Journal of neurosurgery. Case lessons最新文献_第10页

Malignant peripheral nerve sheath tumors arising in SMARCB1-associated schwannomatosis: illustrative cases. smarcb1相关神经鞘瘤病引起的恶性周围神经鞘肿瘤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-16 DOI: 10.3171/CASE25610

Taha Khalilullah, Xinlan Yang, Jonathan Yao, Abdul Karim Ghaith, Jawad M Khalifeh, Tej D Azad, A Karim Ahmed, Yuanxuan Xia, Nicholas Theodore, Carlos G Romo, Jean-Paul Wolinsky, Allan J Belzberg, Daniel Lubelski

{"title":"Malignant peripheral nerve sheath tumors arising in SMARCB1-associated schwannomatosis: illustrative cases.","authors":"Taha Khalilullah, Xinlan Yang, Jonathan Yao, Abdul Karim Ghaith, Jawad M Khalifeh, Tej D Azad, A Karim Ahmed, Yuanxuan Xia, Nicholas Theodore, Carlos G Romo, Jean-Paul Wolinsky, Allan J Belzberg, Daniel Lubelski","doi":"10.3171/CASE25610","DOIUrl":"10.3171/CASE25610","url":null,"abstract":"Background: Schwannomatosis is a rare tumor predisposition syndrome characterized by benign peripheral nerve sheath tumors in the absence of bilateral vestibular schwannomas. In rare cases, malignant peripheral nerve sheath tumors (MPNSTs) may arise with schwannomatosis, particularly with SMARCB1 mutations. These malignancies pose significant diagnostic and therapeutic challenges and a poor prognosis.Observations: The authors present 2 cases of high-grade MPNST with SMARCB1-associated schwannomatosis. Both presented with rapidly enlarging and concerning imaging features, including heterogeneous enhancement, central necrosis, and low apparent diffusion coefficient values. Histopathological analysis confirmed high-grade MPNST with elevated mitotic activity and loss of H3K27me3. Both patients underwent en bloc resection with negative margins. One patient remains disease free at 5 years; the other patient developed metastatic recurrence and died. A systematic review identified 20 cases in the literature.Lessons: These cases emphasize clinical vigilance for malignant transformation in schwannomatosis, particularly with rapidly enlarging lesions or new neurological symptoms. MRI and FDG-PET can aid in identifying concerning features. Despite margin-negative resection, recurrence and metastasis may occur, reflecting the tumor's aggressive biology. Genetic counseling may be considered in SMARCB1-associated cases. While malignant transformation is much more common in NF1 lesions, rare cases do arise in schwannomatosis, requiring close surveillance and multidisciplinary management. https://thejns.org/doi/10.3171/CASE25610.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505958","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

Serial vessel wall imaging reveals rupture site and treatment response in a flow-related aneurysm associated with an arteriovenous malformation: illustrative case. 一系列血管壁成像显示了与动静脉畸形相关的血流相关动脉瘤的破裂部位和治疗反应：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-16 DOI: 10.3171/CASE25951

Taichi Ikedo, Takaaki Morita, Masakazu Okawa, Nanako Miki, Hideo Chihara, Hiroyuki Ikeda, Takeshi Funaki, Takayuki Kikuchi, Chiaki Sakai, Yoshiki Arakawa

{"title":"Serial vessel wall imaging reveals rupture site and treatment response in a flow-related aneurysm associated with an arteriovenous malformation: illustrative case.","authors":"Taichi Ikedo, Takaaki Morita, Masakazu Okawa, Nanako Miki, Hideo Chihara, Hiroyuki Ikeda, Takeshi Funaki, Takayuki Kikuchi, Chiaki Sakai, Yoshiki Arakawa","doi":"10.3171/CASE25951","DOIUrl":"10.3171/CASE25951","url":null,"abstract":"Background: The clinical significance of wall enhancement on vessel wall imaging (VWI) in arteriovenous malformation (AVM)-associated flow-related aneurysms (FRAs) remains unclear.Observations: A healthy adolescent presented with intraventricular hemorrhage and acute hydrocephalus caused by rupture of a left parietal AVM. VWI revealed an FRA protruding into the lateral ventricle with strong wall enhancement and interval growth, suggesting it as the rupture site. Transarterial embolization was performed on day 12, and follow-up VWI the next day showed complete disappearance of wall enhancement. Serial MRA studies demonstrated progressive regression and eventual disappearance of the aneurysm.Lessons: This case uniquely demonstrated rapid postoperative disappearance of aneurysmal wall enhancement and morphological regression on serial VWI. VWI may serve as a valuable tool not only for identifying rupture sites but also for monitoring temporal changes of AVM-associated aneurysms. https://thejns.org/doi/10.3171/CASE25951.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505897","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

