1
Review Surg Neurol Int
. 2020 May 30;11:131. doi: 10.25259/SNI_96_2020. eCollection 2020.
Instrumentation Following Intradural Tumor Resection: A Case Analyses and Literature Review
Brandon Michael Wilkinson 1, Michael Galgano 1
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PMID: 32547818 PMCID: PMC7294150 DOI: 10.25259/SNI_96_2020
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Abstract
Background: Resection of intradural spinal tumors typically utilizes a posterior approach and often contributes to significant biomechanical instability and sagittal deformity.
Methods: We searched PubMed for studies regarding pre- and postoperative spine biomechanics/alignment in patients with intradural tumors undergoing posterior decompressions.
Results: Three patients underwent posterior decompressions with instrumented fusions to preserve good sagittal alignment postoperatively. Variables analyzed in this study included the extent of preoperative and postoperative deformity, the number of surgical levels decompressed and fused, the different frequencies of instability following the resection of cervical versus thoracic versus lumbar lesions, and whether pediatric patients were most likely to develop instability.
Conclusion: Simultaneously performing instrumented fusions following posterior spinal decompressions for tumor removal proved optimal in preventing postoperative spinal deformity. Further, "open" surgical procedures offered more optimal/definitive tumor removal versus minimally invasive approaches, and the greater operative exposure and resultant increased risk for instability were remediated by performing simultaneous fusion.
Keywords: Instrumentation; Intradural; Spine; Tumor.
Copyright: © 2020 Surgical Neurology International.
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2
Surg Neurol Int
. 2020 Jun 6;11:145. doi: 10.25259/SNI_103_2020. eCollection 2020.
Early Versus Delayed Surgical Evacuation of Spontaneous Supratentorial Intracerebral Hematoma: A Prospective Cohort Study
Mostafa Raafat 1, Omar Abdelaleem Ragab 1, Osama Mohamed Abdelwahab 1, Mohamed Mamdouh Salama 2, Mohamed Ahmed Hafez 2
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PMID: 32547832 PMCID: PMC7294152 DOI: 10.25259/SNI_103_2020
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Abstract
Background: The optimum timing for surgical evacuation of spontaneous supratentorial intracerebral hematoma (ICH) is still controversial. The aim of this study was to compare the clinical outcome following early versus delayed surgical evacuation of spontaneous supratentorial ICH.
Methods: This is a prospective cohort study including 70 patients with spontaneous supratentorial ICH ≥30 cc in volume and Glasgow Coma Scale 8-12. Patients were divided into two groups based on the time interval between ictus and surgery; Group A (evacuated within 8 h from ictus) and Group B (evacuated >8 h from ictus). Outcome was assessed at discharge and at 2 months postoperative using extended Glasgow Outcome Scale.
Results: The early evacuation group (Group A) included 44 patients and the late evacuation group (Group B) included 26 patients. Favorable outcome was achieved in 20.5% of the patients in Group A and in 11.5% of the patients in Group B. Mortality rate was 18.2% in Group A and 26.9% in Group B. Three patients in Group A and one patient in Group B required reoperation. The mean hospital stay was 17.18 days and 14.54 days in Groups A and B, respectively.
Conclusion: Early surgical evacuation of spontaneous supratentorial ICH in patients with good preoperative conscious level is associated with better clinical outcome, particularly in the early postoperative period. Early surgical evacuation has no significant impact on the rate of reoperation or the length of hospital stay.
Keywords: Extended Glasgow Outcome Scale; Intracerebral hematoma; Supratentorial; Surgical evacuation.
Copyright: © 2020 Surgical Neurology International.
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16 references
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3
Surg Neurol Int
. 2020 May 30;11:130. doi: 10.25259/SNI_44_2020. eCollection 2020.
Barriers of Neurophysiology Monitoring in Spine Surgery: Latin America Experience
Alfredo Guiroy 1, Marcelo Valacco 2, Martin Gagliardi 1, Juan Pablo Cabrera 3, Juan Emmerich 4, Gaston Camino Willhuber 5, Asdrubal Falavigna 6
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PMID: 32547817 PMCID: PMC7294159 DOI: 10.25259/SNI_44_2020
Free PMC article
Abstract
Background: Intraoperative neurophysiological monitoring (IOM) has become valuable in spine surgery. Unfortunately, it is not always available in many spine centers, especially in developing countries. Our aim was to evaluate the accessibility and barriers to IOM in spine surgery in Latin America.
Methods: We designed a questionnaire to evaluate the characteristics of surgeons and their opinions on the usefulness of IOM for different spine operations. The survey was sent to 9616 members and registered users of AO Spine Latin America (AOSLA) from August 1, 2019, to August 21, 2019. Major variables studied included nationality, years of experience, specialty (orthopedics or neurosurgery), level of complexity of the hospital, number of spine surgeries performed per year by the spine surgeon, the types of spinal pathologies commonly managed, and how important IOM was to the individual surgeon. General questions to evaluate use included accessibility, limitations of IOM usage, management of IOM changes, and the legal value of IOM. The results were analyzed and compared between neurosurgeon and orthopedics, level of surgeon experience, and country of origin.
Results: Questionnaires were answered by 200 members of AOSLA from 16 different countries. The most common responses were obtained from orthopedic surgeons (62%), those with more than 10 years of practice (54%); majority of surgeons performed more than 50 spine surgeries per year (69%) and treated mainly spine degenerative diseases (76%). Most surgeons think that IOM has a real importance during surgeries (92%) and not just a legal value. Although surgeons mostly considered IOM essential to scoliosis surgery in adolescents (70%), thoracolumbar kyphosis correction (68%), and intramedullary tumors (68%), access to IOM was limited to 57% for economic reasons. Of interest, in 64% of cases, where IOM was available and significant change occurred, the actual operative procedures were significantly altered.
Conclusion: Despite the fact that 68% of spine surgeons believe IOM to be indispensable for complex spine surgery, cost remains the main barrier to its use/availability in Latin America.
Keywords: Evoked potentials; Intraoperative neurophysiological monitoring; Latin America; Spine; Spine surgery.
Copyright: © 2020 Surgical Neurology International.
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4
Case Reports Surg Neurol Int
. 2020 Jun 6;11:138. doi: 10.25259/SNI_188_2019. eCollection 2020.
Supratentorial Intraventricular Rosette-Forming Glioneuronal Tumors - Case Report and Review of Treatment Paradigms
Anil K Mahavadi 1, Caroline Temmins 2, Mahesh R Patel 3, Harminder Singh 4
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PMID: 32547825 PMCID: PMC7294172 DOI: 10.25259/SNI_188_2019
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Abstract
Background: Rosette-forming glioneuronal tumors (RGNT) are slow-growing WHO Grade I tumors that are characterized by mixed histology and rosette formation. Although typically located in the posterior fossa, these tumors can rarely originate elsewhere. Here, we describe the fourth case in literature where an RGNT was localized to the lateral ventricles and detail the treatment approach.
