Journal of neurosurgery. Case lessons最新文献_第4页

Long-term outcomes and radiation-induced complications following stereotactic radiosurgery for a left temporal arteriovenous malformation: illustrative case. 立体定向放射手术治疗左颞动静脉畸形的长期预后和放射引起的并发症：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-26 DOI: 10.3171/CASE25201

Moustafa A Mansour, Mohamed Abdel-Fattah El-Salamoni, Hamdi Nabawi Mostafa

{"title":"Long-term outcomes and radiation-induced complications following stereotactic radiosurgery for a left temporal arteriovenous malformation: illustrative case.","authors":"Moustafa A Mansour, Mohamed Abdel-Fattah El-Salamoni, Hamdi Nabawi Mostafa","doi":"10.3171/CASE25201","DOIUrl":"10.3171/CASE25201","url":null,"abstract":"Background: Cerebral arteriovenous malformations (AVMs) are complex vascular anomalies associated with significant risks of hemorrhage and neurological deficits. Stereotactic radiosurgery (SRS) has emerged as a viable treatment option, particularly for small, deep-seated, or eloquent lesions, offering a less invasive alternative to microsurgical resection. However, SRS carries risks, including radiation-induced complications such as radiation necrosis.Observations: This report describes the case of a 24-year-old male with a left temporal AVM, classified as Spetzler-Martin grade II, who underwent SRS with a marginal dose of 18 Gy. Over a 36-month follow-up period, complete obliteration of the AVM nidus was achieved. However, significant radiation-induced complications emerged, including vasogenic edema, radiation necrosis, memory deficits, partial seizures, and bilateral visual field defects. These complications peaked around 20 months post-SRS, requiring long-term management with corticosteroids, diuretics, and anticonvulsants.Lessons: This case underscores the importance of balancing the benefits of AVM obliteration with the risks of radiation-induced injury. While SRS is effective for treating AVMs, particularly in high-risk locations, the potential for delayed complications highlights the need for careful patient selection, meticulous treatment planning, and long-term follow-up. The report also discusses the pathophysiology of radiation-induced necrosis, strategies to mitigate its risk, and the role of advanced imaging techniques in optimizing treatment planning. https://thejns.org/doi/10.3171/CASE25201.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153061","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

Bilateral anteromedial petrosectomy via endoscopic endonasal transclival approach for calcified sphenopetroclival chondrosarcoma with petrous apices and cavernous sinus involvement: technical nuances of a minimally invasive solution. Illustrative case. 经鼻内窥镜经巩膜入路行双侧前内侧岩石切除术治疗伴有岩尖和海绵窦累及的钙化蝶斜坡软骨肉瘤：微创解决方案的技术差别。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-26 DOI: 10.3171/CASE25119

Mehdi Khaleghi, Adnan Hussain Shahid, Danner Butler, Garrett Dyess, Ursula Noelle Hummel, Asa Record Barnett, Jai Deep Thakur

{"title":"Bilateral anteromedial petrosectomy via endoscopic endonasal transclival approach for calcified sphenopetroclival chondrosarcoma with petrous apices and cavernous sinus involvement: technical nuances of a minimally invasive solution. Illustrative case.","authors":"Mehdi Khaleghi, Adnan Hussain Shahid, Danner Butler, Garrett Dyess, Ursula Noelle Hummel, Asa Record Barnett, Jai Deep Thakur","doi":"10.3171/CASE25119","DOIUrl":"10.3171/CASE25119","url":null,"abstract":"Background: Sphenopetroclival chondrosarcomas (SPCCs) typically present as paramidline lytic tumors. Bilateral disease or calcific degeneration is infrequent but associated with increased surgical morbidity and suboptimal removal when adhering to neurovascular structures. The endoscopic endonasal transclival approach (EETA) effectively accesses the retrocarotid space using angled instruments. The authors present the technical nuances of EETA for a large calcified SPCC with bilateral petrous apex involvement without utilizing a full transpterygoid approach or carotid mobilization.Observations: A 41-year-old male presented with chronic, nonspecific headaches. CT imaging revealed a large sclerotic-lytic mass in the upper-middle clival area involving both petrous apices. MRI showed anterior pontine compression, bilateral cavernous sinus involvement, and partial encasement of the left cavernous carotid artery (CCA). An EETA with bilateral anteromedial petrosectomy and transcavernous access was performed, and near-total resection was achieved. Histopathology confirmed a grade 1 conventional chondrosarcoma, and the patient subsequently underwent proton beam radiotherapy. Surveillance imaging showed stable residual attached to the left CCA and posterior clinoid process.Lessons: EETA offers maximal safe resection of SPCC with bilateral anteromedial petrous apex involvement without the need for complex maneuvers that could jeopardize carotid arteries or vidian nerves. When judiciously planned, low recurrence rates are expected for low-grade tumors. https://thejns.org/doi/10.3171/CASE25119.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153039","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

