{"title":"Bilateral L5 pedicle fracture with L5-S1 spondylolisthesis after single-level L4-5 posterior lumbar interbody fusion: illustrative case.","authors":"Toshiyuki Kitaori, Masato Ota, Jiro Tamura","doi":"10.3171/CASE23279","DOIUrl":"10.3171/CASE23279","url":null,"abstract":"<p><strong>Background: </strong>Single-level posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) is a commonly performed surgical procedure for L4-5 isthmic spondylolisthesis. Postoperative L5 pedicle fracture with rapidly progressive spondylolisthesis at L5-S1 segment after L4-5 PLIF/TLIF is quite rare, and the etiology remains unclear. This report describes this rare complication and proposes a possible etiology focusing on the lumbosacral sagittal imbalance characterized by an anteriorly shifted lumbar loading axis.</p><p><strong>Observations: </strong>The authors report a case complicated by L5 bilateral pedicle fractures and rapidly progressive spondylolisthesis at the L5-S1 segment very early after a single-level PLIF for L4-5 isthmic spondylolisthesis. Meyerding grade III anterolisthesis was observed at L5-S1 segment by 3 months after the initial surgery. Additional surgery was performed, and the fixation was extended to L4-ilium. Fracture healing was observed at 6 months postoperatively.</p><p><strong>Lessons: </strong>This complication may have been caused by abnormal local shear forces on the posterior neural arch of L5 vertebra and L5-S1 intervertebral disc, which were triggered by the fusion surgery for L4 shear-type spondylolisthesis. L4 sagittal vertical axis is considered a reasonable parameter representing lumbosacral sagittal imbalance with an anteriorly shifted loading axis and may be a candidate for the predictive parameters of this rare complication.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/68/a0/CASE23279.PMC10555588.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9997857","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}
Nahom Teferi, Ajmain Chowdhury, Sarah Lee, Meron Challa, Lukasz Weiner, Sarah Auerbach, Mahil Rao, Brian J Dlouhy
{"title":"Pediatric brainstem abscess successfully treated with stereotactic aspiration: illustrative case.","authors":"Nahom Teferi, Ajmain Chowdhury, Sarah Lee, Meron Challa, Lukasz Weiner, Sarah Auerbach, Mahil Rao, Brian J Dlouhy","doi":"10.3171/CASE23262","DOIUrl":"10.3171/CASE23262","url":null,"abstract":"<p><strong>Background: </strong>Pediatric brainstem abscesses are rare entities that account for 1% of all brain abscesses and, when diagnosed, constitute a neurosurgical emergency.</p><p><strong>Observations: </strong>A previously healthy 11-year-old male presented with several days of worsening headache, confusion, and ataxia. Brain magnetic resonance imaging (MRI) revealed a midbrain and pons lesion. The patient subsequently had a rapid neurological decline with loss of consciousness and brainstem function. Follow-up MRI revealed significant enlargement of the brainstem lesion with extension into the pons, midbrain, and thalamus, with greater concerns for an abscess rather than a tumor or an inflammatory process. He was taken for an emergent stereotactic aspiration of the abscess, and broad-spectrum antibiotics were initiated. He had neurological improvement, which subsequently declined 5 days later with brain MRI revealing an increase in the brainstem abscess, which required a second stereotactic aspiration. After rehabilitation, he made a significant neurological recovery.</p><p><strong>Lessons: </strong>Pediatric brainstem abscesses are rare pathologies, and a high index of suspicion is needed in patients presenting with a brainstem lesion mimicking tumor but with rapid neurological decline despite no other evidence of infection or infectious/inflammatory markers. Stereotactic aspiration is required for large lesions to target the antibiotic treatment and as an adjunct to broad-spectrum antibiotics.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/a8/CASE23262.PMC10555595.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10000315","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":"Brain metastasis localized to the same area of infarction: illustrative case.","authors":"Oday Atallah, Bipin Chaurasia","doi":"10.3171/CASE23325","DOIUrl":"10.3171/CASE23325","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke and tumor account for a disproportionate share of deaths and disabilities among the elderly. Patients with a tumor who develop recurrent acute neurological deficits after a stroke can be at risk for tumor-related stroke. In contrast, brain metastases (BM) are common causes of neurological symptoms and are associated with a poor prognosis in patients with both malignancy and ischemic stroke.