Journal of neurosurgery. Case lessons最新文献

Successful radiosurgery for a growing vestibular schwannoma following partial resection of an ipsilateral transfundal inner ear schwannoma and cochlear implantation: illustrative case. 同侧经基底内耳神经鞘瘤部分切除和人工耳蜗植入后，前庭神经鞘瘤的放射治疗成功。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-31 DOI: 10.3171/CASE26389

Stefan K Plontke, Markus Kufeld, Sabrina Kösling, Christiane Koitschev, Jonas Scheffler, Dirk Vordermark, Luise Wagner

{"title":"Successful radiosurgery for a growing vestibular schwannoma following partial resection of an ipsilateral transfundal inner ear schwannoma and cochlear implantation: illustrative case.","authors":"Stefan K Plontke, Markus Kufeld, Sabrina Kösling, Christiane Koitschev, Jonas Scheffler, Dirk Vordermark, Luise Wagner","doi":"10.3171/CASE26389","DOIUrl":"10.3171/CASE26389","url":null,"abstract":"Background: Cochlear implantation has become an effective method of hearing rehabilitation for selected patients with vestibular schwannoma (VS) and nonserviceable hearing who are treated by microsurgical tumor resection, radiotherapy, or observation. However, very little information is available on radiotherapy for VS in the presence of a cochlear implant (CI) in cases in which tumor growth occurs following observation, or when residual tumor growth occurs after microsurgery.Observations: The authors report the case of a 60-year-old woman with successful tumor control of a growing VS by radiosurgery after partial resection of a separate, ipsilateral transfundal inner ear schwannoma (IES) with involvement of the modiolus and CI placement. Hearing with the CI could be preserved for the reported observation time of 3 years postradiosurgery.Lessons: Even though they are extremely rare, the presence of unilateral multifocal IES and VS must be considered. Although results from a single observation should be interpreted with caution, this case suggests that VS tumor control using radiosurgery appears, in principle, to be possible despite the presence of a CI. Further studies are needed to determine whether radiosurgery could prove to be a potential treatment option for VS despite the presence of a CI in carefully selected cases. https://thejns.org/doi/10.3171/CASE26389.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 9","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868727","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

Lemierre-like syndrome presenting with extensive intracranial and central venous thrombosis without pulmonary embolism: illustrative case. 勒米尔样综合征表现为广泛的颅内和中心静脉血栓形成，无肺栓塞：说明性病例。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-31 DOI: 10.3171/CASE26541

Hideki Nakajima, Yu Sato, Tetsushi Yago, Kazuhiko Tsuda, Hidenori Suzuki

{"title":"Lemierre-like syndrome presenting with extensive intracranial and central venous thrombosis without pulmonary embolism: illustrative case.","authors":"Hideki Nakajima, Yu Sato, Tetsushi Yago, Kazuhiko Tsuda, Hidenori Suzuki","doi":"10.3171/CASE26541","DOIUrl":"10.3171/CASE26541","url":null,"abstract":"Background: Lemierre-like syndrome is a rare septic thrombotic disorder caused by non-Fusobacterium pathogens. Presentations with predominantly intracranial involvement and extensive central venous thrombosis are particularly uncommon, and optimal management remains unclear.Observations: A 75-year-old female presented with impaired consciousness, fever, and right exophthalmos with conjunctival injection following mild sore throat. Contrast-enhanced CT demonstrated extensive thrombosis involving the superior vena cava, bilateral internal jugular veins, bilateral transverse-sigmoid sinuses, cavernous sinuses, and bilateral superior ophthalmic veins. There was no evidence of pulmonary embolism or septic pulmonary lesions. Brain MRI revealed right occipital venous infarction and marked cerebral venous congestion. Blood cultures yielded Streptococcus intermedius. Intravenous antimicrobial therapy and systemic anticoagulation were initiated immediately. Because antithrombin (AT) activity progressively decreased during the acute phase, adjunctive AT supplementation was administered. Serial MR venography demonstrated gradual recanalization, and the patient achieved favorable neurological recovery without hemorrhagic complications.Lessons: Early recognition of Lemierre-like syndrome with predominant intracranial involvement and individualized multidisciplinary management may contribute to favorable neurological outcomes. https://thejns.org/doi/10.3171/CASE26541.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 9","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868729","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

