Journal of Neurosurgery: Case Lessons最新文献

The paraneurium and the tumefactive appearance of peripheral nerve neurolymphomatosis: illustrative case 周围神经神经淋巴瘤病的副神经元和肿瘤性外观：例证

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-22 DOI: 10.3171/CASE24125

D. Barone, Ryan W Kendziora, S. Broski, David J. Schembri Wismayer, Robert J Spinner

{"title":"The paraneurium and the tumefactive appearance of peripheral nerve neurolymphomatosis: illustrative case","authors":"D. Barone, Ryan W Kendziora, S. Broski, David J. Schembri Wismayer, Robert J Spinner","doi":"10.3171/CASE24125","DOIUrl":"https://doi.org/10.3171/CASE24125","url":null,"abstract":"BACKGROUND Peripheral neurolymphomatosis (NL) is an often-misdiagnosed condition characterized by lymphomatous infiltration within the peripheral nerves. Its rarity and complexity frequently result in delayed diagnosis and suboptimal patient outcomes. This study aims to elucidate the role of the paraneurium (circumneurium) in NL, emphasizing its diagnostic and therapeutic significance. OBSERVATIONS A 72-year-old man presented with lesions on his right lower eyelid. Initial diagnostics were inconclusive until an excisional biopsy confirmed extranodal marginal zone lymphoma. Following a complete metabolic response to rituximab treatment, the patient relapsed 14 months later with progressive lymphoma and bilateral sciatic nerve involvement, as confirmed by positron emission tomography–computed tomography and magnetic resonance imaging. LESSONS This paper underscores the critical role of the paraneurium in NL, enhancing understanding of its pathophysiology. Integrating advanced imaging techniques have proved essential in accurately identifying neurolymphomatous involvement within the paraneurium. This study paves the way for more effective management strategies in NL and similar conditions, focusing on improving patient care and outcomes.","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"69 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incidental durotomy resulting in a postoperative lumbosacral nerve root with eventration into the adjacent facet joint: illustrative cases 腰骶神经根术后偶发性硬膜外切除术导致邻近面关节连通：病例说明

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-22 DOI: 10.3171/CASE2418

MD Michael J. Kelly, MD Franziska C. S. Altorfer, MD Marco D. Burkhard, MD Russel C. Huang, MD Frank P. Cammisa Jr., MD J. Levi Chazen

{"title":"Incidental durotomy resulting in a postoperative lumbosacral nerve root with eventration into the adjacent facet joint: illustrative cases","authors":"MD Michael J. Kelly, MD Franziska C. S. Altorfer, MD Marco D. Burkhard, MD Russel C. Huang, MD Frank P. Cammisa Jr., MD J. Levi Chazen","doi":"10.3171/CASE2418","DOIUrl":"https://doi.org/10.3171/CASE2418","url":null,"abstract":"BACKGROUND Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous postoperative durotomy. Rarely, this nerve root herniation can become entrapped within local structures, including the facet joint. The aim of this study was to illustrate our experience with three cases of lumbosacral nerve root eventration into an adjacent facet joint and to describe our diagnostic and surgical approach to this rare complication. OBSERVATIONS Three patients who had undergone lumbar decompression surgery with or without fusion experienced postoperative radiculopathy. Exploratory revision surgery revealed all three had a durotomy with nerve root eventration into the facet joint. Significant symptom improvement was achieved in all patients following liberation of the neural elements from the facet joints. LESSONS Entrapment of herniated nerve roots into the facet joint may be a previously underappreciated complication and remains quite challenging to diagnose even with the highest-quality advanced imaging. Thus, clinicians must have a high index of suspicion to diagnose this issue and a low threshold for surgical exploration.","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"18 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140673849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Arachnoid bands in hemifacial spasm: an overlooked etiology? Illustrative case 半面痉挛中的蛛网膜带：被忽视的病因？示例病例

