Thai Journal of Neurological Surgery

Efficacy of a Rapid External Ventricular Drain (EVD) Weaning Protocol in Preventing EVD Associated Complications

2025-10-09T06:43:46+07:00

Background: External ventricular drainage (EVD) is a temporary management in patients with acute obstructive hydrocephalus from various causes. However, prolonged EVD placement is associated with significant risk of EVD-associated complications. To mitigate these risks and expedite the weaning process, a rapid external ventricular drainage weaning protocol has been proposed as a potential solution. This research aims to evaluate the efficacy of such a weaning protocol in preventing EVD-associated complications and improving patient outcomes. Methods: Between January 2020 and December 2023, a prospective cohort study was conducted in patients who underwent EVD placement. The rapid EVD weaning protocol was assigned in the cohort group. The rate of EVD-associated complications was compared to the historical control group. Results: Sixty patients were divided into rapid or gradual EVD-weaning groups (n = 30 each). EVD-related infection and complications occurred in 3.3% vs 10%; p = 0.612 and 23.3% and 40.0%: p = 0.258 in the rapid and gradual groups, respectively. Secondary outcomes—VP shunt rate, hospital length of stay, ICU stay, and EVD duration—did not differ significantly between groups. Only EVD-weaning duration was shorter with rapid weaning (4.4 vs 7.61 days; p=0.002). Conclusion: The results indicate that rapid EVD weaning may shorten the weaning process without adversely affecting clinical outcomes or increasing complication rates. Confirmation in larger, adequately powered studies with extended follow-up is needed to define its role in neurocritical care.

5-year recurrent rate and factors related recurrent spinal meningioma

2025-10-31T08:01:59+07:00

Introduction: Spinal meningiomas are usually benign spinal cord tumors, representing about 25% of all spinal tumors. Treatment options include watchful waiting and surgery, which typically removes the tumor completely with a low recurrence risk. However, undetected recurrences can cause neurological issues, necessitating regular MRI scans. Previous studies showed a 7-9% recurrence rate at 5 years post- surgery, increasing to 20-25% after 10 years3. This study aims to find 5-year recurrence rate and related factors for recurrence. Methods: The authors conducted a single-center retrospective descriptive study in patients with spinal meningiomas treated in Siriraj hospital from July 2006 to November 2024. Finding 5-year and overall recurrence rate of 66 spinal meningiomas and related factors for recurrence. Results: 5-year and overall recurrence rates were 10.6% and 24.2%, respectively. The factors mostly affected recurrence were younger age at diagnosis (esp. <45 years) and history of neurofibromatosis type 2 (NF2). Other factors included gender, volume, location of tumor, dural tail sign, histopathological diagnosis and intra-operative finding did not showed statistically significance for tumor recurrence. Conclusions: The study at Siriraj Hospital shows that surgical removal of spinal meningiomas is effective but has a significant risk of recurrence, especially in younger patients or those with NF2. Despite benign nature of disease, our findings emphasize the importance of careful surgery and long-term follow-up. High-risk groups may need early and more frequent investigation.

Infantile High-Grade Glioma : A Case Report from Southern Thailand

2025-12-19T21:08:36+07:00

Background: High-grade gliomas (HGG) in infants under 1 year of age are rare, biologically distinct tumors that often present with subtle, nonspecific symptoms. Early diagnosis remains challenging in resource-limited settings.

Case: We present the case of an 11-month-old Thai girl with one month of progressive early-morning vomiting, irritability, head-grabbing behavior, and recurrent falls. She developed an acute generalized tonic-clonic seizure before hospital arrival. Magnetic resonance imaging revealed a large supratentorial mass with mass effect. Gross total resection was performed. Histopathology demonstrated high-grade glioma with anaplastic features, brisk mitoses, microvascular proliferation, and a Ki-67 index of 35%. Immunohistochemistry showed GFAP positivity, positive H3K27me3, and negative IDH1-R132H. Molecular fusion testing was not available. Postoperative recovery was uneventful, and adjuvant chemotherapy following the Thai POG-BT-131FB protocol was planned.

Discussion: Infantile HGG is a rare and biologically distinct tumor that often presents with nonspecific symptoms, leading to diagnostic delay, particularly in resource-limited settings. In this case, persistent early-morning vomiting and acute seizure activity were key clinical warning signs prompting neuroimaging and timely intervention. Although many infantile hemispheric gliomas are driven by oncogenic kinase fusions, molecular testing was unavailable; therefore, diagnosis relied on characteristic histopathological and immunohistochemical features. Maximal safe resection remains the cornerstone of management and a critical determinant of outcome. Given the substantial neurodevelopmental risks of radiotherapy in infants, chemotherapy-based regimens are favored as first-line adjuvant therapy to achieve disease control while minimizing long-term toxicity.

Conclusion: This case highlights key diagnostic clues for infantile HGG and emphasizes the need for early neuroimaging in infants presenting with persistent vomiting and acute neurological changes. Multimodal treatment -including maximal safe resection and chemotherapy -is essential in this age group.