Bertolotti joint-related cyst: illustrative case. Bertolotti关节相关囊肿：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-16 DOI: 10.3171/CASE25948

William D Chow, Robert J Spinner, Kimberly K Amrami, Benjamin D Elder, Michael P Steinmetz

{"title":"Bertolotti joint-related cyst: illustrative case.","authors":"William D Chow, Robert J Spinner, Kimberly K Amrami, Benjamin D Elder, Michael P Steinmetz","doi":"10.3171/CASE25948","DOIUrl":"10.3171/CASE25948","url":null,"abstract":"Background: Bertolotti syndrome is an underrecognized cause of chronic low back pain. Back pain generated from Bertolotti syndrome is believed to result from altered weight dissipation mechanics and/or instability of the pseudoarticulation, while local nerve root compression may result in radiculopathy. Here, the authors describe the findings of a patient with treatment-refractory low back pain found to have a cystic lesion arising from a Bertolotti joint causing L5 nerve root compression. To their knowledge, this has not been previously described in the literature.Observations: Despite early recognition of Bertolotti syndrome, the patient's back pain remained resistant to many years of both conservative and surgical management. The novel finding of a cyst arising from the pseudoarticulation complicated the management. The patient is scheduled to undergo further surgery this year.Lessons: This case highlights a pseudocyst associated with a Bertolotti joint. The cyst introduced additional clinical uncertainty to what is already an uncommon and difficult to treat condition. Resection of the Bertolotti joint failed to improve the patient's symptoms. Postoperatively, a complex hemorrhagic pseudocyst was seen on imaging, possibly due to the pseudoarticulation with persistent motion. Ongoing efforts to characterize Bertolotti syndrome and its associated imaging findings are necessary to better optimize management strategies in these patients. https://thejns.org/doi/10.3171/CASE25948.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505861","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

Posttraumatic syrinx resulting in syringomyelia and syringobulbia: illustrative case. 创伤后注射器导致脊髓空洞和注射器畸形：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-16 DOI: 10.3171/CASE25797

Nicholas Dietz, Aashka Sheth, Camilo Castillo, David Freeman, Haring Nauta

{"title":"Posttraumatic syrinx resulting in syringomyelia and syringobulbia: illustrative case.","authors":"Nicholas Dietz, Aashka Sheth, Camilo Castillo, David Freeman, Haring Nauta","doi":"10.3171/CASE25797","DOIUrl":"10.3171/CASE25797","url":null,"abstract":"Background: Posttraumatic syringomyelia (PTS) refers to an elongated, intramedullary spinal cyst, representing a spectrum of severity and a variable interval after spinal cord injury (SCI). It typically presents with worsening motor and/or sensory function after a period of relative symptom stability following injury. The worsening ascends rostrally to include spinal cord levels previously intact above the level of injury. Rarely, PTS cavities extend rostrally to brainstem levels.Observations: The case presented demonstrates nearly the full spectrum of features associated with PTS. The onset of worsening occurred relatively early, about 1 year after motor complete SCI at the T2-3 level. The delayed onset of worsening symptoms of the PTS included asymmetric sensory and motor deficits that extended rostral to the upper extremities, face, and swallowing, and caudal to include back pain.Lessons: The authors highlight key features of PTS, including 1) bilateral ascending expansile syrinx in the peridorsal horn gray matter, 2) medullary extension with trigeminal nucleus symptoms consistent with syringobulbia, and 3) evidence of spontaneous remission or collapsing cord sign. Additionally, risk factors for early PTS are discussed, including motor complete thoracic SCI with spinal stenosis on MRI. Operative management included hardware removal, laminectomy, spinal cord untethering with wide syringostomy, and duraplasty. https://thejns.org/doi/10.3171/CASE25797.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505888","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

Early cystic enlargement of hypoglossal schwannoma causing brainstem compression post-Gamma Knife radiosurgery: illustrative cases. 伽玛刀放射手术后早期舌下神经鞘瘤囊性增大引起脑干压迫：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-16 DOI: 10.3171/CASE25933

