Complete Clival Resorption and Pontine Pneumatosis Secondary to Severe Cocaine-Induced Midline Destructive Lesion: A Case Report.

Neurosurgery practice Pub Date : 2024-01-03 eCollection Date: 2024-03-01 DOI:10.1227/neuprac.0000000000000076
Abdulrahman Almansouri, Alex Tham, Abdulaziz Abobotain, Mashael Almarwani, Marc Tewfik, Denis Sirhan
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Abstract

Background and importance: Cocaine-induced midline destructive lesions manifest as various degrees of distortion to normal anatomy. We present a rare case of substance-induced clival defect that underwent surgical repair.

Clinical presentation: This patient presented with transient neurological deficits and was found to have severe clival destruction and pontine pneumatosis secondary to prolonged cocaine use. Surgical reconstruction of the clival defect was performed using a combined open and endoscopic approach.

Discussion: When anatomical integrity is severely compromised, defects of the clival region can be repaired using a hybrid open-endoscopic approach. In this case, the lack of local mucosal tissue for reconstruction led to the use of a pedicled pericranial flap.

Conclusion: Complete clival resorption secondary to cocaine use is uncommon. In advanced cases, pontine inflammation is present on imaging studies. Combined endoscopic and open clival reconstruction is effective in restoring anatomic integrity.

严重可卡因引起的中线破坏性病变继发于完全性斜坡吸收和脑桥肺肺病1例。
背景和重要性:可卡因引起的中线破坏性病变表现为对正常解剖结构不同程度的扭曲。我们提出一个罕见的病例物质诱导的斜坡缺损,接受手术修复。临床表现:该患者表现为短暂性神经功能缺损,并发严重的斜坡破坏和继发于长期使用可卡因的脑桥肺肺病。手术重建的斜坡缺损进行联合开放和内窥镜入路。讨论:当解剖完整性严重受损时,可以使用混合开放内镜入路修复斜坡区缺损。在这种情况下,缺乏局部粘膜组织重建导致使用带蒂颅周皮瓣。结论:可卡因使用后斜坡完全吸收并不常见。在晚期病例中,影像学检查显示脑桥炎症。内窥镜联合开放斜坡重建在恢复解剖完整性方面是有效的。
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