Journal of neurosurgery. Case lessons最新文献_第9页

Mature teratoma with a germinoma component presenting with undetectable placental alkaline phosphatase in cerebrospinal fluid: illustrative case.

Journal of neurosurgery. Case lessons Pub Date : 2025-02-24 DOI: 10.3171/CASE24588

Sogo Oki, Shigeru Yamaguchi, Michinari Okamoto, Yukitomo Ishi, Hiromi Kanno-Okada, Emi Takakuwa, Yukayo Terashita, Shinsuke Hirabayashi, Kentaro Nishioka, Takayuki Hashimoto, Atsushi Manabe, Miki Fujimura

{"title":"Mature teratoma with a germinoma component presenting with undetectable placental alkaline phosphatase in cerebrospinal fluid: illustrative case.","authors":"Sogo Oki, Shigeru Yamaguchi, Michinari Okamoto, Yukitomo Ishi, Hiromi Kanno-Okada, Emi Takakuwa, Yukayo Terashita, Shinsuke Hirabayashi, Kentaro Nishioka, Takayuki Hashimoto, Atsushi Manabe, Miki Fujimura","doi":"10.3171/CASE24588","DOIUrl":"https://doi.org/10.3171/CASE24588","url":null,"abstract":"Background: Diagnosing intracranial mixed germ cell tumors (GCTs) can be challenging due to intratumoral heterogeneity. Placental alkaline phosphatase (PLAP) in the cerebrospinal fluid (CSF) is a highly sensitive and specific marker for identifying pure germinomas and germinoma components within mixed GCTs.Observations: The authors present the case of a 6-year-old boy presenting with a 5-day history of vomiting and headache. Magnetic resonance imaging revealed a heterogeneously enhanced mass with cystic areas in the pineal region. Preoperative serum levels of alpha-fetoprotein and human chorionic gonadotropin, as well as CSF PLAP levels, were not elevated, leading to a preliminary diagnosis of mature teratoma. The tumor was completely resected, and pathological examination of the resected tissue confirmed a mature teratoma with germinoma components. Given the diagnosis of mixed GCT with a germinoma component, the patient underwent postoperative radiation chemotherapy. There has been no recurrence after 8 years of follow-up.Lessons: In this case, the preoperative CSF PLAP level failed to predict the presence of a germinoma component. This report highlights a potential limitation of CSF PLAP as a diagnostic marker, noting that CSF PLAP may be undetectable if the germinoma is confined to a localized area. https://thejns.org/doi/10.3171/CASE24588.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Resolution of refractory trigeminal neuralgia after endoscopic decompression of the foramina rotundum and ovale in a patient with bilateral petrous apex cephaloceles: illustrative case.

Journal of neurosurgery. Case lessons Pub Date : 2025-02-24 DOI: 10.3171/CASE24283

Hope M Reecher, Stephanie A Armstrong, Stephanie K Cheok, Samon G Tavakoli, Christina Feller, Stephanie Schwartz, Christopher Long, Nathan T Zwagerman

{"title":"Resolution of refractory trigeminal neuralgia after endoscopic decompression of the foramina rotundum and ovale in a patient with bilateral petrous apex cephaloceles: illustrative case.","authors":"Hope M Reecher, Stephanie A Armstrong, Stephanie K Cheok, Samon G Tavakoli, Christina Feller, Stephanie Schwartz, Christopher Long, Nathan T Zwagerman","doi":"10.3171/CASE24283","DOIUrl":"https://doi.org/10.3171/CASE24283","url":null,"abstract":"Background: Petrous apex cephaloceles (PACs) are rare cystic lesions that can present with increased intracranial pressure and bony remodeling of the skull. PACs may be associated with trigeminal neuralgia (TN); however, direct causality is not clear. To the author's knowledge, this is the first case reporting bony decompression of the foramina ovale and rotundum via an extended endoscopic endonasal approach (EEA) for the management of TN in the presence of concurrent PACs.Observations: Herein, the authors present the case of a 19-year-old male with bilateral PACs and severely refractory TN surgically managed with decompression of the foramina ovale and rotundum and surrounding bony regions near the maxillary nerve (cranial nerve [CN] V2) and mandibular nerve (CNV3). Prior to EEA, he trialed ten medications and underwent cerebrospinal fluid diversion trials, two microvascular decompressions, and stereotactic radiosurgery with variable symptom relief. Complete resolution of TN occurred 4 months after EEA, and he was weaned off of medication.Lessons: An extended EEA to decompress CNV divisions at the foramina rotundum and ovale may be effective in refractory cases. PACs and associated bony dehiscence may complicate the understanding of TN etiology and impair radiographic visualization of CNV and surrounding structures. There is no clear evidence to support surgical management of PACs and symptom resolution. https://thejns.org/doi/10.3171/CASE24283.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Letter to the Editor Response.

