Journal of neurosurgery. Case lessons最新文献_第7页

Cervical osteomyelitis in the setting of multiple comorbidities: a complex anatomical approach. Illustrative case. 合并多种疾病的颈椎骨髓炎：一种复杂的解剖方法。示例病例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-14 DOI: 10.3171/CASE24448

Jack A Leoni, Michelle E Veillon-Bradshaw, Kaleb J Derouen, John M Wilson, Wesley M Shoap

{"title":"Cervical osteomyelitis in the setting of multiple comorbidities: a complex anatomical approach. Illustrative case.","authors":"Jack A Leoni, Michelle E Veillon-Bradshaw, Kaleb J Derouen, John M Wilson, Wesley M Shoap","doi":"10.3171/CASE24448","DOIUrl":"https://doi.org/10.3171/CASE24448","url":null,"abstract":"Background: Vertebral osteomyelitis (VO), also known as spinal osteomyelitis or spondylodiscitis, is a rather rare yet serious disease comprising 3%-5% of all osteomyelitis cases, with only 3%-6% of this subset affecting the cervical spine. Risk factors include an advanced age, diabetes, immunosuppression, and intravenous (IV) drug use. The incidence of VO has increased over recent decades, with high-risk patients experiencing higher mortality rates. Treatment guidelines for VO are not standardized and rely on physician preference, often starting with IV antibiotics and progressing to surgery, if necessary.Observations: A 54-year-old female with tracheostomy-dependent obesity hypoventilation syndrome, hypertension, and morbid obesity presented with upper back pain after a fall. Imaging revealed early C6-7 discitis osteomyelitis, which was initially managed conservatively with IV antibiotics. Her condition worsened, leading to anterior corpectomy of C6-7, followed by posterior cervical fusion from C5 to T2 in the sitting position. This approach was chosen due to the patient's complex anatomy and tracheostomy.Lessons: This case underscores the need for unique surgical approaches in high-risk patients with complex anatomy. It highlights the importance of interdisciplinary care when managing VO, especially in patients with multiple comorbidities. Given the increasing rates of morbid obesity, this case provides valuable insights for neurosurgical decision-making in similar future cases. https://thejns.org/doi/10.3171/CASE24448.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484383","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

Multilevel thoracic myelopathy: full-endoscopic solution. Illustrative case. 多层次胸椎脊髓病：全内窥镜解决方案。示例病例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-14 DOI: 10.3171/CASE24413

Sukumar Sura, Harshit Dave, Abhinandan Reddy Mallepally, Rajendra Reddy, H C V Tulasi Ram, Padma Ravikanti, Naresh Kumar Pagidimarry

{"title":"Multilevel thoracic myelopathy: full-endoscopic solution. Illustrative case.","authors":"Sukumar Sura, Harshit Dave, Abhinandan Reddy Mallepally, Rajendra Reddy, H C V Tulasi Ram, Padma Ravikanti, Naresh Kumar Pagidimarry","doi":"10.3171/CASE24413","DOIUrl":"https://doi.org/10.3171/CASE24413","url":null,"abstract":"Background: Thoracic myelopathy is relatively uncommon but, when present, causes significant disability. Early surgical intervention is often recommended for patients with myelopathy with compression at multiple levels. Surgical approaches and techniques for thoracic myelopathy have evolved from traditional open spine surgery to less invasive full-endoscopic spine surgery.Observations: This article reports an unusual presentation of a 31-year-old male with thoracic myelopathy due to thoracic disc herniation (TDH) at the T8-9 level and ossification of the ligamentum flavum at the T10-11 level that was managed using full-endoscopic spine surgery techniques in a single sitting. The presence of coexisting spinal disorders, that is, TDH and ossification of the posterior longitudinal ligament at noncontiguous spinal levels, makes surgical decision-making more complicated.Lessons: Uniportal full-endoscopic spine surgery is a safe and effective surgical technique even for thoracic myelopathy. It is less invasive with minimal tissue and bone damage, better access to and visualization of the pathology, and minimal cord handling and is performed through small windows without destabilizing the spine, thus avoiding fusion. Anterior thoracic pathologies are better addressed through the transforaminal approach, whereas the interlaminar approach is preferred for posterior pathologies. Both of these approaches are complementary to each other with their own indications and advantages. https://thejns.org/doi/10.3171/CASE24413.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484389","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 intervention to enable the resection of a large left temporoinsular cystic glioblastoma with language preservation: illustrative case. 通过分期干预，切除左侧颞侧巨大囊性胶质母细胞瘤并保留语言功能：示例病例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-14 DOI: 10.3171/CASE24362

