Journal of neurosurgery. Case lessons最新文献

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Mycobacterium abscessus infection of uncertain etiology following lumbar spine decompression and instrumentation: illustrative case. 腰椎减压和内固定术后病因不明的脓肿分枝杆菌感染:说明性病例。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-28 DOI: 10.3171/CASE24891
Sloan V Rhodes, Noah L A Nawabi, Brian F Saway, Matthew J Triano, Abhay K Varma
{"title":"Mycobacterium abscessus infection of uncertain etiology following lumbar spine decompression and instrumentation: illustrative case.","authors":"Sloan V Rhodes, Noah L A Nawabi, Brian F Saway, Matthew J Triano, Abhay K Varma","doi":"10.3171/CASE24891","DOIUrl":"https://doi.org/10.3171/CASE24891","url":null,"abstract":"<p><strong>Background: </strong>Mycobacterium abscessus, a rapidly growing nontuberculous mycobacterium, is known for its resistance to standard antimicrobial therapies and its association with pulmonary and soft tissue infections, particularly in immunocompromised patients. Spinal infections caused by M. abscessus are rare, with limited reported cases, especially in immunocompetent individuals.</p><p><strong>Observations: </strong>The authors report the case of a 76-year-old male who developed a deep-seated M. abscessus infection following lumbar spinal fusion surgery. Despite an initial postoperative recovery, the patient experienced progressive symptoms requiring multiple surgical washouts, removal of spinal hardware, and prolonged multidrug antibiotic therapy. Diagnostic challenges were compounded by the organism's resistance and the emergence of a possible underlying lymphoproliferative disorder. Comprehensive microbiological testing, including acid-fast bacilli cultures, identified the pathogen and guided targeted therapy.</p><p><strong>Lessons: </strong>This case highlights the diagnostic and therapeutic complexities of managing multidrug-resistant pathogens like M. abscessus in postoperative settings. Early microbiological testing, multidisciplinary collaboration, and individualized treatment strategies were critical to the patient's recovery. Additionally, the present case underscores the need for vigilance in identifying atypical infections and potential immunological dysregulation in postoperative patients. Further research is essential to refine prevention and management approaches for rare and challenging infections. https://thejns.org/doi/10.3171/CASE24891.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001021","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
Extra-axial small cell prostate carcinoma intracranial metastasis: illustrative case. 轴外小细胞前列腺癌颅内转移一例。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-28 DOI: 10.3171/CASE24705
Carl Porto, Hael Abdulrazeq, Rahul Sastry, Allison Chang, Tori Riccelli, Michael Punsoni, Prakash Sampath
{"title":"Extra-axial small cell prostate carcinoma intracranial metastasis: illustrative case.","authors":"Carl Porto, Hael Abdulrazeq, Rahul Sastry, Allison Chang, Tori Riccelli, Michael Punsoni, Prakash Sampath","doi":"10.3171/CASE24705","DOIUrl":"https://doi.org/10.3171/CASE24705","url":null,"abstract":"<p><strong>Background: </strong>Prostate carcinoma, despite being the most common cancer in men, rarely metastasizes to the brain. Small cell prostate carcinoma represents a small percentage of cases, and few cases of intracranial small cell prostate metastases have been reported. Here, the authors report a unique case of an operatively managed extra-axial small cell prostate carcinoma.</p><p><strong>Observations: </strong>A 63-year-old male with a history of small cell prostate carcinoma presented asymptomatically with abnormal brain imaging. MRI and prostate-specific membrane antigen PET imaging revealed a 2.8-cm mass in the right frontal lobe and a smaller right thalamic lesion. The mass was resected through a frontotemporal approach, and gross-total resection was achieved. The patient will receive adjuvant chemotherapy and radiation therapy.</p><p><strong>Lessons: </strong>Intracranial prostate metastases tend to be slow growing and can have indolent clinical courses, although they can become symptomatic at large sizes. Small cell prostate metastases are more aggressive than adenocarcinoma and have a higher propensity for dural rather than intraparenchymal localization. The standard of care, which is derived from the management of metastatic prostate adenocarcinoma, involves maximal safe resection and adjuvant chemotherapy and radiation therapy, although intracranial small cell prostate metastases are a poor prognosticator. https://thejns.org/doi/10.3171/CASE24705.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012890","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
