Journal of neurosurgery. Case lessons最新文献

Recurrent thrombus formation in a carotid web: highlighting the importance of timely surgical intervention. Illustrative case. 颈动脉网复发性血栓形成：强调及时手术干预的重要性。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-20 DOI: 10.3171/CASE24682

Toshihide Takahashi, Kiyoyuki Yanaka, Minami Saura, Hitoshi Aiyama, Nobuyuki Takahashi, Aiki Marushima, Yuji Matsumaru, Eiichi Ishikawa

{"title":"Recurrent thrombus formation in a carotid web: highlighting the importance of timely surgical intervention. Illustrative case.","authors":"Toshihide Takahashi, Kiyoyuki Yanaka, Minami Saura, Hitoshi Aiyama, Nobuyuki Takahashi, Aiki Marushima, Yuji Matsumaru, Eiichi Ishikawa","doi":"10.3171/CASE24682","DOIUrl":"https://doi.org/10.3171/CASE24682","url":null,"abstract":"Background: Carotid webs are rare nonatherosclerotic disorders in the carotid artery and are increasingly recognized as factors of ischemic stroke in the young population. Asymptomatic webs can be treated with antithrombotic therapy, whereas symptomatic cases frequently require surgical interventions, including carotid endarterectomy (CEA). However, guidelines for the optimal timing of these treatments remain unestablished, especially compared to atherosclerotic stenotic lesions, due to the rarity of carotid webs.Observations: A 50-year-old female patient had a carotid web-induced left hemispheric ischemic stroke. Mechanical thrombectomy successfully restored blood flow, but a thrombus reformed in the carotid web within 1 month following the procedure. This caused early CEA, during which the carotid web and thrombus were removed. This case highlights rapid thrombus reformation, indicating that some carotid webs can be more unstable than previously thought.Lessons: This case emphasizes the importance of timely surgical intervention in symptomatic carotid webs to prevent recurrent strokes. Additionally, antithrombotic therapy can manage asymptomatic webs, but surgical treatment may be required in unstable cases. Thus, further studies are warranted to establish standardized treatment guidelines for carotid webs. https://thejns.org/doi/10.3171/CASE24682.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019076","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

Retrograde thrombosis of the superficial sylvian vein following liquid adhesive hemostat use during craniotomy: illustrative case. 开颅术中使用液体粘连止血剂后浅表静脉逆行血栓形成：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-20 DOI: 10.3171/CASE24607

Gabrielle E A Hovis, Jordan Davies, Joseph Lockwood, Frank P K Hsu

{"title":"Retrograde thrombosis of the superficial sylvian vein following liquid adhesive hemostat use during craniotomy: illustrative case.","authors":"Gabrielle E A Hovis, Jordan Davies, Joseph Lockwood, Frank P K Hsu","doi":"10.3171/CASE24607","DOIUrl":"https://doi.org/10.3171/CASE24607","url":null,"abstract":"Background: Intravascular injection of liquid adhesive hemostats is a rare but serious complication that can result in cerebral thromboembolism.Observations: A 64-year-old female underwent orbitozygomatic craniotomy for posterior communicating artery aneurysm clipping with the routine use of a flowable hemostatic agent during extradural dissection. After placement of the aneurysm clip, flow was confirmed through the parent vessel and nearby branches. On postoperative day 1, the patient was found to have superficial middle cerebral vein thrombosis with retrograde embolization and subsequent hemorrhagic infarction of the temporal lobe. Eight prior cases of intracranial infarction or hemorrhage secondary to thrombosis with intravascular liquid adhesive were identified. With a craniotomy approach, the transverse and sigmoid sinuses were the most common sites of thrombosis, and the vertebral and basilar arteries had the highest incidence of thrombosis after cervical fusion.Lessons: Intravascular injection of liquid adhesive agents can result in cerebral venous thrombosis, typically of a dural venous sinus. This may present following retrograde embolization, which has not previously been reported. The choice of hemostat, surgical approach, nearby vasculature, and anatomical variations should be carefully considered in the operative management of neurosurgical patients. https://thejns.org/doi/10.3171/CASE24607.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019087","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

Rathke cleft cyst with squamous metaplasia and activating mutations of mitogen-activated protein kinase signaling: illustrative case. Rathke裂囊伴鳞状化生和丝裂原活化蛋白激酶信号的激活突变：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-20 DOI: 10.3171/CASE24657