Ultrasound-guided needle technique as a relaxation strategy for early cranioplasty: illustrative case. 超声引导针技术作为早期颅骨成形术的放松策略：说明性病例。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-31 DOI: 10.3171/CASE26132

Haris Yaseen, Maaz A Khan, Ishan Purani, Haysum Khan, Matthan Tharakan, Gregory Zipfel, Peter G Passias, Luis Tumialán, Angela Downes, John Burke, A Basit Khan, Hakeem Shakir, M Burhan Janjua

{"title":"Ultrasound-guided needle technique as a relaxation strategy for early cranioplasty: illustrative case.","authors":"Haris Yaseen, Maaz A Khan, Ishan Purani, Haysum Khan, Matthan Tharakan, Gregory Zipfel, Peter G Passias, Luis Tumialán, Angela Downes, John Burke, A Basit Khan, Hakeem Shakir, M Burhan Janjua","doi":"10.3171/CASE26132","DOIUrl":"10.3171/CASE26132","url":null,"abstract":"Background: Achieving brain relaxation during early cranioplasty is essential for safe dural closure and bone flap replacement. Conventional strategies, such as preoperative lumbar drainage or intraoperative external ventricular drain (EVD) placement, are effective but carry significant procedural burden, increased costs, and risks associated with indwelling hardware. The authors describe a simplified, ultrasound-guided needle technique as a resource-sparing alternative.Observations: During cranioplasty in a patient with a tense operative field, intraoperative ultrasound was utilized to visualize the temporal bone window. A sterile 18-gauge angiocatheter was introduced under real-time guidance, adhering to validated anatomical safety limits. Aspiration of 35 mL of CSF yielded immediate brain relaxation, facilitating tension-free dural closure. No intraoperative complications occurred. A literature review distinguished this approach from existing methods, identifying it as the first report of a transient, catheter-free aspiration for this indication, effectively eliminating the need for tunneling or postoperative drain management.Lessons: Ultrasound-guided transient ventriculocentesis of the temporal horn offers a safe, cost-effective, and rapid alternative to formal EVD placement. This technique combines the precision of image guidance with the simplicity of a single-puncture aspiration, successfully achieving operative goals while avoiding the morbidity and resource utilization of long-term drainage systems. https://thejns.org/doi/10.3171/CASE26132.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 9","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868660","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

Internal carotid artery anterior transposition for internal jugular vein decompression: illustrative case. 颈内动脉前移位用于颈内静脉减压：说明性病例。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-31 DOI: 10.3171/CASE26599

Kamran Aghayev, Zachary Comella, Frank D Vrionis

{"title":"Internal carotid artery anterior transposition for internal jugular vein decompression: illustrative case.","authors":"Kamran Aghayev, Zachary Comella, Frank D Vrionis","doi":"10.3171/CASE26599","DOIUrl":"10.3171/CASE26599","url":null,"abstract":"Background: Compression of the upper segment (J3) of the internal jugular vein (IJV) between the C1 transverse process (C1TP) and styloid process (SP) is an increasingly recognized condition. No previous case of J3-IJV compression by the internal carotid artery (ICA) has been reported. The authors present the case of a patient with J3-IJV compression treated with arterial transposition.Observations: A 49-year-old male presented with a multiyear history of intractable pulsatile tinnitus, headaches, visual disturbances, cognitive disturbance, and head pressure. The patient had previously undergone right transverse sinus stent placement for presumed stenosis, which failed to relieve symptoms. Imaging revealed compression of the right J3-IJV by the adjacent ICA at the level of the SP and atlas. The authors performed anterior transposition of the ICA with fixation to the SP and C1TP resection for circumferential IJV decompression. Complete resolution of all presenting symptoms occurred postoperatively, with sustained improvement at follow-up. Postoperative imaging confirmed elimination of J3-IJV stenosis and disappearance of the posterior collateral network.Lessons: This case demonstrates that anterior ICA transposition with styloid fixation is a viable surgical option for symptomatic IJV compression. This technique may represent a novel approach for select patients with arterial-venous compression syndromes in the neck. https://thejns.org/doi/10.3171/CASE26599.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 9","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868636","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