Open vascular treatment after internal carotid artery knife transection: illustrative case. 颈内动脉刀切术后开放血管治疗:说明性病例。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-28 DOI: 10.3171/CASE2532
Nicole A Silva, Marco Antonio Leal Santos, Herison H Silva Vaz, Carlos A David, Erik Leonardo Jennings Simões
{"title":"Open vascular treatment after internal carotid artery knife transection: illustrative case.","authors":"Nicole A Silva, Marco Antonio Leal Santos, Herison H Silva Vaz, Carlos A David, Erik Leonardo Jennings Simões","doi":"10.3171/CASE2532","DOIUrl":"https://doi.org/10.3171/CASE2532","url":null,"abstract":"<p><strong>Background: </strong>Although penetrating, nonmissile, traumatic cranial injuries with associated vascular injuries make up a small portion of all traumatic brain injuries, they can pose a unique challenge to the neurosurgeon. Recently, less invasive, endovascular treatment options have shown promise, but there remains a need for experience with open vascular treatment in certain circumstances. The authors describe the importance of careful surgical planning for open vascular repair of an internal carotid artery (ICA) transection injury after traumatic knife cranial penetration.</p><p><strong>Observations: </strong>The authors present the case of a 21-year-old Brazilian male, victim of domestic assault by knife, which penetrated the temporal bone, anterior temporal lobe, cranial nerves, cavernous sinus, and right ICA. Digital subtraction angiography showed right ICA occlusion with associated thrombosis of cervical through clinoidal segments, with adequate collateral perfusion. The authors performed a pterional craniotomy for clip ligation of the clinoidal segment of the ICA, with safe removal of the knife and a favorable patient outcome. The authors describe a technical case illustration, accompanied by a surgical video and cadaver and anatomical illustration.</p><p><strong>Lessons: </strong>This case highlights the importance of detailed knowledge of cerebrovascular and skull base anatomy and preservation of complex open vascular neurosurgical techniques, especially in settings where endovascular treatment is not a feasible option. https://thejns.org/doi/10.3171/CASE2532.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013210","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
Multiple intradural extramedullary Müllerian duct cysts: illustrative case. 多发性硬膜内髓外胆管囊肿:说明性病例。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-28 DOI: 10.3171/CASE2511
Feifan Xu, Xingwen Wang, Wei Wang, Zhiqiang Yi
{"title":"Multiple intradural extramedullary Müllerian duct cysts: illustrative case.","authors":"Feifan Xu, Xingwen Wang, Wei Wang, Zhiqiang Yi","doi":"10.3171/CASE2511","DOIUrl":"https://doi.org/10.3171/CASE2511","url":null,"abstract":"<p><strong>Background: </strong>Müllerian duct cysts (MDCs) are rare congenital anomalies. They arise from Müllerian duct remnant (MDR) and usually present as prostatic utricle cyst or pelvic mass. The authors report their experience with an extremely rare case of multiple intradural extramedullary MDCs.</p><p><strong>Observations: </strong>The patient, a 31-year-old female, presented with a 6-month history of progressive numbness, weakness, and sensory deficit in her lower extremities. After neurological examination at the authors' hospital, an MRI study was performed, revealing multiple intradural cystic lesions from C6 to L3, extending over 17 vertebral segments. Preoperative differential diagnoses included hydatid cysts, arachnoid cysts, enterogenous cysts, tuberculosis, and infection. Seven extramedullary noncommunicating transparent cysts were totally removed by surgery, with significant improvement of the neurological symptoms. Pathological examination showed MDCs.</p><p><strong>Lessons: </strong>This is the first reported case of compressive myelopathy caused by multiple intraspinal subdural extramedullary MDCs. Regular imaging examinations and laboratory tests do not provide valuable information for differential diagnosis. Careful preoperative cyst localization and complete microsurgical resection are essential for a good outcome. https://thejns.org/doi/10.3171/CASE2511.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065534","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