Journal of neurosurgery. Case lessons Pub Date : 2025-02-24 DOI: 10.3171/CASE24748

Jack A Leoni, Wesley M Shoap

引用次数: 0

Challenges in the treatment of giant cavernous carotid aneurysm associated with hemophilia A: illustrative case.

Journal of neurosurgery. Case lessons Pub Date : 2025-02-24 DOI: 10.3171/CASE24693

Yuichi Hirata, Masafumi Hiramatsu, Kenji Sugiu, Juntaro Fujita, Yuta Sotome, Masato Kawakami, Ryu Kimura, Yuki Ebisudani, Jun Haruma, Shota Tanaka

{"title":"Challenges in the treatment of giant cavernous carotid aneurysm associated with hemophilia A: illustrative case.","authors":"Yuichi Hirata, Masafumi Hiramatsu, Kenji Sugiu, Juntaro Fujita, Yuta Sotome, Masato Kawakami, Ryu Kimura, Yuki Ebisudani, Jun Haruma, Shota Tanaka","doi":"10.3171/CASE24693","DOIUrl":"https://doi.org/10.3171/CASE24693","url":null,"abstract":"Background: Hemophilia A is characterized by a deficiency of factor VIII, leading to severe bleeding disorders. Abnormal blood coagulation can complicate the treatment of cerebral aneurysms.Observations: A 20-year-old man with congenital hemophilia A presented with abducens nerve palsy caused by a giant cavernous carotid aneurysm (CCA). Because of the coagulopathy, simple internal carotid artery ligation was chosen, and the aneurysm initially shrank following treatment. However, it recurred due to collateral arteries from the posterior communicating artery and branches of the external carotid artery. These arteries were occluded using endovascular techniques, resulting in complete obliteration of the aneurysm.Lessons: To the best of the authors' knowledge, this is the first reported case of treating a giant CCA associated with hemophilia A. In patients with coagulopathy, surgical options are limited, and standard treatments may not achieve a complete cure. Careful consideration of treatment strategies is crucial when managing giant CCA in the context of a coagulation disorder. https://thejns.org/doi/10.3171/CASE24693.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgical correction of severe cervical kyphosis secondary to tuberculoid Pott's disease: illustrative case.

Journal of neurosurgery. Case lessons Pub Date : 2025-02-24 DOI: 10.3171/CASE24652

Drew Thibault, Jordyn Mullins, Alejandro Pando, Misha Movahed-Ezazi, Timothy Wong

{"title":"Surgical correction of severe cervical kyphosis secondary to tuberculoid Pott's disease: illustrative case.","authors":"Drew Thibault, Jordyn Mullins, Alejandro Pando, Misha Movahed-Ezazi, Timothy Wong","doi":"10.3171/CASE24652","DOIUrl":"https://doi.org/10.3171/CASE24652","url":null,"abstract":"Background: Pott's disease (PD) is an infection of the vertebral bodies due to Mycobacterium tuberculosis. Commonly presenting with back pain, the insidious nature of the disease can result in the development of kyphotic deformities, epidural collections, and neurological dysfunction. The authors describe the case of a 21-year-old male who presented with symptoms of cervical myelopathy and was found to have a kyphotic deformity involving the C5 and C6 vertebrae with epidural extension. The patient was treated with a combined anterior-posterior surgical approach: anteriorly with C5-6 corpectomy and cage placement and posteriorly with C2-T2 instrumentation. The final pathology was positive for M. tuberculosis, and the patient was placed on antibacterial therapy.Observations: PD often presents late with symptoms that do not match the severity of the radiological spinal deformities. Surgical intervention is warranted in patients with severe deformity, neural element compression, and concordant neurological deficits. A literature review demonstrated that the combined anterior-posterior approach provides the greatest correction of kyphotic deformities. However, both anterior and combined approaches are associated with good outcomes and relatively few surgical complications.Lessons: The combined anterior-posterior surgical approach for cervical PD is recommended when kyphosis is severe. With appropriate surgical and medical management, most patients recover well without recurrence of symptoms. https://thejns.org/doi/10.3171/CASE24652.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgical findings and precautions for removing cement that leaked into the spinal canal due to balloon kyphoplasty: illustrative cases.

