Neurosurgery practice最新文献

{"title":"De Novo Plasmacytoma at the Site of Previous Anterior Cervical Fusion.","authors":"Noah J Burket, Dillon C Mobasser, Vincent J Alentado, Jean-Pierre Mobasser","doi":"10.1227/neuprac.0000000000000074","DOIUrl":"10.1227/neuprac.0000000000000074","url":null,"abstract":"<p><strong>Background and importance: </strong>Solitary plasmacytoma of bone (SPB) is a rare tumor that forms from monoclonal plasma cells within bone. These tumors are typically found in patients in their fifth to sixth decade of life and often progress to multiple myeloma. Previous reports have noted the formation of these tumors at the site of previous procedures or trauma, yet none have reported the development of SPB at the same site of a previous spinal surgery.</p><p><strong>Clinical presentation: </strong>The authors report on a 47-year-old woman who developed a de novo plasmacytoma 6 years after anterior cervical discectomy and fusion at the surgical site.</p><p><strong>Conclusion: </strong>Although SPB is a rare tumor primarily seen in bone that has been unaffected by surgery, it should be included in the differential after finding a tumor at the site of a previous spine surgery. Furthermore, biopsy should be considered once a lesion is identified in the area of a previous spine surgery, as SPB may progress to multiple myeloma, resulting in worse outcomes.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"5 1","pages":"e00074"},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434013","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":"Phase 1, Dose Escalation, Nonrandomized, Open-Label, Clinical Trial Evaluating the Safety and Preliminary Efficacy of Allogenic Adipose-Derived Mesenchymal Stem Cells for Recurrent Glioblastoma: A Clinical Trial Protocol.","authors":"Andres Ramos-Fresnedo, Rawan Al-Kharboosh, Erin L Twohy, Aleeshba N Basil, Ewa C Szymkiewicz, Abba C Zubair, Daniel M Trifiletti, Nisha Durand, Dennis W Dickson, Erik H Middlebrooks, David N Abarbanel, Stephany Y Tzeng, Joao Paulo Almeida, Kaisorn L Chaichana, Jordan J Green, Wendy J Sherman, Alfredo Quiñones-Hinojosa","doi":"10.1227/neuprac.0000000000000062","DOIUrl":"10.1227/neuprac.0000000000000062","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite standard of care with maximal safe resection and chemoradiation, glioblastoma is the most common and aggressive type of primary brain cancer. Surgical resection provides a window of opportunity to locally treat gliomas while the patient is recovering, and before initiating concomitant chemoradiation. To assess the safety and establish the maximum tolerated dose of adipose-derived mesenchymal stem cells (AMSCs) for the treatment of recurrent glioblastoma (GBM). Secondary objectives are to assess the toxicity profile and long-term survival outcomes of patients enrolled in the trial. Additionally, biospecimens will be collected to explore the local and systemic responses to this therapy.</p><p><strong>Methods: </strong>We will conduct a phase 1, dose escalated, non-randomized, open label, clinical trial of GBM patients who are undergoing surgical resection for recurrence. Up to 18 patients will receive intra-cavitary application of AMSCs encapsulated in fibrin glue during surgical resection. All patients will be followed for up to 5 years for safety and survival data. Adverse events will be recorded using the CTCAE V5.0.</p><p><strong>Expected outcomes: </strong>This study will explore the maximum tolerated dose (MTD) of AMSCs along with the toxicity profile of this therapy in patients with recurrent GBM. Additionally, preliminary long-term survival and progression-free survival outcome analysis will be used to power further randomized studies. Lastly, CSF and blood will be obtained throughout the treatment period to investigate circulating molecular and inflammatory tumoral/stem cell markers and explore the mechanism of action of the therapeutic intervention.</p><p><strong>Discussion: </strong>This prospective translational study will determine the initial safety and toxicity profile of local delivery of AMSCs for recurrent GBM. It will also provide additional survival metrics for future randomized trials.