Journal of neurosurgery. Case lessons最新文献_第5页

Selective resection of the medial wall of the cavernous sinus in acromegaly: patient series. 肢端肥大症的海绵窦内侧壁选择性切除：患者系列。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE2665

Rob A Vergeer, Mark R Postma, Melanie M van der Klauw, Astrid G W Korsten-Meijer, Robert A Feijen, Wilfred F A den Dunnen, J Marc C van Dijk, Jos M A Kuijlen

{"title":"Selective resection of the medial wall of the cavernous sinus in acromegaly: patient series.","authors":"Rob A Vergeer, Mark R Postma, Melanie M van der Klauw, Astrid G W Korsten-Meijer, Robert A Feijen, Wilfred F A den Dunnen, J Marc C van Dijk, Jos M A Kuijlen","doi":"10.3171/CASE2665","DOIUrl":"10.3171/CASE2665","url":null,"abstract":"Background: Transsphenoidal surgery (TSS) is the primary treatment of choice in acromegaly. Tumor invasion into the medial wall of the cavernous sinus (MWCS) has been observed, even in Knosp grades 0-2, and may lead to suboptimal surgical results if not additionally resected. Removal of the MWCS may enhance the surgical outcome and result in improved endocrine remission rates. The aim of this study was to evaluate the impact of additional MWCS resection during TSS for acromegaly on endocrine remission and complication rates. The authors prospectively collected the data of acromegaly patients at a large tertiary pituitary referral center. Between January 2023 and January 2025, patients treated with TSS and additional selective resection of the MWCS were included. Patient demographics, tumor characteristics, surgical outcome, and postoperative complications were reviewed.Observations: Twelve patients were included (9 primary TSS, 3 re-TSS). Tumor invasion of the MWCS was confirmed in 91.7%. The median follow-up was 19 months (range 3-27 months). After primary TSS, 8 of 9 patients (88.9%) were in endocrine remission. Following re-TSS, remission was observed in 33.3%. Ultimately, disease control was achieved in 11 of 12 patients (91.7%). No carotid injuries or permanent neurological deficits were observed.Lessons: Additional selective resection of the MWCS during TSS in acromegaly is a technique that can be safely executed, and it seems to enhance endocrine remission rates especially in primary TSS. https://thejns.org/doi/10.3171/CASE2665.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679150","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

Cost-effective unilateral biportal endoscopic microdiscectomy: illustrative case. 具有成本效益的单侧双门静脉内镜显微椎间盘切除术：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE2678

Shivani Mody, Tomo Kinoshita, Tyler C Steed, Ki-Eun Chang, Michael H Lawless DO

{"title":"Cost-effective unilateral biportal endoscopic microdiscectomy: illustrative case.","authors":"Shivani Mody, Tomo Kinoshita, Tyler C Steed, Ki-Eun Chang, Michael H Lawless DO","doi":"10.3171/CASE2678","DOIUrl":"10.3171/CASE2678","url":null,"abstract":"Background: Unilateral biportal endoscopic (UBE) spine surgery is an ultra-minimally invasive technique that provides enhanced visualization while minimizing the tissue disruption associated with traditional open surgery. It utilizes separate portals for visualization and instrumentation, which allows for tactile feedback and freedom of movement similar to open procedures.Observations: Despite these advantages, a significant barrier to the widespread adoption of endoscopic spine surgery can be capital expense for specialized endoscopic systems. This technical paper aims to overcome that barrier by providing a detailed, step-by-step guide for performing a UBE microdiscectomy utilizing standard arthroscopic and basic spine equipment that are widely available.Lessons: The authors describe patient positioning, operating room setup, portal placement, fluid management, and a systematic approach to decompression. Key steps, including establishing the visualization window and managing hemostasis, are detailed. The authors also discuss postoperative considerations and provide technical tips to shorten the learning curve. By leveraging standard instrumentation, this technique makes the benefits of UBE surgery more accessible to surgeons and institutions, thereby lowering the financial barrier to adoption without compromising surgical goals. https://thejns.org/doi/10.3171/CASE2678.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679925","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

Anatomical localization and resection of a refractory epileptic focus in the right supplementary motor area/presupplementary motor area using augmented reality: illustrative case. 应用增强现实技术对右侧辅助运动区/前辅助运动区顽固性癫痫病灶的解剖定位和切除：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE25611

Venina S Kalistratova, Gabriel Urreola, E Brandon Strong, Paolo Palmisciano, Rocelle Evangelista, Osama Raslan, Julia D Sharma