Journal of neurosurgery. Case lessons Pub Date : 2025-02-24 DOI: 10.3171/CASE24796

Michita Noma, Yujiro Takeshita, Fumiko Saiki, Masaya Sekimizu, Yuta Nakayama, Ryoko Onodera, Motohiro Haseyama, Satoshi Miwa, Yasushi Oshima, Kota Miyoshi

{"title":"Surgical findings and precautions for removing cement that leaked into the spinal canal due to balloon kyphoplasty: illustrative cases.","authors":"Michita Noma, Yujiro Takeshita, Fumiko Saiki, Masaya Sekimizu, Yuta Nakayama, Ryoko Onodera, Motohiro Haseyama, Satoshi Miwa, Yasushi Oshima, Kota Miyoshi","doi":"10.3171/CASE24796","DOIUrl":"https://doi.org/10.3171/CASE24796","url":null,"abstract":"Background: Balloon kyphoplasty (BKP) is a widely utilized procedure for osteoporotic and metastatic vertebral fractures. However, cement leakage into the spinal canal is a serious complication that can result in neurological deficits, requiring timely and precise surgical intervention.Observations: This report presents two illustrative cases of BKP-related cement leakage. The first case involved a 52-year-old man with a metastatic L3 fracture, in which cement leaked into the spinal canal. Surgical intervention included L2 and L3 laminectomy, resulting in successful cement removal without neurological deficits. The second case involved an 86-year-old man with an L5 osteoporotic burst fracture and cement leakage into the right lateral recess space, causing a unilateral drop foot. An L5 laminectomy performed 3 days later enabled cement removal, although neurological recovery was incomplete, possibly because of nerve compression or thermal injury. In both cases, the cement was brittle and nonadherent to the dura mater, facilitating safe removal.Lessons: Evaluating cement leakage after cement injection is essential to avoid oversights. Comprehensive preoperative imaging and meticulous planning are crucial due to the variability in cement leakage patterns. Surgical indications and timing require careful consideration, as cement leakage might be asymptomatic in some cases but result in irreversible damage if untreated. https://thejns.org/doi/10.3171/CASE24796.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Letter to the Editor. Aseptic osteomyelitis due to a vertebral pressure injury after a fall.

Journal of neurosurgery. Case lessons Pub Date : 2025-02-24 DOI: 10.3171/CASE24735

Josef Finsterer

引用次数: 0

Plaque shift to the brachiocephalic artery after subclavian artery stenting: illustrative case.

Journal of neurosurgery. Case lessons Pub Date : 2025-02-24 DOI: 10.3171/CASE24760

Junji Fukumori, Kenji Fukutome, Shuta Aketa, Yuki Shiraishi, Atsuko Shimotsuma, Ryuta Matsuoka, Rinsei Tei, Yasushi Shin, Yasushi Motoyama

{"title":"Plaque shift to the brachiocephalic artery after subclavian artery stenting: illustrative case.","authors":"Junji Fukumori, Kenji Fukutome, Shuta Aketa, Yuki Shiraishi, Atsuko Shimotsuma, Ryuta Matsuoka, Rinsei Tei, Yasushi Shin, Yasushi Motoyama","doi":"10.3171/CASE24760","DOIUrl":"https://doi.org/10.3171/CASE24760","url":null,"abstract":"Background: Subclavian artery stenosis (SAS) has a prevalence of 1.9% in the general United States population. Revascularization, often by stenting, is indicated for symptomatic patients. Plaque shift (PS) is a well-known poststenting complication in coronary interventions but has not been reported in subclavian artery (SA) stenting. This case report documents the occurrence of PS after stenting for SAS, highlighting a rare but significant complication.Observations: An 87-year-old woman with a history of hypertension and dyslipidemia presented with right upper-limb pain and fatigue. Imaging confirmed stenosis with calcified plaque at the origin of the right SA. Following endovascular stenting under local anesthesia, imaging revealed PS to the brachiocephalic artery (BA). To prevent migration into the common carotid artery (CCA), a dual-layer stent was placed from the CCA to the BA. The patient's symptoms resolved, and follow-up confirmed successful plaque stabilization without restenosis 1 year postprocedure.Lessons: Even apparently hard SA plaque with calcification can result in PS with stenting. When PS occurs, prompt stenting can prevent cerebral embolism. https://thejns.org/doi/10.3171/CASE24760.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143495059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Re-irradiation followed by resection for recurrent brain metastases after initial stereotactic radiosurgery: illustrative cases. 首次立体定向放射外科手术后复发脑转移瘤的再次放射治疗和切除术：案例说明。

