Journal of neurosurgery. Case lessons最新文献_第3页

Multilevel spinal fractures in ankylosing spondylitis: illustrative case. 强直性脊柱炎多节段脊柱骨折：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE25236

Matthew A Abikenari, Lindsay S Park, Kelly H Yoo, Ummey Hani, Bhav Jain, Anand Veeravagu

{"title":"Multilevel spinal fractures in ankylosing spondylitis: illustrative case.","authors":"Matthew A Abikenari, Lindsay S Park, Kelly H Yoo, Ummey Hani, Bhav Jain, Anand Veeravagu","doi":"10.3171/CASE25236","DOIUrl":"10.3171/CASE25236","url":null,"abstract":"Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease marked by spinal rigidity, which predisposes patients to unstable fractures even after minor trauma. While isolated spinal fractures in AS are well described, multilevel fractures across the cervical, thoracic, and lumbar spine following a single traumatic event are exceedingly rare and pose substantial diagnostic and surgical challenges.Observations: The authors present the case of a 41-year-old male with advanced AS and a history of alcohol use and diabetes who sustained six unstable spinal fractures spanning the cervical, thoracic, and lumbar regions after a motor vehicle accident. The surgical intervention involved staged posterior spinal fusion (C3-T7, L2-S2 with pelvic extension), open reduction and internal fixation (C6-7, T2-3, L4), and laminectomy (T2-3). Neuronavigation and intraoperative fluoroscopy guided precise instrumentation. The patient had no postoperative neurological deficits and was discharged with a comprehensive postoperative care plan, including physical therapy and follow-up imaging.Lessons: This case underscores the importance of high clinical suspicion and early imaging in AS patients with trauma, given their high risk for occult spinal fractures. Posterior-only surgical approaches can provide effective stabilization in complex multilevel injuries, especially in patients with comorbidities that preclude anterior exposure. https://thejns.org/doi/10.3171/CASE25236.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532071","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

Intrathecal baclofen therapy can improve spasticity associated with infantile-onset dentatorubral-pallidoluysian atrophy: illustrative cases. 鞘内巴氯芬治疗可以改善与婴儿发病的齿状网膜-白斑萎缩相关的痉挛：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE24784

Tomoyoshi Nakagawa, Naoki Tani, Kuriko Kagitani-Shimono, Shin Nabatame, Satoru Oshino, Koichi Hosomi, Hui Ming Khoo, Shuhei Kawabata, Motohisa Hayashi, Ryoko Kuwayma, Rie Nakai, Haruhiko Kishima

{"title":"Intrathecal baclofen therapy can improve spasticity associated with infantile-onset dentatorubral-pallidoluysian atrophy: illustrative cases.","authors":"Tomoyoshi Nakagawa, Naoki Tani, Kuriko Kagitani-Shimono, Shin Nabatame, Satoru Oshino, Koichi Hosomi, Hui Ming Khoo, Shuhei Kawabata, Motohisa Hayashi, Ryoko Kuwayma, Rie Nakai, Haruhiko Kishima","doi":"10.3171/CASE24784","DOIUrl":"10.3171/CASE24784","url":null,"abstract":"Background: In this study, the authors aimed to investigate the efficacy of intrathecal baclofen (ITB) therapy in alleviating intractable spasticity in patients with infantile-onset dentatorubral-pallidoluysian atrophy (DRPLA). Given the lack of effective treatments for the severe spasticity observed in infantile-onset DRPLA patients, this study explored ITB therapy as a potential therapeutic strategy.Observations: The authors included 3 patients (2 males and 1 female, aged 9-24 years) diagnosed with infantile-onset DRPLA who underwent ITB pump implantation. All patients exhibited severe spasticity unresponsive to conventional treatments. Patient demographics, clinical history, cytosine-adenine-guanine repeat number, radiological findings, and symptomatic improvements after ITB therapy were recorded and analyzed. The 3 patients demonstrated marked improvement in spasticity following ITB therapy, with significant reductions in modified Ashworth scale score and alleviation of pain, facilitating easier care and improving quality of life. Improvements were also noted in paroxysmal hypertonia frequency, sleep disturbances, and emaciation.Lessons: ITB therapy significantly reduced intractable spasticity and associated symptoms in patients with infantile-onset DRPLA, offering a promising therapeutic option for this patient population. Further studies are warranted to explore the long-term efficacy and safety of ITB therapy in a larger cohort of DRPLA patients. https://thejns.org/doi/10.3171/CASE24784.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532064","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

