NMC case report journal最新文献

{"title":"Regression of Lumbar Ossification of the Ligamentum Flavum after Indirect Decompression via Full-endoscopic Trans-Kambin's Triangle Lumbar Interbody Fusion: A 3-year Case Report.","authors":"Van Tuan Nguyen, Takayuki Kitahara, Yuji Nagao, Takafumi Ohshima, Naoto Ono, Saori Soeda, Makoto Takeuchi, Hiroaki Manabe, Masatoshi Morimoto, Fumitake Tezuka, Hiroshi Kageyama, Junzo Fujitani, Koichi Sairyo","doi":"10.2176/jns-nmc.2025-0401","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0401","url":null,"abstract":"<p><p>Ossification of the ligamentum flavum is a pathological condition that can cause progressive myelopathy or severe radiculopathy. Standard surgical management involves direct decompression via posterior resection of the ossification. However, there is a substantial risk of complications, including dural tears and iatrogenic instability. We report a rare case of lumbar ossification of the ligamentum flavum with degenerative spondylolisthesis treated solely by full-endoscopic trans-Kambin's triangle lumbar interbody fusion, aiming for indirect decompression and stabilization, without direct resection of the ossification. A 68-year-old woman had progressive low back pain, bilateral lower extremity radiculopathy, and severe neurogenic claudication, limiting ambulation to 100 m. Imaging revealed Meyerding Grade I L4-L5 spondylolisthesis with dynamic instability and significant canal stenosis due to ossification of the ligamentum flavum, measuring 4.06 mm in maximal thickness. She underwent single-level Kambin's triangle lumbar interbody fusion at L4-L5. Postoperatively, rapid improvement was observed (visual analog scale low back pain: 7→1, leg pain: 8→0; Oswestry Disability Index: 52%→10% at 3 years). Follow-up computed tomography/magnetic resonance imaging demonstrated progressive regression of the ossification, from 4.06 mm to 3.2 mm at 1 year and 1.46 mm at 3 years (64.0%). This case suggests that Kambin's triangle lumbar interbody fusion with indirect decompression is an effective surgical option in lumbar ossification of the ligamentum flavum with segmental instability. The remarkable regression of the ossification suggests that spinal stabilization may suppress pathological mechanical stress, shifting bone remodeling toward resorption, and supports a mechanistic hypothesis. Further prospective studies are warranted to validate this pathophysiological mechanism.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"135-140"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Ultra-late Recurrence with Adenoid Cystic Carcinoma-like Malignant Transformation of a Pineal Immature Teratoma after 35 Years: A Case Report.","authors":"Keisuke Ohtani, Akira Gomi, Hirofumi Oguma, Makoto Sato, Rintaro Kuroda, Tomoru Miwa, Naoto Kunii, Kensuke Kawai","doi":"10.2176/jns-nmc.2025-0420","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0420","url":null,"abstract":"<p><p>Immature teratomas of the pineal region are a subtype of non-germinomatous germ cell tumors typically associated with early recurrence. Ultra-late recurrence decades after initial treatment is exceedingly uncommon. We report an immature teratoma case in the pineal region that recurred 35 years after subtotal resection and chemoradiotherapy, showing somatic-type malignant transformation into adenoid cystic carcinoma-like adenocarcinoma. A 16-year-old boy initially underwent ventriculoperitoneal shunting followed by tumor resection, after the pathological confirmation of an immature teratoma (grade 2 according to the ovarian teratoma grading system). A small residual lesion remained, and the patient's condition remained stable for more than a decade, but he was lost to follow-up. At 51 years of age, the patient presented with obstructive hydrocephalus and tumor regrowth. Preoperative serum and cerebrospinal fluid tumor markers levels were normal. An endoscopic biopsy revealed poorly differentiated adenocarcinoma. Resection through an occipital transtentorial approach indicated tumor infiltration into the bilateral thalamus. Histology showed glandular and cartilaginous components with marked atypia and immunohistochemical features resembling adenoid cystic carcinoma, whereas germ cell markers were negative, thus establishing a diagnosis of teratoma with somatic-type malignant transformation. Despite ifosfamide, carboplatin, and etoposide chemotherapy (all at 50% dose) and stereotactic radiosurgery, the disease progressed with leptomeningeal dissemination, and the patient died 613 days after he underwent the second surgery. This case represents the longest reported interval of recurrence for a central nervous system immature teratoma and highlights the possibility of long-term tumor dormancy followed by malignant transformation. Lifelong surveillance is therefore warranted in patients with residual immature teratomas.