Journal of neurosurgery. Case lessons最新文献

{"title":"Intraoperative neurovascular considerations for efficient intraventricular meningioma surgery: illustrative case.","authors":"Khaled Alok, Maria Isabel Ocampo-Navia, Bilgue Yaşar, Miguel Millares Chavez, Aladine A Elsamadicy, Jennifer Moliterno","doi":"10.3171/CASE2569","DOIUrl":"10.3171/CASE2569","url":null,"abstract":"<p><strong>Background: </strong>Intraventricular meningiomas (IVMs) are a rare subtype of brain tumors. Typically slow growing, these tumors can occasionally reach a substantial size, causing ventricular obstruction and hydrocephalus. Resection remains the treatment of choice; however, the deep location and proximity to critical neurovascular structures can pose significant challenges. Various surgical strategies and adjuncts have been described. Here, the authors highlight the benefits of early intraoperative tumor devascularization to minimize blood loss and enable safe, efficient removal through a minimally disruptive transsulcal approach.</p><p><strong>Observations: </strong>A 59-year-old woman presented with symptoms of increased intracranial pressure due to a large atrial IVM causing temporal horn entrapment. The tumor was hypervascular, with prominent arterial feeders. Early intraoperative microsurgical devascularization was favored over preoperative embolization, combined with temporary clipping of adjacent arterial feeders and intraoperative neurophysiological monitoring. This strategy facilitated piecemeal gross-total tumor resection within a relatively short surgical duration, minimizing brain retraction. The patient was neurologically intact after gross-total resection.</p><p><strong>Lessons: </strong>Early and strategic tumor devascularization is an effective approach to achieve safe and efficient resection of large intraventricular tumors with minimal brain retraction. https://thejns.org/doi/10.3171/CASE2569.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311121","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":"Malignant transformation of pituitary adenoma to carcinosarcoma: illustrative case.","authors":"Lin Shaoyong, Huanxiang Huang, Mingyue Wang, Jun Li, Yuhui Chen, Shousen Wang","doi":"10.3171/CASE24765","DOIUrl":"10.3171/CASE24765","url":null,"abstract":"<p><strong>Background: </strong>Carcinosarcomatous transformation is a rare complication following radiotherapy for pituitary adenomas (PAs).</p><p><strong>Observations: </strong>The authors report what they believe to be the first case of a benign nonfunctioning PA developing into a carcinosarcoma after surgery and radiotherapy.</p><p><strong>Lessons: </strong>Radiotherapy for PAs should account for the risk of secondary intracranial tumors, with long-term follow-up recommended for treated patients. Combined therapeutic strategies may be considered for radiation-induced sarcomas, and comprehensive molecular pathological studies of radiation-induced tumors are imperative for advancing understanding and management. https://thejns.org/doi/10.3171/CASE24765.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of a pulmonary neuroendocrine tumor causing epidural spinal cord compression and transdural intramedullary invasion: illustrative case.","authors":"Wesley Shoap, Kion Gregory, Jack A Leoni, Gabriel C Tender","doi":"10.3171/CASE25200","DOIUrl":"10.3171/CASE25200","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary spinal cord metastasis from local transdural invasion is an exceedingly rare event. Therefore, specific guidance on the timing, type, and extent of surgical intervention is lacking.</p><p><strong>Observations: </strong>A 60-year-old male with a known pulmonary neuroendocrine tumor presented with 2 days of progressive lower extremity paraplegia rendering him nonambulatory. MRI demonstrated transpleural and paravertebral invasion by the mass with extension through the left T1-2 and T2-3 neural foramina causing significant epidural compression. There was also transdural invasion at T2 extending intramedullary to the C4 spinal level, with associated cord edema. He underwent posterior cervicothoracic laminectomy and fusion with transpedicular epidural tumor debulking. The intramedullary component was not removed. He received adjuvant radiation therapy and chemotherapy and at the 6-month follow-up demonstrated significant return of motor function in his lower extremities, ambulating with a walker.</p><p><strong>Lessons: </strong>This case illustrates that rapid surgical decompression can still provide benefit even for aggressive tumors causing transdural and intramedullary invasion. The decision on whether to remove the intramedullary component should be made on a case-by-case basis and guided by the patient's neurological examination in combination with imaging findings. https://thejns.org/doi/10.3171/CASE25200.