Aaron S C Foo, Calista L S Por, Vincent D W Nga, Tseng Tsai Yeo, Char Loo Tan, Bengt Karlsson

{"title":"Early cystic enlargement of hypoglossal schwannoma causing brainstem compression post-Gamma Knife radiosurgery: illustrative cases.","authors":"Aaron S C Foo, Calista L S Por, Vincent D W Nga, Tseng Tsai Yeo, Char Loo Tan, Bengt Karlsson","doi":"10.3171/CASE25933","DOIUrl":"10.3171/CASE25933","url":null,"abstract":"Background: Hypoglossal schwannomas (HSs) are rare lesions comprising approximately 1% of intracranial schwannomas. For treatment of these lesions, both microsurgery and radiosurgery are accepted modalities. While post-radiosurgery transient tumor enlargement (TTE) is well described in other intracranial schwannomas, it is not well documented in HSs due to their rarity. The authors present 2 cases of TTE in HS post-radiosurgery that led to clinical deterioration.Observations: Two patients with HS developed brainstem compression secondary to Gamma Knife surgery TTE within 6 months of treatment at the authors' center. Both needed surgical debulking of the intradural portion of the HS to relieve symptoms.Lessons: TTE is a well-documented reaction of schwannomas to radiosurgery. In the context of HS, the authors believe that the risk of brainstem compression is substantially higher in HS due to the tapered configuration of the posterior fossa, which narrows at the foramen magnum. As the hypoglossal nerve courses just above the foramen magnum, the available space for accommodation of any TTE in that area is very limited, and even a small degree of tumor swelling can cause significant brainstem compression. Upfront radiosurgery should thus be used with caution in HS, especially for lesions already abutting the brainstem. https://thejns.org/doi/10.3171/CASE25933.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505904","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

Intracranial hypotension secondary to a spontaneous cervical nerve root leak repaired using a chimeric rotational paraspinal flap: a multidisciplinary surgical approach. Illustrative case. 应用椎旁嵌合旋转皮瓣修复自发性颈神经根渗漏致颅内低血压：一种多学科外科方法。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-16 DOI: 10.3171/CASE25698

Russel T Wagner, Hannah L Walsh, Jacopo Berardinelli, Melanie Fukui, Neil S Mundi, Amin B Kassam, Russ P Nockels

{"title":"Intracranial hypotension secondary to a spontaneous cervical nerve root leak repaired using a chimeric rotational paraspinal flap: a multidisciplinary surgical approach. Illustrative case.","authors":"Russel T Wagner, Hannah L Walsh, Jacopo Berardinelli, Melanie Fukui, Neil S Mundi, Amin B Kassam, Russ P Nockels","doi":"10.3171/CASE25698","DOIUrl":"10.3171/CASE25698","url":null,"abstract":"Background: Spontaneous intracranial hypotension (SIH) caused by a CSF leak due to a subtle dural defect often leads to debilitating orthostatic headaches and subdural fluid collection. Various surgical techniques have been described for iatrogenic leaks but not for spontaneous cervical nerve root leaks.Observations: A 35-year-old female presented with progressive neck pain, severe orthostatic headaches, and bilateral subdural fluid collection. Imaging revealed a type 1b ventral dural tear at the right C8 nerve root. A posterior cervical approach exposing the nerve roots located the subtle leak site. A team consisting of neurosurgeons and a head and neck reconstructive surgeon harvested and positioned a paraspinal musculature flap, fashioned into two leaflets, to envelop the nerve roots ventrally and dorsally. Fibrin sealant and muscle plugs reinforced the closure. Postoperatively, the patient experienced rapid resolution of orthostatic headaches. At 6 months, she reported only mild, intermittent neck tightness without headache recurrence or evidence of CSF leakage.Lessons: A multidisciplinary surgical approach utilizing a chimeric rotational paraspinal flap to repair a spontaneous cervical CSF leak at the right C8 nerve root provided robust, vascularized coverage with resolution of SIH signs and symptoms. This flap-based technique offers a durable solution for challenging CSF leaks. https://thejns.org/doi/10.3171/CASE25698.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505947","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