Adham Halaoui, Melanie Estrella, Carol H Yan, Vanessa S Goodwill, Thomas L Beaumont

{"title":"Rathke cleft cyst with squamous metaplasia and activating mutations of mitogen-activated protein kinase signaling: illustrative case.","authors":"Adham Halaoui, Melanie Estrella, Carol H Yan, Vanessa S Goodwill, Thomas L Beaumont","doi":"10.3171/CASE24657","DOIUrl":"https://doi.org/10.3171/CASE24657","url":null,"abstract":"Background: Rathke cleft cysts (RCCs) are benign sellar/suprasellar lesions that result from mucin-secreting vestigial remnants within the pars intermedia of the pituitary gland. When symptomatic, they can present with retro-orbital headaches, visual field defects, and/or pituitary dysfunction.Observations: A 35-year-old female presented with subacute retro-orbital headache, right ptosis, and blurred vision. Workup revealed panhypopituitarism with central hypothyroidism and adrenal insufficiency. Imaging demonstrated a sellar/suprasellar mass with subacute intralesional hemorrhage, which was thought to represent chronic pituitary apoplexy. The patient underwent an endoscopic endonasal approach in which the initial intraoperative frozen section suggested papillary craniopharyngioma. Subsequent specimens suggested RCC, thus presenting a surgical management conundrum. Hemihypophysectomy with lesionectomy was performed. Final histopathology demonstrated RCC with squamous metaplasia (RCC-SM), rupture, and hemorrhage. BRAF V600E was not detected. However, activating mutations in KRAS and MAP2K1 were identified.Lessons: RCC can undergo SM and rupture, leading to a hemorrhagic-appearing cystic sellar/suprasellar mass associated with cranial nerve palsies and hypopituitarism that mimics pituitary apoplexy. Intraoperative frozen sections can be ambiguous due to overlapping histopathological features with craniopharyngioma, complicating surgical decision-making. The authors hypothesize that RCC-SM may represent a transitional state between RCC and craniopharyngioma. Neurosurgeons should be mindful of this transitional entity and be prepared to modify their surgical strategy accordingly. https://thejns.org/doi/10.3171/CASE24657.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019040","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

Cryptic presentation: primary amoebic meningoencephalitis mimicking a high-grade malignancy resulting in surgical fatality within 48 hours. Illustrative case. 隐蔽性表现：原发性阿米巴脑膜脑炎模拟高级别恶性肿瘤，导致48小时内手术死亡。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-20 DOI: 10.3171/CASE24358

M Kodeeswaran, Gaurav R Dhoka, Jamila Alagarsamy, K P Priyadharshan, Arun Narinder, Panchabakesan Manivannan, Bipin Chaurasia

{"title":"Cryptic presentation: primary amoebic meningoencephalitis mimicking a high-grade malignancy resulting in surgical fatality within 48 hours. Illustrative case.","authors":"M Kodeeswaran, Gaurav R Dhoka, Jamila Alagarsamy, K P Priyadharshan, Arun Narinder, Panchabakesan Manivannan, Bipin Chaurasia","doi":"10.3171/CASE24358","DOIUrl":"https://doi.org/10.3171/CASE24358","url":null,"abstract":"Background: A 71-year-old male presented with weakness of the right upper limb and headache for the past 3 months. Brain magnetic resonance imaging (MRI) with contrast showed a left frontal space-occupying lesion, suggestive of a high-grade malignancy. Awake craniotomy with complete excision of the lesion was performed under immunofluorescence guidance. On postoperative day 2, the patient developed signs of meningoencephalitis and died. The histopathology report showed an abscess with parasitic infection, suggestive of primary amoebic meningoencephalitis (PAM), an infection caused by Naegleria fowleri.Observations: The patient presented with the above symptoms. Intraoperatively, the lesion exhibited fluorescence uptake and had a firm consistency. The patient did not exhibit any new neurological deficits during surgery, but on postoperative day 2, signs of meningitis emerged, and his condition deteriorated, ultimately leading to his death.Lessons: PAM typically manifests with nonspecific symptoms of meningitis, progressing to a rapidly developing, severe form of meningitis that has a high mortality rate. The patient displayed obscure symptoms, and brain MRI revealed a space-occupying lesion with fluorescence uptake during surgery, suggestive of a high-grade malignancy. The diagnosis of PAM as a high-grade malignant space-occupying lesion was confirmed postmortem through histopathological analysis, a presentation considered exceedingly rare and unprecedented in the literature. https://thejns.org/doi/10.3171/CASE24358.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019035","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