{"title":"Anatomical localization and resection of a refractory epileptic focus in the right supplementary motor area/presupplementary motor area using augmented reality: illustrative case.","authors":"Venina S Kalistratova, Gabriel Urreola, E Brandon Strong, Paolo Palmisciano, Rocelle Evangelista, Osama Raslan, Julia D Sharma","doi":"10.3171/CASE25611","DOIUrl":"10.3171/CASE25611","url":null,"abstract":"Background: Medically refractory seizures occur in up to 30% of patients with epilepsy. Treatments may include neuromodulation, ablative procedures, and stereotactic surgery. Cutting-edge technology, such as neuroimaging, anatomical mapping, electroencephalography, and augmented reality (AR), assist in localization and safer treatment planning.Observations: A 26-year-old male with focal onset epilepsy underwent phase II monitoring with stereo-electroencephalography (sEEG) that localized his seizure focus to the right supplementary motor area (SMA)/pre-SMA. A combination of traditional navigation, phase-reversal electrocorticography, and AR was used to perform anatomical localization and verification to assist with craniotomy and resection. He is now seizure free with no significant neurological deficit 9 months after surgery.Lessons: AR has multiple applications in neurosurgery, including preoperative planning, anatomical verification, and intraoperative guidance. In this case, AR navigation provided real-time 3D overlays of MRI- and CT-derived patient anatomy onto the surgical field, allowing visualization of segmented cortical surface anatomy, vascular structures, white matter tracts, and electrodes via voice commands. This enabled precise mapping of deep-seated anatomy and electrode trajectories without increasing operative time or complication risk. Given the early stage of the technology, AR was used adjunctively with neuronavigation during SMA/pre-SMA resection and demonstrated localization concordant with traditional mapping techniques. https://thejns.org/doi/10.3171/CASE25611.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679940","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

Massive brain swelling after cranioplasty in the setting of severe sunken flap syndrome: illustrative case. 严重皮瓣凹陷综合征颅骨成形术后大面积脑肿胀：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE2659

Austin Walker, Michael Feldman, Ronald Alvarado-Dyer

{"title":"Massive brain swelling after cranioplasty in the setting of severe sunken flap syndrome: illustrative case.","authors":"Austin Walker, Michael Feldman, Ronald Alvarado-Dyer","doi":"10.3171/CASE2659","DOIUrl":"10.3171/CASE2659","url":null,"abstract":"Background: Massive brain swelling after cranioplasty (MBSC) is a rare but frequently fatal complication characterized by cerebral edema following cranial vault reconstruction. Evidence suggests that MBSC occurs in patients with chronic intracranial hypotension, often in the setting of severe sinking skin flap (SSF) syndrome after decompressive craniectomy (DC).Observations: The authors report a case of MBSC in a 42-year-old man who underwent custom cranioplasty 5 months after DC. Preoperative imaging demonstrated SSF syndrome with a 15-mm midline shift. Within 1 hour after surgery, the patient developed a seizure followed by rapid neurological deterioration. CT of the head revealed diffuse supratentorial and cerebellar edema with a new intraparenchymal hemorrhage. Despite aggressive medical therapy and emergency removal of the implant with re-decompression, the patient sustained profound neurological injury.Lessons: This case highlights the malignant presentation pattern of MBSC and underscores severe SSF syndrome as a critical preoperative risk state. Sudden restoration of the cranial vault may precipitate a pathological intracranial pressure surge in patients chronically adapted to intracranial hypotension. Cranioplasty timing and seizure activity may impact MBSC risk. Further study is needed to clarify optimal timing strategies and prophylactic antiseizure therapy. Heightened perioperative vigilance and explicit risk counseling may be necessary, as outcomes remain poor once the MBSC cascade is established. https://thejns.org/doi/10.3171/CASE2659.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680002","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

Neurogenic irritable bowel syndrome? Long-term resolution of chronic gastrointestinal stress following vagus nerve microvascular decompression: illustrative case. 神经源性肠易激综合征？迷走神经微血管减压后慢性胃肠道应激的长期解决：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE2688

James Tanner McMahon, Roy Raheb Khelo, Brent D Weinberg, Nicholas M Boulis

{"title":"Neurogenic irritable bowel syndrome? Long-term resolution of chronic gastrointestinal stress following vagus nerve microvascular decompression: illustrative case.","authors":"James Tanner McMahon, Roy Raheb Khelo, Brent D Weinberg, Nicholas M Boulis","doi":"10.3171/CASE2688","DOIUrl":"10.3171/CASE2688","url":null,"abstract":"Background: Microvascular decompression (MVD) is a well-established treatment for compressive cranial neuralgias such as trigeminal neuralgia and hemifacial spasm. The vagus nerve (cranial nerve [CN] X), with its extensive parasympathetic innervation to the gastrointestinal (GI) system, has less clearly defined neuropathic symptomatology, and MVD of CN X has only been reported once. The authors report a unique case of treatment-refractory GI distress that resolved completely following CN X MVD.Observations: A 32-year-old male with a 13-year history of hemifacial spasm also experienced chronic, debilitating GI distress characterized by sudden, painful abdominal cramping and diarrhea. Despite extensive workup, including three colonoscopies, no clear etiology was found. During MVD for his facial nerve, a large vertebral artery loop was incidentally found significantly displacing CN X. Both nerves were decompressed. Both the patient's hemifacial spasms and GI symptoms resolved immediately, and this has persisted for more than 5 years of follow-up.Lessons: While vagal injury (including intentionally via vagotomy) results in gastroparesis, the authors propose that chronic CN X compression may induce a \"hyperactive rhizopathy\" resulting in symptoms of overactive peristalsis. CN X compression may be an underrecognized, reversible etiology of chronic GI distress, and clinicians should consider the possibility of neurovascular conflict in this patient population. https://thejns.org/doi/10.3171/CASE2688.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147680028","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