Technical nuance of ventriculoperitoneal shunt placement in a patient with cutis verticis gyrata: illustrative case. 脑室-腹膜分流术在旋涡性皮肤患者中的技术差别：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE25174

Youssef J Hamade, Colin Zhu, Elizabeth Ogando-Rivas, Mohsin Khan, Jeffrey E Arle, Emanuela Binello, Ekkehard M Kasper

{"title":"Technical nuance of ventriculoperitoneal shunt placement in a patient with cutis verticis gyrata: illustrative case.","authors":"Youssef J Hamade, Colin Zhu, Elizabeth Ogando-Rivas, Mohsin Khan, Jeffrey E Arle, Emanuela Binello, Ekkehard M Kasper","doi":"10.3171/CASE25174","DOIUrl":"10.3171/CASE25174","url":null,"abstract":"Background: Cutis verticis gyrata (CVG) is a rare benign scalp condition that causes the formation of skin ridges and furrows. Because of the altered scalp anatomy, this condition can pose unique challenges in neurosurgical procedures.Observations: The authors report the case of a 47-year-old man with CVG and neurosarcoidosis who developed hydrocephalus requiring a ventriculoperitoneal shunt. Initial shunt placement at Kocher's point proceeded without complications. However, the patient presented several months later with shunt failure caused by migration of the proximal catheter. The cause of this was determined to be related to the patient's scalp hypermobility. After shunt revision and fixation of the hardware using titanium plates and screws, the patient had an uneventful recovery and a stable outcome at follow-up.Lessons: This case emphasizes the importance of preoperative planning and intraoperative measures tailored to CVG patients. Further research is needed to elucidate the condition's neurosurgical implications and optimize procedural outcomes. https://thejns.org/doi/10.3171/CASE25174.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532075","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

Letter to the Editor Response. 致编辑的信

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE25180

Yu Nomura, Takahiro Morita, Kota Ueno, Ryota Watanabe, Takeshi Katagai, Kenichiro Asano, Atsushi Saito

引用次数: 0

Optic nerve sheath schwannoma: illustrative case. 视神经鞘神经鞘瘤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE25156

George Rudd, Amir Kaywan Aftahy, Bernhard Meyer, Maria Wostrack

{"title":"Optic nerve sheath schwannoma: illustrative case.","authors":"George Rudd, Amir Kaywan Aftahy, Bernhard Meyer, Maria Wostrack","doi":"10.3171/CASE25156","DOIUrl":"10.3171/CASE25156","url":null,"abstract":"Background: In this case report, the authors discuss the diagnosis and treatment of a rare primary optic nerve sheath schwannoma (ONSS). Typically, intracranial schwannomas arise from the vestibular division of cranial nerve VIII and seldom cranial nerves V and VII. This case underscores the need for further documentation of ONSS to better understand its origins, refine diagnostic approaches, and optimize management strategies to enable earlier detection and better outcomes for patients' vision.Observations: The authors present the case of a 36-year-old patient who presented via an ophthalmologist due to visual loss in the left eye. She was initially treated for optic neuritis before further deterioration prompted repeat imaging, demonstrating a left extraorbital lesion distal to the optic chiasm. The patient underwent a complete resection of the lesion via pterional craniotomy in July 2024.Lessons: The authors report the 17th case of ONSS in the literature. Despite the optic nerve's usual myelination pattern, these tumors can form, likely originating from ectopic Schwann cells or perioptic sympathetic fibers. Resection via a pterional approach enabled complete removal without postoperative complications. Because of the rarity of ONSS, further study is essential to enhance diagnosis, treatment, and surgical strategies. https://thejns.org/doi/10.3171/CASE25156.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532072","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