Journal of neurosurgery. Case lessons Pub Date : 2025-02-17 DOI: 10.3171/CASE24737

Takenori Kato, Toshinori Hasegawa, Kyoko Kuwabara, Masasuke Ohno, Shunichiro Kuramitsu, Takehiro Naito, Akihiro Mizuno, Yosuke Sakai, Hiroyuki Oishi

{"title":"Re-irradiation followed by resection for recurrent brain metastases after initial stereotactic radiosurgery: illustrative cases.","authors":"Takenori Kato, Toshinori Hasegawa, Kyoko Kuwabara, Masasuke Ohno, Shunichiro Kuramitsu, Takehiro Naito, Akihiro Mizuno, Yosuke Sakai, Hiroyuki Oishi","doi":"10.3171/CASE24737","DOIUrl":"10.3171/CASE24737","url":null,"abstract":"Background: The management of recurrent brain metastases after initial stereotactic radiosurgery (SRS) remains challenging, with high local recurrence rates following salvage surgery. While preoperative SRS has shown promise for newly diagnosed metastases, its application in post-SRS recurrences is largely unexplored.Observations: The authors treated three patients with recurrent brain metastases using preoperative re-irradiation followed by resection. Gamma Knife SRS was performed at marginal doses of 16-18 Gy, followed by resection within 24-48 hours. Local control was achieved in all patients without radiation-related complications. Histopathological examination confirmed the presence of viable tumor cells and radiation-induced changes. Follow-up magnetic resonance imaging revealed no evidence of tumor recurrence or adverse effects. Two patients remained alive at 35 and 19 months, whereas one died of primary cancer progression at 20 months.Lessons: Preoperative re-irradiation followed by resection for recurrent brain metastases after initial SRS is feasible and offers promise for short-term safety, local control, and rapid symptom improvement. The ability to promptly implement SRS enables its application in oncological emergencies. These findings suggest that preoperative re-irradiation can be a valuable strategy for managing symptomatic post-SRS recurrent brain metastases that require prompt surgical intervention. https://thejns.org/doi/10.3171/CASE24737.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443054","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

Eagle syndrome with repeated transient disturbances of consciousness diagnosed using digital subtraction angiography with head rotation: illustrative case. 利用旋转头部的数字减影血管造影术诊断出反复出现短暂意识障碍的伊格尔综合征：示例病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-02-17 DOI: 10.3171/CASE24744

Hiroki Kobayashi, Yoshinori Kotani, Mamoru Ogiso, Yusuke Egashira, Shinji Noda

{"title":"Eagle syndrome with repeated transient disturbances of consciousness diagnosed using digital subtraction angiography with head rotation: illustrative case.","authors":"Hiroki Kobayashi, Yoshinori Kotani, Mamoru Ogiso, Yusuke Egashira, Shinji Noda","doi":"10.3171/CASE24744","DOIUrl":"10.3171/CASE24744","url":null,"abstract":"Background: Eagle syndrome with repeated transient disturbances of consciousness is uncommon, with only a few reported cases. Here, the authors report a rare case of Eagle syndrome with repeated transient disturbances of consciousness in a specific head position, diagnosed using digital subtraction angiography (DSA) with head rotation.Observations: A 74-year-old man experienced several episodes of transient disturbance of consciousness. When he stared downward toward the left, he experienced transient tremors in the right upper and lower limbs and a transient loss of consciousness. Magnetic resonance imaging failed to identify the cause. DSA performed with external head rotation and leftward flexion revealed a delay of blood flow distal to the cervical portion of the left internal carotid artery caused by compression from the left styloid process. A superficial temporal artery-middle cerebral artery (STA-MCA) bypass was required in the right cerebral hemisphere. The styloid process was removed first, as the head needed leftward rotation during surgery. Transient disturbance of consciousness did not recur after surgery. Four months later, a right STA-MCA bypass was performed.Lessons: This case highlights Eagle syndrome as a potential cause of repeated transient disturbances of consciousness. DSA with head rotation proved useful for the diagnosis. https://thejns.org/doi/10.3171/CASE24744.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143443104","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