Facial lymphatic malformation: the root cause of trigeminal neuralgia is not its root. Illustrative case. 面部淋巴畸形：三叉神经痛的根本原因不是其根源。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE25973

Intouch Sopchokchai, Benjamin K H Ho, Andrius Radziunas, Stefan T Lang, Manraj K S Heran, Christopher R Honey

{"title":"Facial lymphatic malformation: the root cause of trigeminal neuralgia is not its root. Illustrative case.","authors":"Intouch Sopchokchai, Benjamin K H Ho, Andrius Radziunas, Stefan T Lang, Manraj K S Heran, Christopher R Honey","doi":"10.3171/CASE25973","DOIUrl":"10.3171/CASE25973","url":null,"abstract":"Background: Trigeminal neuralgia (TN) is commonly caused by a vascular compression of the trigeminal nerve (classical TN). Due to the high frequency of this compression at the nerve's root entry zone, a misunderstanding has arisen in the literature that this location is the only site that can cause TN. The present case demonstrates that TN can be caused by compression anywhere along the nerve-even in the face.Observations: A 15-year-old female presented with medically refractory left TN. MRI revealed no neurovascular conflict at the root entry zone, but ultrasound revealed a lymphatic malformation in her face. After the lesion was sclerosed with bleomycin, her TN pain improved significantly.Lessons: Trigeminal nerve compression distal to the root entry zone, although uncommon, is a treatable cause of TN. Treatment for classical TN should consider the full anatomical course of the nerve and potential compression points. This case challenges the conventional understanding that TN is exclusively caused by compression at its more vulnerable root entry zone. https://thejns.org/doi/10.3171/CASE25973.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679922","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

Giant cauda equina neuroendocrine tumor with superficial siderosis: illustrative case. 巨大马尾神经内分泌肿瘤伴浅表性铁沉着：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE251015

Yaojing Lin, Kakeru Abe, Takeshi Hiu, Hirokazu Kurohama, Keishi Tsunoda, Koichi Yoshida, Shuhei Uotani, Hirofumi Koike, Masaomi Takeuchi, Mai Shirahama, Ayaka Matsuo, Daiki Uchida, Yuki Matsunaga, Shiro Baba, Kenta Ujifuku, Masahiro Nakashima, Takayuki Matsuo

{"title":"Giant cauda equina neuroendocrine tumor with superficial siderosis: illustrative case.","authors":"Yaojing Lin, Kakeru Abe, Takeshi Hiu, Hirokazu Kurohama, Keishi Tsunoda, Koichi Yoshida, Shuhei Uotani, Hirofumi Koike, Masaomi Takeuchi, Mai Shirahama, Ayaka Matsuo, Daiki Uchida, Yuki Matsunaga, Shiro Baba, Kenta Ujifuku, Masahiro Nakashima, Takayuki Matsuo","doi":"10.3171/CASE251015","DOIUrl":"10.3171/CASE251015","url":null,"abstract":"Background: Cauda equina neuroendocrine tumor (CENET) is a rare spinal neuroendocrine tumor, and its coexistence with superficial siderosis (SS) is even more rare. CENETs are usually small and most commonly located below L2, and their imaging often overlaps with that of myxopapillary ependymomas or schwannomas, thus complicating their preoperative differentiation. The coexistence of SS and intratumoral fluid-fluid level (FFL) in CENET has not been documented.Observations: The authors describe a giant thoracolumbar CENET (T12-L3) with intracranial SS in a patient with progressive paraparesis and bladder dysfunction. MRI revealed a hypervascular intradural extramedullary mass with an intratumoral FFL and neuraxial hemosiderin deposition, suggesting recurrent hemorrhage. Because of dense cauda equina adhesions, function-preserving subtotal resection was performed under intraoperative neurophysiological monitoring, resulting in marked neurological improvement.Lessons: In CENETs, the coexistence of SS, intratumoral FFL, and marked hypervascularity on preoperative imaging may indicate a chronic hemorrhagic phenotype with severe adhesions to the cauda equina, particularly in large multisegmental tumors. In such cases, nerve-sparing subtotal resection planned with preoperative vascular assessment and performed under intraoperative neurophysiological monitoring can be an appropriate strategy to balance tumor control with preservation of neurological function when safe dissection planes are limited. https://thejns.org/doi/10.3171/CASE251015.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679937","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