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311104","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":"Progressive thrombosis and involution of a pediatric giant middle cerebral artery pseudoaneurysm following superficial temporal artery-to-middle cerebral artery bypass: illustrative case.","authors":"Nicole Villalba, Lucinda T Chiu, Jonathan Scoville, Ali Shaibani, Tord D Alden, Sandi K Lam","doi":"10.3171/CASE2591","DOIUrl":"10.3171/CASE2591","url":null,"abstract":"<p><strong>Background: </strong>Direct arterial cerebral bypass is commonly performed as part of the definitive treatment strategy for complex aneurysms. While several reports have demonstrated aneurysm thrombosis after direct bypass alone, this report highlights the successful treatment of pediatric giant pseudoaneurysm with direct bypass, leading to thrombosis without requiring additional steps for aneurysm trapping.</p><p><strong>Observations: </strong>A 13-year-old male presented with vomiting and the worst headache of his life. Imaging revealed a partially thrombosed giant right middle cerebral artery (MCA) pseudoaneurysm and right MCA territory hypoperfusion. Superficial temporal artery-to-MCA (STA-MCA) bypass was performed, with planned endovascular trapping for definitive aneurysm treatment in a few months. Angiography 3 months postoperatively demonstrated nearly complete thrombosis of the pseudoaneurysm and a patent bypass; thus, additional treatment was not needed. At the 2-year follow-up, the patient was doing well with an active age-appropriate lifestyle and no aneurysm recurrence.</p><p><strong>Lessons: </strong>This is the first case report of successful treatment of a pediatric giant MCA pseudoaneurysm with STA-MCA bypass, obviating the need for additional treatment in a planned stepwise strategy. STA-MCA bypass alone may be an alternative for the treatment of certain complex MCA aneurysms in pediatric patients when standard approaches are not straightforward. https://thejns.org/doi/10.3171/CASE2591.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311102","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":"Traumatic bilateral deep cerebral venous thrombosis: illustrative case.","authors":"Callum D Dewar, Maureen Scarboro, Cara Lomangino, Gary Schwartzbauer, Timothy Chryssikos, Ross C Puffer, Kristopher G Hooten, Bizhan Aarabi","doi":"10.3171/CASE25192","DOIUrl":"10.3171/CASE25192","url":null,"abstract":"<p><strong>Background: </strong>Deep cerebral venous thrombosis (DCVT) is exceedingly rare in isolation in the setting of trauma. Repercussions from delayed or absent treatment are associated with permanent neurological deficits and high rates of mortality.</p><p><strong>Observations: </strong>A 19-year-old male presented with headache and lethargy following a motor vehicle accident 4 days prior. CT findings were concerning for DCVT, which was confirmed on CT venogram. MRI showed venous congestion of the bilateral thalami, likely secondary to outflow obstruction. The patient's symptoms improved following anticoagulation therapy.</p><p><strong>Lessons: </strong>This case represents the first documented case of isolated traumatic bilateral DCVT without a preexisting hypercoagulable state or associated mass lesion. Dedicated venous imaging should be obtained in high-impact traumatic brain injury when noncontrasted imaging studies are inconclusive and clinical symptoms indicate further investigation is needed. https://thejns.org/doi/10.3171/CASE25192.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259632","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":"Intraorbital arteriovenous fistulas: illustrative case.","authors":"Marharyta Krylova, Erik F Hauck","doi":"10.3171/CASE24857","DOIUrl":"10.3171/CASE24857","url":null,"abstract":"<p><strong>Background: </strong>Intraorbital arteriovenous fistulas (ioAVFs) represent a rare but distinct entity of arteriovenous shunts, separate from the more common carotid-cavernous fistulas (CCFs). There is currently no consensus on the optimal treatment approach for ioAVFs, necessitating analysis of available cases to guide clinical decision-making and establish effective management strategies.