Case description: A 41-year-old male presented with a 10 day history of gradually worsening headaches and mild gait difficulty. Computed tomography and magnetic resonance imaging (MRI) identified a heterogeneously enhancing 6.0 cm left lateral ventricular cystic mass with hydrocephalus. An interhemispheric transcallosal approach was performed for tumor debulking. The mass was emanating from the roof of the left lateral ventricle. Sub-total resection (STR) was achieved. Pathology showed a glioneuronal neoplasm with vague neurocytic rosettes and loose perivascular pseudorosettes. Tumor vessels were thickly hyalinized and contained eosinophilic granular bodies and Rosenthal fibers. Tumor stained positive for GFAP, S-100, OLIG2, and SOX10, and patchy positive for epithelial membrane antigen (EMA), D2-40, CD99, and p16. Neurocytic rosettes and perivascular structures stained positive for synaptophysin. The patient was discharged home uneventfully and remained intact at his 6-month follow-up visit. Long-term care included MRI surveillance with repeat surgery being considered in case of progression.
Conclusion: In this report, we describe the fourth case of an RGNT being isolated to the lateral ventricles and the first where it stained positive for EMA and D2-40. Our patient's uneventful recovery after STR indicates that surgery alone continues to be a viable initial treatment option.
Keywords: Lateral ventricle; Outcomes; Rosette-forming glioneuronal tumor; Sub-total resection; Supratentorial.
Copyright: © 2020 Surgical Neurology International.
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30 references6 figures
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Surg Neurol Int
. 2020 Jun 6;11:144. doi: 10.25259/SNI_192_2020. eCollection 2020.
Effect of Length Time to Surgery on Postoperative Hospital Length of Stay Among Neurosurgical Patients
Yahya H Khormi 1, Andrew Nataraj 2
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PMID: 32547831 PMCID: PMC7294178 DOI: 10.25259/SNI_192_2020
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Abstract
Background: In most hospitals, inpatient urgent surgery is triaged based on the degree of urgency and time of surgical booking. A longer wait for semi-urgent surgery due to sharing resources between specialties might impact the postoperative course. The objective of this study is to determine the effect of length time to semi- urgent surgery on postoperative hospital length of stay among neurosurgical patients.
Methods: A retrospective cohort study was conducted included all admitted adult patients placed on semi-urgent University of Alberta Hospital surgical list between 2008 and 2013. Linear and logistic regression analyses were performed. The main exposure variable was time from surgical booking to the time of surgery, and the outcome variable was time from surgery to discharge.
Results: A total of 1367 neurosurgical cases were included in the study. The mean age was 54.3 years. The mean length of time in the hospital before and after surgery was 1.2 and 12.5 days, respectively. Overall, the time from booking to surgery did not affect the time from surgery to discharge. Increased age, higher ASA score, and surgeries performed after 24 h from booking in the group of patients who were discharged to another facility were associated with a longer postoperative stay.
Conclusion: Neurosurgery patients booked for surgery to be done within 24 h waited longer to have their procedure completed. Overall, there was no significant association between length of time waiting for surgery and postoperative stay, although there was an increase in postoperative stays among patients who were discharged to another facility and had their surgeries performed after 24 h.
Keywords: Early surgery; Hospital length of stay; Late surgery; Postoperative stay; Waiting time.
Copyright: © 2020 Surgical Neurology International.
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6
Case Reports Surg Neurol Int
. 2020 May 30;11:136. doi: 10.25259/SNI_240_2020. eCollection 2020.
A Case Report of Microvascular Decompression for Cervical Myelopathy and Radiculopathy Caused by Tortuous and Abnormal Bilateral Vertebral Artery
Naoki Omura 1, Yangtae Park 1, Shunsuke Ikeda 1, Hideki Tanabe 1
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PMID: 32547823 PMCID: PMC7294169 DOI: 10.25259/SNI_240_2020
Free PMC article
Abstract
Background: Tortuous/abnormal vertebral arteries (VAs) sometimes cause neurovascular compression syndromes (NVCs), such as trigeminal neuralgia, hemifacial spasm, and, rarely, myelopathy/radiculopathy. Abnormalities/tortuosity of the VA at the level of the atlas and axis are of particular note; these may be characterized by a persistent first intersegmental artery (PFIA) and C2 segmental type of VA. Herein, we report a 72-year-old male who presented with cervical myelopathy/radiculopathy due to bilateral tortuosity of the PFIA resulting in spinal cord compression at the craniocervical junction.
Case description: A 72-year-old male presented with cervical pain when turning his neck and progressive gait disturbance. The neurological examination demonstrated a moderate myeloradicular syndrome (Nurick Grade III). The magnetic resonance revealed compression of the medulla and spinal cord due to tortuosity of both dorsal VA at the C1 vertebral level. The three-dimensional computed tomography angiogram confirmed bilateral PFIA running medially. In addition, the left side of VA forms fenestration. Surgery through a C1 laminectomy and midline small suboccipital craniectomy, both VAs were transposed and tethered to the ipsilateral dura utilizing Aron Alpha and vinyl prostheses. In addition, a large vinyl prosthesis was inserted between both VAs to protect them from contacting the spinal cord. Following this decompressive procedure, the patient's symptoms fully resolved, and he remains asymptomatic 10 years later exhibiting no recurrent vascular pathology.
Conclusion: Microvascular decompression of anomalous VAs contributing to cord compression at the C1 level was safe and effective in a 72-year-old male.
Keywords: Cervical myelopathy and radiculopathy; Microvascular decompression; Persistent first intersegmental artery; Vertebral artery anomaly.
Copyright: © 2020 Surgical Neurology International.
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7
Case Reports Surg Neurol Int
. 2020 Jun 6;11:141. doi: 10.25259/SNI_56_2020. eCollection 2020.
Hemifacial Spasm Caused by the Brainstem Developmental Venous Anomaly: A Case Report and Review of the Literature
George Grigoryan 1, Andrey Sitnikov 1, Yuri Grigoryan 1
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PMID: 32547828 PMCID: PMC7294170 DOI: 10.25259/SNI_56_2020
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Abstract
Background: Hemifacial spasm (HFS) is usually caused by vascular compression of the root exit zone (REZ) of the facial nerve. Dual compression of the REZ by veins and arteries is also associated with HFS, but venous origin alone is rarely reported. We present a rare case of HFS caused by the brainstem developmental venous anomaly (DVA) treated with microvascular decompression (MVD).
Case description: A 30-year-old women presented with the left-sided HFS since the age of 18 years. The brainstem DVA was diagnosed by magnetic resonance imaging (MRI) and followed by two attempts of MVD at some other clinics without any improvement. At our hospital, MVD was performed through a left retromastoid craniotomy. Intraoperatively, after detaching the strong adhesions between the cerebellar hemisphere, petrosal dura and lower cranial nerves, and removing the Teflon sponge inserted during the previous operations, the compressing large vein was found, separated from facial nerve REZ and MVD was completed. The postoperative computed tomography angiography and MRI showed the thrombosis of the main trunk of DVA and decompression of the facial nerve REZ. Complete cessation of HFS with hearing preservation was observed with only slight weakness of mimic muscles which disappeared within 3 months after surgery.