Hayley Donaldson, Danielle Golub, Dimitris G Placantonakis

{"title":"Staged intervention to enable the resection of a large left temporoinsular cystic glioblastoma with language preservation: illustrative case.","authors":"Hayley Donaldson, Danielle Golub, Dimitris G Placantonakis","doi":"10.3171/CASE24362","DOIUrl":"https://doi.org/10.3171/CASE24362","url":null,"abstract":"Background: Resection of glioblastoma (GBM) in eloquent regions depends on functional mapping to limit perioperative neurological morbidity. When neurological deficits preclude reliable mapping, neurosurgeons should explore potential mitigation strategies. The authors present the case of a patient with a large left cystic temporoinsular GBM and aphasia, for whom the authors used intraoperative language mapping and a staged approach to enable safe tumor resection.Observations: A 49-year-old female presented with progressive mixed aphasia for 1 month and new-onset right facial droop. Magnetic resonance imaging (MRI) revealed a large, heterogeneously enhancing, left temporoinsular tumor with a significant cystic component. Her aphasia was profound, and resection without reliable language mapping was deemed unsafe. An initial stereotactic tumoral cyst aspiration was performed, which reduced local mass effect and improved her language function. Cyst decompression thereby enabled both task-based functional MRI and intraoperative awake speech mapping, resulting in a safe resection of her GBM.Lessons: Safe resection of eloquently localized GBM is compromised when neurological deficits prohibit intraoperative functional mapping. This case demonstrates a mitigation strategy specific to cystic lesions in which an initial-stage stereotactic cyst aspiration is aimed at generating sufficient interval neurological improvement, such that intraoperative functional mapping can be performed during a second-stage resection. https://thejns.org/doi/10.3171/CASE24362.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484318","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

Extracranial-intracranial bypass using a cephalic vein graft for iatrogenic internal carotid artery injury during functional endoscopic sinus surgery: illustrative case. 在功能性内窥镜鼻窦手术中使用头静脉移植治疗颈内动脉先天性损伤的颅外-颅内搭桥术：示例病例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-14 DOI: 10.3171/CASE24222

Nader Wehbi, Redi Rahmani, Arnau Benet, Jennifer E Kim, Lea Scherschinski, Joshua S Catapano, Austin W Anthony, Ashutosh P Jadhav, Andrew F Ducruet, Felipe C Albuquerque, Andrew S Little, Griffin D Santarelli, Shawn M Stevens, Ameya A Jategaonkar, Michael T Lawton

{"title":"Extracranial-intracranial bypass using a cephalic vein graft for iatrogenic internal carotid artery injury during functional endoscopic sinus surgery: illustrative case.","authors":"Nader Wehbi, Redi Rahmani, Arnau Benet, Jennifer E Kim, Lea Scherschinski, Joshua S Catapano, Austin W Anthony, Ashutosh P Jadhav, Andrew F Ducruet, Felipe C Albuquerque, Andrew S Little, Griffin D Santarelli, Shawn M Stevens, Ameya A Jategaonkar, Michael T Lawton","doi":"10.3171/CASE24222","DOIUrl":"https://doi.org/10.3171/CASE24222","url":null,"abstract":"Background: Injury to the internal carotid artery (ICA) during functional endoscopic sinus surgery is a rare but potentially fatal complication. Although treatment algorithms have been developed, guidelines for effectively managing iatrogenic ICA injury have not been established. A case of ICA perforation during functional endoscopic sinus surgery treated with cerebral bypass utilizing a cephalic vein graft is presented.Observations: A woman in her late 50s presented with a left cavernous ICA injury that had occurred during endoscopic nasal polypectomy at an outside hospital. Hemostasis was achieved with intranasal Foley catheter placement. Left common carotid artery angiography revealed a high-flow carotid-cavernous fistula. Cerebral revascularization was chosen as the optimal procedure. The initial intent was to use a radial artery graft, but the radial artery was found to be occluded intraoperatively. Postoperatively, the patient experienced decreased vision and left eye movement but was otherwise neurologically intact. Postoperative angiography showed complete resolution of the fistula.Lessons: In cases involving ICA injury and carotid-cavernous fistula formation, microsurgical trapping with high-flow bypass is a favorable treatment option. The cephalic vein is a viable graft option when unexpected challenges arise with a radial artery graft. https://thejns.org/doi/10.3171/CASE24222.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484385","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