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10923529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095334","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":"Removal of Spinal Calcified Meningiomas With Piezosurgery: Technical Note on a New Application of a Known Device.","authors":"Rossella Rispoli, Stefano Pizzolitto, Barbara Cappelletto","doi":"10.1227/neuprac.0000000000000063","DOIUrl":"10.1227/neuprac.0000000000000063","url":null,"abstract":"<p><strong>Background and importance: </strong>Ossified spinal meningiomas are a rare form of spinal tumor. The removal in narrow surgical space is challenging because of their hard consistency and strong adhesion to the neural tissue. These meningiomas are often located in the upper thoracic spine, and sometimes, even the identification of the correct intraoperative level is difficult.</p><p><strong>Clinical presentation: </strong>We describe the clinical findings, surgical strategies, and histological findings of a patient with a thoracic ossified meningioma.</p><p><strong>Discussion: </strong>We discuss the technical points, safety, and efficacy of the piezosurgery device in reducing the calcified mass.</p><p><strong>Conclusion: </strong>The device has the potential to reduce the operating time and enhance surgical safety when removing ossified meningiomas.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00063"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434538","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":"A Case of Sellar Arachnoid Cyst Operated Using the Endoscopic Supraorbital Keyhole Approach.","authors":"Kei Yamashiro, Saeko Higashiguchi, Akira Wakako, Tatsuo Omi, Motoharu Hayakawa, Yuichi Hirose","doi":"10.1227/neuprac.0000000000000069","DOIUrl":"10.1227/neuprac.0000000000000069","url":null,"abstract":"<p><strong>Background and importance: </strong>In recent years, sellar arachnoid cysts (ACs) have been increasingly treated using an endoscopic transnasal approach. It is important to connect the subarachnoid space with the AC to prevent recurrence; however, a high frequency of postoperative cerebrospinal fluid (CSF) leakage has been reported with the endoscopic transnasal approach, and the suitability of the endoscopic transnasal approach for treating sellar ACs is questionable to begin with.</p><p><strong>Clinical presentation: </strong>A man in his 40s underwent surgery for a sellar AC compressing the optic chiasm. The normal pituitary gland was compressed dorsally by the cyst, and an endoscopic supraorbital keyhole approach was adopted to reduce the risk of postoperative CSF leakage. A small incision was made in the right eyebrow, and a small craniotomy was performed. A rigid scope was used to approach the cyst and incise the arachnoid membrane of the prechiasmatic cistern and the anterior wall of the cyst. Postoperatively, the cyst shrank, and the preoperative visual field defects improved. The duration of the endoscopic manipulation was approximately 40 minutes.</p><p><strong>Discussion: </strong>The endoscopic supraorbital keyhole approach eliminates the need to incise the dura mater of the anterior skull base and reduces the risk of CSF leakage compared with the transnasal approach. In addition, cumbersome dural reconstruction using fat and fascia is not required during the supraorbital keyhole approach, which reduces operation time.</p><p><strong>Conclusion: </strong>The endoscopic supraorbital keyhole approach may be more suitable than the transnasal approach for surgery of sellar ACs.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00069"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434514","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":"Phase 1, Dose Escalation, Nonrandomized, Open-Label, Clinical Trial Evaluating the Safety and Preliminary Efficacy of Allogenic Adipose-Derived Mesenchymal Stem Cells for Recurrent Glioblastoma: A Clinical Trial Protocol.","authors":"Andres Ramos-Fresnedo, Rawan Al-Kharboosh, Erin L Twohy, Aleeshba N Basil, Ewa C Szymkiewicz, Abba C Zubair, Daniel M Trifiletti, Nisha Durand, Dennis W Dickson, Erik H Middlebrooks, David N Abarbanel, Stephany Y Tzeng, Joao Paulo Almeida, Kaisorn L Chaichana, Jordan J Green, Wendy J Sherman, Alfredo Quiñones-Hinojosa","doi":"10.1227/neuprac.0000000000000062","DOIUrl":"10.1227/neuprac.0000000000000062","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite standard of care with maximal safe resection and chemoradiation, glioblastoma (GBM) is the most common and aggressive type of primary brain cancer. Surgical resection provides a window of opportunity to locally treat gliomas while the patient is recovering and before initiating concomitant chemoradiation. The objective was to assess the safety and establish the maximum tolerated dose of adipose-derived mesenchymal stem cells (AMSCs) for the treatment of recurrent GBM. Secondary objectives were to assess the toxicity profile and long-term survival outcomes of patients enrolled in the trial. In addition, biospecimens will be collected to explore the local and systemic responses to this therapy.