Frontoethmoidal encephalocele repair in prematurity: illustrative case. 早产儿额筛样脑膨出修复：说明性病例。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-24 DOI: 10.3171/CASE2614

Callum D Dewar, Sebastian Salas-Vega, Leon E Moores

{"title":"Frontoethmoidal encephalocele repair in prematurity: illustrative case.","authors":"Callum D Dewar, Sebastian Salas-Vega, Leon E Moores","doi":"10.3171/CASE2614","DOIUrl":"https://doi.org/10.3171/CASE2614","url":null,"abstract":"Background: Prenatal care in medically advanced countries dramatically decreases rates of neural tube defects. Yet despite this standardization, rare cases of encephaloceles persist in the United States. Definitive repair is ideally delayed, allowing for physiological maturation and improved tolerance of anesthesia and blood loss.Observations: A male was born at 28 weeks and 3 days' gestation to a nulliparous group B Streptococcus-positive mother who had not received any prenatal care. At the time of birth, the patient was noted to have a large frontoethmoidal encephalocele with subsequent concern for CSF egress through a skin defect, necessitating urgent surgical intervention.Lessons: In this illustrative case, the rarity and challenges of anterior encephalocele repair in extreme prematurity are evaluated. The report focuses on the surgical goals of encephalocele repair, including minimization of blood loss, controlled encephalocele excision, durable repair of dural and bony defects, and tension-free skin closure. The authors emphasize an optimal use of cadaveric bone for skull defect reconstruction to limit autograft morbidity. https://thejns.org/doi/10.3171/CASE2614.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 8","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814903","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

Bilateral bow hunter's syndrome at the craniocervical junction: illustrative case. 双侧颅颈交界处弓猎人综合征：说明性病例。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-24 DOI: 10.3171/CASE26286

John M Bernabei, Arati Patel, Hunter Yamada, Mahmoud M Elguindy, Lee A Tan, Daniel M S Raper

{"title":"Bilateral bow hunter's syndrome at the craniocervical junction: illustrative case.","authors":"John M Bernabei, Arati Patel, Hunter Yamada, Mahmoud M Elguindy, Lee A Tan, Daniel M S Raper","doi":"10.3171/CASE26286","DOIUrl":"10.3171/CASE26286","url":null,"abstract":"Background: Rotational vertebrobasilar ischemia, also known as bow hunter's syndrome (BHS), is an underrecognized cause of posterior circulation stroke. Fewer than 200 cases have previously been documented, with most involving unilateral dynamic compression of the vertebral artery by adjacent bony structures that are subsequently treated with surgical decompression.Observations: The authors report a case of bilateral BHS involving the craniocervical junction in a 37-year-old patient who presented with multiple posterior circulation ischemic events. Dynamic angiography revealed that his left vertebral artery was occluded by head turn to the right, and his right vertebral artery became stenotic during head turn to the left. The patient had multiple anomalies of the craniocervical junction; however, no direct bony vertebral artery compression was seen. Therefore, occiput-C3 fusion was performed to prevent dynamic vertebral artery kinking on neck rotation and thus further stroke.Lessons: BHS can present with bilateral vertebral artery kinking in rare cases. Particularly at the craniocervical junction, vertebrobasilar ischemia can occur in the presence of tortuous vertebral artery anatomy and vertebral anomalies without obvious bony compression. Dynamic catheter and CT angiography are essential diagnostic studies, and occipitocervical fusion can be useful if no direct bony compression is identified. https://thejns.org/doi/10.3171/CASE26286.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 8","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814878","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

A coexisting pseudoaneurysm hidden behind a saccular distal middle cerebral artery aneurysm in long-standing postirradiation vasculopathy: illustrative case. 长期放射后血管病变并发的假性动脉瘤隐藏在囊状远端大脑中动脉动脉瘤后：说明性病例。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-24 DOI: 10.3171/CASE26561