</p><p><strong>Observations: </strong>The authors report a rare case of metastatic melanoma that manifested in the same region as a previous ischemic infarction. A 22-year-old female presented at our emergency department with right hemiparesis and sensory difficulties. Infarction in the left frontoparietal and basal ganglia regions was found on a computed tomography scan of the brain. A decompressive hemicraniectomy was performed urgently. After 16 years, a biopsy taken from her chin revealed malignant melanoma. Hemorrhagic metastasis on the frontal lobe of the brain was detected with magnetic resonance imaging and was histopathologically confirmed upon resection.</p><p><strong>Lessons: </strong>In addition to recurrence, BM may be considered when a person with ischemic stroke and a cancer such as melanoma has new neurological problems in one area that cannot be explained by the stroke.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/dc/CASE23325.PMC10555590.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9991513","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}
Audrey Grossen, Helen H Shi, Mallory Schenk, Amber Stocco, Justin Ramsey, Suneet Sahgal, Andrew K Conner, Virendra R Desai
{"title":"Deep brain stimulation in a pediatric dystonia patient with cochlear implants and mitochondrial disorder: novel application of a frameless stereotactic system and navigating the anesthesia choice and neurosurgical complexities. Illustrative case.","authors":"Audrey Grossen, Helen H Shi, Mallory Schenk, Amber Stocco, Justin Ramsey, Suneet Sahgal, Andrew K Conner, Virendra R Desai","doi":"10.3171/CASE23128","DOIUrl":"10.3171/CASE23128","url":null,"abstract":"<p><strong>Background: </strong>This report presents a case of medically refractory dystonia in a pediatric patient successfully treated with bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) while under general anesthesia by using microelectrode recordings (MERs) with intraoperative computed tomography (CT).</p><p><strong>Observations: </strong>The patient was an 18-year-old female with primary dystonia secondary to mitochondrial Leigh syndrome. Her past medical history was significant for complex partial epilepsy and hearing loss treated with cochlear implants. Her cochlear implants precluded anatomical targeting via magnetic resonance imaging. Additionally, the patient could not tolerate awake surgery with MER. The decision was made to proceed with bilateral STN DBS with intraoperative CT with the patient under general anesthesia. The patient's cochlear implants made standard frame placement difficult, so navigation was performed with the Nexframe system. Recordings were obtained with the patient under general anesthesia with ketamine, dexmedetomidine, and remifentanil. At the 3- and 6-month follow-ups, the patient demonstrated marked improvement in dystonia without neurological complications.</p><p><strong>Lessons: </strong>This is the first case of dystonia secondary to Leigh syndrome treated with DBS. Additionally, the authors describe the novel use of the Nexframe for DBS lead placement in a pediatric patient. This demonstrates that STN DBS with the use of MER and intraoperative CT can be a safe and effective method of treating dystonia in certain pediatric patients.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/98/6e/CASE23128.PMC10555587.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9991510","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}
Enrique Jimenez Hakim, Luis Garcia Rairan, Julian Guzman, Yessid Araque
{"title":"Bilateral visual disturbances caused by a glomus vagale: illustrative case.","authors":"Enrique Jimenez Hakim, Luis Garcia Rairan, Julian Guzman, Yessid Araque","doi":"10.3171/CASE23145","DOIUrl":"10.3171/CASE23145","url":null,"abstract":"<p><strong>Background: </strong>A glomus vagale tumor is an infrequent paraganglioma primarily characterized by auditory symptoms, cranial nerve involvement, or autonomic symptoms. However, visual involvement is not commonly observed, and to date, no cases have been reported in the literature.</p><p><strong>Observations: </strong>The case involves a 62-year-old female patient with a history of right carotid body tumor resection. She presented to the emergency department with a sudden decrease in visual acuity and bitemporal hemianopsia, accompanied by a left parietal headache. Initial brain magnetic resonance imaging (MRI) revealed a pituitary macroadenoma, which was completely resected. However, postoperatively, the patient developed left amaurosis. Subsequent brain MRI showed the presence of hemostatic material mixed with blood in the sellar region, causing displacement of the optic chiasm. A repeat intervention was performed, identifying bleeding from both cavernous sinuses. Head and neck angiography demonstrated a right glomus vagale tumor with abundant blood drainage into the right cavernous sinus. Embolization of the glomus vagale tumor was performed, resulting in no further bleeding and improvement of symptoms.</p><p><strong>Lessons: </strong>The aim of this case report is to describe a rare occurrence of bilateral visual disturbances caused by bleeding in both cavernous sinuses due to venous hypertension caused by a right glomus vagale tumor.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/a5/CASE23145.PMC10555592.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9997853","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}