Distal posterior inferior cerebellar artery (PICA) displacement with end-to-side anastomosis to contralateral PICA: a novel bypass surgery for PICA aneurysm. Illustrative case. 小脑后下动脉(PICA)远端移位与对侧PICA端侧吻合:一种新型的PICA动脉瘤搭桥手术。说明情况。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-28 DOI: 10.3171/CASE24741
Yunyu Wen, Wenfeng Feng, Songtao Qi, Gang Wang
{"title":"Distal posterior inferior cerebellar artery (PICA) displacement with end-to-side anastomosis to contralateral PICA: a novel bypass surgery for PICA aneurysm. Illustrative case.","authors":"Yunyu Wen, Wenfeng Feng, Songtao Qi, Gang Wang","doi":"10.3171/CASE24741","DOIUrl":"https://doi.org/10.3171/CASE24741","url":null,"abstract":"<p><strong>Background: </strong>Posterior inferior cerebellar artery (PICA) aneurysms pose significant surgical challenges. The authors present a novel bypass technique involving distal PICA displacement and end-to-side anastomosis to the contralateral PICA.</p><p><strong>Observations: </strong>The authors describe a successful case in which the distal PICA was relocated, followed by an end-to-side anastomosis to the contralateral PICA, effectively bypassing the aneurysm and restoring normal blood flow.</p><p><strong>Lessons: </strong>This innovative approach highlights the potential of bypass surgery for PICA aneurysms, particularly when traditional endovascular methods are unsuitable. Individual anatomical considerations are crucial for effective treatment planning. https://thejns.org/doi/10.3171/CASE24741.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060706","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
Hypertrophic olivary degeneration after posterior cranial fossa tumor resection in adults: illustrative case. 成人后颅窝肿瘤切除术后增生性橄榄变性:一个说明性病例。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-28 DOI: 10.3171/CASE25130
Joshua M Venegas, Aaron Miller, Coulter Small, Ben A Strickland
{"title":"Hypertrophic olivary degeneration after posterior cranial fossa tumor resection in adults: illustrative case.","authors":"Joshua M Venegas, Aaron Miller, Coulter Small, Ben A Strickland","doi":"10.3171/CASE25130","DOIUrl":"https://doi.org/10.3171/CASE25130","url":null,"abstract":"<p><strong>Background: </strong>Posterior cranial fossa tumor resection can be complicated by a rare but potentially debilitating condition known as hypertrophic olivary degeneration (HOD). This condition is diagnosed using a high degree of clinical suspicion as well as T2/FLAIR MRI findings of nonenhancing, hyperintense enlargement of the inferior olivary nucleus.</p><p><strong>Observations: </strong>The authors present a unique case of HOD in a 49-year-old female 4 months after resection of a low-grade pilocytic astrocytoma from the cerebellar vermis. The patient displayed classic signs associated with HOD, including palatal tremor, ocular nystagmus, and ocular myoclonus. Management will likely be challenging, and the patient was referred to movement disorder specialists to discuss potential treatment options.</p><p><strong>Lessons: </strong>Few case reports of HOD after neurosurgical intervention in adults are available in the literature. In this work, the authors conducted a literature review of available data for 23 cases of HOD in adult patients after midline posterior cranial fossa tumor resection. The prognosis of symptomatic HOD is generally poor, as no standardized treatment regimen for these patients currently exists. https://thejns.org/doi/10.3171/CASE25130.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065532","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 of dorsal atlantoaxial pseudoarticulation with full endoscopic approach: illustrative case. 寰枢背假关节的全内镜手术治疗:说明性病例。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-21 DOI: 10.3171/CASE24766
Vivek M Abraham, Nelson Sofoluke, Vyacheslav Makler, Gino Mongelluzzo, Sean M Barber, Mazen Taman, Carl Porto, Owen P Leary, Alexander Chernysh, Albert Telfeian, Sanjay Konakondla
{"title":"Surgical treatment of dorsal atlantoaxial pseudoarticulation with full endoscopic approach: illustrative case.","authors":"Vivek M Abraham, Nelson Sofoluke, Vyacheslav Makler, Gino Mongelluzzo, Sean M Barber, Mazen Taman, Carl Porto, Owen P Leary, Alexander Chernysh, Albert Telfeian, Sanjay Konakondla","doi":"10.3171/CASE24766","DOIUrl":"https://doi.org/10.3171/CASE24766","url":null,"abstract":"<p><strong>Background: </strong>Atlantoaxial pseudoarticulation is a rare condition characterized by atypical joint formation at C1-2, potentially causing severe neck pain and progressive cervical myelopathy due to spinal cord compression. Traditional treatments often involve decompression with or without fusion and can lead to significant tissue disruption and extended recovery time. Here, the authors describe a novel, minimally invasive full endoscopic technique for resecting atlantoaxial pseudoarticulation, achieving successful spinal decompression.