Radiofrequency thermoablation of the infraorbital nerve for posttraumatic trigeminal neuropathic pain: illustrative case. 眶下神经射频热消融治疗创伤后三叉神经痛：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE25553

David M Fletcher, Vishal V Thakur, Alexander Braley, Aniruddha Bhagwat, Adeel A Memon, Manish Ranjan, Peter E Konrad

{"title":"Radiofrequency thermoablation of the infraorbital nerve for posttraumatic trigeminal neuropathic pain: illustrative case.","authors":"David M Fletcher, Vishal V Thakur, Alexander Braley, Aniruddha Bhagwat, Adeel A Memon, Manish Ranjan, Peter E Konrad","doi":"10.3171/CASE25553","DOIUrl":"10.3171/CASE25553","url":null,"abstract":"Background: Trigeminal neuropathic pain (TNP), particularly posttraumatic TNP (PTTN), is often refractory to medical therapy and difficult to manage surgically. Although radiofrequency thermoablation (RFA) of the gasserian ganglion is established, peripheral nerve RFA remains underutilized, particularly in anatomically complex cases.Observations: A 62-year-old man developed severe left maxillary (V2) facial pain following sinus surgery, refractory to multiple pharmacological therapies and prior gasserian balloon rhizotomy. A diagnostic infraorbital nerve block produced significant temporary relief, supporting a peripheral pain generator and RFA consideration. An initial infraorbital nerve RFA performed with fluoroscopic guidance failed to provide durable benefit. A subsequent CT-guided infraorbital nerve RFA resulted in marked pain reduction. The patient later developed localized recurrent dysesthesia, prompting a third CT-guided, navigation-assisted RFA with sustained improvement. At the last follow-up (8, 6, and 3 months after the first, second, and third RFAs, respectively), his visual analog scale pain score improved from 10 to 2, with approximately 80% reduction in pain flares and significant quality of life improvement.Lessons: CT-guided infraorbital nerve RFA is a minimally invasive and effective option for refractory PTTN. Peripheral RFA, particularly when combined with advanced image guidance and potentially awake mapping, should be considered when central interventions fail or are contraindicated. https://thejns.org/doi/10.3171/CASE25553.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679962","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

Staged Gamma Knife radiosurgery for multicompartment skull base metastatic ameloblastoma: illustrative case. 分阶段伽玛刀放射治疗多室颅底转移性成釉细胞瘤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE2651

Deniz Kılıç, Akın Akakın, Murat Şakir Ekşi, Türker Kılıç

{"title":"Staged Gamma Knife radiosurgery for multicompartment skull base metastatic ameloblastoma: illustrative case.","authors":"Deniz Kılıç, Akın Akakın, Murat Şakir Ekşi, Türker Kılıç","doi":"10.3171/CASE2651","DOIUrl":"10.3171/CASE2651","url":null,"abstract":"Background: Metastatic ameloblastoma with skull base or intracranial involvement is exceedingly rare, and optimal local therapy is not well defined when complete resection is infeasible or morbid. Stereotactic radiosurgery (SRS) may offer focal control for complex skull base targets.Observations: A patient with ameloblastoma underwent six prior resections at an outside institution (2010, 2011, 2015, 2018, 2021, and November 2024) before developing multicompartment skull base progression involving the cavernous sinus-sellar region and the infratemporal fossa-right lateral orbital region. SRS (Gamma Knife radiosurgery) was delivered in a staged (sequenced) manner to anatomically distinct targets over time, treating the cavernous sinus-sellar component in November 2024 and the recurrent lesion lateral to the right orbit in April 2025. The cavernous sinus-sellar target received 13 Gy (50% isodose), and the second target received 14 Gy (50% isodose). Follow-up imaging demonstrated marked volumetric response (-93% and -100%, respectively), with clinical improvement and no clinically identified adverse radiation effects.Lessons: In selected patients with heavily pretreated metastatic ameloblastoma, staged SRS to different skull base compartments can provide durable local control while limiting morbidity. Radiosurgical sequencing may preserve future options in a longitudinal disease course and underscores the need for long-term imaging surveillance. https://thejns.org/doi/10.3171/CASE2651.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"11 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13072442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679596","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

Spontaneous regression of a presumed orbitocranial eosinophilic granuloma in an adult patient: illustrative case. 1例成人眼眶眼眶嗜酸性肉芽肿自发性消退：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2026-04-13 DOI: 10.3171/CASE25426

Lisa Y Lin, Carolina A Chiou, Myron Rolle, Anna M Stagner, Bob Carter, Michael K Yoon

引用次数: 0