Victoria Jane Horak, Med Jimson D Jimenez, Melissa A LoPresti, Jeffrey S Raskin
{"title":"Pediatric intraspinal arachnoid cyst: successful endoscopic fenestration. Illustrative case.","authors":"Victoria Jane Horak, Med Jimson D Jimenez, Melissa A LoPresti, Jeffrey S Raskin","doi":"10.3171/CASE23217","DOIUrl":"10.3171/CASE23217","url":null,"abstract":"<p><strong>Background: </strong>Intradural spinal arachnoid cysts (SACs) are a rare cause of spinal cord compression. Treatment is centered on decompression of the spinal cord via laminectomy or laminoplasty followed by resection or fenestration of the cyst. Although laminectomy or laminoplasty access may be needed to achieve the desired result, either procedure can be associated with more extensive surgical dissections and long-term spinal stability concerns, including postsurgical kyphosis.</p><p><strong>Observations: </strong>The authors present a case of a cervical intradural SAC in a 4-month-old girl presenting with symptomatic compression. The patient was treated by laminotomy and endoscopic fenestration of the SAC with resolution of symptoms and no disease progression 10 months postoperatively, when the patient was 14 months old.</p><p><strong>Lessons: </strong>Microsurgical endoscopic fenestration of an intradural SAC can provide a less invasive means of treatment while avoiding the risks associated with more invasive approaches.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8a/a0/CASE23217.PMC10555594.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9997854","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":"Spontaneous middle meningeal arteriovenous fistula without cortical venous reflux presenting with acute subdural hematoma: illustrative case.","authors":"Masahiro Yabuki, Yosuke Akamatsu, Hiroshi Kashimura, Yoshitaka Kubo, Kuniaki Ogasawara","doi":"10.3171/CASE23306","DOIUrl":"10.3171/CASE23306","url":null,"abstract":"<p><strong>Background: </strong>Dural arteriovenous fistula (AVF) without cortical venous reflux (CVR) has a relatively benign course. Here, the authors describe a patient presenting with subdural hematoma due to a middle meningeal AVF without CVR.</p><p><strong>Observations: </strong>A 17-year-old male was admitted to the emergency department with acute headache without an episode of head trauma. Computed tomography demonstrated a left acute subdural hematoma (SDH). Because the nontraumatic SDH raised the suspicion of vascular pathology, emergent angiography was performed, which demonstrated an AVF fed by the middle meningeal artery and draining to the diploic vein via the serpentine meningeal vein without CVR. T2-weighted magnetic resonance imaging (MRI) revealed no signs of venous congestion. Given the proximity of the AVF to the SDH and the MRI findings, we suspected that the serpentine meningeal vein was responsible for the SDH. The patient was successfully treated with transarterial Onyx embolization. During the injection, Onyx migrated to the extravascular space following its penetration into the serpentine meningeal vein, suggesting the meningeal vein was a bleeding source of the subdural hematoma.</p><p><strong>Lessons: </strong>Despite the absence of cortical venous reflux, serpentine meningeal venous drainage of middle meningeal AVF can be a source of subdural hemorrhage.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/ef/CASE23306.PMC10555593.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9991508","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":"Surgical treatment for extremely rare solitary fibrous tumors of the central nervous system originating from cranial nerve VIII: new clinicopathological findings. Illustrative case.","authors":"Shintaro Arai, Katsuyoshi Shimizu, Tohru Mizutani","doi":"10.3171/CASE23244","DOIUrl":"10.3171/CASE23244","url":null,"abstract":"<p><strong>Background: </strong>Reports of solitary fibrous tumors (SFTs) of the central nervous system (CNS) originating from cranial nerves are extremely rare. The origins of these neurogenic SFTs of the CNS have been determined only by intraoperative findings, and there is no pathological evidence of whether they really originated from cranial nerves.