Hiroaki Matsumoto, Yasunori Yoshida, Akihiro Okada, Yusuke Tomogane, Atsushi Masuda, Ikuya Yamaura, Hiroaki Minami, Yasuhisa Yoshida

{"title":"A coexisting pseudoaneurysm hidden behind a saccular distal middle cerebral artery aneurysm in long-standing postirradiation vasculopathy: illustrative case.","authors":"Hiroaki Matsumoto, Yasunori Yoshida, Akihiro Okada, Yusuke Tomogane, Atsushi Masuda, Ikuya Yamaura, Hiroaki Minami, Yasuhisa Yoshida","doi":"10.3171/CASE26561","DOIUrl":"10.3171/CASE26561","url":null,"abstract":"Background: Delayed cerebrovascular complications after childhood cranial irradiation may include progressive vasculopathy and aneurysmal disease. However, attributing a ruptured aneurysm directly to prior irradiation can be difficult in patients with complex preexisting cerebrovascular pathology. The authors describe a diagnostic pitfall in a patient with long-standing postirradiation vasculopathy who presented with hemorrhagic distal middle cerebral artery (MCA) aneurysmal lesions.Observations: A 51-year-old man who had undergone whole-brain irradiation for pineal germinoma at 8 years of age presented with intracerebral and subarachnoid hemorrhage. He had a long history of progressive cerebrovascular disease, including recurrent ischemic strokes, prior intracerebral hemorrhage, intracranial arterial stenosis, and a previously treated internal carotid artery aneurysm. MR angiography and initial digital subtraction angiography demonstrated a newly detected saccular distal MCA aneurysm, which was treated with coil embolization. Hematoma enlargement occurred the following day. Repeat angiography showed complete obliteration of the treated saccular aneurysm but revealed a coexisting pseudoaneurysm in the same vascular territory. Parent artery occlusion achieved definitive hemostasis without additional clinically apparent neurological deterioration.Lessons: In patients with long-standing postirradiation vasculopathy, a conspicuous saccular aneurysm may obscure a coexisting pseudoaneurysm. Repeat angiography should be considered when hemorrhage progresses despite apparent aneurysm obliteration. https://thejns.org/doi/10.3171/CASE26561.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 8","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814823","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

Intraoperative ultrasound in spinal arachnoid cyst resection: illustrative cases. 术中超声在脊髓蛛网膜囊肿切除术中的应用：举例说明。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-24 DOI: 10.3171/CASE251034

Daniel T Lilly, Akshay Sharma, Michael Mann, Jenny Wu, Edward Benzel, Lilyana Angelov

{"title":"Intraoperative ultrasound in spinal arachnoid cyst resection: illustrative cases.","authors":"Daniel T Lilly, Akshay Sharma, Michael Mann, Jenny Wu, Edward Benzel, Lilyana Angelov","doi":"10.3171/CASE251034","DOIUrl":"10.3171/CASE251034","url":null,"abstract":"Background: Intraoperative ultrasound (iUS) has emerged as a valuable imaging resource in neurosurgical procedures. To improve familiarity with iUS technology and optimize its usage, additional exposure and technical demonstrations are needed. Spinal arachnoid cysts (SACs) are rare spinal cord lesions most often treated with resection, with procedural challenges stemming from poor preoperative lesion visualization and the infrequency of the procedure. The authors present a case series to detail the use of iUS in assisting with the resection of SAC.Observations: The cases of 2 patients with symptomatic thoracic SAC are presented. Case 1 involves a patient undergoing a T3-4 laminectomy with SAC resection, and case 2 involves a patient undergoing T7-9 laminectomy and SAC resection. Use of iUS assisted with tailored durotomies, allowed for improved perioperative visualization of the lesions, and provided immediate postresection CSF flow feedback. Both patients noted subjective improvement following resection, and no surgical complications were observed.Lessons: In SAC resection, iUS proved to be an effective tool by enhancing visualization, providing immediate feedback on resection efficacy, and limiting surgical risk. Real-time imaging allowing for improved surgical direction may decrease potential harm and contribute to improved outcomes. Increasing iUS use in neurosurgical procedures should prove beneficial. https://thejns.org/doi/10.3171/CASE251034.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 8","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815024","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