Intentional staged embolization via the "highway bypass" using a radial artery graft for a large posterior circulation aneurysm: illustrative case. 采用桡动脉移植术经“高速公路旁路”有意分阶段栓塞治疗大后循环动脉瘤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-20 DOI: 10.3171/CASE24527

Masahiro Indo, Soichi Oya, Sho Nakamura, Ikuo Kobayashi, Shinsuke Yoshida, Masaaki Shojima, Shigeru Nemoto

{"title":"Intentional staged embolization via the \"highway bypass\" using a radial artery graft for a large posterior circulation aneurysm: illustrative case.","authors":"Masahiro Indo, Soichi Oya, Sho Nakamura, Ikuo Kobayashi, Shinsuke Yoshida, Masaaki Shojima, Shigeru Nemoto","doi":"10.3171/CASE24527","DOIUrl":"https://doi.org/10.3171/CASE24527","url":null,"abstract":"Background: The presence of significant tortuosity in access routes to aneurysms can interfere with catheter guidance and manipulation and significantly impact treatment strategies.Observations: In this report, the authors combined intentional staged aneurysm embolization with the construction of a new direct access route, which they call a \"highway bypass,\" for a symptomatic posterior circulation cerebral aneurysm that was difficult to access with a catheter. Notably, the highway bypass is used for catheter passage, and technical tips should be considered. The patient had a symptomatic unruptured cerebral aneurysm in the first segment of the left posterior cerebral artery with bilateral internal carotid artery occlusion and severe tortuosity of the bilateral vertebral arteries. The highway bypass using a radial artery graft was performed in the first stage; in the second stage, the aneurysm was accessed using the graft, and embolization was performed. The catheter was passed through the graft without complications. The aneurysm was successfully embolized, no ischemic lesions were found in the postoperative images, and the patient was discharged without worsening neurological findings.Lessons: Intentional staged aneurysm embolization combined with the highway bypass effectively treats aneurysms that are difficult to access. Anastomoses should be designed to allow catheters to pass through the graft. https://thejns.org/doi/10.3171/CASE24527.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019037","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

Hemorrhagic astroblastoma: atypical presentation of a rare tumor. Illustrative case. 出血性星形母细胞瘤：罕见肿瘤的不典型表现。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-20 DOI: 10.3171/CASE24486

Jorge Zumaeta, Raul Martinez, Noe Santiago Rea, William Efrain Anicama-Lima, Sandro Casavilca-Zambrano, Jose Valerio

{"title":"Hemorrhagic astroblastoma: atypical presentation of a rare tumor. Illustrative case.","authors":"Jorge Zumaeta, Raul Martinez, Noe Santiago Rea, William Efrain Anicama-Lima, Sandro Casavilca-Zambrano, Jose Valerio","doi":"10.3171/CASE24486","DOIUrl":"https://doi.org/10.3171/CASE24486","url":null,"abstract":"Background: Astroblastoma is an extremely rare tumor of the central nervous system, and its origin and validity as a different entity are still being debated. Because of its rarity and similarities to other glial neoplasms, it is often misdiagnosed, impacting treatment and outcomes.Observations: Astroblastoma is very rare and mainly affects children and young adults. It does not have a definitive World Health Organization grade and is divided into low- and high-grade categories. The clinical presentation is consistent with signs of intracranial hypertension. Radiographic imaging shows a bubbly, solid-cystic supratentorial mass with irregular contrast enhancement. The case reported herein is unusual because the intratumoral hemorrhage caused compression and midline shift, requiring urgent surgery.Lessons: Astroblastoma with intratumoral hemorrhage is atypical and is associated with high-grade tumors. Managing severe intracranial hypertension requires emergency surgery to prevent fatalities. Treatment can include adjunctive chemotherapy and radiation therapy based on the extent of tumor resection. https://thejns.org/doi/10.3171/CASE24486.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018950","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