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"123-129"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surfer's Myelopathy with Magnetic Resonance Imaging Evidence Suggestive of Venous Congestion: A Case Report.","authors":"Shohei Noguchi, Tatsuya Ohtonari, Kyohei Sakai, Junkoh Yamamoto","doi":"10.2176/jns-nmc.2025-0396","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0396","url":null,"abstract":"<p><p>Surfer's myelopathy is a rare, nontraumatic spinal cord injury affecting novice surfers. Although spinal ischemia is considered the primary mechanism, whether the initial insult is arterial or venous remains controversial. We report a case of surfer's myelopathy with magnetic resonance imaging findings suggestive of venous congestion-radiological features that, to our knowledge, have not been previously described. A previously healthy 23-year-old man developed acute low back pain, progressive lower limb weakness, and bladder and bowel dysfunction after his first surfing experience. Magnetic resonance imaging on admission showed longitudinal T2 hyperintensity from T8/9 to the conus medullaris without abnormalities on diffusion-weighted imaging. On day 2, repeat magnetic resonance imaging again demonstrated no diffusion-weighted imaging changes, whereas the apparent diffusion coefficient map revealed hyperintensity, indicating vasogenic edema. These findings were more consistent with venous rather than arterial ischemia. The patient was treated with antiplatelet and anticoagulation therapy along with rehabilitation and ultimately achieved complete neurological recovery. This case may represent the first description of magnetic resonance imaging findings suggestive of venous congestion in surfer's myelopathy. Apparent diffusion coefficient hyperintensity in the absence of diffusion restriction may reflect reversible venous ischemia. Incorporating diffusion-weighted imaging and apparent diffusion coefficient maps into routine magnetic resonance imaging protocols for suspected surfer's myelopathy could provide valuable insight into pathophysiology and prognosis.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"131-134"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Ectopic Tentorial Schwannoma Mimicking Tentorial Meningioma: A Case Report and Literature Review.","authors":"Taishi Honda, Masahito Kawabori, Yasuhiro Ito, Daisuke Shimbo, Hiromi Okada, Masanori Isobe, Miki Fujimura","doi":"10.2176/jns-nmc.2025-0386","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0386","url":null,"abstract":"<p><p>Intracranial schwannomas account for approximately 8% of all primary brain tumors, and the majority arise in the cerebellopontine angle. Ectopic schwannomas that originate from non-cranial nerve sites, such as the dura mater or brain parenchyma, are rare, representing less than 1% of all intracranial schwannomas. These lesions often mimic meningiomas on neuroimaging, making preoperative diagnosis challenging. A woman in her 50s was referred to our department after a brain check-up incidentally revealed a mass lesion extending both above and below the tentorium. Neurological examination was unremarkable. Magnetic resonance imaging demonstrated a well-defined, heterogeneously enhancing extra-axial mass widely attached to the tentorium, suggestive of meningioma. The lesion was completely resected via a suboccipital approach. Histopathological examination revealed spindle-shaped tumor cells with palisading nuclei, positive for S-100 protein and negative for epithelial membrane antigen, confirming the diagnosis of schwannoma. The MIB-1 (Ki-67) labeling index was below 5%, consistent with a benign lesion. Postoperative magnetic resonance imaging confirmed total resection, and the patient's postoperative course was uneventful. No recurrence was observed during a 7-month follow-up period. Tentorial ectopic schwannoma is an extremely rare entity that can closely resemble meningioma both radiologically and intraoperatively. Awareness of this entity is important when evaluating tentorial extra-axial tumors. Although the clinical course is generally favorable following complete resection, careful preoperative evaluation is essential for accurate diagnosis and appropriate management.