results: PRP-derived factors exert their effects through activation of the Smad, PI3K/AKT, MAPK, and JAK/STAT pathways while attenuating NF-κB activity, leading to decreased levels of pro-inflammatory cytokines (IL-1β, TNF-α) and metalloproteinases (MMPs, ADAMTS). These effects are accompanied by enhanced expression of type II collagen and aggrecan, stabilization of the extracellular matrix, restoration of tissue homeostasis and increased cell proliferation.

Conclusions: PRP therapy demonstrates considerable potential as a pathogenetically oriented regenerative strategy for the treatment of IVDD. Its efficacy arises from a multimodal influence on inflammatory, catabolic, and apoptotic pathways. Further clinical research is warranted to standardize treatment protocols and confirm the long-term therapeutic effectiveness of PRP.

Post-concussion syndrome: Part 1. Overview of the epidemiology and pathophysiology of mild blast-related traumatic brain injury

Vadym V. Biloshytsky — 2025-12-29

This article provides a review of current data on the epidemiology and pathophysiology of mild blast-related traumatic brain injury (mbTBI), which has become the leading type of injury in modern military conflicts. The prevalence of mbTBI among U.S. military personnel during operations in Afghanistan and Iraq is described, with emphasis on the cumulative effect of repeated injuries that increases the risk of chronic traumatic encephalopathy. The paper discusses the main mechanisms of blast wave impact on the brain, including direct and indirect effects, pathomorphological changes, and differences from “civilian” mild traumatic brain injury (TBI). Current insights into molecular and cellular alterations underlying mbTBI are summarized, along with data from experimental and clinical studies. These findings are crucial for developing effective diagnostic approaches, treatment strategies, and rehabilitation programs for service members and veterans.

Unexpected detection of a meningioma on 18F-Fluorocholine PET/CT in a prostate cancer patient

Yassir Benameur — 2025-12-29

A 77-year-old man with a prior diagnosis of prostate adenocarcinoma, previously treated with radiotherapy and hormone therapy, presented with rising PSA levels suggestive of biochemical recurrence. While no evidence of metastatic prostate disease was detected, the PET/CT (positron emission tomography–computed tomography) scan incidentally revealed an area of abnormal radiotracer uptake in the left temporal lobe of the brain, unrelated to the patient’s known malignancy. The imaging characteristics raised the suspicion of a meningioma. A subsequent brain MRI confirmed the presence of an extra-axial lesion consistent with a meningioma. This unexpected finding highlights the additional diagnostic value of ¹⁸F-fluorocholine PET/CT beyond its primary role in prostate cancer imaging, particularly in detecting clinically significant incidental intracranial lesions. This case underscores the importance of careful and systematic interpretation of imaging studies during oncologic evaluations, even in regions outside the primary area of concern.