</p><p><strong>Observations: </strong>A systematic literature review revealed a total of 28 ioAVF cases reported since 1978. An additional illustrative case is included. Intraorbital AVFs present with similar symptoms as the CCFs such as skin changes (chemosis, ecchymosis, erythema; 86.2%), proptosis (72.4%), and headaches (34.5%). Visual impairment was observed in 12 cases (41.4%); ophthalmoplegia occurred in 8 cases (27.6%). Five patients (17.2%) presented with an afferent pupillary defect. All patients underwent catheter angiography for their diagnostic workup. The ophthalmic artery (OA) was a direct feeder to the fistula in almost all patients (96.6%). Additional feeding vessels included the facial artery, sphenopalatine artery, middle meningeal artery, internal maxillary artery, and superficial temporal artery. Venous drainage was mainly via the superior ophthalmic vein (SOV). Other draining veins involved the inferior ophthalmic vein, facial vein, superior temporal vein, basal vein of Rosenthal, and superior sagittal sinus. Spontaneous resolution occurred in 5 cases (< 20%). Treatment was reported in 21 cases and included embolization (66.7%), resection (14.3%), or combined techniques (19.0%). Embolization was performed most often transvenously (14 cases). Three cases were embolized via direct puncture. A transarterial approach was selected in 6 cases. The OA was embolized directly (distal to the central retinal artery) in 2 cases, including the illustrative case. The average follow-up was 7.8 months (range 3 days-3 years). Overall, treatment was successful with a high cure rate (85.7%). Complications included extensive hemorrhage during transvenous embolization in 1 case and profound thrombosis of the SOV in 2 cases.</p><p><strong>Lessons: </strong>Intraorbital AVFs are characterized by direct inflow via the OA. Treatment can be challenging. A multimodal approach, including observation, can result in high cure rates. Transvenous embolization is the most commonly performed intervention. Embolization via the OA is an option, but carries the risk of permanent visual deficit. https://thejns.org/doi/10.3171/CASE24857.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259628","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":"Patient-specific 3D reconstruction models for sacral tumor resection: illustrative cases.","authors":"Vivek Sanker, Aneysis D Gonzalez-Suarez, Niccolo Innocenti, Maria Jose Cavagnaro, Ikchan Jeon, Corinna Zygourakis, Atman Desai","doi":"10.3171/CASE2522","DOIUrl":"10.3171/CASE2522","url":null,"abstract":"<p><strong>Background: </strong>The surgical methods used to resect sacral tumors are extensive and require maneuvering through complex anatomical systems such as the pelvic organs and sacral nerve roots. These procedures may result in complications and adverse patient outcomes. The technology integrating 3D reconstruction models in the field of spine surgery is rapidly evolving, and these challenging cases present a unique opportunity to leverage this technology's capability for enhanced patient outcomes.</p><p><strong>Observations: </strong>The authors present two sacral tumor cases diagnosed with synovial cell sarcoma and giant cell osteosarcoma, respectively. Both patients underwent a three-staged en bloc tumor resection assisted by 3D reconstruction models. Postoperative imaging showed a complete tumor resection, and the patients symptomatically improved, with no signs of recurrence on follow-up.</p><p><strong>Lessons: </strong>Surgical planning and execution have clearly advanced significantly with the introduction of 3D modeling into spine surgery. Based on the authors' experience, this technology can be used to improve outcomes for complicated spinal tumors with successful results. Although these results are encouraging, extensive studies with larger patient cohorts must be carried out to fully appreciate the technology's advantages across a range of patient demographics and tumor types. https://thejns.org/doi/10.3171/CASE2522.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259631","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":"Mechanical thrombectomy for top of basilar artery occlusion and delayed distal thrombus migration involving the artery of Percheron: illustrative case.","authors":"Yujiro Matsushima, Takahiro Sanada, Adam Tucker, Manabu Kinoshita, Teruo Kimura","doi":"10.3171/CASE25171","DOIUrl":"10.3171/CASE25171","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) for acute basilar artery occlusion (BAO) has become the standard of treatment. Indications for MT in cases of BAO are determined by the degree of activities of daily living before onset, clinical severity, extent of baseline ischemia, and time from onset.