</p><p><strong>Methods: </strong>We will conduct a phase 1, dose-escalated, nonrandomized, open-label, clinical trial of patients with GBM who are undergoing surgical resection for recurrence. Up to 18 patients will receive intracavitary application of AMSCs encapsulated in fibrin glue during surgical resection. All patients will be followed for up to 5 years for safety and survival data. Adverse events will be recorded using the CTCAE V5.0.</p><p><strong>Expected outcomes: </strong>This study will explore the maximum tolerated dose of AMSCs along with the toxicity profile of this therapy in patients with recurrent GBM. In addition, preliminary long-term survival and progression-free survival outcome analysis will be used to power further randomized studies. Finally, cerebrospinal fluid and blood will be obtained throughout the treatment period to investigate circulating molecular and inflammatory tumoral/stem cell markers and explore the mechanism of action of the therapeutic intervention.</p><p><strong>Discussion: </strong>This prospective translational study will determine the initial safety and toxicity profile of local delivery of AMSCs for recurrent GBM. It will also provide additional survival metrics for future randomized trials.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00062"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434534","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":"Time-Spatial Labeling Inversion Pulse (Time-SLIP) MRI for Evaluating Cerebrospinal Fluid Velocity and Visualizing Flow Dynamics in Patients With Chiari Type I Malformation.","authors":"Tatsushi Inoue, Masahiro Joko, Kazuhiro Murayama, Masato Ikedo, Fumiaki Saito, Jun Muto, Hiroki Takeda, Shinjiro Kaneko, Yuichi Hirose","doi":"10.1227/neuprac.0000000000000065","DOIUrl":"10.1227/neuprac.0000000000000065","url":null,"abstract":"<p><strong>Background and objectives: </strong>Phase-contrast MRI is unstable and is not widely implemented in the imaging of Chiari malformation type I (CM-I) because of its low signal-to-noise ratio and the need for subsequent additional averaging. Time-spatial labeling inversion pulse MRI (T-SLIP MRI) is an emerging imaging modality with a high signal-to-noise ratio. This study is the first to examine cerebrospinal fluid (CSF) dynamics on the basis of velocity exclusively in patients with CM-I using T-SLIP MRI before and after posterior fossa decompression.</p><p><strong>Methods: </strong>Eleven patients with CM-I underwent T-SLIP MRI before and/or after posterior fossa decompression. CSF dynamics were analyzed at 5 points around the craniovertebral junction. T-SLIP measurements included (1) targeted CSF labeling; (2) manual frame-by-frame annotation of the labeled CSF wave; (3) description of CSF flow in terms of wave functions calculated using computation software; and use of this function for (4) calculation of CSF velocity (rostral and caudal peak), total distance traveled by labeled CSF, and mean CSF velocity ( <math> <mrow><mover><mi>V</mi> <mo>¯</mo></mover> </mrow> </math> ). Differences between preoperative and postoperative peak velocity (rostral and caudal) and <math> <mrow><mover><mi>V</mi> <mo>¯</mo></mover> </mrow> </math> were assessed using paired <i>t</i>-test.</p><p><strong>Results: </strong>Rostral and caudal peaks significantly increased at 2 of the 5 points (40%), whereas <math> <mrow><mover><mi>V</mi> <mo>¯</mo></mover> </mrow> </math> significantly increased at 4 points (80%), altogether covering all observation points with significant changes. CSF filling the syrinx through the syrinx wall from the spinal subarachnoid space and complex CSF flow at the dorsal craniovertebral junction were captured preoperatively and postoperatively, respectively.</p><p><strong>Conclusion: </strong>T-SLIP MRI data for patients with CM-I were successfully quantified on the basis of velocity. Tailor-made optimal decompression should be pursued based on both T-SLIP data with high accuracy and bibliographical craniometric data with surgical outcomes, which can now be easily and comprehensively analyzed using machine learning.