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An Ectopic Tentorial Schwannoma Mimicking Tentorial Meningioma: A Case Report and Literature Review. 异位幕神经鞘瘤模拟幕脑膜瘤1例报告及文献复习。
NMC case report journal Pub Date : 2026-04-01 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0386
Taishi Honda, Masahito Kawabori, Yasuhiro Ito, Daisuke Shimbo, Hiromi Okada, Masanori Isobe, Miki Fujimura
{"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":"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}
引用次数: 0
Two Cases of Lumbar Spinal Canal Stenosis with Dorsal Meningovertebral Ligaments: Potential Risk of Dural Laceration. 腰椎管狭窄伴脊膜背侧韧带2例:硬脑膜撕裂的潜在危险。
NMC case report journal Pub Date : 2026-04-01 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0354
Kyohei Kin, Ryoji Tominaga, Kento Takebayashi, Hiroki Iwai, Hisashi Koga
{"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":"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}
引用次数: 0
Intraprocedural Rupture During Coil Embolization of a Ruptured, Rapidly Thrombosing Anterior Cerebral Artery Aneurysm: A Case Report. 术中线圈栓塞术中破裂,迅速形成血栓的大脑前动脉瘤1例报告。
NMC case report journal Pub Date : 2026-04-01 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0407
Taro Suzuki, Yosuke Akamatsu, Yasushi Ogasawara
{"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":"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}
引用次数: 0
Multimodal Imaging to Support Vim Targeting in Magnetic Resonance-Guided Focused Ultrasound Thalamotomy: Two Technically and Anatomically Challenging Cases. 磁共振引导聚焦超声丘脑切开术中支持Vim靶向的多模态成像:两个技术和解剖学上具有挑战性的案例。
NMC case report journal Pub Date : 2026-04-01 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0390
Mohammad Ali Akbar, Tomoko Hanada, Kazumichi Yamada, Takuichiro Higashi, Tsuneo Makiuchi, Ryosuke Hanaya
{"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":"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}
引用次数: 0
Staged Full-endoscopic Foraminotomy for Multilevel Lumbar Stenosis with Scoliosis: A Case Report. 分期全内窥镜椎间孔切开术治疗多节段腰椎管狭窄伴脊柱侧凸1例。
NMC case report journal Pub Date : 2026-03-19 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0339
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
{"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":"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}
引用次数: 0
Successful Return to Elite Competition following a Foraminal Block for Minimal Far-lateral Disc Herniation at L5-S1: A Report of 2 Cases. 椎间孔阻滞治疗L5-S1轻度远外侧椎间盘突出后成功恢复精英比赛:2例报告
NMC case report journal Pub Date : 2026-03-19 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0287
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
{"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":"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}
引用次数: 0
Isolated Abducens Nerve Palsy Caused by a Meningohypophyseal Trunk Aneurysm Treated with Endovascular Coiling: A Case Report. 血管内卷绕术治疗脑膜下垂体干动脉瘤所致孤立性外展神经麻痹1例。
NMC case report journal Pub Date : 2026-03-06 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0295
Fuminori Shimizu, Hidetoshi Matsukawa, Yusuke Kitada, Hiroto Kakita, Nobuyuki Sakai
{"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}
引用次数: 0
Choroid Plexus Cyst with Parenchymal Localization in a Symptomatic 50-year-old Male: A Case Report. 有症状的50岁男性脉络丛囊肿伴实质定位1例。
NMC case report journal Pub Date : 2026-03-06 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0252
Berkay Ayhan, Hüseyin Ömer Semiz, Zeyad Kamar, Ülker Karagece Yalçin, Tuğçe Aycan Akbal Ersöz
{"title":"Choroid Plexus Cyst with Parenchymal Localization in a Symptomatic 50-year-old Male: A Case Report.","authors":"Berkay Ayhan, Hüseyin Ömer Semiz, Zeyad Kamar, Ülker Karagece Yalçin, Tuğçe Aycan Akbal Ersöz","doi":"10.2176/jns-nmc.2025-0252","DOIUrl":"10.2176/jns-nmc.2025-0252","url":null,"abstract":"<p><p>Choroid plexus cysts are typically benign lesions found within the ventricular system during prenatal imaging and are usually asymptomatic. Intraparenchymal choroid plexus cysts, especially in adults, are exceptionally rare, with very few reported cases. This case report aims to present a rare instance of a symptomatic, intraparenchymal choroid plexus cyst in an adult patient and to discuss the diagnostic and surgical considerations involved. We present the case of a 50-year-old man with complaints of lower extremity weakness and imbalance who was found to have a bilobulated cyst in the frontal cortex causing significant mass effect and midline shift. The patient underwent cyst fenestration through endoscope-assisted open craniotomy, with marked postoperative reduction in cyst size and resolution of neurological symptoms. Histopathology confirmed the diagnosis of a choroid plexus cyst. This case highlights the importance of considering rare pathologies such as choroid plexus cysts in the differential diagnosis of cystic brain lesions with mass effect in adults.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"77-84"},"PeriodicalIF":0.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147523518","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}
引用次数: 0
Intra-aneurysmal Thrombectomy Using Exo-endoscopic 2-step Approach for Thrombosed Vertebral Artery Aneurysm: A Technical Case Report. 采用外腔内镜两步入路治疗血栓性椎动脉动脉瘤的动脉瘤内血栓切除术:一例技术病例报告。