A Woven EndoBridge dislodging from an aneurysm 12 days after the implantation procedure: illustrative case. 植入手术 12 天后，编织 EndoBridge 从动脉瘤中脱落：示例病例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-14 DOI: 10.3171/CASE24278

Ryuzaburo Kanazawa, Takanori Uchida, Tetsuhiro Higashida, Takao Kono, Hiroki Ebise, Noboru Kuniyoshi

{"title":"A Woven EndoBridge dislodging from an aneurysm 12 days after the implantation procedure: illustrative case.","authors":"Ryuzaburo Kanazawa, Takanori Uchida, Tetsuhiro Higashida, Takao Kono, Hiroki Ebise, Noboru Kuniyoshi","doi":"10.3171/CASE24278","DOIUrl":"https://doi.org/10.3171/CASE24278","url":null,"abstract":"Background: The Woven EndoBridge (WEB) is an effective embolization device. A few cases of WEB migration have been reported as adverse events, and most occurred during the procedure. A case of internal carotid artery (ICA) occlusion due to a trapped WEB, which occurred 12 days after the implantation procedure, is reported.Observations: A woman in her 70s was referred for an enlarged left ICA aneurysm during follow-up. A WEB SL 5 × 3 was chosen as the embolic device, and the implantation procedure was completed uneventfully. The patient's postoperative course was good, and she was discharged from the hospital. However, 12 days later, she was brought to the authors' hospital because the WEB device was trapped and occluded in the left ICA. The trapped WEB could not be retrieved using a gooseneck snare or stent retriever, but suction from a Sofia catheter released the trapped device, allowing it to be repositioned within the aneurysm.Lessons: Most cases of WEB migration occur during surgery. In the present case, migration occurred 12 days after surgery, and to the best of the authors' knowledge, no similar cases have been reported. It is important to keep in mind that there are cases similar to the current case. https://thejns.org/doi/10.3171/CASE24278.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484382","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

Hemorrhagic intramedullary spinal cord metastasis from renal cell carcinoma: a rare case 15 years after cured renal cell carcinoma. Illustrative case. 肾细胞癌出血性髓内脊髓转移：肾细胞癌治愈 15 年后的罕见病例。示例病例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-14 DOI: 10.3171/CASE24349

Mohammad Khalil Al-Barbarawi, Amr Badary, Jörg Silbermann, Oday Atallah, Mohamad Kinan Sultan, Adel Osman, Abdulaziz Albardan, Salah Maksoud, Wahab Moustafa

{"title":"Hemorrhagic intramedullary spinal cord metastasis from renal cell carcinoma: a rare case 15 years after cured renal cell carcinoma. Illustrative case.","authors":"Mohammad Khalil Al-Barbarawi, Amr Badary, Jörg Silbermann, Oday Atallah, Mohamad Kinan Sultan, Adel Osman, Abdulaziz Albardan, Salah Maksoud, Wahab Moustafa","doi":"10.3171/CASE24349","DOIUrl":"https://doi.org/10.3171/CASE24349","url":null,"abstract":"Background: Renal cell carcinoma (RCC), the most common kidney cancer, often metastasizes to bones, lungs, liver, and the central nervous system. Intramedullary spinal metastasis from RCC is rare but can cause significant neurological deficits, necessitating prompt diagnosis and treatment through surgical intervention, radiotherapy, and immunotherapy.Observations: An 86-year-old man presented with progressive right lower-limb weakness and reduced sensation over 3 weeks. His medical history included a right nephrectomy for RCC 15 years earlier and L4-S1 spondylosis. Imaging identified a bleeding lesion in the conus medullaris at T11-12 and an incidental left kidney mass. Urgent surgical exploration led to a T12 laminectomy and en bloc removal of the lesion, which was confirmed as RCC metastasis. Postoperatively, the patient received focused radiotherapy and immunotherapy, showing significant motor and sensory improvement before dying 3 months later.Lessons: This case underscores the importance of comprehensive diagnostic imaging for the accurate identification and characterization of spinal lesions. An interdisciplinary approach involving neurosurgeons, oncologists, radiologists, and pathologists is crucial for optimal treatment planning. Urgent surgical intervention can effectively address acute neurological deficits caused by intramedullary lesions. Additionally, adhering to postoperative care instructions, such as deep venous thrombosis prophylaxis, is vital to prevent fatal complications. https://thejns.org/doi/10.3171/CASE24349.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484386","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