Septic embolus resulting in M1 occlusion with separate, multiple distal mycotic aneurysms, complicated by surrounding concurrent cerebral abscess: illustrative case. 脓毒性栓子导致M1闭塞，并发分离的多个远端真菌性动脉瘤，并发周围并发脑脓肿：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-09 DOI: 10.3171/CASE25902

Nicholas K Dietz, Jasmine Omair, Andrea Becerril-Gaitan, Joel M Sequeiros, Redi Rahmani, Dale Ding, Isaac J Abecassis

{"title":"Septic embolus resulting in M1 occlusion with separate, multiple distal mycotic aneurysms, complicated by surrounding concurrent cerebral abscess: illustrative case.","authors":"Nicholas K Dietz, Jasmine Omair, Andrea Becerril-Gaitan, Joel M Sequeiros, Redi Rahmani, Dale Ding, Isaac J Abecassis","doi":"10.3171/CASE25902","DOIUrl":"10.3171/CASE25902","url":null,"abstract":"Background: Intracranial mycotic aneurysms are rare, representing only 0.7%-5.4% of all intracranial aneurysms, and typically arise from septic emboli secondary to infective endocarditis. Large-vessel occlusion due to a septic embolus is exceedingly uncommon and carries high morbidity.Observations: A 29-year-old man with methicillin-resistant Staphylococcus aureus endocarditis and intravenous drug use presented with intracerebral and subarachnoid hemorrhage. CT angiography revealed a left parieto-occipital hematoma with midline shift. An emergency craniotomy for hematoma evacuation exposed a ruptured distal middle cerebral artery (MCA) mycotic aneurysm, which was clipped, and pathological analysis confirmed abscess formation within the aneurysm wall. Despite antibiotic therapy, a new distal MCA aneurysm developed within an abscess cavity. Cerebral angiography later demonstrated M1 occlusion requiring mechanical thrombectomy, achieving partial reperfusion consistent with Thrombolysis in Cerebral Infarction grade 2a. The persistent abscess and aneurysm required Onyx embolization and abscess drainage in a hybrid operating room.Lessons: Sequential mycotic aneurysms with concurrent large-vessel occlusion and abscess formation represent a rare and aggressive manifestation of septic emboli. Successful management depends on coordinated microsurgical clipping, endovascular embolization, thrombectomy, and abscess evacuation. Early recognition of evolving vascular pathology and combined surgical-endovascular approaches improve outcomes in infective mycotic aneurysm-related cerebrovascular disease. https://thejns.org/doi/10.3171/CASE25902.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391999","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

Posttraumatic cerebrospinal fluid leak with cognitive dysfunction, especially visual memory disturbance: illustrative case. 创伤后脑脊液漏伴认知功能障碍，尤其是视觉记忆障碍：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-09 DOI: 10.3171/CASE25939

Kaito Suzuki, Taku Matsuda, Keijiro Hara, Kazumi Nakamura, Megumi Kuno, Kazuhisa Miyake, Masaaki Korai, Nori Sato, Tetsuya Matsuura, Yasushi Takagi

{"title":"Posttraumatic cerebrospinal fluid leak with cognitive dysfunction, especially visual memory disturbance: illustrative case.","authors":"Kaito Suzuki, Taku Matsuda, Keijiro Hara, Kazumi Nakamura, Megumi Kuno, Kazuhisa Miyake, Masaaki Korai, Nori Sato, Tetsuya Matsuura, Yasushi Takagi","doi":"10.3171/CASE25939","DOIUrl":"10.3171/CASE25939","url":null,"abstract":"Background: Cerebrospinal fluid (CSF) leaks are associated with various clinical and neurological manifestations. Although cognitive dysfunction has been reported in patients with a CSF leak, its detailed characteristics and cognitive profile remain unclear.Observations: A 17-year-old male patient developed progressive cognitive decline after minor head trauma. The initial neuroimaging findings were unremarkable; however, over several months, he exhibited memory impairment, academic decline, and personality changes. Neuropsychological testing has demonstrated significant deficits in visual memory, reduced working memory, and reduced processing speed. A detailed interview revealed a subtle orthostatic headache that had been present since the head injury, prompting further evaluation. Spinal MRI and CT myelography confirmed a CSF leak in the cervical spine. The patient underwent placement of a blind lumbar epidural blood patch, which resulted in immediate headache relief and gradual cognitive improvement, particularly in visual memory.Lessons: CSF leaks can manifest primarily as cognitive dysfunction, even without typical headache or imaging findings, leading to diagnostic delays and potential misdiagnosis of psychiatric illnesses. Visual memory impairment might represent a characteristic and underrecognized feature of a CSF leak. Comprehensive neuropsychological assessment with domain-specific testing is essential for accurate diagnosis of atypical presentations. https://thejns.org/doi/10.3171/CASE25939.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391970","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