</p><p><strong>Observations: </strong>A 44-year-old female patient presented with 6 months of progressive cervical myelopathy, including gait instability, right-sided weakness, and numbness. Imaging confirmed a C1-2 pseudoarticulation causing severe spinal cord compression. A paraspinal endoscopic approach was used, avoiding the need for instrumented fusion. Postoperatively, the patient's condition rapidly improved, with complete symptom resolution at 6 months and only mild intermittent hand numbness at 18 months. Imaging confirmed stable, effective decompression without complications.</p><p><strong>Lessons: </strong>This case represents the first documented application of a full endoscopic approach for atlantoaxial pseudoarticulation, achieving effective decompression while preserving spinal integrity and reducing recovery time. This technique offers a promising, minimally invasive alternative for complex cervical pathologies, supporting a shift toward less invasive, tissue-sparing spinal surgery. https://thejns.org/doi/10.3171/CASE24766.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062876","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
Chronic expanding hematoma following Gamma Knife irradiation for primary central nervous system lymphoma: illustrative case. 伽玛刀照射治疗原发性中枢神经系统淋巴瘤后慢性扩张性血肿:说明性病例。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-21 DOI: 10.3171/CASE258
Etsuko Yamamoto Hattori, Yukinori Terada, Yasuhide Takeuchi, Yasuhide Makino, Shigeki Takada, Noritaka Sano, Masahiro Tanji, Yohei Mineharu, Yoshiki Arakawa
{"title":"Chronic expanding hematoma following Gamma Knife irradiation for primary central nervous system lymphoma: illustrative case.","authors":"Etsuko Yamamoto Hattori, Yukinori Terada, Yasuhide Takeuchi, Yasuhide Makino, Shigeki Takada, Noritaka Sano, Masahiro Tanji, Yohei Mineharu, Yoshiki Arakawa","doi":"10.3171/CASE258","DOIUrl":"https://doi.org/10.3171/CASE258","url":null,"abstract":"<p><strong>Background: </strong>Chronic expanding hematoma (CEH) is a rare disease characterized by slow expansion, especially reported after Gamma Knife radiosurgery (GKRS) for cerebral arteriovenous malformations. No cases have been reported following treatment for primary central nervous system lymphoma (PCNSL). Vascular endothelial growth factor and vascular endothelial growth factor receptor-1 (VEGFR-1) have been reported to be responsible for CEH induction.</p><p><strong>Observations: </strong>A 56-year-old woman underwent partial tumor removal for PCNSL in the left temporo-occipital lobe at another hospital. One and a half months later, a new lesion was observed, and she underwent GKRS, including the residual lesion. She was treated with multiple chemotherapy regimens including R-MPV (rituximab, methotrexate, procarbazine, vincristine) but relapsed repeatedly and was administered tirabrutinib. Four years after GKRS, the gadolinium-enhanced lesion slowly grew. Tumor recurrence or radiation necrosis was suspected, and surgical removal was performed. The tissue was composed of nonmalignant brain tissue and fibrinized hematoma, which demonstrated strong expression of VEGFR-1 on immunostaining, and the pathological diagnosis was CEH.</p><p><strong>Lessons: </strong>In this patient, CEH could have resulted from VEGFR-1 expression due to GKRS. For a patient with slow lesion growth following GKRS for PCNSL, surgical removal should be considered, taking into account the possibility of CEH along with recurrence and radiation necrosis. https://thejns.org/doi/10.3171/CASE258.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048244","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 management of symptomatic retroperitoneal migratory disc herniation anterior to the sacral ala causing L5 radiculopathy using direct decompression and fusion: illustrative case. 骶侧前症状性腹膜后移位椎间盘突出引起L5神经根病的直接减压融合手术治疗:说明性病例。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-21 DOI: 10.3171/CASE24866
Jan Gewiess, Esther Vögelin, Karolina Kasparkova, Marius J B Keel, Rainer J Egli, Moritz C Deml, Christoph E Albers