</p><p><strong>Observations: </strong>A 43-year-old woman was treated by endovascular intervention for BAO with delayed occlusion of the artery of Percheron (AOP) due to presumed distal thrombus migration. After a fluctuating mild clinical course of more than 60 hours, the patient was finally transferred to the author's institution, presenting with severely impaired consciousness (Glasgow Coma Scale score of 7). The radiological assessment suggested initial BAO followed by distal thrombus migration, resulting in an acute AOP occlusion. Emergency MT was performed because the onset of severe symptoms had worsened within the last 16 hours. Endovascular intervention resulted in complete vascular reperfusion with an abrupt return of consciousness and a modified Rankin Scale score of 2 four months after transfer.</p><p><strong>Lessons: </strong>Understanding the anatomical and hemodynamic relationships between the BA and AOP is important for the effective treatment of acute BAO. In particular, ischemic changes in the posterior circulation can be reversible despite prolonged symptom duration. https://thejns.org/doi/10.3171/CASE25171.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259629","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":"Neurosurgical management of a giant anterior sacral meningocele in a patient with combined Currarino syndrome and caudal duplication anomaly: illustrative case.","authors":"Khushi H Shah, Seth S Tigchelaar, Adham M Khalafallah, Allan D Levi","doi":"10.3171/CASE2572","DOIUrl":"10.3171/CASE2572","url":null,"abstract":"<p><strong>Background: </strong>Anterior sacral meningoceles (ASMs) are rare spinal lesions that may be associated with Currarino syndrome, a condition defined by the triad of anorectal malformations, sacral anomalies, and a presacral mass. While Currarino syndrome and caudal duplication syndrome are distinct entities, their coexistence is exceptionally rare, with only 2 reported cases-none involving an ASM. The authors present a unique case of an ASM in a patient with Currarino syndrome and features of caudal duplication anomaly.</p><p><strong>Observations: </strong>The patient presented with chronic low back pain, paresthesia in the lateral right thigh, and worsening renal function due to hydronephrosis of her solitary left kidney. Imaging revealed a large ASM compressing the left ureter, resulting in severe hydronephrosis and elevated creatinine levels. Surgical intervention included sacral laminectomy, spinal cord untethering, sectioning of the filum terminale, and disconnection of the fistulous connection between the spinal cord and the sacral meningocele. Postoperatively, her renal function improved, and her headache, paresthesia, and back pain significantly resolved.</p><p><strong>Lessons: </strong>This case underscores the rare coexistence of Currarino syndrome and caudal duplication anomaly, providing valuable insights into the management of an ASM in this setting. https://thejns.org/doi/10.3171/CASE2572.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259630","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":"Cervical vertebral metastases from a recurrent intracranial anaplastic meningioma: illustrative case.","authors":"Grimi Alessandro, Mario De Robertis, Ali Baram, Gabriele Capo, Elena Clerici, Bethania Fernandes, Marco Riva, Federico Pessina, Carlo Brembilla, Maurizio Fornari","doi":"10.3171/CASE24863","DOIUrl":"10.3171/CASE24863","url":null,"abstract":"<p><strong>Background: </strong>Meningiomas represent the most prevalent primary tumors of the central nervous system, with the majority classified as benign (WHO grade I) and exhibiting favorable prognoses. However, a rare subset of meningiomas show malignant behavior, characterized by local invasion and distant metastasis, occurring in less than 1% of cases. Metastatic meningiomas most commonly involve the lungs, bones, liver, and soft tissues, with bone metastases presenting significant diagnostic and therapeutic challenges.</p><p><strong>Observations: </strong>A 61-year-old male with a history of recurrent intracranial meningiomas presented with neck pain and digital paresthesia. Imaging studies revealed lesions at the C4 and C5 vertebrae, accompanied by a pathological fracture at C5. Consequently, a C4 and C5 corpectomy with anterior reconstruction was performed. Histomolecular analysis confirmed the presence of an intraosseous anaplastic meningioma.</p><p><strong>Lessons: </strong>Metastatic meningiomas are an uncommon entity that necessitates a multidisciplinary approach for accurate detection and effective management. The integration of molecular and genetic profiling, along with advanced imaging techniques, may facilitate the identification of high-risk tumors, guide personalized treatment strategies, and ultimately improve patient outcomes. https://thejns.org/doi/10.3171/CASE24863.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210579","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}