Conclusion: HFS associated with brainstem DVA is a very rare condition. MVD of the facial nerve REZ with transposition of the large draining vein should be considered as an effective treatment option.
Keywords: Brainstem; Developmental venous anomaly; Hemifacial spasm; Microvascular decompression; Venous angioma.
Copyright: © 2020 Surgical Neurology International.
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33 references3 figures
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Case Reports Surg Neurol Int
. 2020 Jun 6;11:140. doi: 10.25259/SNI_20_2020. eCollection 2020.
Parvimonas micra: A Potential Causative Pathogen to Consider When Diagnosing Odontogenic Brain Abscesses
Ruth Prieto 1, Alejandro Callejas-Díaz 2, Rasha Hassan 1, Alberto Pérez de Vargas 3, Luis Fernando López-Pájaro 3
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PMID: 32547827 PMCID: PMC7294173 DOI: 10.25259/SNI_20_2020
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Abstract
Background: Brain abscess is a life-threatening entity which requires prompt and long-term antibiotic therapy, generally associated with surgical drainage, and eradicating the primary source of infection. Parvimonas micra (Pm) has only been reported once before as the lone infecting organism of an orally originated, solitary brain abscess. Diagnosing brain abscesses caused by this Gram-positive anaerobic coccus, constituent of the oral cavity flora, is challenging, and an optimal treatment regimen has not been well established. We report the diagnosis and successful treatment of a Pm caused odontogenic brain abscess.
Case description: A 62-year-old immunocompetent male with a right-parietal brain abscess presented with headache and seizures. He was started on empirical antibiotic therapy and subsequently underwent surgical drainage. The only source of infection found was severe periodontitis with infected mandibular cysts. Thus, tooth extraction and cyst curettage were performed 1 week after brain surgery. Cultures of brain abscess fluid were negative, but amplification of bacterial 16S ribosomal RNA (rRNA) with polymerase chain reaction demonstrated Pm. After 3 weeks of intravenous ceftriaxone and metronidazole, the patient was switched to oral metronidazole and moxifloxacin for 6 weeks.
Conclusions: This case highlights the potential risk of untreated dental infections causing brain abscesses. Pm should be considered as a possible pathogen of odontogenic brain abscesses despite its presence usually not being detected by standard bacterial cultures. Therefore, 16S rRNA gene sequencing analysis is strongly recommended for bacterial identification before defining brain abscesses as cryptogenic.
Keywords: 16S rRNA analysis; Brain abscess; Dental infection; Odontogenic abscess; Parvimonas micra.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 May 30;11:134. doi: 10.25259/SNI_178_2020. eCollection 2020.
Intracranial Ewing Sarcoma - A Case Report
Jiahua Huang 1, Finn Ghent 1, Robyn Levingston 1, Martin Scholsem 1
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PMID: 32547821 PMCID: PMC7294174 DOI: 10.25259/SNI_178_2020
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Abstract
Background: Intracranial Ewing's sarcoma (ES) is a rare entity with <15 cases reported in the literature. It belongs to a family of round-cell neuroectodermally derived tumors bearing many similarities to peripheral primitive neuroectodermal tumor (pPNET). There is currently no established treatment protocol. Reported cases are treated with either surgery alone or surgery with adjuvant chemotherapy and radiation.
Case description: We describe a case of intracranial left frontal ES in a 19-year-old patient who presented with change in behavior. Diagnosis was unclear based on radiological findings on MRI and CT alone. MRI brain with contrast demonstrated a large extra-axial ovoid heterogeneously enhancing left frontal convexity mass. The patient underwent gross total resection with adjuvant chemotherapy and radiation. No local or systemic recurrence was found at 12 months postoperatively.
Conclusion: Intracranial ES/pPNET is rare tumor with nonspecific clinical presentation and radiological findings. They are locally invasive. Surgery with adjuvant chemoradiation is the mainstay treatment. Distinction of pPNET and cPNET is important for therapeutic and prognostic purposes.
Keywords: Ewing’s sarcoma; Meningeal tumor; Neuro-oncology; Peripheral primitive neuroectodermal tumor; Soft-tissue tumor.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 6;11:139. doi: 10.25259/SNI_506_2019. eCollection 2020.
Fungal Mycotic Aneurysm in a Patient With Aspergillus terreus Chronic Meningoencephalitis
Marcos Vinicius Sangrador-Deitos 1, Jimena Alejandra González Olvera 2, Heidy Adames Espinal 3, Graciela Cárdenas Hernández 3, Verónica Angeles Morales 3, José Luis Soto Hernandez 3
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PMID: 32547826 PMCID: PMC7294177 DOI: 10.25259/SNI_506_2019
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Abstract
Background: Central nervous system involvement due to aspergillosis is an extremely serious entity, particularly in patients with severe neutropenia, hematological diseases, or post-transplant cases. Immunocompetent patients can be infected by intense exposure, particularly iatrogenic after invasive procedures.
Case description: We present the case of a 26-year-old male with a 1 year appendectomy background, which required epidural anesthesia. After that surgery, insidious headache presented, requiring mild analgesics for adequate control. In the following weeks, headaches increased and tomographic imaging revealed hydrocephalus. A ventriculoperitoneal shunt was placed, and empirical treatment for neurocysticercosis was established, but diagnosis was never confirmed. Sequentially, shunt dysfunction occurred twice, for which shunt replacement was performed. Cerebrospinal fluid and shunt's catheter were cultured. Some days later, a filamentous fungus was isolated and finally identified as Aspergillus sp. Intravenous amphotericin B and fluconazole at therapeutic dosage were administered; however, a torpid clinical evolution was observed. After a 2-week antifungal scheme, the fungus was identified as Aspergillus terreus. The patient developed sudden rostrocaudal deterioration. Computed tomography imaging was done, revealing a 70 cc hematoma in the right operculoinsular region, midline shift, and a 9 mm saccular aneurysm at the bifurcation of the middle cerebral artery.
Conclusion: Cerebral aspergillosis is a serious disease with high mortality in patients, particularly those without identifiable risk factors. The iatrogenic forms are serious, due to the delay of clinical diagnosis. It is important to have a high index of suspicion in patients with a history of invasive procedures such as epidural anesthesia or surgery, and who develop a persistent chronic headache or chronic meningitis.
Keywords: Aneurysm; Aspergillus terreus; Mycotic.
Copyright: © 2020 Surgical Neurology International.
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11
Case Reports Surg Neurol Int
. 2020 Jun 6;11:142. doi: 10.25259/SNI_160_2020. eCollection 2020.
Spinal Dural Arteriovenous Fistula Masquerading as Subdural Hematoma
Kristin Huntoon 1, Umang Khandpur 1, David Dornbos 1, Patrick P Youssef 1
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PMID: 32547829 PMCID: PMC7294149 DOI: 10.25259/SNI_160_2020
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Abstract
Background: This case highlights an angiographically occult spinal dural AVF presenting with a spinal subdural hematoma. While rare, it is important that clinicians be aware of this potential etiology of subdural hematomas before evacuation.