Preoperative intra-articular fluorescein injection to detect the articular branch at surgery on a sural intraneural ganglion cyst at the ankle: illustrative case. 术前关节内注射荧光素检测踝关节腓肠神经节囊肿手术中的关节分支：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-09 DOI: 10.3171/CASE251018

Rahul Gogoi, Robert J Spinner, Kimberly K Amrami, Emile G Coerkamp, Godard C W de Ruiter

{"title":"Preoperative intra-articular fluorescein injection to detect the articular branch at surgery on a sural intraneural ganglion cyst at the ankle: illustrative case.","authors":"Rahul Gogoi, Robert J Spinner, Kimberly K Amrami, Emile G Coerkamp, Godard C W de Ruiter","doi":"10.3171/CASE251018","DOIUrl":"10.3171/CASE251018","url":null,"abstract":"Background: Intraneural ganglion cysts (IGCs) are mucinous lesions that originate from adjacent synovial joints. According to the articular theory, synovial fluid tracks from a joint into the parent nerve through an articular branch. In uncommon sites such as the sural nerve, this connection can be difficult to identify. This report illustrates the use of a preoperative intra-articular fluorescein injection as a tool to identify the articular branch during surgery.Observations: A 60-year-old woman presented with lateral foot pain, numbness, and a palpable mass along the left sural distribution. MRI showed a large cyst extending along the course of the sural nerve with connection to the subtalar joint. Fluorescein was injected preoperatively into this joint to detect the articular branch intraoperatively with ultraviolet illumination. The connection was transected at the joint origin, and the cyst was decompressed, preserving the parent nerve. Postoperatively, the patient had complete pain relief and sensory recovery, and MRI at 3 and 8 months confirmed resolution of the cyst.Lessons: Sural IGCs conform to the articular theory and can be managed effectively by transection of the articular branch. Preoperative intra-articular fluorescein injection is a useful tool to detect the articular branch that can be difficult to find in sural IGCs. https://thejns.org/doi/10.3171/CASE251018.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391994","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

Microvascular decompression for hemifacial spasm associated with large fenestration of the vertebral artery: illustrative case. 微血管减压治疗伴有椎动脉大开窗的面肌痉挛：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-03-09 DOI: 10.3171/CASE25777

Keigo Matsumiya, Shigeki Nakano, Shinichi Origuchi, Daiki Yokoyama, Kentaro Horiguchi, Iwao Yamakami, Yoshinori Higuchi

{"title":"Microvascular decompression for hemifacial spasm associated with large fenestration of the vertebral artery: illustrative case.","authors":"Keigo Matsumiya, Shigeki Nakano, Shinichi Origuchi, Daiki Yokoyama, Kentaro Horiguchi, Iwao Yamakami, Yoshinori Higuchi","doi":"10.3171/CASE25777","DOIUrl":"10.3171/CASE25777","url":null,"abstract":"Background: Hemifacial spasm (HFS) associated with a large fenestration of the vertebral artery (VA) is extremely rare. Here, the authors report a case of HFS caused by this vascular anomaly and discuss its embryological background and clinical implications.Observations: A man in his 30s presented with a 7-year history of right-sided HFS. MRI demonstrated vascular compression at the root exit zone of the facial nerve. MR angiography revealed an aberrant artery running parallel to the right VA, forming a large fenestration. Three-dimensional CT angiography demonstrated a common trunk giving rise to the anterior inferior cerebellar artery and posterior inferior cerebellar artery. The offending artery was identified as the common trunk.. Microvascular decompression with real-time abnormal muscle response monitoring achieved sufficient arterial transposition, with careful preservation of the brainstem perforators. The patient experienced complete resolution of spasms postoperatively, without complications.Lessons: A large VA fenestration may represent a persistent primitive lateral basilovertebral anastomosis. Successful surgical treatment requires a precise preoperative understanding of the complex vascular architecture and consideration of the limitations imposed by perforating branches during arterial transposition. https://thejns.org/doi/10.3171/CASE25777.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391974","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