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-15 DOI: 10.3171/CASE24164

Mariam Al-Mutawa, H. Schroeder

引用次数: 0

Evaluation of the shrinkage process of a neck remnant after stent-coil treatment of a cerebral aneurysm using silent magnetic resonance angiography and computational fluid dynamics analysis: illustrative case 利用无声磁共振血管造影术和计算流体动力学分析评估支架盘旋治疗脑动脉瘤后颈部残余物的收缩过程：示例病例

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-15 DOI: 10.3171/CASE24141

T. Satoh, K. Sugiu, M. Hiramatsu, J. Haruma, I. Date

{"title":"Evaluation of the shrinkage process of a neck remnant after stent-coil treatment of a cerebral aneurysm using silent magnetic resonance angiography and computational fluid dynamics analysis: illustrative case","authors":"T. Satoh, K. Sugiu, M. Hiramatsu, J. Haruma, I. Date","doi":"10.3171/CASE24141","DOIUrl":"https://doi.org/10.3171/CASE24141","url":null,"abstract":"BACKGROUND Silent magnetic resonance angiography (MRA) mitigates metal artifacts, facilitating clear visualization of neck remnants after stent and coil embolization of cerebral aneurysms. This study aims to scrutinize hemodynamics at the neck remnant by employing silent MRA and computational fluid dynamics. OBSERVATIONS The authors longitudinally tracked images of a partially thrombosed anterior communicating artery aneurysm’s neck remnant, which had been treated with stent-assisted coil embolization, using silent MRA over a decade. Computational fluid dynamics delineated the neck remnant’s reduction process, evaluating hemodynamic parameters such as flow rate, wall shear stress magnitude and vector, and streamlines. The neck remnant exhibited diminishing surface area, volume, neck size, dome depth, and aspect ratio. Its reduction correlated with a decline in the flow rate ratio of the remnant dome to the inflow parent artery. Analysis delineated regions within the contracting neck remnant characterized by consistently low average wall shear stress magnitude and variation, accompanied by notable variations in wall shear stress vector directionality. LESSONS Evaluation of neck remnants after stent-coil embolization is possible through silent MRA and computational fluid dynamics. Predicting the neck remnant reduction may be achievable through hemodynamic parameter analysis.","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"2 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140700736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Novel use of a closed-tip stent retriever to prevent distal embolism in the posterior circulation: illustrative case 使用闭合尖端支架回取器预防后循环远端栓塞的新方法：示例病例

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-15 DOI: 10.3171/CASE24137

Rikuo Nishii, Masanori Goto, Yuki Takano, Kota Nakajima, Takateru Takamatsu, Masanori Tokuda, Hikari Tomita, Mai Yoshimoto, Satohiro Kawade, Yasuhiro Yamamoto, Yuji Naramoto, Kunimasa Teranishi, Nobuyuki Fukui, T. Sunohara, R. Fukumitsu, Junichi Takeda, Masaomi Koyanagi, C. Sakai, Nobuyuki Sakai, T. Ohta

{"title":"Novel use of a closed-tip stent retriever to prevent distal embolism in the posterior circulation: illustrative case","authors":"Rikuo Nishii, Masanori Goto, Yuki Takano, Kota Nakajima, Takateru Takamatsu, Masanori Tokuda, Hikari Tomita, Mai Yoshimoto, Satohiro Kawade, Yasuhiro Yamamoto, Yuji Naramoto, Kunimasa Teranishi, Nobuyuki Fukui, T. Sunohara, R. Fukumitsu, Junichi Takeda, Masaomi Koyanagi, C. Sakai, Nobuyuki Sakai, T. Ohta","doi":"10.3171/CASE24137","DOIUrl":"https://doi.org/10.3171/CASE24137","url":null,"abstract":"BACKGROUND In mechanical thrombectomy for tandem occlusions in vertebrobasilar stroke, distal emboli from the vertebral artery lesion should be prevented. However, no suitable embolic protection devices are currently available in the posterior circulation. Here, the authors describe the case of a vertebral artery lesion effectively treated with a closed-tip stent retriever as an embolic protection device in the posterior circulation. OBSERVATIONS A 65-year-old male underwent mechanical thrombectomy for basilar artery occlusion, with tandem occlusion of the proximal vertebral artery. After basilar artery recanalization via the nonoccluded vertebral artery, a subsequent mechanical thrombectomy was performed for the occluded proximal vertebral artery. To prevent distal embolization of the basilar artery, an EmboTrap III stent retriever was deployed as an embolic protection device within the basilar artery to successfully capture the thrombus. LESSONS A stent retriever with a closed-tip structure can effectively capture thrombi, making it a suitable distal embolic protection device in the posterior circulation.","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"270 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A rare case of atypical intradural extramedullary glioblastoma diagnosed utilizing next-generation sequencing and methylation profiling: illustrative case 利用新一代测序和甲基化分析诊断出的一例罕见非典型硬膜外胶质母细胞瘤：说明性病例