Case description: A 79-year-old female presented with acute lumbar pain, paraparesis, and a T10 sensory level loss. The MRI showed lower cord displacement due to curvilinear/triangular enhancement along the right side of the canal at the T12-L1 level. The lumbar MRA, craniospinal CTA, and multivessel spinal angiogram were unremarkable. A decompressive exploratory laminectomy revealed a subdural hematoma that contained blood products of different ages, and a large arterialized vein exiting near the right L1 nerve root sheath. The fistula was coagulated and sectioned. Postoperatively, the patient regained normal function.
Conclusion: Symptomatic subdural thoracolumbar hemorrhages from SDAVF are very rare. Here, we report a patient with an acute paraparesis and T10 sensory level attributed to an SDAVF and subdural hematoma. Despite negative diagnostic studies, even including spinal angiography, the patient underwent surgical intervention and successful occlusion of the SDAVF.
Keywords: Angiographically occult; Arteriovenous fistula; Subdural hematoma; Vascular malformation.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 May 30;11:135. doi: 10.25259/SNI_206_2020. eCollection 2020.
"Crown and Necklace" Appearance of Cisternal Tuberculoma
Ahmed Ansari 1
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PMID: 32547822 PMCID: PMC7294176 DOI: 10.25259/SNI_206_2020
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13
Case Reports Surg Neurol Int
. 2020 May 30;11:128. doi: 10.25259/SNI_578_2019. eCollection 2020.
Reversible Cerebral Vasoconstriction Syndrome Concomitant With Cerebral Venous Sinus Thrombosis Following Ovarian Tumor Resection: A Report of Two Cases
Yu Shimizu 1, Katsuhiro Tsuchiya 2, Hironori Fujisawa 2
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PMID: 32547815 PMCID: PMC7294317 DOI: 10.25259/SNI_578_2019
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Abstract
Background: Reversible cerebral vasoconstriction syndrome (RCVS) presents with characteristic clinical, brain imaging, and angiographic findings. The most common clinical feature of RCVS is a severe acute headache, which is often referred to as a thunderclap headache due to the nature of its presentation. It may occur spontaneously or may be provoked by various precipitating factors. We present a rare case of RCVS concomitant with cerebral venous sinus thrombosis (CVST) in a woman who underwent resection of an ovarian tumor.
Case description: Case 1 - A 42-year-old woman was admitted to our hospital with severe headache radiating to the neck, with associated vomiting. She revealed a medical history of ovarian cancer and underwent an operation for the resection of the tumor, a month before presentation. After resection, her estradiol (E2) levels were reduced from 288 pg/ml to 31 pg/ml (normal range, 0-49 pg/ml). Initial imaging on admission to our hospital revealed the left posterior convexity subarachnoid hemorrhage. Magnetic resonance angiography (MRA) showed findings consistent with RCVS affecting the left posterior cerebral artery. Magnetic resonance venography (MRV) showed CVST of the left transverse and sigmoid sinuses. Single-photon emission computed tomography (SPECT) showed a left posterior ischemic lesion. These findings improved following treatment with nimodipine and anticoagulant. Case 2 - A 39-year-old woman presented with holocranial headache associated with vomiting. She was diagnosed with an ovarian tumor. She underwent an operation 3 months before presentation. After tumor resection, her E2 level decrease from 193 pg/ml to 19 pg/ml (normal range, 0-49 pg/ml). Magnetic resonance angiography (MRA) confirmed the presence of a vasospasm involving the right anterior cerebral artery. Magnetic resonance venography (MRV) confirmed the presence of thrombosis involving the superior sagittal sinus. She was discharged on postpartum day 31 without neurological deficits after treatment with anticoagulants. At her 3-month follow-up, both MRA and MRV were within the normal limits.
Conclusion: This is the first report of two women diagnosed with RCVS with concomitant CVST following ovarian tumor resection. Marked reductions in postoperative E2 levels could have contributed to the development of CVST and RCVS.
Keywords: Cerebral venous sinus thrombosis; Edoxaban; Ovarian tumor; Reversible cerebral vasoconstriction syndrome; Single-photon emission computed tomography.
Copyright: © 2020 Surgical Neurology International.
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14
Case Reports Surg Neurol Int
. 2020 Jun 6;11:143. doi: 10.25259/SNI_193_2020. eCollection 2020.
Supratentorial Convexity Schwannoma Unrelated to Cranial Nerves: Case Report and Review of the Literature
Daisuke Wajima 1, Shuta Aketa 1, Taiji Yonezawa 1
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PMID: 32547830 PMCID: PMC7294175 DOI: 10.25259/SNI_193_2020
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Abstract
Background: Intracranial schwannoma not related to cranial nerves is rare entity, and difficult to be diagnosed preoperatively. Here, we experienced a case of convexity schwannoma mimicking convexity meningioma, and discuss about the characteristics of such cases based on the past published reports.
Case description: A 48-year-old man presented with a sudden onset of seizures. Brain magnetic resonance image (MRI) revealed a small mass lesion in the peripheral aspect of the right parieto-frontal lobe. The mass was isointense on T1-weighted and hyperintense on T2-weighted MRI, with homogenous enhancement after contrast medium administration. After the feeder embolization on the previous day, removal of the tumor was performed. The tumor revealed a well-demarcated, firm, spherical tumor beyond, and beneath the dura and was relatively easy to be separated from the brain. Histologically, the tumor was observed to be in subarachnoid space extending to outer space of dura-mater, intimately attached to the pia mater. The histological diagnosis was schwannoma.
Conclusion: In our case, MRI findings are similar to convexity meningioma; however, the pathological diagnosis was schwannoma. Cerebral convexity is an extremely rare location for schwannoma. We emphasize that schwannoma, not related to cranial nerves, may arise in the subdural convexity space.
Keywords: Convexity schwannoma; Review; Unrelated cranial nerve origin.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 May 30;11:129. doi: 10.25259/SNI_2_2020. eCollection 2020.
Risk Factors of Diffuse Alveolar Hemorrhage After Acute Ischemic Stroke Treated With Tissue-Type Plasminogen Activator. The Effectiveness of Activated Recombinant Factor VII Treatment
Yu Shimizu 1, Katsuhiro Tsuchiya 1, Norihiro Fujisawa 1
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PMID: 32547816 PMCID: PMC7294161 DOI: 10.25259/SNI_2_2020
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Abstract
Background: Diffuse alveolar hemorrhage (DAH) is a rare and frequently life-threatening complication of a variety of conditions. DAH may result from coagulation disorders, inhaled toxins, or infections. We report a series of patients who developed DAH after receiving a tissue-type plasminogen activator (tPA) for acute cerebral infarction. We aimed to find risk factors of DAH in patients receiving tPA and the effectiveness of activated recombinant factor VII (rFVIIa) treatment for the same.
