Ukrainian Neurosurgical Journal

Crossroads of Neurology and Virology: The Neurological Manifestations of COVID-19

Kirolos Eskandar — 2024-12-30

Introduction: The COVID-19 pandemic, caused by SARS-CoV-2, has led to an unprecedented global health crisis. While primarily recognized for its respiratory implications, the virus has shown a significant affinity for the nervous system, resulting in a wide spectrum of neurological manifestations. This literature review explores the intersection of neurology and virology, focusing on the acute and long-term neurological effects of COVID-19.

Methods: A comprehensive review of current literature was conducted using databases such as PubMed, Scopus, and Web of Science. Relevant studies were selected based on their focus on the pathophysiology, clinical presentations, and long-term neurological outcomes of COVID-19. Special attention was given to peer-reviewed articles, meta-analyses, and clinical case reports published between 2019 and 2024.

Results: The review identifies multiple mechanisms by which SARS-CoV-2 invades the nervous system, including direct viral entry and systemic inflammation. Acute neurological manifestations include encephalitis, stroke, and Guillain-Barré syndrome, while long-term sequelae encompass cognitive impairment, neurodegeneration, and psychiatric disorders. The findings underscore the complexity of COVID-19’s impact on the nervous system, with both immediate and enduring effects.

Conclusion: Neuro-COVID represents a significant and evolving challenge in the context of the pandemic. Understanding the neurological implications of COVID-19 is crucial for improving patient outcomes and guiding future research. This review underscores the need for heightened clinical awareness and a multidisciplinary approach to effectively address the complex neuro-COVID spectrum.

Age-related aspects of glioma: current understanding. Literature review

Serhii P. Luhovskyi — 2024-12-30

The updated 2021 WHO Classification of Central Nervous System (CNS) Tumors introduces, for the first time, an age-based approach to glioma classification, leveraging advances in molecular biology and epigenetics of CNS tumors. This classification groups gliomas within the category "Gliomas, glioneuronal tumors, and neuronal tumors," distinguishing between adult-type and pediatric-type diffuse gliomas, corresponding to low-grade and high-grade malignancies (LGG and HGG), highlighting the fundamental role of age in gliomagenesis. A review of current literature deepens the understanding of age-related characteristics, differences, and patterns in gliomagenesis across age groups, which is essential for effective diagnosis and treatment.

Pediatric-type and adult-type low-grade gliomas (pLGG and aLGG) differ in location, biological behavior, and molecular-genetic profiles. Inherited syndromes (e.g., NF-1, TSC) associated with glioma development are linked to specific LGG subtypes occurring in childhood, adolescence, and adulthood. Moreover, pLGG differs from aLGG in its potential for malignant transformation and spontaneous regression, as well as in mutations affecting the MAPK (mitogen-activated protein kinase) pathway.

While pediatric-type and adult-type high-grade gliomas (pHGG and aHGG) share histological features, they differ in location, biological behavior, molecular-genetic profiles, and prognosis. A major distinction between aHGG and pHGG lies in mutations such as IDH 1/2, EGFR gene expression, TERT mutations, chromosome alterations (+7/-10), and TP53 mutations, all contributing to a poorer prognosis in HGG gliomas. Additionally, changes in histone proteins H3.3 or 3.1 (H3.3 K27 and H3 G34) in pHGG, as opposed to aHGG, carry diagnostic and prognostic significance.

An analysis of data on glioma epidemiology, risk factors, and characteristic molecular-genetic features considering age is provided. The next publication will cover certain clinical aspects of this issue.

The impact of the number of aneurysms on the course of the acute period of subarachnoid hemorrhage in patients with multiple intracranial aneurysms

Yulia O. Solodovnikova — 2024-12-30

Objective to determine the effect of the number of multiple intracranial aneurysms (MIA) on the course of the acute period of subarachnoid hemorrhage (SAH).