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00065"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434570","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":"Supplementary Motor Area Syndrome After Resection of a Dominant Hemisphere Parasagittal Meningioma: A Case Report.","authors":"Samantha E Walker, Lydia Kaoutzani, Fernando L Vale","doi":"10.1227/neuprac.0000000000000067","DOIUrl":"10.1227/neuprac.0000000000000067","url":null,"abstract":"<p><strong>Background and importance: </strong>Supplementary motor area (SMA) syndrome is a common, transient postoperative complication of intra-axial tumor resections involving the SMA and posterior cingulate gyrus. It is also reported as a rare complication of resecting extra-axial lesions. Meningiomas represent the most common, nonmalignant primary central nervous system tumor in adults, which present most commonly in parasagittal locations. Resection of dominant hemisphere parasagittal meningiomas overlying or infiltrating into the SMA region carry a recognizable risk for developing SMA syndrome postoperatively.</p><p><strong>Clinical presentation: </strong>We present a 58-year-old woman with intermittent headaches and concern for new-onset seizures. MRI demonstrated an extra-axial mass involving the left frontal convexity and SMA region with homogenous postcontrast enhancement. There was radiographic involvement of the superior sagittal sinus and inner table of the skull. Fluid-attenuated recovery signal and perilesional vasogenic edema were also noted. The imaging findings favored a parasagittal meningioma, and surgical resection was performed. Arachnoid invasion and pial infiltration of the tumor over the SMA were evident during the operation.</p><p><strong>Conclusion: </strong>A detailed understanding of the functional neuroanatomy and clinical pathophysiology of eloquent cortical regions is important for preoperative planning and patient counseling. Surgical resection of lesions in such areas can result in rare complications uniquely implicated in specific patient subsets. Recognizing these patients in the preoperative setting is imperative for proper counseling of patients and families.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00067"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434504","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":"Operative Strategies for Aplastic Circle of Willis Arteries on CTA in Meningioma Surgery: A Case Report.","authors":"Joanna K Tabor, Alexandros F Pappajohn, Haoyi Lei, Joseph O'Brien, Robert K Fulbright, Saul F Morales-Valero, Jennifer Moliterno","doi":"10.1227/neuprac.0000000000000058","DOIUrl":"10.1227/neuprac.0000000000000058","url":null,"abstract":"<p><strong>Background and importance: </strong>Meningiomas frequently involve critical neurovascular structures. Preoperative imaging with computed tomography angiography (CTA) can help understand the relationship of tumor with neurovascular structures. Although CTA was useful in preoperative planning and less invasive, we present a unique case in which it mistakenly represents a hypoplastic anterior cerebral artery as aplastic and thus displays poor sensitivity in the Circle of Willis.</p><p><strong>Clinical presentation: </strong>A 66-year-old woman presented with new onset seizures and MRI demonstrated a sphenoid wing meningioma with tumor involvement of the internal carotid artery and right M1 artery. On preoperative CTA, a right A1 artery was not appreciated. However, a hypoplastic right A1 artery was identified during careful dissection guided by micro-Doppler and found to be encased within the tumor. All arteries were preserved, and a near-total resection was achieved with a small remnant of tumor at the supraclinoid internal carotid artery.</p><p><strong>Conclusion: </strong>Although CTAs can be useful in understanding vascular anatomy and its association with tumors, they are not ideal for providing information about hypoplastic arterial segments. Seemingly aplastic arteries on CTA may very well be present, albeit hypoplastic. While we recognize the usefulness of a less invasive modality of CTA to help guide surgical strategy, we underscore recognizing this potential pitfall and recommend the use of the microvascular Doppler during careful dissection when working within tumor in the location of a seemingly aplastic artery.