Lung adenocarcinoma dural metastasis at the petroclival region mimicking meningioma: a frozen-section diagnostic pitfall. Illustrative case. 模拟脑膜瘤的岩斜坡区肺腺癌硬脑膜转移：一个冷冻切片诊断缺陷。说明情况。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-24 DOI: 10.3171/CASE26425

Tomoya Sofue, Yudai Morisaki, Yumi Ko, Kenta Nakase, Shohei Yokoyama, Shuichi Yamada, Ichiro Nakagawa

{"title":"Lung adenocarcinoma dural metastasis at the petroclival region mimicking meningioma: a frozen-section diagnostic pitfall. Illustrative case.","authors":"Tomoya Sofue, Yudai Morisaki, Yumi Ko, Kenta Nakase, Shohei Yokoyama, Shuichi Yamada, Ichiro Nakagawa","doi":"10.3171/CASE26425","DOIUrl":"10.3171/CASE26425","url":null,"abstract":"Background: Dural metastasis is a distinct entity from metastatic brain tumors with secondary dural invasion and may mimic meningioma on neuroimaging. Skull base involvement is relatively uncommon and can present a diagnostic challenge.Observations: A 74-year-old woman presented with left lip and tongue numbness and diplopia. MRI revealed a 21 × 16-mm homogeneously enhancing mass at the left cerebellopontine angle along the anterior petrous ridge with a dural tail sign, suggestive of a skull base meningioma. The tumor was removed via an anterior transpetrosal approach. Intraoperative frozen-section analysis suggested meningioma; however, permanent histopathological evaluation revealed dural metastasis of lung adenocarcinoma.Lessons: Misinterpretation of the frozen-section analysis was likely caused by crush artifacts and architectural distortion that obscured glandular structures and produced meningothelial-like cellular clusters with whorl-like formations. Skull base dural metastasis can closely mimic meningioma both radiologically and intraoperatively. https://thejns.org/doi/10.3171/CASE26425.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 8","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815143","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

Sacral extradural arteriovenous fistula in a filum terminale lipoma with retained medullary cord: illustrative case. 骶骨硬膜外动静脉瘘的终末丝脂肪瘤，保留髓索：说明性病例。

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Journal of neurosurgery. Case lessons Pub Date : 2026-08-24 DOI: 10.3171/CASE26546

Hisaaki Uchikado, Takayasu Ando, Yuko Baba, Takehiro Makizono, Gohsuke Hattori, Kiyohiko Sakata

{"title":"Sacral extradural arteriovenous fistula in a filum terminale lipoma with retained medullary cord: illustrative case.","authors":"Hisaaki Uchikado, Takayasu Ando, Yuko Baba, Takehiro Makizono, Gohsuke Hattori, Kiyohiko Sakata","doi":"10.3171/CASE26546","DOIUrl":"10.3171/CASE26546","url":null,"abstract":"Background: Sacral extradural arteriovenous fistula (AVF) associated with filum terminale (FT) is an extremely rare disease. Here, the authors report a progressive congestive myelopathy accompanied by tethered cord syndrome and lipoma.Observations: A 52-year-old woman who had a subcutaneous mass in the sacrococcygeal region since birth and developed urinary dysfunction 5 years earlier and gait disturbance 3 years earlier was referred for progressive paraplegia. She presented with myelopathy below the T11 level, and spinal MRI revealed edema with intramedullary hyperintensity changes, surrounding flow voids, and retain medullary cord with sacral lipoma. Spinal angiography revealed reflux from the left lateral sacral artery through the AVF within the lipoma to the vein of the FT within the dura mater. Preoperatively, the patient experienced worsening neurological symptoms, and endovascular embolization was followed by surgical curative treatment. Postoperatively, improvement in symptoms was observed.Lessons: In sacral AVF associated with FT, knowledge of vascular anatomy and classification diagnosis significantly influence the treatment outcome. https://thejns.org/doi/10.3171/CASE26546.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"12 8","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815300","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