Communicating hydrocephalus following stereotactic radiosurgery for periventricular meningiomas: illustrative cases. 立体定向放射治疗脑室周围脑膜瘤后的交通性脑积水：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-20 DOI: 10.3171/CASE24722

Aleksandra B Lasica, Cornel Tancu, Zeid A Abussuud, Laurence D Watkins, Patrick J Grover

{"title":"Communicating hydrocephalus following stereotactic radiosurgery for periventricular meningiomas: illustrative cases.","authors":"Aleksandra B Lasica, Cornel Tancu, Zeid A Abussuud, Laurence D Watkins, Patrick J Grover","doi":"10.3171/CASE24722","DOIUrl":"https://doi.org/10.3171/CASE24722","url":null,"abstract":"Background: Stereotactic radiosurgery (SRS) is a well-established option for the management of intracranial tumors, including meningiomas. Although valued for its low invasiveness and precision, it still carries a risk of complications. Communicating hydrocephalus is a serious, albeit rarely reported, complication of SRS. Here, the authors report two cases of communicating hydrocephalus following Gamma Knife radiosurgery (GKRS) for periventricular meningiomas.Observations: In both reported cases, the patients experienced a sudden deterioration in their clinical condition a few months after the second GKRS for recurrent periventricular World Health Organization grade II atypical meningiomas. The patients underwent ventriculoperitoneal shunt implantation, and cerebrospinal fluid (CSF) samples revealed elevated levels of total protein and albumin. Additionally, both patients underwent multiple resections before radiation, and some of their lesions were located near the venous sinuses.Lessons: Though rare, communicating hydrocephalus represents a significant potential sequela of SRS for meningiomas that clinicians should be aware of. Factors such as tumor volume and location, histology, and previous irradiation or surgery can exacerbate radiation-induced damage and collectively underlie the development of hydrocephalus. The authors also speculate that the CSF protein levels can serve as a unifying marker of SRS-induced radiation damage in the form of radiation-associated tumor necrosis, radiation-induced hyperpermeability, and inflammatory response. https://thejns.org/doi/10.3171/CASE24722.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019032","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

Coexisting sellar Rathke cleft cyst and planum sphenoidale meningioma: illustrative case. 鞍区Rathke裂隙囊肿与蝶状平面脑膜瘤并存：一例说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-20 DOI: 10.3171/CASE24551

Amirhossein Akhavan-Sigari, David J Park, Paul M Harary, Maya Chivakula, Debebe Theodros, Krishna L Bharani, Yusuke S Hori, Amit R L Persad, Fred C Lam, Sara C Emrich, Louisa Ustrzynski, Armine Tayag, Steven D Chang

{"title":"Coexisting sellar Rathke cleft cyst and planum sphenoidale meningioma: illustrative case.","authors":"Amirhossein Akhavan-Sigari, David J Park, Paul M Harary, Maya Chivakula, Debebe Theodros, Krishna L Bharani, Yusuke S Hori, Amit R L Persad, Fred C Lam, Sara C Emrich, Louisa Ustrzynski, Armine Tayag, Steven D Chang","doi":"10.3171/CASE24551","DOIUrl":"https://doi.org/10.3171/CASE24551","url":null,"abstract":"Background: The co-occurrence of Rathke cleft cysts (RCCs) and meningiomas in the sellar and parasellar regions represents an exceedingly rare clinical entity. Achieving maximal resection through a single operative approach while minimizing adverse events is challenging, often necessitating multiple surgical approaches, as suggested by previous reports.Observations: The authors report the case of a 49-year-old female with a history of kidney transplant who presented with headaches and was diagnosed with coexisting RCC and meningioma in the sellar and planum sphenoidale regions, respectively. Given the prolonged, refractory nature of her symptoms and based on her treatment preferences, a two-stage surgical approach was planned. This involved an endoscopic transnasal transsphenoidal approach followed by a right craniotomy to achieve maximal tumor resection while minimizing potential complications. No residual disease or tumor remnants were present at the 6-month follow-up. The pituitary gland was preserved, and the patient's preoperative symptoms had fully resolved.Lessons: The preoperative diagnosis of concurrent skull base tumors is essential for effective management planning and determining the optimal surgical approach. The proximity of these tumors to critical neurovascular structures necessitates meticulous surgical planning to minimize adverse effects while ensuring maximal tumor resection. https://thejns.org/doi/10.3171/CASE24551.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019029","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