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"147-151"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Cases of Lumbar Spinal Canal Stenosis with Dorsal Meningovertebral Ligaments: Potential Risk of Dural Laceration.","authors":"Kyohei Kin, Ryoji Tominaga, Kento Takebayashi, Hiroki Iwai, Hisashi Koga","doi":"10.2176/jns-nmc.2025-0354","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0354","url":null,"abstract":"<p><p>Dural laceration is a critical complication in full endoscopic spinal surgery. We need to recognize precise surgical anatomy to avoid it. Recently identified dorsal meningovertebral ligaments, connecting the dorsal spinal dura mater to the ligamentum flavum, may contribute to this risk, but their role remains unclear. We present 2 cases of lumbar spinal canal stenosis treated with full endoscopic laminectomy. In both cases, dorsal meningovertebral ligaments anchored the dura to the ligamentum flavum and were visible through high-resolution endoscopy. Attempts to remove ligamentum flavum fragments caused dural traction via the dorsal meningovertebral ligament, nearly resulting in laceration. We modified our approach by detaching the dorsal meningovertebral ligament before flavectomy, preventing dural injury and ensuring uneventful recoveries. These cases highlight the importance of recognizing dorsal meningovertebral ligament as a potential risk factor for dural laceration during full endoscopic laminectomy. Although the presence of dorsal meningovertebral ligament cannot be predicted preoperatively, the enhanced visualization provided by full endoscopic spinal surgery allows for intraoperative identification. We recommend careful inspection for dorsal meningovertebral ligament before flavectomy during full endoscopic laminectomy. If identified, these ligaments should be detached prior to ligamentum flavum removal to minimize the risk of dural injury. This approach can significantly enhance the safety of the full endoscopic laminectomy procedure and potentially reduce the incidence of dural complications in full endoscopic spinal surgery.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"111-116"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraprocedural Rupture During Coil Embolization of a Ruptured, Rapidly Thrombosing Anterior Cerebral Artery Aneurysm: A Case Report.","authors":"Taro Suzuki, Yosuke Akamatsu, Yasushi Ogasawara","doi":"10.2176/jns-nmc.2025-0407","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0407","url":null,"abstract":"<p><p>Acute thrombosis is often observed following the rupture of an intracranial aneurysm, and optimal coil selection during endovascular coiling is challenging. A 75-year-old woman presented with a subarachnoid hemorrhage. Computed tomography angiography revealed aneurysms at the right anterior cerebral artery A2/3 junction and the right middle cerebral artery. Based on vessel wall imaging, the anterior cerebral artery aneurysm was diagnosed as the rupture site. Initial digital subtraction angiography demonstrated a 4.4 × 3.4 × 3.4 mm aneurysm with a 1.6 mm neck. Coil embolization was performed 1 day after diagnostic angiography. Preprocedural angiography revealed significant lumen shrinkage to 2.0 mm, probably due to aneurysmal thrombosis. A 4 mm framing coil was selected based on the initial digital subtraction angiography findings. Contrast extravasation occurred after coil deployment. Immediate protamine administration, blood pressure reduction, and coil embolization with smaller coils in the opacified aneurysm dome achieved hemostasis. Final angiography confirmed complete occlusion, without residual filling or distal thrombus migration. Postoperative computed tomography showed an intracerebral hematoma in the left frontal lobe, which subsequently resolved. The patient recovered without focal neurological deficits and was transferred to a rehabilitation hospital on day 18 with mild attention deficits. This case demonstrates the risk of intraprocedural rupture when coil sizing is selected based on pre-thrombosis dimensions rather than current lumen visualization in rapidly thrombosing aneurysms. When thrombosis reduces the lumen, selecting the coil size based on pre-thrombosis dimensions may increase the risk of intraoperative rupture. Coil size selection should match the currently visualized lumen.