Endoscopic percutaneous extraction of a retained bullet fragment in the lumbar spine for lead toxicity management: illustrative case. 内镜下经皮取出腰椎残留子弹碎片用于铅中毒处理：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-26 DOI: 10.3171/CASE2538

Richard J Chung, Ryan Screven, Diego T Soto-Rubio, Elliot G Neal, Jay I Kumar, Erik Hayman, Patrick Kim

{"title":"Endoscopic percutaneous extraction of a retained bullet fragment in the lumbar spine for lead toxicity management: illustrative case.","authors":"Richard J Chung, Ryan Screven, Diego T Soto-Rubio, Elliot G Neal, Jay I Kumar, Erik Hayman, Patrick Kim","doi":"10.3171/CASE2538","DOIUrl":"10.3171/CASE2538","url":null,"abstract":"Background: It is often common practice to leave gunshot wound (GSW) bullet fragments in the spinal column given the morbidity of surgical removal. When extraction is indicated, the least invasive approach is favored to preserve surrounding neurovascular structures, particularly in cases without focal neurological deficits. This report highlights a percutaneous endoscopic technique for the retrieval of a retained bullet causing lead toxicity.Observations: The authors present the case of an 18-year-old female who presented for a GSW bullet lodged within her lumbar spine, who was neurologically intact with no overt instability. Outpatient follow-up was concerning for elevating blood lead serum levels of 12 μg/dL, which exceeded WHO guidelines of < 5 μg/dL. She underwent endoscopic removal of the bullet with no complications and subsequent improvement of her lead levels.Lessons: Endoscopic techniques present a promising approach for removing bullets from the spine, with reduced tissue trauma, improved visualization, and shorter recovery times compared with traditional open or minimally invasive surgery. In cases of retained bullet fragments with no focal deficit, migration, or instability, conservative management with serial lead monitoring is recommended. However, when surgical removal is indicated from lead toxicity, endoscopic extraction of foreign bullets can be considered as an effective, yet less invasive alternative to open or minimally invasive surgical procedures. https://thejns.org/doi/10.3171/CASE2538.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153041","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

An adult patient with initial presentation of myxopapillary ependymoma at the cerebellopontine angle: illustrative case. 一例成年患者，最初表现为桥小脑角黏液乳头状室管膜瘤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-26 DOI: 10.3171/CASE2586

Khatcher O Margossian, Marcin Marciniak, Akram Al-Warqi, Kenneth Aldape, Mehmet Kocak, Lorenzo Munoz, Elias Michaelides, Michael S Marshall

{"title":"An adult patient with initial presentation of myxopapillary ependymoma at the cerebellopontine angle: illustrative case.","authors":"Khatcher O Margossian, Marcin Marciniak, Akram Al-Warqi, Kenneth Aldape, Mehmet Kocak, Lorenzo Munoz, Elias Michaelides, Michael S Marshall","doi":"10.3171/CASE2586","DOIUrl":"10.3171/CASE2586","url":null,"abstract":"Background: Myxopapillary ependymomas (MPEs) are a relatively rare subtype of ependymoma that occur almost exclusively at the conus medullaris and filum terminale in the lumbosacral spine. Intracranial occurrences of this tumor are rare, and of those, localization to the cerebellopontine angle (CPA) is an exceptional event. To the authors' knowledge, this is the fifthreported MPE in the CPA and only the third reported instance of an MPE in the CPA at the initial presentation.Observations: The authors describe an adult patient with an initial presentation of MPE at the CPA, originally thought to be a schwannoma on radiological imaging. Follow-up imaging later revealed additional clinically asymptomatic spinal masses consistent with MPEs. This case is particularly unique not only because of the patient's presenting symptoms being exclusive to tinnitus and ear fullness without any spinal symptoms, but also because it is the first case, to the authors' knowledge, in which DNA methylation profiling results have been reported to confirm the diagnosis of MPE in the CPA.Lessons: This case highlights the importance of considering a broad differential diagnosis for lesions in the CPA. https://thejns.org/doi/10.3171/CASE2586.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152996","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