Materials and methods: A cross-sectional retrospective study was conducted involving 92 patients in the acute phase of SAH due to the rupture of MIA. Patients were divided into two groups depending on the number of aneurysms. Demographic indicators (age, gender) and clinical-instrumental factors (comorbidities, extent of hemorrhage, severity at admission, clinical manifestations), treatment characteristics, and outcomes were analyzed using descriptive statistics and logistic regression.

Results: Comorbidities were 3.4 times more common among patients with three or more aneurysms (p=0.143). Patients in group 2 were 1.9 times more likely to be admitted with a World Federation of Neurosurgical Societies (WFNS) grade 2 (p=0.335). WFNS grade 3 at admission was observed twice as often in group 1 (p=0.447). Patients from group 1 and group 2 were equally likely to present with WFNS grade 4 (p=0.978). The probability of being admitted with a WFNS grade 5 was 1.8 times higher in group 2 (p=0.830). The presence of meningeal syndrome increased the risk of having 3 or more aneurysms by more than four times (OR 4.41, CI 0.41-47.13, p=0.21). The presence of motor impairments significantly reduced the risk of having 3 or more aneurysms (OR 0.63, CI 0.09-4.18, p=0.63). Patients in group 2 were slightly more likely to develop vasospasm than those in group 1 (OR 1.22, CI 0.34-4.31, p=0.752). The presence of comorbidities increased with the number of aneurysms (OR 3.42, CI 0.65-17.62, p=0.143).

Conclusions: The presence of comorbidities more than triples the chances of having 3 or more aneurysms. Patients with fewer aneurysms are twice as likely to be admitted in a milder condition (WFNS grade 2). The probability of severe condition (WFNS grade 5) at hospital admission for patients in group 2 is 1.8 times higher than in group 1. The likelihood of motor disorders decreases by 4.4 times with an increasing number of aneurysms. The probability of vasospasm development slightly increased with the number of aneurysms. These data emphasize the importance of a comprehensive approach to the assessment of SAH patients and the need for careful monitoring of patients at high risk of vasospasm.

The rat's sciatic nerve functional index dynamics after its transection and recovery by means of epineural neurorrhaphy

Ziia K. Melikov — 2024-12-30

Introduction. Peripheral nerve injury (PNI) is a common wartime pathology, the presence of which significantly complicates the course and treatment of combat injuries to the limbs. The development of new methods of treatment of PNI is impossible without validating existing models of PNI and clarifying the dynamics of the recovery process in this type of injury over long periods of observation. In this paper, the dynamics of the sciatic functional index (SFI) after transection and immediate suturing of the sciatic nerve of an adult rat during 24 weeks of observation was analyzed in detail.

Objective: to analyze the dynamics of SFI after transection, as well as after transection and immediate suturing of the sciatic nerve of an adult rat for 24 weeks and compare the obtained results with the data of other authors under similar experimental conditions.

Materials and Methods. The study was performed on 76 white adult outbred male rats, adhering to bioethical norms. In animals of the Sham group (n=24) an access to the sciatic nerve was performed, in animals of the Sect group (n=29) — the sciatic nerve was transected, and Raph group (n=23) — transection and immediate epineural suturing of the sciatic nerve was performed. A certain number of animals were removed from each group 4, 8, and 12 weeks after surgery for electrophysiological and morphological studies, and for the rest of the animals, the experiment was completed 24 weeks after the start of observation. SFI was determined before animals were removed, for all animals in each group at 4, 8, 12, 16, 20 and 24 weeks according to the Bain-Mackinnon-Hunter formula. Processing of digital data was carried out by various means of mathematical statistics.