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"117-121"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal Imaging to Support Vim Targeting in Magnetic Resonance-Guided Focused Ultrasound Thalamotomy: Two Technically and Anatomically Challenging Cases.","authors":"Mohammad Ali Akbar, Tomoko Hanada, Kazumichi Yamada, Takuichiro Higashi, Tsuneo Makiuchi, Ryosuke Hanaya","doi":"10.2176/jns-nmc.2025-0390","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0390","url":null,"abstract":"<p><p>Essential tremor is the most common adult movement disorder, typically presenting with kinetic and postural tremor that interferes with daily activities. For patients unresponsive to medications, surgical options such as radiofrequency thalamotomy, deep brain stimulation, and magnetic resonance-guided focused ultrasound can provide therapeutic benefit. Magnetic resonance-guided focused ultrasound, an incisionless lesioning modality, has gained clinical use; however, accurate targeting of the ventral intermediate nucleus remains challenging because the nucleus cannot be directly visualized on routine magnetic resonance imaging and exhibits substantial individual variability. This report describes 2 cases of medication-refractory essential tremor treated with magnetic resonance-guided focused ultrasound ventral intermediate nucleus thalamotomy under structurally complex conditions. One patient had a thick skull with a low skull density ratio, and the other exhibited marked thalamic distortion. In both cases, individualized ventral intermediate nucleus targeting was performed using multimodal imaging that combined a stereotactic planning platform, dentatorubrothalamic tract tractography, and Fast Gray Matter Acquisition T1 Inversion Recovery. The Fast Gray Matter Acquisition T1 Inversion Recovery sequence, which enhances gray-white matter contrast, provided relative contrast of intrathalamic structures, including signal patterns corresponding to the internal medullary lamina. When integrated with connectivity-based dentatorubrothalamic tract tractography, this approach provided complementary information to support anatomically guided targeting. Stepwise sonication with intraoperative thermal monitoring resulted in substantial tremor reduction without new neurological deficits. These observations suggest that combining Fast Gray Matter Acquisition T1 Inversion Recovery with tractography offers practical, complementary guidance for ventral intermediate nucleus targeting, including in settings without access to advanced commercial integration software. Although limited to 2 patients, this work suggests the value of accessible multimodal imaging for improving confidence in anatomy-informed targeting in magnetic resonance-guided focused ultrasound and potentially other lesioning procedures.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"141-146"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged Full-endoscopic Foraminotomy for Multilevel Lumbar Stenosis with Scoliosis: A Case Report.","authors":"Takayuki Kitahara, Yuji Nagao, Takafumi Ohshima, Naoto Ono, Saori Soeda, Makoto Takeuchi, Kosuke Sugiura, Hiroaki Manabe, Masatoshi Morimoto, Fumitake Tezuka, Hiroshi Kageyama, Junzo Fujitani, Koichi Sairyo","doi":"10.2176/jns-nmc.2025-0339","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0339","url":null,"abstract":"<p><p>This report discusses the case of a 70-year-old male orthopedic surgeon with multilevel lumbar foraminal stenosis and degenerative scoliosis (Cobb angle 21°) who presented with right leg radiculopathy and foot drop. To accommodate his inability to take extended leave and his desire to avoid fusion, we performed a staged transforaminal full-endoscopic lumbar foraminotomy, consisting of one procedure per level, under local anesthesia. The procedures targeted the L5/S1, L4/5, and L3/4 levels sequentially at 1-month intervals. The patient's foot drop resolved immediately after the first surgery. At the 3-month follow-up after the final procedure, his motor deficits showed marked improvement, and his Oswestry Disability Index score decreased from 12% to 8%. He returned to his clinical duties the day after each discharge and was able to continue managing his private clinic without interruption. He resumed playing golf 2 months after the final surgery. A staged, non-fusion transforaminal full-endoscopic lumbar foraminotomy approach under local anesthesia was a safe and effective strategy for multilevel foraminal stenosis, even in the presence of deformity, providing excellent functional recovery with minimal disruption to the patient's professional life.