Theophylline can resolve refractory acute negative-pressure hydrocephalus: illustrative case. 茶碱能治疗难治性急性负压性脑积水：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-26 DOI: 10.3171/CASE2554

Smeer Salam, Miguel Quintero-Consuegra, Megan V Ryan, Enrique Vargas, Catherine Garcia, Serena Wong, Maryam Rejali, Robin Babadjouni, Adam N Mamelak

{"title":"Theophylline can resolve refractory acute negative-pressure hydrocephalus: illustrative case.","authors":"Smeer Salam, Miguel Quintero-Consuegra, Megan V Ryan, Enrique Vargas, Catherine Garcia, Serena Wong, Maryam Rejali, Robin Babadjouni, Adam N Mamelak","doi":"10.3171/CASE2554","DOIUrl":"10.3171/CASE2554","url":null,"abstract":"Background: Negative-pressure hydrocephalus is characterized by neurological deterioration with ventriculomegaly but negative intracranial pressure (ICP), clinically indistinguishable from acute hydrocephalus with elevated ICP. Subatmospheric CSF drainage, neck wrapping, endoscopic third ventriculostomy (ETV), and shunt placement are treatment methods. Medical therapy remains elusive. The authors describe a patient with refractory negative-pressure hydrocephalus who failed conventional therapies but responded robustly to theophylline.Observations: A 30-year-old man with traumatic brain injury underwent decompressive hemicraniectomy, cranioplasty, and ventriculoperitoneal shunt placement. He was later rehospitalized for acute hydrocephalus and shunt infection. Surgical revision was complicated by intraventricular hemorrhage with worsening hydrocephalus. An external ventricular drain was inserted, demonstrating negative ICP. Treatment for more than 3 months with subzero drainage, two ETVs, and ventriculopleural shunt placement was unsuccessful. Theophylline was initiated and the ventriculomegaly improved drastically on imaging with increased ICP. He developed status epilepticus, managed medically, with resolution within 5 days. He was discharged with return to his neurological baseline.Lessons: Theophylline, a methylxanthine derivate used for obstructive pulmonary disease, can raise ICP in intracranial hypotension. The authors present the first successful case of theophylline for the treatment of refractory acute negative-pressure hydrocephalus. Further studies are warranted to explore the safety and efficacy of theophylline for negative-pressure hydrocephalus. https://thejns.org/doi/10.3171/CASE2554.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153145","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

Flow reversal bypass surgery for giant intracranial aneurysms: illustrative cases. 颅内巨动脉瘤的血流逆转搭桥手术：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-26 DOI: 10.3171/CASE2583

Madeleine de Lotbiniere-Bassett, Mohammed Hasen, William T Couldwell

{"title":"Flow reversal bypass surgery for giant intracranial aneurysms: illustrative cases.","authors":"Madeleine de Lotbiniere-Bassett, Mohammed Hasen, William T Couldwell","doi":"10.3171/CASE2583","DOIUrl":"10.3171/CASE2583","url":null,"abstract":"Background: Giant intracranial aneurysms (GIAs) have no definitive treatment paradigm. Flow reversal bypass (FRB) through high- or low-flow extracranial-to-intracranial bypass may facilitate aneurysm thrombosis while maintaining perforator patency, yet predicting when FRB will be successful remains challenging. The authors compared 2 patients with GIAs after FRB surgery to illustrate the successes and possible pitfalls.Observations: The first patient was a 13-year-old boy with giant, partially thrombosed, unruptured aneurysms of the internal carotid artery and upper basilar artery. The second patient was a 38-year-old man with a giant unruptured proximal middle cerebral artery (MCA) M1 aneurysm. Both underwent FRB. The child's upper basilar aneurysm resolved completely without complication. The adult experienced progressive aneurysm recanalization after initial thrombosis and associated MCA territory infarct requiring a subsequent trapping procedure with clipping of distal outflow, which has not been described previously.Lessons: For select patients with GIAs, proximal occlusion paired with flow reversal is a promising surgical technique that may balance aneurysm thrombosis with maintenance of distal and perforator perfusion. The significant procedural risks of FRB surgery must be balanced with the aggressive natural history of GIAs. Future directions include aneurysm and perforator vessel flow analysis and careful documentation of aneurysm filling following high-flow bypass. https://thejns.org/doi/10.3171/CASE2583.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153045","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