Iatrogenic pseudoaneurysm formation of the anterior cerebral artery following placement of an external ventricular drain: illustrative case. 脑外引流后脑前动脉医源性假性动脉瘤形成：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-20 DOI: 10.3171/CASE24558

Zein Al-Atrache, Stanley Dennison, Mazen Zaher, Joshua Santucci, Daniel A Tonetti

{"title":"Iatrogenic pseudoaneurysm formation of the anterior cerebral artery following placement of an external ventricular drain: illustrative case.","authors":"Zein Al-Atrache, Stanley Dennison, Mazen Zaher, Joshua Santucci, Daniel A Tonetti","doi":"10.3171/CASE24558","DOIUrl":"https://doi.org/10.3171/CASE24558","url":null,"abstract":"Background: External ventricular drains (EVDs) provide an invaluable diagnostic method for accessing cerebrospinal fluid and therapeutically treating elevated intracranial pressure. Although complications including hemorrhage and infection have been well documented, the formation of iatrogenic pseudoaneurysms following EVD placement has rarely been reported. The authors present a case of this exceedingly rare complication of iatrogenic pseudoaneurysm formation following EVD placement.Observations: In this report, the authors document the formation of a pseudoaneurysm within the A4 segment of the anterior cerebral artery in a 77-year-old female following frontal EVD placement, which was promptly recognized and successfully embolized endovascularly. They discuss the suspected pathophysiology, given the literature citing similar complications, and the differing management strategies following the discovery of iatrogenic pseudoaneurysms.Lessons: Although rare, iatrogenic vascular injury following EVD placement or removal should not be overlooked. If hemorrhage following catheter placement or manipulation develops, suspicion for iatrogenic vascular injury should be high, and appropriate vascular imaging should be performed. As reported here, prompt treatment with endovascular embolization provides a safe and effective means to prevent future rupture and worsening hemorrhage. This case and the literature review emphasize the importance of rapid diagnosis of postprocedural pseudoaneurysm formation and treatment to prevent continued secondary brain injury. https://thejns.org/doi/10.3171/CASE24558.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018953","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

Resection of a ventrally located ossified thoracic spinal meningioma: illustrative case. 切除腹侧骨化胸椎脑膜瘤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-01-13 DOI: 10.3171/CASE24603

Ricardo H Menéndez, Horacio Barea, Pablo E Lehrner, Delfina Mazza Elizalde, Jaqueline Elvira, German Arias, Natalia Castelletti, Sabrina Mayoni, Horacio A Sole

{"title":"Resection of a ventrally located ossified thoracic spinal meningioma: illustrative case.","authors":"Ricardo H Menéndez, Horacio Barea, Pablo E Lehrner, Delfina Mazza Elizalde, Jaqueline Elvira, German Arias, Natalia Castelletti, Sabrina Mayoni, Horacio A Sole","doi":"10.3171/CASE24603","DOIUrl":"10.3171/CASE24603","url":null,"abstract":"Background: Resection of calcified meningiomas in the ventral thoracic spinal canal remains a formidable surgical challenge despite advances in technology and refined microsurgical techniques. These tumors, which account for a small percentage of spinal meningiomas, are characterized by their hardness, complicating safe resection and often resulting in worse outcomes than their noncalcified counterparts.Observations: The authors present the case of a 68-year-old woman with a ventrally located ossified meningioma at the T9-10 level, successfully treated via a posterolateral transpedicular approach. Additionally, they conducted a systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on the origins, imaging findings, surgical strategies, and outcomes of calcified meningiomas in the ventral thoracic spinal canal. Data were extracted and analyzed from 15 articles encompassing 18 cases.Lessons: Calcified meningiomas in the ventral thoracic spinal canal require meticulous preoperative planning and a tailored surgical approach to optimize outcomes. The posterolateral transpedicular approach offers a balance between adequate exposure and minimizing spinal cord manipulation, making it a viable option for resecting these challenging tumors. A single facetectomy and pediculotomy do not compromise long-term spinal stability. Technological adjuncts, including ultrasonic aspiration, neuromonitoring, and endoscopic assistance, can further enhance surgical safety and effectiveness. https://thejns.org/doi/10.3171/CASE24603.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980788","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