Minimally invasive fixation and management of sacral fibrous dysplasia with impending pathological fracture: illustrative case. 骶骨纤维发育不良伴病理性骨折的微创固定和治疗：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE25159

Dustin J Kress, Rafael Garcia, Jason J Haselhuhn, Yan Zhou, Paari Murugan, Jonathan N Sembrano

{"title":"Minimally invasive fixation and management of sacral fibrous dysplasia with impending pathological fracture: illustrative case.","authors":"Dustin J Kress, Rafael Garcia, Jason J Haselhuhn, Yan Zhou, Paari Murugan, Jonathan N Sembrano","doi":"10.3171/CASE25159","DOIUrl":"10.3171/CASE25159","url":null,"abstract":"Background: Fibrous dysplasia (FD) is a rare, benign fibro-osseous disorder that can compromise structural integrity, particularly in weight-bearing bones like the sacrum. Managing sacral FD is challenging due to the need for both lesion control and biomechanical stabilization.Observations: A 34-year-old woman presented with chronic right sacral pain, functional impairment, and a large lytic lesion in the right sacral ala, later confirmed as FD. Conservative treatment, including physical therapy and epidural steroid injection, failed to provide relief. Imaging revealed an impending pathological fracture, prompting surgical intervention. A minimally invasive approach, including curettage, bone grafting, and iliosacral fixation with ingrowth screws, was performed. The patient experienced significant pain relief, functional improvement, and sustained stability, with 2-year follow-up confirming stable fixation and complete lesion filling.Lessons: This case highlights the role of minimally invasive sacropelvic fixation in preventing structural failure in sacral FD. Integrating biomechanical stabilization with targeted lesion management optimizes outcomes. Long-term follow-up is essential to monitor implant stability and bone remodeling. https://thejns.org/doi/10.3171/CASE25159.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532070","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

Lipomatosis of nerve and osseous nerve territory overgrowth patterns affecting knee: illustrative cases. 影响膝关节的神经和骨神经区域脂肪增生：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE25132

Tomas Marek, Barbara Hanna, Robert J Spinner

{"title":"Lipomatosis of nerve and osseous nerve territory overgrowth patterns affecting knee: illustrative cases.","authors":"Tomas Marek, Barbara Hanna, Robert J Spinner","doi":"10.3171/CASE25132","DOIUrl":"10.3171/CASE25132","url":null,"abstract":"Background: Lipomatosis of the nerve (LN) is a rare peripheral nerve pathology characterized by abundant proliferation of fat within the epineurium giving it pathognomonic features on MRI. Any nerve may be affected, but major nerves such as the median and sciatic nerves are most reported. One of the clinical hallmarks of LN is associated bony and soft tissue overgrowth occurring distal to the nerve lesion. While macrodactyly and limb length overgrowth are well known in LN, this study aims to look at nerve territory bony overgrowth affecting the knee.Observations: An initial search revealed 59 cases of LN in the Mayo Clinic system. Of 19 patients with LN of the lower limbs, 12 cases involved nerves in the pelvis, buttock, or thigh. Three cases fulfilled the criteria (LN of lower extremity with available MR images and knee radiographs) that affected the femoral, sciatic, and combined femoral/sciatic nerves. Knee radiographs revealed bony overgrowth in the respective nerve territories in each case: anterior, posterior, and both anterior and posterior portions of the knee.Lessons: These illustrative cases of LN with overgrowth of the knee demonstrate that bone overgrowth follows the territory of the associated nerve in LN, which supports the previously published evidence on LN-associated nerve territory overgrowth. https://thejns.org/doi/10.3171/CASE25132.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532069","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

Takayasu arteritis with a ruptured intracranial aneurysm in a pediatric patient: illustrative case. 小儿高须动脉炎伴颅内动脉瘤破裂：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE25166

Naohito Seki, Masakazu Okawa, Hideo Chihara, Masahiro Sawada, Takeshi Funaki, Takayuki Kikuchi, Chiaki Sakai, Taichi Ikedo, Yoshiki Arakawa