Surgical treatment strategies for intracranial fusiform aneurysms secondary to cardiac myxomas: illustrative case. 心脏黏液瘤继发的颅内梭状动脉瘤的手术治疗策略：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-26 DOI: 10.3171/CASE2590

Wu Xinyu, Wei Zhen, Fuyong Li, Peng Cao

{"title":"Surgical treatment strategies for intracranial fusiform aneurysms secondary to cardiac myxomas: illustrative case.","authors":"Wu Xinyu, Wei Zhen, Fuyong Li, Peng Cao","doi":"10.3171/CASE2590","DOIUrl":"10.3171/CASE2590","url":null,"abstract":"Background: Intracranial myxomatous aneurysms secondary to cardiac myxomas are rare. Fusiform aneurysms, often multiple and predominantly involving distal vessels, represent the predominant manifestation. To date, there remains no consensus on the optimal management strategy for these fusiform aneurysms.Observations: The authors present the first case of a patient who underwent resection of a middle cerebral artery aneurysm and M3-superficial temporal artery (STA)-M3 end-to-end anastomosis bypass surgery 10 years following cardiac myxoma resection. They also review case reports on the treatment, neurological symptoms, and prognosis of fusiform aneurysms secondary to cardiac myxomas since 2005.Lessons: Treatment options for aneurysms encompass conservative management, embolization, radiation therapy, clipping, resection, and combined bypass procedures. Among the cases included this report, only 1 patient died during follow-up; the rest of the patients had a good prognosis. Although the natural course of unruptured, seemingly benign aneurysms seems favorable, many patients experience concurrent neurological symptoms. Aneurysm resection combined with M3-STA-M3 end-to-end anastomosis bypass is an effective treatment for fusiform aneurysms and reducing the risk of cerebral ischemia. https://thejns.org/doi/10.3171/CASE2590.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153143","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

Rare case of de novo anastomotic site aneurysm after anterior cerebral artery side-to-side bypass: curative treatment with superficial temporal artery interposition graft-assisted trapping and etiological analysis. Illustrative case. 脑前动脉侧对侧搭桥术后新生吻合口动脉瘤罕见病例：颞浅动脉间置移植术治疗及病因分析。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-19 DOI: 10.3171/CASE25100

Gahn Duangprasert, Nakao Ota, Yulius Hermanto, Sergi Cobos Codina, Kosumo Noda, Rokuya Tanikawa

{"title":"Rare case of de novo anastomotic site aneurysm after anterior cerebral artery side-to-side bypass: curative treatment with superficial temporal artery interposition graft-assisted trapping and etiological analysis. Illustrative case.","authors":"Gahn Duangprasert, Nakao Ota, Yulius Hermanto, Sergi Cobos Codina, Kosumo Noda, Rokuya Tanikawa","doi":"10.3171/CASE25100","DOIUrl":"10.3171/CASE25100","url":null,"abstract":"Background: De novo aneurysms occurring at the anastomotic site are extremely uncommon, especially following side-to-side (STS) bypass for anterior cerebral artery (ACA) revascularization. Their etiology remains uncertain; however, it is believed to be related to hemodynamic shear stress and inherent vascular fragility, potentially linked to genetic anomalies. Furthermore, surgical intervention is mandatory to avert aneurysm growth or rupture.Observations: A 38-year-old-male first presented with a large fusiform aneurysm of the left distal ACA and underwent ACA-ACA STS bypass with aneurysm excision. Nonetheless, the de novo aneurysm was discovered to arise at the bypass site 7 months after the operation. Subsequently, a strategic radical intervention was performed. At the 26-month follow-up, the patient's modified Rankin Scale score was 0, and there was good bypass patency without aneurysm recurrence. The aneurysm formation was attributed to the fragility of the underlying arterial wall, which might be aggravated by STS bypass as evidenced by the histological findings and computational fluid dynamics (CFD) analysis.Lessons: The revascularization strategy must be executed cautiously given the existence of wall disease, which poses a risk for aneurysm formation, particularly following modification by STS bypass, as demonstrated by CFD and histological findings. Careful monitoring and long-term vascular assessment are crucial. https://thejns.org/doi/10.3171/CASE25100.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103364","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