Acute middle cerebral artery occlusion due to a small internal carotid aneurysm cavity with blood stagnation: illustrative case. 颈内动脉瘤小腔导致的急性大脑中动脉闭塞伴血液淤滞：示例病例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-07 DOI: 10.3171/CASE24406

Minami Uezato, Hiroyuki Ikeda, Genki Kimura, Takuya Osuki, Yasunori Yokochi, Masanori Kinosada, Yoshitaka Kurosaki, And Masaki Chin

{"title":"Acute middle cerebral artery occlusion due to a small internal carotid aneurysm cavity with blood stagnation: illustrative case.","authors":"Minami Uezato, Hiroyuki Ikeda, Genki Kimura, Takuya Osuki, Yasunori Yokochi, Masanori Kinosada, Yoshitaka Kurosaki, And Masaki Chin","doi":"10.3171/CASE24406","DOIUrl":"10.3171/CASE24406","url":null,"abstract":"Background: In cerebral large vessel occlusion, even when an aneurysm is close to the target vessel, if the aneurysm is relatively small and angiography shows no thrombus within the aneurysm, it is difficult to identify the aneurysm as the embolic source.Observations: A 67-year-old man with a history of two left-sided cerebral infarctions developed a small left-sided cerebral infarction. On hospital day 3, he developed a left M2 occlusion and underwent thrombectomy with retraction of a stent retriever into an aspiration catheter at the proximal end of the thrombus. A red thrombus was retrieved, and M2 recanalization was successfully achieved. Angiography revealed a large partially thrombotic aneurysm with a small cavity with blood stagnation in the left cervical internal carotid artery, which was considered the embolic source. Stent-assisted coil embolization was performed on the aneurysm, and no recurrent cerebral infarction was observed after embolization.Lessons: In cerebral large vessel occlusion, an aneurysm cavity with blood stagnation may be the embolic source. Using an aspiration catheter alone or retracting a stent retriever into an aspiration catheter could be a useful technique and help to avoid interference between the aneurysm and the stent retriever. https://thejns.org/doi/10.3171/CASE24406.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396394","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

Recurrent symptomatic intracranial hemorrhage in high-grade astrocytoma with piloid features: illustrative case. 具有梭形细胞特征的高级别星形细胞瘤复发性症状性颅内出血：示例病例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-07 DOI: 10.3171/CASE24395

Hirotaka Niwa, Takenori Kato, Toshinori Hasegawa, Kyoko Kuwabara, Fumiharu Ohka, Junko Hirato, Shoh Sasaki, Koichi Ichimura, Takako Yoshioka, Takehiro Naito, Akihiro Mizuno, Akinori Kageyama, Hiroyuki Oishi, Ryuta Saito

{"title":"Recurrent symptomatic intracranial hemorrhage in high-grade astrocytoma with piloid features: illustrative case.","authors":"Hirotaka Niwa, Takenori Kato, Toshinori Hasegawa, Kyoko Kuwabara, Fumiharu Ohka, Junko Hirato, Shoh Sasaki, Koichi Ichimura, Takako Yoshioka, Takehiro Naito, Akihiro Mizuno, Akinori Kageyama, Hiroyuki Oishi, Ryuta Saito","doi":"10.3171/CASE24395","DOIUrl":"10.3171/CASE24395","url":null,"abstract":"Background: High-grade astrocytoma with piloid features (HGAP) is a novel condition introduced in the 2021 World Health Organization classification. Given that it has been recently classified, reports clarifying its clinical features or diagnostic criteria are lacking, especially in cases of atypical presentation. Herein, the authors present a rare case of HGAP with repeated symptomatic hemorrhages.Observations: A woman in her 20s presented with an acute headache and vertigo. Computed tomography and magnetic resonance imaging revealed a 2.5 × 2.8 × 2.3-cm hemorrhagic cerebellar mass with calcifications. After moderate improvement of her symptoms, she developed recurrent hemorrhage, and the tumor size increased (3.0 × 3.6 × 4.0 cm) 18 days later, necessitating resection. Pathological and molecular analyses confirmed the diagnosis of HGAP with an FGFR1-TACC1 fusion, MTAP/CDKN2A/B deletion, and SETD2 rearrangement. Radiologically, the presence of calcification and cystic components and the absence of perilesional edema were atypical features of previously reported HGAP.Lessons: Although recurrent symptomatic intracranial hemorrhages are rare in HGAP, enhancing lesions on magnetic resonance imaging suggest the need for resection to obtain tissue for molecular diagnosis and guide adjuvant treatment strategies. https://thejns.org/doi/10.3171/CASE24395.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396406","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