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-15 DOI: 10.3171/CASE24103

MD William J. Shelton, BS Andrew P. Mathews, MD Karrar Aljiboori, MD J. Stephen Nix, MD Murat Gokden, MD Analiz Rodriguez

{"title":"A rare case of atypical intradural extramedullary glioblastoma diagnosed utilizing next-generation sequencing and methylation profiling: illustrative case","authors":"MD William J. Shelton, BS Andrew P. Mathews, MD Karrar Aljiboori, MD J. Stephen Nix, MD Murat Gokden, MD Analiz Rodriguez","doi":"10.3171/CASE24103","DOIUrl":"https://doi.org/10.3171/CASE24103","url":null,"abstract":"BACKGROUND Primary spinal cord tumors, especially primary spinal cord glioblastoma multiforme (PSC-GBM), are exceptionally rare, accounting for less than 1.5% of all spinal tumors. Their infrequency and aggressive yet atypical presentation make diagnosis challenging. In uncertain cases, a surgical approach for tissue diagnosis is often optimal. OBSERVATIONS A 76-year-old male presented with a rapidly progressing clinical history marked by worsening extremity weakness, urinary retention, and periodic fecal incontinence alongside diffuse changes on neuraxis imaging. The patient, in whom subacute polyneuropathy was initially diagnosed, received multiple rounds of steroids and intravenous immunoglobulin without clinical improvement. Histopathological review of the biopsy tissue yielded an initial diagnosis of spindle cell neoplasm. Next-generation sequencing (NGS) is done routinely on all neuropathology specimens at the authors’ institution, and methylation profiling is pursued in difficult cases. Ultimately, NGS and methylation profiling results were essential to an integrated final diagnosis of GBM. LESSONS PSC-GBM is a rare but highly aggressive occurrence of this tumor. Prolonged back pain, rapid neurological decline, and imaging changes warrant the consideration of lesional biopsy for precise disease characterization. In inconclusive cases, NGS has proved invaluable for clinical clarification and diagnosis, underscoring its importance for integrated diagnoses in guiding appropriate treatment strategies.","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"34 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140702257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thoracic spinal cord injury after surgical removal of a ruptured cerebellar arteriovenous malformation in a patient in the Concorde position: illustrative case 协和体位患者小脑动静脉畸形破裂手术切除后的胸椎脊髓损伤：示例病例

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-15 DOI: 10.3171/CASE249

Kohei Ishikawa, Hideki Endo, Yasufumi Ohtake, Toshiichi Watanabe, Hirohiko Nakamura

引用次数: 0

Metastatic intradural primary spinal osteosarcoma: illustrative case 转移性硬膜内原发性脊柱骨肉瘤：示例病例

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-15 DOI: 10.3171/CASE2480

Shreyas Thiruvengadam, Mark Lam, Stephen Honeybul

引用次数: 0

Epidural lipomatosis with foci of hemorrhage and acute compression of the spinal cord in a child with CLOVES syndrome: illustrative case 硬膜外脂肪瘤病伴有出血灶和脊髓急性压迫，患儿患有 CLOVES 综合征：示例病例