</p><p><strong>Observations: </strong>A 54-year-old female with hearing loss and facial paralysis presented with a giant right cerebellopontine angle tumor. She was diagnosed with a petrous meningioma based on preoperative imaging, and the tumor was removed via the retrosigmoid approach after embolization of the tumor-feeding vessels. Intraoperatively, the tumor was not attached to the dura mater but extended from the internal auditory canal to the cisternal portion. The acoustic nerve was not identified, but it was possible to separate the tumor from the facial nerve. The tumor was removed as an acoustic schwannoma intraoperatively. Postoperative pathological examination revealed an SFT. Immunostaining revealed peripheral nerve bundles entrapped within the tumor tissue. The patient was diagnosed with an SFT of the CNS originating from the acoustic nerve.</p><p><strong>Lessons: </strong>A neurogenic SFT of the CNS was diagnosed based on both intraoperative and pathological findings.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/2c/CASE23244.PMC10555586.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9997855","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}
Brandon R W Laing, Benjamin Best, John D Nerva, Aditya Vedantam
{"title":"Open surgical ligation of a thoracic spinal epidural arteriovenous fistula causing thoracic myelopathy: illustrative case.","authors":"Brandon R W Laing, Benjamin Best, John D Nerva, Aditya Vedantam","doi":"10.3171/CASE23275","DOIUrl":"10.3171/CASE23275","url":null,"abstract":"<p><strong>Background: </strong>Spinal epidural arteriovenous fistulas (eAVFs) are rare spinal vascular malformations characterized by an abnormal connection from the paraspinal and paravertebral system to the epidural venous plexus. This contrasts with the more frequently seen spinal dural AVF, where the fistula is entirely intradural. Although endovascular repair is commonly performed for spinal eAVF, few cases require open surgical ligation.</p><p><strong>Observations: </strong>The authors present a case of a 74-year-old male with progressive thoracic myelopathy secondary to a spinal eAVF. Thoracic magnetic resonance imaging (MRI) showed intramedullary T2 signal hyperintensity from T8 to T12. Spinal angiography revealed a primary arterial supply from the right T11 segmental artery and minor supply from the left T11 branches with drainage into the ventral epidural space. The patient underwent T11-12 laminectomy and complete right T11-12 facetectomy for ligation of the fistula with T11-L1 fusion. A postoperative spinal angiogram showed resolution of the fistula. Postoperatively, the patient's myelopathy improved, and MRI showed a decrease in T2 cord intensity.</p><p><strong>Lessons: </strong>Spinal eAVFs are rare lesions that differ from the more commonly seen intradural dural AVF in that the abnormal connection is in the epidural space, and they are often associated with a dilated epidural venous pouch. Treatment involves endovascular, open surgical, or combined approaches.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b3/73/CASE23275.PMC10555585.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9997858","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}
Efecan Cekic, Ahmet Karagoz, Mustafa Sakar, Rabia Emel Senay, Kadriye Ebru Akar, Suheyla Bozkurt, Adnan Dagcinar
{"title":"Langerhans cell histiocytosis located in the spheno-orbital bone and the pons: illustrative case.","authors":"Efecan Cekic, Ahmet Karagoz, Mustafa Sakar, Rabia Emel Senay, Kadriye Ebru Akar, Suheyla Bozkurt, Adnan Dagcinar","doi":"10.3171/CASE22367","DOIUrl":"10.3171/CASE22367","url":null,"abstract":"<p><strong>Background: </strong>This is a case of aggressive Langerhans cell histiocytosis (LCH) with an atypical intracranial location.</p><p><strong>Observations: </strong>In this report, the authors present the diagnosis and treatment of a 12-year-old male patient diagnosed with LCH. The patient was admitted to the emergency department with left-sided facial palsy, and a solid lesion with mass effect in the pons was found. A biopsy was performed via suboccipital craniotomy, and the diagnosis was LCH. A chemotherapy regimen was started since the LCH sample was the resistant type. The patient showed improvement in his neurological deficit following treatment.</p><p><strong>Lessons: </strong>This rare localized and aggressive case's diagnosis process and treatment choices may apply to future cases.</p>","PeriodicalId":16554,"journal":{"name":"Journal of Neurosurgery: Case Lessons","volume":"6 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/34/CASE22367.PMC10555582.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943962","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}