Results. In animals of the Sham group, which were observed throughout the entire 24 weeks of the experiment (n=7), the average value of SFI one month after the injury simulation was -8.9 points and did not change significantly until the end of the experiment. In animals of the Sect group, which were observed throughout the entire 24 weeks of the experiment (n=8), one month after the injury, the mean SFI value was –84.7 points, significantly increasing to –67.0 points at the end of the 16th week, and subsequently significantly decreasing to –96.5 points. In animals of the Raph group, which were observed throughout the entire 24 weeks of the experiment (n=7), the average value of SFI after one month was -64.4 points, and its increase to -45.4 points at the end of week 24 should be considered relatively reliable. Pairwise comparison of the averaged for all animals SFI values in the Sham and Sect, Sham and Raph, and Sect and Raph groups revealed significant differences at 4, 8, 12, 20, and 24 weeks after simulated injury. At 16 weeks post-intervention, the SFI values in the Sect and Raph groups were significantly different from those in the Sham group, but were not different from each other.

Conclusions. The method of determining the function of the paretic limb after sciatic nerve injury in rats using SFI has a number of technical limitations, which are the reason for significant variability in experimental results among different research groups. The reliable biphasic SFI dynamics that was discovered after sciatic nerve transection, as well as the insignificant (according to this data) fluctuations in SFI after sciatic nerve transection and neurorrhaphy, require independent verification, pathophysiological interpretation, and should be taken into account when evaluating rehabilitation methods using such an experimental model of peripheral nerve injury.

Evaluation of the structures of the optic nerve and chiasm in patients with skull base tumors using high-resolution MRI

Ekaterina S. Egorova — 2024-12-30

Objective: To investigate the effectiveness of radiological methods for diagnosing optic nerve and chiasm atrophy in compressive optic neuropathy caused by tumors of the chiasmal-sellar region (CSR).

Material and methods: The diagnostic and treatment outcomes of 50 patients (100 eyes) with CSR tumors were analyzed. These patients were treated at the A.P. Romodanov Institute of Neurosurgery of the National Academy of Medical Sciences of Ukraine from 2021 to 2023. The study group of patients (50 patients) was divided into two subgroups: Group I – restoration of visual functions (26 patients, 52%, 52 eyes); Group II – no restoration of visual functions (24 patients, 48%, 48 eyes). Clinical-neurological, ophthalmological, and otoneurological examinations were performed. MRI of the brain was conducted on all patients using high-field scanners (1.5 and 3.0 Tesla), and measurements of the optic nerve (ON) diameter in the intraorbital and intracranial parts, as well as the height and width of the chiasm.

Results: The morphometric parameters of the ON diameter in the intraorbital part and the height of the chiasm did not significantly differ between the studied groups (p>0.05). The morphometric parameters of Group I did not differ from the control group (p>0.05). In Group II the average diameter of the intracranial part of the ON (2.31±0.26 mm) and the average width of the chiasm (11.39±0.31 mm) were statistically significantly different from the control group values: 2.97±0.2 mm and 13.69±0.57 mm, respectively, p<0.05. Despite significant variability in individual characteristics, the parameters of the intracranial part of the ON ≤ 2.31 mm and the chiasm width of ≤ 11.39 mm indicate irreversible atrophic changes and can be used to predict ophthalmological outcomes in patients with CSR tumors.

Conclusions: Measuring the thickness of the chiasm and the diameter of the intracranial part of the optic nerve using high-resolution MRI is a convenient and effective method for diagnosing optic nerve atrophy (ONA) and predicting ophthalmological outcomes after decompression of the optochiasmal complex.

Surgical treatment of meningiomas invading the superior sagittal sinus

Michail S. Kvasha — 2024-12-30

Objective: To investigate the impact of the degree of invasion of the superior sagittal sinus by meningiomas on the radicality of removal and to assess the risks of complications during surgical intervention for superior sagittal sinus meningiomas.

Materials and Methods: The study included 82 patients who underwent surgery at the Romodanov Neurosurgery Institute over the past 10 years (from 2013 to 2023). The cohort comprised 53 women and 29 men, with an average age of 43.4±1.7 years. Inclusion criteria are: a histologically confirmed diagnosis of meningioma and evidence of superior sagittal sinus invasion based on neuroimaging (MRI with intravenous contrast enhancement, MSCT angiography).