引用次数: 0

A rare case of intradural intramedullary cervical spinal neurenteric cyst in an adult: illustrative case. 一例罕见的成人硬膜内髓内颈脊髓神经肠囊肿：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE25253

Carl Porto, Raj Thakrar, Hael Abdulrazeq, Abigail Teshome, Navin Ramesh, Jennifer Dailey, Harry Rosenberg, Jared Fridley

{"title":"A rare case of intradural intramedullary cervical spinal neurenteric cyst in an adult: illustrative case.","authors":"Carl Porto, Raj Thakrar, Hael Abdulrazeq, Abigail Teshome, Navin Ramesh, Jennifer Dailey, Harry Rosenberg, Jared Fridley","doi":"10.3171/CASE25253","DOIUrl":"10.3171/CASE25253","url":null,"abstract":"Background: Neurenteric cysts are rare congenital lesions of the CNS, typically found in the cervical or thoracic spine and presenting in early life. Only 5% of spinal neurenteric cysts are intramedullary. The authors report the case of an intradural intramedullary neurenteric cyst in a 68-year-old woman.Observations: The patient presented with 4 months of progressive left extremity numbness, weakness, and imbalance consistent with cervical myelopathy. MRI revealed a 1-cm cystic lesion in the intradural intramedullary cervical spine. Multilevel posterior cervical laminectomy for cyst resection was performed with gross-total resection. Histopathological analysis revealed squamous, columnar, and pseudostratified epithelium positive for epithelial membrane antigen and cytokeratin and negative for glial fibrillary acidic protein and S100 protein, consistent with a neurenteric cyst. Her symptoms and examination significantly improved after surgery.Lessons: Neurenteric cysts comprise 1% of spinal lesions, and 5% are intradural intramedullary. Symptoms progress gradually but may fluctuate with cyst size changes. MRI is the preferred imaging, with histopathological analysis required for diagnosis. Operative intervention for gross-total resection is the recommended management. This case emphasizes that neurenteric cysts should be considered in older adults with cervical myelopathy and a cystic intramedullary mass and demonstrates the benefit of complete surgical removal. https://thejns.org/doi/10.3171/CASE25253.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532061","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

Removal of a nonmissile, transorbital, intracranial glass shard: illustrative case. 非飞弹，经眼眶，颅内玻璃碎片的移除：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-06-30 DOI: 10.3171/CASE24851

Aaron Miller, Matheus P Pereira, Jeffrey Wessell, Isaiah Miller, Guilherme Porto

{"title":"Removal of a nonmissile, transorbital, intracranial glass shard: illustrative case.","authors":"Aaron Miller, Matheus P Pereira, Jeffrey Wessell, Isaiah Miller, Guilherme Porto","doi":"10.3171/CASE24851","DOIUrl":"10.3171/CASE24851","url":null,"abstract":"Background: The management of nonmissile penetrating head injuries is not well established given the heterogeneity of injuries described. The authors describe the management of a patient who presented to their institution along with a review of the literature.Observations: The glass shard was removed in the operating room with the ophthalmology team without complication. A diagnostic cerebral angiogram was also obtained in an urgent and delayed fashion. A total of 53 studies with 90 patients were included. The mean age was 27 years, and 86% of subjects were male. The frontal region violated via metal spike was the most common location of injury. Prophylactic antibiotics and antiepileptic drugs were administered in 68% and 24%, respectively. Craniotomy for removal was performed in 82% of cases and infection occurred in 6%.Lessons: Emergency CT angiography should be obtained when concern for vascular injury based on trajectory or significant depth of penetration exists. Immediate administration of prophylactic antibiotics and AEDs should be completed. Diagnostic angiography for suspicion of vessel injury in an urgent and delayed fashion should be performed. Removal of intracranial objects should only occur in the operating room. Immediate postoperative CT should be utilized to rule out worsening of intracranial injury. https://thejns.org/doi/10.3171/CASE24851.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532073","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