Case description: A total of 1023 acute ischemic stroke (AIS) patients who received tPA in our department from January 2006 to December 2018 were enrolled in this study. Four of the 1023 patients (0.39%) developed DAH. The modified Rankin scale was used to assess clinical severity. Infarction volume was assessed upon follow-up using DWI (diffusion-weighted imaging). Atherothrombotic brain infarction cases were excluded from the study. The age, sex, occlusion site, area of infarction, emphysema, intracranial hemorrhage, and neurological outcomes were analyzed. Patients who developed DAH were more likely to have a history of emphysema. We administered rFVIIa to three DAH patients with good prognosis.
Conclusion: The inclusion/exclusion criteria of tPA were based on the AHA/ASA Guidelines for the early management of patients with AIS.These patients had no evidence of infections, bronchoscopy, autoimmune diseases, HIV, and transplantations. Our study suggests that systemic administration of rFVIIa for DAH is effective. Emphysema may be a risk factor for the development of DAH following tPA. When we use tPA for emphysema patients, we must be careful about DAH enough.
Keywords: Activated recombinant factor VII; Acute ischemic stroke; Diffuse alveolar hemorrhage; National Institutes of Health Stroke Scale; Tissue-type plasminogen activator.
Copyright: © 2020 Surgical Neurology International.
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16
Case Reports Surg Neurol Int
. 2020 May 30;11:137. doi: 10.25259/SNI_226_2020. eCollection 2020.
Hyperextension Thoracic Spine Fracture With Complete Neurological Recovery After Surgical Fixation: A Case Report
Arash Fattahi 1, Seyed Mohammad Reza Mohajeri 1, Abdolhadi Daneshi 1, Ardeshir Shahivand 1
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PMID: 32547824 PMCID: PMC7294168 DOI: 10.25259/SNI_226_2020
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Abstract
Background: Hyperextension thoracic spine fractures (HTSFs) typically involve the anterior ligamentous complex of the spine. These patients often present with paraplegia and warrant early surgical reduction/fixation even though few deficits resolve. Here, we present the unusual case of a 40-year-old male whose paraparetic deficit resolved following reduction/fixation of a T7-T8 HTSF.
Case description: A 40-year-old male presented with a thoracic computed tomography (CT) documented T7- T8 HTSF following a motor vehicle accident. His neurological examination revealed severe paraparesis, but without a sensory level (ASIA motor score 78). The chest CT angiogram scan revealed a hypodensity in the aorta, representing a small traumatic aortic dissection responsible for the patient's right hemothorax; 450 ml of blood was removed on chest tube placement. He underwent urgent/emergent thoracic spine reduction and fixation at the T7-T8 level. Within 5 postoperative months, he recovered fully neurological function (ASIA motor score 100).
Conclusion: We recommend urgent/emergent surgical reduction/stabilization for patients with thoracic HTSF to decrease offer the potential for neurological recovery and avoid secondary injury due to continued compression.
Keywords: Aortic dissection; Hyperextension thoracic spine fractures; Spinal cord injury; Traction; Trauma.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 May 30;11:133. doi: 10.25259/SNI_174_2020. eCollection 2020.
Cervical Epidural Neurosarcoidosis: A Case Report and Literature Review
Sami Khairy 1 2 3, N A Alharbi 1 2 3, Abeer Alaglan 1 2 3, Fahd Al Sufiani 2 3 4, Ahmed Alkhani 1 2 3
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PMID: 32547820 PMCID: PMC7294160 DOI: 10.25259/SNI_174_2020
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Abstract
Background: Neurosarcoidosis is a rare disease. In the spine, it commonly presents as an intramedullary lesion. Epidural spinal lesions are extremely rare.
Case description: A 29-year-old patient presented with a 22-month history of progressive neck, upper limb pain, and myelopathy. The cervical MRI showed a large epidural mass infiltrating the paraspinal soft tissue. After an open biopsy, the diagnosis of neurosarcoidosis was established and was followed-up by appropriate medical management.
Conclusion: To manage cervical epidural neurosarcoidosis, first, you must obtain a tissue diagnosis and then follow with appropriate medical management.
Keywords: Cervical; Epidural; Neurosarcoidosis.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 May 30;11:132. doi: 10.25259/SNI_173_2020. eCollection 2020.
A Case of Cervical Myelopathy Following Chronic Hypertrophic Non-Union Type 2 Odontoid Fracture Managed With Posterior C1 Decompression and C1-3 Instrumentation: Case Report and Brief Review of Literature
Ahmed Taha Elsayed Shaaban 1, Ahmed Doomi 1, Sirajeddin Belkheir 1 2 3
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PMID: 32547819 PMCID: PMC7294179 DOI: 10.25259/SNI_173_2020
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Abstract
Background: Type 2 odontoid fractures are the most common type of fracture of the axis. In rare cases, nonunion of a type 2 odontoid fracture can be hypertrophic resulting in myelopathy due to cervical cord compression.
Case description: A 48-year-old male presented with hypertrophic nonunion of a chronic type 2 odontoid fracture resulting in cord compression/myelopathy. This was adequately treated utilizing a C1 decompression and C1-3 instrumented fusion; no anterior procedure was necessary.
Conclusion: Here, we successfully treated a patient with a hypertrophic nonunion of a chronic type 2 odontoid fracture utilizing a posterior only approach consisting of a C1 laminectomy with C1-C3 fusion.
Keywords: Fracture; Hypertrophic; Myelopathy; Non-union; Odontoid.
Copyright: © 2020 Surgical Neurology International.
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Review Surg Neurol Int
. 2020 May 30;11:131. doi: 10.25259/SNI_96_2020. eCollection 2020.
Instrumentation Following Intradural Tumor Resection: A Case Analyses and Literature Review
Brandon Michael Wilkinson 1, Michael Galgano 1
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PMID: 32547818 PMCID: PMC7294150 DOI: 10.25259/SNI_96_2020
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Abstract
Background: Resection of intradural spinal tumors typically utilizes a posterior approach and often contributes to significant biomechanical instability and sagittal deformity.
Methods: We searched PubMed for studies regarding pre- and postoperative spine biomechanics/alignment in patients with intradural tumors undergoing posterior decompressions.
Results: Three patients underwent posterior decompressions with instrumented fusions to preserve good sagittal alignment postoperatively. Variables analyzed in this study included the extent of preoperative and postoperative deformity, the number of surgical levels decompressed and fused, the different frequencies of instability following the resection of cervical versus thoracic versus lumbar lesions, and whether pediatric patients were most likely to develop instability.
Conclusion: Simultaneously performing instrumented fusions following posterior spinal decompressions for tumor removal proved optimal in preventing postoperative spinal deformity. Further, "open" surgical procedures offered more optimal/definitive tumor removal versus minimally invasive approaches, and the greater operative exposure and resultant increased risk for instability were remediated by performing simultaneous fusion.
Keywords: Instrumentation; Intradural; Spine; Tumor.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 6;11:145. doi: 10.25259/SNI_103_2020. eCollection 2020.