{"title":"Surgical management of symptomatic retroperitoneal migratory disc herniation anterior to the sacral ala causing L5 radiculopathy using direct decompression and fusion: illustrative case.","authors":"Jan Gewiess, Esther Vögelin, Karolina Kasparkova, Marius J B Keel, Rainer J Egli, Moritz C Deml, Christoph E Albers","doi":"10.3171/CASE24866","DOIUrl":"https://doi.org/10.3171/CASE24866","url":null,"abstract":"<p><strong>Background: </strong>Atypical lumbar disc herniations, such as migratory extreme lateral and intradural herniations, can mimic malignancy on imaging, complicating diagnosis and treatment. These herniations can involve unusual locations, such as the retroperitoneal or presacral area. Migratory herniations, in particular, can appear similar to peripheral nerve sheath tumors, presenting diagnostic challenges.</p><p><strong>Observations: </strong>The authors present the case of a 39-year-old male with symptomatic migratory extreme lateral disc herniation causing L5 radiculopathy. Initial MRI suggested a peripheral nerve sheath tumor, and positron emission tomography/CT (PET/CT) showed minimal metabolic activity. Biopsy confirmed a migratory disc herniation, which was treated with anterior lumbar interbody fusion at L5-S1 via a pararectus approach. The patient showed significant pain relief and improvement in hypoesthesia postsurgery, but L5 motor weakness remained unchanged.</p><p><strong>Lessons: </strong>Imaging can be unreliable in distinguishing migratory disc herniation from tumors. Although MRI and PET/CT are standard tools, they can show features that overlap with neoplastic processes. Histopathological evaluation remains crucial for accurate diagnosis. The pararectus approach provides excellent access for biopsy and direct decompression in cases of atypical herniations, minimizing recurrence risk while addressing concurrent disc degeneration. This case highlights the importance of comprehensive imaging and interdisciplinary discussions when diagnosing and treating rare disc herniations, with the pararectus approach offering a viable surgical solution for these challenging cases. Surgeons should consider atypical herniation locations when diagnosing lumbar radiculopathy, especially in cases where imaging is inconclusive. For retroperitoneal herniations, the pararectus approach allows for both diagnostic biopsy and effective surgical management, including decompression and fusion in a single procedure. https://thejns.org/doi/10.3171/CASE24866.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036107","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
Management of intracardiac migrated ventriculoperitoneal shunts: illustrative case. 心内心室腹腔分流的处理:说明性病例。
Journal of neurosurgery. Case lessons Pub Date : 2025-04-21 DOI: 10.3171/CASE24871
Joseph Yoon, Nigel Mott, Jason Jenkins, Michael Rudd, Jason Papacostas, Hamish Alexander
{"title":"Management of intracardiac migrated ventriculoperitoneal shunts: illustrative case.","authors":"Joseph Yoon, Nigel Mott, Jason Jenkins, Michael Rudd, Jason Papacostas, Hamish Alexander","doi":"10.3171/CASE24871","DOIUrl":"https://doi.org/10.3171/CASE24871","url":null,"abstract":"<p><strong>Background: </strong>Ventriculoperitoneal (VP) shunts are pivotal in managing hydrocephalus but are not without complications, including the rare but serious phenomenon of intracardiac migration. With only 32 cases previously documented, this complication lacks a robust evidence base, making each new case an important contribution to clinical understanding and management strategies. This paper presents an illustrative case alongside a comprehensive review of intracardiac VP shunt migrations, aiming to elucidate management principles for this daunting scenario.</p><p><strong>Observations: </strong>The review identified 32 previous cases of intracardiac VP shunt migration. Including the authors' case, patients ranged in age from 6 to 81 years, with a predominance of male patients. Common symptoms included headaches and cardiorespiratory issues, although some cases were asymptomatic. Manual withdrawal of the catheter was successful in some cases, while others required interventional radiology or surgical extraction via venotomy or similar.</p><p><strong>Lessons: </strong>Intracardiac migration of VP shunts is a rare but significant complication. Early detection and a multidisciplinary approach are essential for effective management. Future research should focus on refining surgical techniques to prevent migration and to understand better the mechanisms involved. Enhanced awareness and diagnostic strategies can improve patient outcomes and reduce the risk of such complications. https://thejns.org/doi/10.3171/CASE24871.</p>","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059390","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
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