Congenital hypoplasia of the right C6 pedicle and anomalous vertebral artery entry: illustrative case. 先天性右C6椎弓根发育不全和椎动脉进入异常：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-19 DOI: 10.3171/CASE25161

Asma Eslami, Gabriel Dos Reis Correa, Darius Ansari, Allison M Grayev, Amgad S Hanna

{"title":"Congenital hypoplasia of the right C6 pedicle and anomalous vertebral artery entry: illustrative case.","authors":"Asma Eslami, Gabriel Dos Reis Correa, Darius Ansari, Allison M Grayev, Amgad S Hanna","doi":"10.3171/CASE25161","DOIUrl":"10.3171/CASE25161","url":null,"abstract":"Background: Congenital anomalies of the cervical spine are rare, often asymptomatic conditions that may only be detected incidentally. However, they can have significant clinical implications, particularly when associated with vascular anomalies. This case highlights a unique combination of congenital hypoplasia of the C6 pedicle and superior articulating facet, resulting in an anomalous course of the vertebral artery (VA).Observations: A 28-year-old female presented to the emergency department after a minor trauma without neurological deficits. Imaging revealed congenital hypoplasia of the right C6 pedicle and superior articulating facet, absence of the C6 transverse foramen, and anomalous entry of the right VA at the C5 transverse foramen. The patient was managed conservatively with a cervical collar and remained neurologically intact at follow-up.Lessons: This case underscores the importance of thorough radiological evaluation in identifying rare cervical spine malformations and their potential clinical significance. Recognition of such anomalies is critical for surgical planning and risk mitigation, especially during anterior cervical spine procedures. https://thejns.org/doi/10.3171/CASE25161.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103342","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

Postoperative paralysis following the surgery for thoracic ossification of the posterior longitudinal ligament: perioperative and intraoperative management strategies. Illustrative case. 胸后纵韧带骨化术后瘫痪：围手术期和术中处理策略。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-19 DOI: 10.3171/CASE25195

Kohei Takahashi, Ko Hashimoto, Kenichiro Yahata, Takahiro Onoki, Junya Kusakabe, Tomonori Kawaharada, Toshimi Aizawa

{"title":"Postoperative paralysis following the surgery for thoracic ossification of the posterior longitudinal ligament: perioperative and intraoperative management strategies. Illustrative case.","authors":"Kohei Takahashi, Ko Hashimoto, Kenichiro Yahata, Takahiro Onoki, Junya Kusakabe, Tomonori Kawaharada, Toshimi Aizawa","doi":"10.3171/CASE25195","DOIUrl":"10.3171/CASE25195","url":null,"abstract":"Background: The treatment of thoracic ossification of the posterior longitudinal ligament (OPLL) remains a significant challenge, with a postoperative paralysis rate exceeding 30%. The underlying mechanisms of postoperative paralysis are still unclear, necessitating further investigation into potential risk factors and preventive strategies.Observations: The authors report the case of a 42-year-old male with diabetes and hypertension who developed complete lower limb paralysis after surgery for thoracic myelopathy due to OPLL. Intraoperative monitoring showed absent motor evoked potentials until the posterior longitudinal ligament was severed, after which they became detectable. The surgery lasted more than 13 hours, with mean arterial pressure maintained between 44 and 91 mm Hg. Postoperative MRI revealed extensive spinal cord edema without severe compression. The exact cause of postoperative paralysis in this case remains unclear; however, possible causes include white cord syndrome or spinal cord ischemia.Lessons: Postoperative paralysis in thoracic OPLL surgery remains poorly understood. Identifying and addressing risk factors for spinal cord ischemia and reperfusion injury are crucial. The authors propose strategies to reduce risk, including prone and supine position tests, the use of an ultrasonic surgical aspirator to prevent heat-induced spinal cord damage, shortening surgical duration, and meticulous blood pressure management. https://thejns.org/doi/10.3171/CASE25195.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103350","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