Early Versus Delayed Surgical Evacuation of Spontaneous Supratentorial Intracerebral Hematoma: A Prospective Cohort Study
Mostafa Raafat 1, Omar Abdelaleem Ragab 1, Osama Mohamed Abdelwahab 1, Mohamed Mamdouh Salama 2, Mohamed Ahmed Hafez 2
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PMID: 32547832 PMCID: PMC7294152 DOI: 10.25259/SNI_103_2020
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Abstract
Background: The optimum timing for surgical evacuation of spontaneous supratentorial intracerebral hematoma (ICH) is still controversial. The aim of this study was to compare the clinical outcome following early versus delayed surgical evacuation of spontaneous supratentorial ICH.
Methods: This is a prospective cohort study including 70 patients with spontaneous supratentorial ICH ≥30 cc in volume and Glasgow Coma Scale 8-12. Patients were divided into two groups based on the time interval between ictus and surgery; Group A (evacuated within 8 h from ictus) and Group B (evacuated >8 h from ictus). Outcome was assessed at discharge and at 2 months postoperative using extended Glasgow Outcome Scale.
Results: The early evacuation group (Group A) included 44 patients and the late evacuation group (Group B) included 26 patients. Favorable outcome was achieved in 20.5% of the patients in Group A and in 11.5% of the patients in Group B. Mortality rate was 18.2% in Group A and 26.9% in Group B. Three patients in Group A and one patient in Group B required reoperation. The mean hospital stay was 17.18 days and 14.54 days in Groups A and B, respectively.
Conclusion: Early surgical evacuation of spontaneous supratentorial ICH in patients with good preoperative conscious level is associated with better clinical outcome, particularly in the early postoperative period. Early surgical evacuation has no significant impact on the rate of reoperation or the length of hospital stay.
Keywords: Extended Glasgow Outcome Scale; Intracerebral hematoma; Supratentorial; Surgical evacuation.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 May 30;11:130. doi: 10.25259/SNI_44_2020. eCollection 2020.
Barriers of Neurophysiology Monitoring in Spine Surgery: Latin America Experience
Alfredo Guiroy 1, Marcelo Valacco 2, Martin Gagliardi 1, Juan Pablo Cabrera 3, Juan Emmerich 4, Gaston Camino Willhuber 5, Asdrubal Falavigna 6
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PMID: 32547817 PMCID: PMC7294159 DOI: 10.25259/SNI_44_2020
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Abstract
Background: Intraoperative neurophysiological monitoring (IOM) has become valuable in spine surgery. Unfortunately, it is not always available in many spine centers, especially in developing countries. Our aim was to evaluate the accessibility and barriers to IOM in spine surgery in Latin America.
Methods: We designed a questionnaire to evaluate the characteristics of surgeons and their opinions on the usefulness of IOM for different spine operations. The survey was sent to 9616 members and registered users of AO Spine Latin America (AOSLA) from August 1, 2019, to August 21, 2019. Major variables studied included nationality, years of experience, specialty (orthopedics or neurosurgery), level of complexity of the hospital, number of spine surgeries performed per year by the spine surgeon, the types of spinal pathologies commonly managed, and how important IOM was to the individual surgeon. General questions to evaluate use included accessibility, limitations of IOM usage, management of IOM changes, and the legal value of IOM. The results were analyzed and compared between neurosurgeon and orthopedics, level of surgeon experience, and country of origin.
Results: Questionnaires were answered by 200 members of AOSLA from 16 different countries. The most common responses were obtained from orthopedic surgeons (62%), those with more than 10 years of practice (54%); majority of surgeons performed more than 50 spine surgeries per year (69%) and treated mainly spine degenerative diseases (76%). Most surgeons think that IOM has a real importance during surgeries (92%) and not just a legal value. Although surgeons mostly considered IOM essential to scoliosis surgery in adolescents (70%), thoracolumbar kyphosis correction (68%), and intramedullary tumors (68%), access to IOM was limited to 57% for economic reasons. Of interest, in 64% of cases, where IOM was available and significant change occurred, the actual operative procedures were significantly altered.
Conclusion: Despite the fact that 68% of spine surgeons believe IOM to be indispensable for complex spine surgery, cost remains the main barrier to its use/availability in Latin America.
Keywords: Evoked potentials; Intraoperative neurophysiological monitoring; Latin America; Spine; Spine surgery.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 6;11:138. doi: 10.25259/SNI_188_2019. eCollection 2020.
Supratentorial Intraventricular Rosette-Forming Glioneuronal Tumors - Case Report and Review of Treatment Paradigms
Anil K Mahavadi 1, Caroline Temmins 2, Mahesh R Patel 3, Harminder Singh 4
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PMID: 32547825 PMCID: PMC7294172 DOI: 10.25259/SNI_188_2019
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Abstract
Background: Rosette-forming glioneuronal tumors (RGNT) are slow-growing WHO Grade I tumors that are characterized by mixed histology and rosette formation. Although typically located in the posterior fossa, these tumors can rarely originate elsewhere. Here, we describe the fourth case in literature where an RGNT was localized to the lateral ventricles and detail the treatment approach.
Case description: A 41-year-old male presented with a 10 day history of gradually worsening headaches and mild gait difficulty. Computed tomography and magnetic resonance imaging (MRI) identified a heterogeneously enhancing 6.0 cm left lateral ventricular cystic mass with hydrocephalus. An interhemispheric transcallosal approach was performed for tumor debulking. The mass was emanating from the roof of the left lateral ventricle. Sub-total resection (STR) was achieved. Pathology showed a glioneuronal neoplasm with vague neurocytic rosettes and loose perivascular pseudorosettes. Tumor vessels were thickly hyalinized and contained eosinophilic granular bodies and Rosenthal fibers. Tumor stained positive for GFAP, S-100, OLIG2, and SOX10, and patchy positive for epithelial membrane antigen (EMA), D2-40, CD99, and p16. Neurocytic rosettes and perivascular structures stained positive for synaptophysin. The patient was discharged home uneventfully and remained intact at his 6-month follow-up visit. Long-term care included MRI surveillance with repeat surgery being considered in case of progression.
Conclusion: In this report, we describe the fourth case of an RGNT being isolated to the lateral ventricles and the first where it stained positive for EMA and D2-40. Our patient's uneventful recovery after STR indicates that surgery alone continues to be a viable initial treatment option.
Keywords: Lateral ventricle; Outcomes; Rosette-forming glioneuronal tumor; Sub-total resection; Supratentorial.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 Jun 6;11:144. doi: 10.25259/SNI_192_2020. eCollection 2020.
Effect of Length Time to Surgery on Postoperative Hospital Length of Stay Among Neurosurgical Patients
Yahya H Khormi 1, Andrew Nataraj 2
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PMID: 32547831 PMCID: PMC7294178 DOI: 10.25259/SNI_192_2020
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Abstract
Background: In most hospitals, inpatient urgent surgery is triaged based on the degree of urgency and time of surgical booking. A longer wait for semi-urgent surgery due to sharing resources between specialties might impact the postoperative course. The objective of this study is to determine the effect of length time to semi- urgent surgery on postoperative hospital length of stay among neurosurgical patients.