Results: A total of 84 surgical procedures were performed on 82 patients. Among these, 71 were primary cases (84.5%), and 13 were secondary cases (15.5%). In 7 out of 13 secondary surgeries, superior sagittal sinus invasion was first detected through neuroimaging and confirmed intraoperatively. Postoperative hemiparesis of varying degrees was observed in 41 patients (50%), with 10 cases showing an increase in neurological deficits due to surgical intervention. Motor deficits completely regressed within 3-6 months post-surgery in 28 out of 41 patients. Tumor recurrence was identified in 4 patients (4.9%) within 2.5-6 years after the primary surgery. Among these, 3 were morphologically confirmed as "anaplastic meningioma Grade III," and 1 as "atypical meningioma Grade II".

Conclusions: Meningiomas originating from the arachnoid membrane constitute a significant proportion of primary intracranial tumors, with varying degrees of venous sinus invasion. Surgical planning for meningiomas invading the superior sagittal sinus should consider the radiological classification of invasion degrees, which aids in determining the treatment strategy. MRI with intravenous contrast and MSCT angiography are crucial for identifying collateral blood flow and assessing the degree of venous sinus invasion before surgical intervention.

Minimizing skull defects in retrosigmoid approach: precision mapping of the sigmoid sinus with mastoid emissary vein canal

Artem V. Rozumenko — 2024-12-30

Objective. The retrosigmoid approach is a commonly used cranial approach to the cerebellopontine angle lesions, vascular and nerve pathologies. This study aims to develop a practical technique for intraoperative mapping of the sigmoid sinus using the topography of the mastoid emissary vein (MEV) canal to improve the accuracy of retrosigmoid craniotomy, and minimize postoperative adverse outcomes.

Materials and methods. Consecutive patients who underwent retrosigmoid approaches for cerebellopontine angle occupying lesions from October 2023 through August 2024 were included in the study. Perioperative computed tomography (CT) was performed with a slice thickness 0.5 mm in the axial plane. The projection of the internal opening of the MEV canal onto the external surface of the mastoid process was determined as the posterior border sigmoid sinus and anterior border for craniotomy. Comparative analyses were performed using t-test and Chi-square test.

Results. A total of 20 patients were operated for neoplasms occupying the cerebellopontine angle using retrosigmoid approach. The average measured distance from the external opening of the MEV canal to the projection of sigmoid sinus posterior border was 9.36 ± 2.17 mm (range 6.3–13.20 mm). The postoperative CT data showed statistically significant differences between the study and control groups in measures of bone window (p = 0.057) and surrounding cranial defect (p < 0.001). The size of bone flaps was slightly similar in all groups (p = 0.114). The mean cranial defect in the study group was almost twice smaller than in the control group 22.4% vs. 44.5% respectively.

Conclusions. This study confirms the utility of mastoid emissary vein canal topography in improving the accuracy of retrosigmoid craniotomy. By facilitating precise sigmoid sinus mapping, the technique reduces the extent of bone removal and minimizes postoperative cranial defect.

A multiple suture craniosynostosis with fusion of sagittal, metopic, and bilateral coronal sutures: Case report

Ozan Başkurt — 2024-12-30

Multisutural synostosis, characterized by the fusion of multiple cranial sutures without a clear underlying syndrome, represents a rare subtype of craniosynostosis. Particularly uncommon is the simultaneous fusion of the sagittal, metopic, and bilateral coronal sutures. This report details the case of a 50-month-old boy, who had an abnormal head shape due to the simultaneous fusion of four sutures. The closure of the sagittal, metopic, and bilateral coronal sutures has led to a distinct head shape marked by flattening of the forehead and anterior skull, contrasting with the typical Mercedes-Benz pattern observed in craniosynostosis cases. Surgical intervention involved osteotomy with symmetrical barrel staves in the parietal and frontal regions, resulting in improved forehead contour.