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"103-110"},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Return to Elite Competition following a Foraminal Block for Minimal Far-lateral Disc Herniation at L5-S1: A Report of 2 Cases.","authors":"Takayuki Kitahara, Yuji Nagao, Naoto Ono, Takafumi Ohshima, Saori Soeda, Kosuke Sugiura, Masatoshi Morimoto, Hiroaki Manabe, Fumitake Tezuka, Hiroshi Kageyama, Junzo Fujitani, Kazuta Yamashita, Koichi Sairyo","doi":"10.2176/jns-nmc.2025-0287","DOIUrl":"https://doi.org/10.2176/jns-nmc.2025-0287","url":null,"abstract":"<p><p>This report presents 2 cases demonstrating how a foraminal block served as both a diagnostic tool and an effective treatment for small far-lateral lumbar disc herniation at L5-S1 in elite athletes. The patients were a male swimmer in his early 20s and a female figure skater in her late teens, both of whom developed activity-related low back pain, with symptoms acutely exacerbated by the high flexion and extension loads inherent to their sports, which compromised their ability to compete at the highest level. A fluoroscopy-guided foraminal block was performed in each case; the key technical component was careful paraneural needle placement, stopping just short of the nerve root to minimize the risk of iatrogenic injury while targeting the inflammatory environment throughout the foramen. The diagnosis was confirmed in both athletes by reproducing their specific pain during injection. This non-operative intervention provided pain relief that was sufficient for successful participation in a major international competition in one case and continuation of a critical qualifying season for a premier global event in the other. This approach represents a critical diagnostic and therapeutic strategy that can avoid the need for surgery and preserve an elite athlete's immediate career goals.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"97-102"},"PeriodicalIF":0.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13076128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Abducens Nerve Palsy Caused by a Meningohypophyseal Trunk Aneurysm Treated with Endovascular Coiling: A Case Report.","authors":"Fuminori Shimizu, Hidetoshi Matsukawa, Yusuke Kitada, Hiroto Kakita, Nobuyuki Sakai","doi":"10.2176/jns-nmc.2025-0295","DOIUrl":"10.2176/jns-nmc.2025-0295","url":null,"abstract":"<p><p>Aneurysms of the meningohypophyseal trunk are rare and usually asymptomatic, but because of the close anatomical relationship between the meningohypophyseal trunk and cranial nerves within the cavernous sinus, they can cause neurological deficits. We describe an 80-year-old woman who presented with acute horizontal diplopia exacerbated on rightward gaze. Neurological examination revealed isolated right abducens nerve palsy. Magnetic resonance angiography demonstrated an aneurysm arising from the right meningohypophyseal trunk in close proximity to the abducens nerve. Endovascular coil embolization was performed under dual antiplatelet therapy, and the aneurysm was successfully occluded while preserving meningohypophyseal trunk patency. The procedure was uneventful, although postoperative diffusion-weighted imaging revealed multiple small cerebral infarctions suggestive of distal embolism. The patient remained neurologically stable, and her diplopia gradually improved. At the 6-month follow-up, she exhibited complete recovery of abducens nerve function. This case highlights the anatomical vulnerability of the abducens nerve to compression by meningohypophyseal trunk aneurysms and underscores the importance of considering vascular lesions in the differential diagnosis of isolated cranial nerve palsies. Despite radiographic evidence of silent embolic infarction, endovascular coil embolization resulted in full clinical recovery, supporting its role as a safe and effective therapeutic option in appropriately selected symptomatic meningohypophyseal trunk aneurysms.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}