Methods: A retrospective cohort study was conducted included all admitted adult patients placed on semi-urgent University of Alberta Hospital surgical list between 2008 and 2013. Linear and logistic regression analyses were performed. The main exposure variable was time from surgical booking to the time of surgery, and the outcome variable was time from surgery to discharge.
Results: A total of 1367 neurosurgical cases were included in the study. The mean age was 54.3 years. The mean length of time in the hospital before and after surgery was 1.2 and 12.5 days, respectively. Overall, the time from booking to surgery did not affect the time from surgery to discharge. Increased age, higher ASA score, and surgeries performed after 24 h from booking in the group of patients who were discharged to another facility were associated with a longer postoperative stay.
Conclusion: Neurosurgery patients booked for surgery to be done within 24 h waited longer to have their procedure completed. Overall, there was no significant association between length of time waiting for surgery and postoperative stay, although there was an increase in postoperative stays among patients who were discharged to another facility and had their surgeries performed after 24 h.
Keywords: Early surgery; Hospital length of stay; Late surgery; Postoperative stay; Waiting time.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 May 30;11:136. doi: 10.25259/SNI_240_2020. eCollection 2020.
A Case Report of Microvascular Decompression for Cervical Myelopathy and Radiculopathy Caused by Tortuous and Abnormal Bilateral Vertebral Artery
Naoki Omura 1, Yangtae Park 1, Shunsuke Ikeda 1, Hideki Tanabe 1
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PMID: 32547823 PMCID: PMC7294169 DOI: 10.25259/SNI_240_2020
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Abstract
Background: Tortuous/abnormal vertebral arteries (VAs) sometimes cause neurovascular compression syndromes (NVCs), such as trigeminal neuralgia, hemifacial spasm, and, rarely, myelopathy/radiculopathy. Abnormalities/tortuosity of the VA at the level of the atlas and axis are of particular note; these may be characterized by a persistent first intersegmental artery (PFIA) and C2 segmental type of VA. Herein, we report a 72-year-old male who presented with cervical myelopathy/radiculopathy due to bilateral tortuosity of the PFIA resulting in spinal cord compression at the craniocervical junction.
Case description: A 72-year-old male presented with cervical pain when turning his neck and progressive gait disturbance. The neurological examination demonstrated a moderate myeloradicular syndrome (Nurick Grade III). The magnetic resonance revealed compression of the medulla and spinal cord due to tortuosity of both dorsal VA at the C1 vertebral level. The three-dimensional computed tomography angiogram confirmed bilateral PFIA running medially. In addition, the left side of VA forms fenestration. Surgery through a C1 laminectomy and midline small suboccipital craniectomy, both VAs were transposed and tethered to the ipsilateral dura utilizing Aron Alpha and vinyl prostheses. In addition, a large vinyl prosthesis was inserted between both VAs to protect them from contacting the spinal cord. Following this decompressive procedure, the patient's symptoms fully resolved, and he remains asymptomatic 10 years later exhibiting no recurrent vascular pathology.
Conclusion: Microvascular decompression of anomalous VAs contributing to cord compression at the C1 level was safe and effective in a 72-year-old male.
Keywords: Cervical myelopathy and radiculopathy; Microvascular decompression; Persistent first intersegmental artery; Vertebral artery anomaly.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 6;11:141. doi: 10.25259/SNI_56_2020. eCollection 2020.
Hemifacial Spasm Caused by the Brainstem Developmental Venous Anomaly: A Case Report and Review of the Literature
George Grigoryan 1, Andrey Sitnikov 1, Yuri Grigoryan 1
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PMID: 32547828 PMCID: PMC7294170 DOI: 10.25259/SNI_56_2020
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Abstract
Background: Hemifacial spasm (HFS) is usually caused by vascular compression of the root exit zone (REZ) of the facial nerve. Dual compression of the REZ by veins and arteries is also associated with HFS, but venous origin alone is rarely reported. We present a rare case of HFS caused by the brainstem developmental venous anomaly (DVA) treated with microvascular decompression (MVD).
Case description: A 30-year-old women presented with the left-sided HFS since the age of 18 years. The brainstem DVA was diagnosed by magnetic resonance imaging (MRI) and followed by two attempts of MVD at some other clinics without any improvement. At our hospital, MVD was performed through a left retromastoid craniotomy. Intraoperatively, after detaching the strong adhesions between the cerebellar hemisphere, petrosal dura and lower cranial nerves, and removing the Teflon sponge inserted during the previous operations, the compressing large vein was found, separated from facial nerve REZ and MVD was completed. The postoperative computed tomography angiography and MRI showed the thrombosis of the main trunk of DVA and decompression of the facial nerve REZ. Complete cessation of HFS with hearing preservation was observed with only slight weakness of mimic muscles which disappeared within 3 months after surgery.
Conclusion: HFS associated with brainstem DVA is a very rare condition. MVD of the facial nerve REZ with transposition of the large draining vein should be considered as an effective treatment option.
Keywords: Brainstem; Developmental venous anomaly; Hemifacial spasm; Microvascular decompression; Venous angioma.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 6;11:140. doi: 10.25259/SNI_20_2020. eCollection 2020.
Parvimonas micra: A Potential Causative Pathogen to Consider When Diagnosing Odontogenic Brain Abscesses
Ruth Prieto 1, Alejandro Callejas-Díaz 2, Rasha Hassan 1, Alberto Pérez de Vargas 3, Luis Fernando López-Pájaro 3
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PMID: 32547827 PMCID: PMC7294173 DOI: 10.25259/SNI_20_2020
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Abstract
Background: Brain abscess is a life-threatening entity which requires prompt and long-term antibiotic therapy, generally associated with surgical drainage, and eradicating the primary source of infection. Parvimonas micra (Pm) has only been reported once before as the lone infecting organism of an orally originated, solitary brain abscess. Diagnosing brain abscesses caused by this Gram-positive anaerobic coccus, constituent of the oral cavity flora, is challenging, and an optimal treatment regimen has not been well established. We report the diagnosis and successful treatment of a Pm caused odontogenic brain abscess.
Case description: A 62-year-old immunocompetent male with a right-parietal brain abscess presented with headache and seizures. He was started on empirical antibiotic therapy and subsequently underwent surgical drainage. The only source of infection found was severe periodontitis with infected mandibular cysts. Thus, tooth extraction and cyst curettage were performed 1 week after brain surgery. Cultures of brain abscess fluid were negative, but amplification of bacterial 16S ribosomal RNA (rRNA) with polymerase chain reaction demonstrated Pm. After 3 weeks of intravenous ceftriaxone and metronidazole, the patient was switched to oral metronidazole and moxifloxacin for 6 weeks.
Conclusions: This case highlights the potential risk of untreated dental infections causing brain abscesses. Pm should be considered as a possible pathogen of odontogenic brain abscesses despite its presence usually not being detected by standard bacterial cultures. Therefore, 16S rRNA gene sequencing analysis is strongly recommended for bacterial identification before defining brain abscesses as cryptogenic.