NMC case report journal Pub Date : 2026-03-06 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0316
I Gusti Ketut Agung Surya Kencana, Kenichiro Iwami, Masahiro Nishihori, Kazuhito Takeuchi, Yuichi Nagata, Eriko Okumura, Yoshiki Sato, I Wayan Niryana, Tjokorda Gde Bagus Mahadewa, Ryuta Saito
{"title":"Intra-aneurysmal Thrombectomy Using Exo-endoscopic 2-step Approach for Thrombosed Vertebral Artery Aneurysm: A Technical Case Report.","authors":"I Gusti Ketut Agung Surya Kencana, Kenichiro Iwami, Masahiro Nishihori, Kazuhito Takeuchi, Yuichi Nagata, Eriko Okumura, Yoshiki Sato, I Wayan Niryana, Tjokorda Gde Bagus Mahadewa, Ryuta Saito","doi":"10.2176/jns-nmc.2025-0316","DOIUrl":"10.2176/jns-nmc.2025-0316","url":null,"abstract":"<p><p>Although rare, thrombosed vertebral artery aneurysms can lead to severe symptoms and are challenging to treat due to their proximity to vital structures. The location of a thrombosed aneurysm on the anterior aspect of the brainstem poses a significant challenge to conventional microscopic approaches. We herein report a 78-year-old man with a thrombosed right vertebral artery aneurysm who developed progressive quadriparesis, dysphagia, and respiratory failure despite prior interventions, including flow diverter stent placement, parent artery occlusion, and microscopic thrombectomy. Given worsening medullary compression and poor clinical status, intra-aneurysmal thrombectomy was performed using an exo-endoscopic 2-step approach. The procedure involved reopening the previous suboccipital craniotomy, partial condylectomy, and C1 hemilaminectomy. Exoscopic thrombus de-bulking was followed by endoscopic evacuation of the residual thrombus compressing the ventral brainstem. Postoperatively, no complication was observed, and the patient demonstrated gradual neurological improvement, including recovery of spontaneous respiration and the ability to wean from mechanical ventilation within 3 weeks. Follow-up imaging confirmed resolution of medullary compression without thrombus recurrence. The exo-endoscopic 2-step approach is a viable option for surgical decompression of thrombosed vertebral artery aneurysms that cause brainstem compression. This enhances surgical access and visualization, particularly in the ventral brainstem, while potentially minimizing brainstem manipulation. Further investigation is warranted to better define the indications, efficacy, and safety of the management of complex thrombosed aneurysms.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"91-96"},"PeriodicalIF":0.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577200","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}
引用次数: 0
Cerebral Hemodynamics in Pediatric Abusive Head Trauma: 3 Severe Cases with Preserved Motor Cortex, Hyperperfusion, and Recovery of Mild Paralysis. 儿童虐待性头部创伤的脑血流动力学:3例运动皮质保留、高灌注和轻度瘫痪恢复的严重病例。
NMC case report journal Pub Date : 2026-02-20 eCollection Date: 2026-01-01 DOI: 10.2176/jns-nmc.2025-0258
Mitsuru Tamura, Shinji Yamashita, Tomoki Kawano, Satoru Komaki, Takeru Tsukino, Koutarou Kojima, Kenichi Maeda, Yasuhiro Kimoto, Yoshihito Kadota, Minako Azuma, Yoshiko Okita
{"title":"Cerebral Hemodynamics in Pediatric Abusive Head Trauma: 3 Severe Cases with Preserved Motor Cortex, Hyperperfusion, and Recovery of Mild Paralysis.","authors":"Mitsuru Tamura, Shinji Yamashita, Tomoki Kawano, Satoru Komaki, Takeru Tsukino, Koutarou Kojima, Kenichi Maeda, Yasuhiro Kimoto, Yoshihito Kadota, Minako Azuma, Yoshiko Okita","doi":"10.2176/jns-nmc.2025-0258","DOIUrl":"10.2176/jns-nmc.2025-0258","url":null,"abstract":"<p><p>Abusive head trauma in infants and young children can have a significant impact on neurological outcomes and, in severe cases, may be life-threatening. We report 3 cases of abusive head trauma that presented with acute subdural hematomas on computed tomography scans, accompanied by extensive low-density areas and parenchymal brain swelling. All patients exhibited impaired consciousness due to brain injury and underwent craniotomy for hematoma evacuation as well as extensive decompressive craniectomy. Despite the severity of the initial presentation, hemiparesis was mild and gradually improved over several months. Postoperative magnetic resonance imaging revealed widespread parenchymal injury but preservation of the corticospinal tract, including the precentral gyrus. In the acute phase, diffusion-weighted imaging showed no irreversible infarction in the motor cortex, and arterial spin labeling demonstrated increased perfusion in peri-motor regions of the affected hemisphere. These findings suggest that preserved corticospinal pathways and compensatory hyperperfusion may correlate with favorable motor recovery even in the presence of extensive parenchymal damage. These cases highlight the radiological features and short-term neurological outcomes of abusive head trauma, demonstrating preserved motor function despite extensive parenchymal damage.</p>","PeriodicalId":101331,"journal":{"name":"NMC case report journal","volume":"13 ","pages":"69-75"},"PeriodicalIF":0.0,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12995511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489277","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}
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