Responsive neurostimulation of the frontal lobe for the detection and treatment of seizures in intractable epilepsy due to tuberous sclerosis complex: illustrative case. 检测和治疗结节性硬化综合症引起的难治性癫痫发作的额叶反应性神经刺激：示例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-07 DOI: 10.3171/CASE23411

Paige J Brabant, Cameron P Beaudreault, Steven M Wolf, Patricia E McGoldrick, Saadi Ghatan, Carrie R Muh

{"title":"Responsive neurostimulation of the frontal lobe for the detection and treatment of seizures in intractable epilepsy due to tuberous sclerosis complex: illustrative case.","authors":"Paige J Brabant, Cameron P Beaudreault, Steven M Wolf, Patricia E McGoldrick, Saadi Ghatan, Carrie R Muh","doi":"10.3171/CASE23411","DOIUrl":"10.3171/CASE23411","url":null,"abstract":"Background: Responsive neurostimulation (RNS) is often considered to be a palliative therapy for drug-resistant epilepsy (DRE) and is generally not considered to be a treatment for patients with tuberous sclerosis complex (TSC). Here, the authors present the case of a 24-year-old male with TSC who obtained seizure freedom following RNS device implantation.Observations: Prior to RNS device implantation, the patient underwent tuberectomies, subependymal giant cell astrocytoma resection, vagus nerve stimulator placement, and left frontal lobe resection but continued to have frequent seizures. An RNS device was implanted, which initially led to a decrease in seizures, but he continued to have 12 seizures per month. He then underwent lead revision for stimulation via a different electrode. After that lead change, he had no seizures for almost 3 years. In the following 3 years, he had two episodes of breakthrough seizures, both of which occurred with medication weans. Although the patient still requires antiseizure medication, he has had years of seizure freedom with RNS therapy.Lessons: This study exhibits the potential effectiveness of RNS therapy for patients with TSC and DRE. RNS should be considered for patients with TSC when other therapies have not sufficiently treated their epilepsy. https://thejns.org/doi/10.3171/CASE23411.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396407","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

Seizure freedom using a regional approach to responsive neurostimulation for multifocal drug-resistant epilepsy: illustrative case. 采用区域反应性神经刺激方法治疗多灶性耐药癫痫，摆脱癫痫发作：示例。

Journal of neurosurgery. Case lessons Pub Date : 2024-10-07 DOI: 10.3171/CASE24369

Anna R Kimata, Scott A Collins, Wael F Asaad, Neishay Ayub

{"title":"Seizure freedom using a regional approach to responsive neurostimulation for multifocal drug-resistant epilepsy: illustrative case.","authors":"Anna R Kimata, Scott A Collins, Wael F Asaad, Neishay Ayub","doi":"10.3171/CASE24369","DOIUrl":"10.3171/CASE24369","url":null,"abstract":"Background: Responsive neurostimulation (RNS) has emerged as an effective neuromodulatory intervention for patients with medically refractory epilepsy who are not candidates for resective or ablative surgery. However, in patients with multifocal seizures arising from a widely distributed network, optimizing lead placement can be challenging.Observations: Here, the authors present the case of a patient with drug-resistant multifocal, nonlateralizing seizures and multiple developmental brain lesions who underwent phase II monitoring with stereoelectroencephalography electrodes targeting the lesion and surrounding cortex as well as the centromedian thalamus. Neurophysiological signals observed during recorded events implicated a seizure network within the left perisylvian polymicrogyria, involving the left parietal operculum, insula, and centromedian thalamic regions rather than a single focus.Lessons: Using a regional RNS approach to modulate this network, the patient improved from 5 seizures a day to freedom from disabling seizures shortly after lead implantation despite low stimulation parameters. This has implications for understanding the timescale of adaptive mechanisms that occur in response to stimulation and supports the use of RNS as a surgical treatment for drug-resistant epilepsy. https://thejns.org/doi/10.3171/CASE24369.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"8 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396408","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