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-15 DOI: 10.3171/CASE23772

Dmytro Ishchenko, Iryna Benzar, Andrii Holoborodko

{"title":"Epidural lipomatosis with foci of hemorrhage and acute compression of the spinal cord in a child with CLOVES syndrome: illustrative case","authors":"Dmytro Ishchenko, Iryna Benzar, Andrii Holoborodko","doi":"10.3171/CASE23772","DOIUrl":"https://doi.org/10.3171/CASE23772","url":null,"abstract":"BACKGROUND Congenital lipomatous overgrowth, vascular malformations, epidermal nevi, spinal/skeletal anomalies, and/or scoliosis (CLOVES) syndrome is the most recently described combined vascular anomaly characterized by congenital excessive growth of adipose tissue, vascular malformations, epidermal nevi, and skeletal deformities. This condition exhibits a significant variability in clinical manifestations and a tendency for rapid progression and affects extensive anatomical regions. Information regarding the association of epidural lipomatosis with low-flow venous lymphatic malformations is rare, with few reports in the literature. OBSERVATIONS The authors present a case of a 6-year-old girl who was admitted to the emergency department complaining of rapidly progressing weakness in her lower extremities and partial loss of sensation in the inguinal area. Radiologically, an extradural mass was identified at the T2–6 level, causing acute spinal cord compression. Urgent decompression and partial resection of the mass were performed. Despite satisfactory intraoperative hemo- and lymphostasis, postoperative lymphorrhea/seroma leakage was encountered as a delayed complication and was managed conservatively. LESSONS CLOVES syndrome is characterized by the combination of various clinical symptoms, not all of which are included in the abbreviation, as well as a progressively deteriorating course, the emergence of new symptoms, and complications throughout the patient’s life. This necessitates ongoing monitoring of such patients.","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"73 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140699841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Primary intracranial peripheral primitive neuroectodermal tumor: lessons from an exceptionally rare neoplasm. Illustrative case 原发性颅内外周原始神经外胚层肿瘤：从一种异常罕见的肿瘤中汲取的教训。示例病例

Journal of Neurosurgery: Case Lessons Pub Date : 2024-04-15 DOI: 10.3171/CASE24133

Jhon E. Bocanegra-Becerra, Luis Felipe Novoa-Ramírez, Alan Jesús Latorre-Zúñiga, Norka Tacas-Gil, Rolando V Rojas-Apaza

{"title":"Primary intracranial peripheral primitive neuroectodermal tumor: lessons from an exceptionally rare neoplasm. Illustrative case","authors":"Jhon E. Bocanegra-Becerra, Luis Felipe Novoa-Ramírez, Alan Jesús Latorre-Zúñiga, Norka Tacas-Gil, Rolando V Rojas-Apaza","doi":"10.3171/CASE24133","DOIUrl":"https://doi.org/10.3171/CASE24133","url":null,"abstract":"BACKGROUND The primary intracranial peripheral primitive neuroectodermal tumor (pPNET) is a lesion subtype within the Ewing sarcoma family of tumors. pPNETs are extremely uncommon pathologies, accounting for 0.03% of intracranial tumors and 1% to 2% of Ewing sarcoma cases. Given its histological aspect similar to other highly proliferative malignant neuroectodermal neoplasms, pPNET merits extensive workup for accurate diagnosis and treatment. OBSERVATIONS A 36-year-old male presented to the emergency department with a 1-year history of headaches in the right frontoparietal area, generalized tonic-clonic seizures, and a history of the resection of a tumor labeled as a meningioma 5 years before admission. He was neurologically intact. Brain magnetic resonance imaging revealed a heterogeneous focal lesion of 25 × 35 × 23 mm with a necrotic center and neoformative appearance in the right frontal cortex. The patient underwent multimodal treatment with gross-total resection, radiotherapy, and chemotherapy. Histopathological examination results supported the diagnosis of pPNET. At the 2-year follow-up, the patient had no new-onset symptoms, and brain imaging revealed absent signs of tumor recurrence. LESSONS The present case describes an extraordinary pPNET case, initially confounded as a clear cell meningioma. Managing pPNET requires thorough investigation, careful differentiation from similar neuroectodermal lesions, and multimodal treatment to improve the patient’s prognosis.","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140699357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0