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00058"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434530","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":"Second-Generation Wide-Field Visualization Devices for 5-ALA-Induced Fluorescence and Concepts for Validation in Neurosurgery-A Systematic Review.","authors":"Zeynep Özdemir, Eric Suero Molina, Sönke J Hellwig, Herbert Stepp, Walter Stummer","doi":"10.1227/neuprac.0000000000000059","DOIUrl":"10.1227/neuprac.0000000000000059","url":null,"abstract":"<p><strong>Background and objectives: </strong>Fluorescence-guided resection (FGR) of malignant gliomas with five-aminolevulinic acid (5-ALA) is an established method using surgical microscopes equipped with filter systems for observing fluorescence. Over the past decade, new technologies have been introduced for the same purpose, with available publications evaluating their clinical efficacy based on varying criteria. This study aims to review technologies and concepts of validation in the context of 5-ALA-mediated FGR.</p><p><strong>Methods: </strong>A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was performed to identify devices capable of detecting 5-ALA-induced fluorescence. Articles found eligible for this review were analyzed, focusing on the methods of validation used for novel devices. A qualitative analysis is presented.</p><p><strong>Results: </strong>Using predefined eligibility criteria, 22 studies were analyzed. Publications on the following visualization devices were reviewed: FL400 (Leica Microsystems), Aeos (Aesculap), BLUE400 and BLUE400 AR Filter System (Carl Zeiss Meditec AG), Endoscope with D-Light C (Karl Storz), Fiberscope N-4L (Machida), ORBEYE 4K 3D Digital Video Microscope (Olympus), and several customized surgical loupe systems. In many cases, validation seemed unstandardized, with inherent biases and limited reproducibility.</p><p><strong>Conclusion: </strong>This review illustrates the significance of device validation within the framework of FGR. It emphasizes the criticality of validating devices in accordance with established standard, i.e. the BLUE400 filter system, which was employed in the approval studies of 5-ALA. Furthermore, standardized concepts of validation are required to assess whether new devices are, in fact, a reliable or superior alternative in the field of FGR. Published guidelines should be considered when performing future studies.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00059"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434555","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":"Subarachnoid Hemorrhage Because of Ruptured Multiple Peripheral Fusiform Aneurysms Associated With Systemic Lupus Erythematosus: A Case Report.","authors":"Yuki Hirose, Koji Hashimoto, Ryota Murase, Hideyuki Yoshioka, Takuma Wakai, Toru Tateoka, Masakazu Ogiwara, Hiroyuki Kinouchi","doi":"10.1227/neuprac.0000000000000064","DOIUrl":"10.1227/neuprac.0000000000000064","url":null,"abstract":"<p><strong>Background and importance: </strong>In rare cases, systemic lupus erythematosus (SLE) can cause subarachnoid hemorrhage (SAH) because of aneurysm rupture. Such aneurysms are most commonly located in the posterior circulatory system, but can occur extremely rarely in the spinal vascular territory.</p><p><strong>Clinical presentation: </strong>We describe a patient with SLE who had a sudden onset of posterior neck pain. Cranial computed tomography and MRI showed SAH, but no aneurysm could be identified on computed tomography angiography or magnetic resonance angiography. Digital subtraction angiography (DSA) revealed multiple small fusiform aneurysms in the spinal vascular territory, which were treated conservatively without rebleeding. One year later, the patient suffered from recurrent SAH. On DSA, the fusiform aneurysms seen at the previous admission had disappeared and a de novo small fusiform aneurysm was observed in the anterior spinal artery. Conservative treatment was performed, and rebleeding was not observed thereafter. On follow-up DSA performed 2 weeks later, the aneurysm had decreased in size.</p><p><strong>Conclusion: </strong>In SLE, spinal arteriography should be performed to evaluate the possible development of peripheral fusiform aneurysms in the spinal vascular territory associated with vasculitis, and careful follow-up is necessary considering the risk of rebleeding because of de novo aneurysms.</p>","PeriodicalId":74298,"journal":{"name":"Neurosurgery practice","volume":"4 4","pages":"e00064"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11810011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434559","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}