Keywords: 16S rRNA analysis; Brain abscess; Dental infection; Odontogenic abscess; Parvimonas micra.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 May 30;11:134. doi: 10.25259/SNI_178_2020. eCollection 2020.
Intracranial Ewing Sarcoma - A Case Report
Jiahua Huang 1, Finn Ghent 1, Robyn Levingston 1, Martin Scholsem 1
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PMID: 32547821 PMCID: PMC7294174 DOI: 10.25259/SNI_178_2020
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Abstract
Background: Intracranial Ewing's sarcoma (ES) is a rare entity with <15 cases reported in the literature. It belongs to a family of round-cell neuroectodermally derived tumors bearing many similarities to peripheral primitive neuroectodermal tumor (pPNET). There is currently no established treatment protocol. Reported cases are treated with either surgery alone or surgery with adjuvant chemotherapy and radiation.
Case description: We describe a case of intracranial left frontal ES in a 19-year-old patient who presented with change in behavior. Diagnosis was unclear based on radiological findings on MRI and CT alone. MRI brain with contrast demonstrated a large extra-axial ovoid heterogeneously enhancing left frontal convexity mass. The patient underwent gross total resection with adjuvant chemotherapy and radiation. No local or systemic recurrence was found at 12 months postoperatively.
Conclusion: Intracranial ES/pPNET is rare tumor with nonspecific clinical presentation and radiological findings. They are locally invasive. Surgery with adjuvant chemoradiation is the mainstay treatment. Distinction of pPNET and cPNET is important for therapeutic and prognostic purposes.
Keywords: Ewing’s sarcoma; Meningeal tumor; Neuro-oncology; Peripheral primitive neuroectodermal tumor; Soft-tissue tumor.
Copyright: © 2020 Surgical Neurology International.
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Case Reports Surg Neurol Int
. 2020 Jun 6;11:139. doi: 10.25259/SNI_506_2019. eCollection 2020.
Fungal Mycotic Aneurysm in a Patient With Aspergillus terreus Chronic Meningoencephalitis
Marcos Vinicius Sangrador-Deitos 1, Jimena Alejandra González Olvera 2, Heidy Adames Espinal 3, Graciela Cárdenas Hernández 3, Verónica Angeles Morales 3, José Luis Soto Hernandez 3
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PMID: 32547826 PMCID: PMC7294177 DOI: 10.25259/SNI_506_2019
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Abstract
Background: Central nervous system involvement due to aspergillosis is an extremely serious entity, particularly in patients with severe neutropenia, hematological diseases, or post-transplant cases. Immunocompetent patients can be infected by intense exposure, particularly iatrogenic after invasive procedures.
Case description: We present the case of a 26-year-old male with a 1 year appendectomy background, which required epidural anesthesia. After that surgery, insidious headache presented, requiring mild analgesics for adequate control. In the following weeks, headaches increased and tomographic imaging revealed hydrocephalus. A ventriculoperitoneal shunt was placed, and empirical treatment for neurocysticercosis was established, but diagnosis was never confirmed. Sequentially, shunt dysfunction occurred twice, for which shunt replacement was performed. Cerebrospinal fluid and shunt's catheter were cultured. Some days later, a filamentous fungus was isolated and finally identified as Aspergillus sp. Intravenous amphotericin B and fluconazole at therapeutic dosage were administered; however, a torpid clinical evolution was observed. After a 2-week antifungal scheme, the fungus was identified as Aspergillus terreus. The patient developed sudden rostrocaudal deterioration. Computed tomography imaging was done, revealing a 70 cc hematoma in the right operculoinsular region, midline shift, and a 9 mm saccular aneurysm at the bifurcation of the middle cerebral artery.
Conclusion: Cerebral aspergillosis is a serious disease with high mortality in patients, particularly those without identifiable risk factors. The iatrogenic forms are serious, due to the delay of clinical diagnosis. It is important to have a high index of suspicion in patients with a history of invasive procedures such as epidural anesthesia or surgery, and who develop a persistent chronic headache or chronic meningitis.
Keywords: Aneurysm; Aspergillus terreus; Mycotic.
Copyright: © 2020 Surgical Neurology International.
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11
Case Reports Surg Neurol Int
. 2020 Jun 6;11:142. doi: 10.25259/SNI_160_2020. eCollection 2020.
Spinal Dural Arteriovenous Fistula Masquerading as Subdural Hematoma
Kristin Huntoon 1, Umang Khandpur 1, David Dornbos 1, Patrick P Youssef 1
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PMID: 32547829 PMCID: PMC7294149 DOI: 10.25259/SNI_160_2020
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Abstract
Background: This case highlights an angiographically occult spinal dural AVF presenting with a spinal subdural hematoma. While rare, it is important that clinicians be aware of this potential etiology of subdural hematomas before evacuation.
Case description: A 79-year-old female presented with acute lumbar pain, paraparesis, and a T10 sensory level loss. The MRI showed lower cord displacement due to curvilinear/triangular enhancement along the right side of the canal at the T12-L1 level. The lumbar MRA, craniospinal CTA, and multivessel spinal angiogram were unremarkable. A decompressive exploratory laminectomy revealed a subdural hematoma that contained blood products of different ages, and a large arterialized vein exiting near the right L1 nerve root sheath. The fistula was coagulated and sectioned. Postoperatively, the patient regained normal function.
Conclusion: Symptomatic subdural thoracolumbar hemorrhages from SDAVF are very rare. Here, we report a patient with an acute paraparesis and T10 sensory level attributed to an SDAVF and subdural hematoma. Despite negative diagnostic studies, even including spinal angiography, the patient underwent surgical intervention and successful occlusion of the SDAVF.
Keywords: Angiographically occult; Arteriovenous fistula; Subdural hematoma; Vascular malformation.
Copyright: © 2020 Surgical Neurology International.
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Surg Neurol Int
. 2020 May 30;11:135. doi: 10.25259/SNI_206_2020. eCollection 2020.
"Crown and Necklace" Appearance of Cisternal Tuberculoma
Ahmed Ansari 1
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PMID: 32547822 PMCID: PMC7294176 DOI: 10.25259/SNI_206_2020
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Case Reports Surg Neurol Int
. 2020 May 30;11:128. doi: 10.25259/SNI_578_2019. eCollection 2020.
Reversible Cerebral Vasoconstriction Syndrome Concomitant With Cerebral Venous Sinus Thrombosis Following Ovarian Tumor Resection: A Report of Two Cases
Yu Shimizu 1, Katsuhiro Tsuchiya 2, Hironori Fujisawa 2
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PMID: 32547815 PMCID: PMC7294317 DOI: 10.25259/SNI_578_2019
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Abstract
Background: Reversible cerebral vasoconstriction syndrome (RCVS) presents with characteristic clinical, brain imaging, and angiographic findings. The most common clinical feature of RCVS is a severe acute headache, which is often referred to as a thunderclap headache due to the nature of its presentation. It may occur spontaneously or may be provoked by various precipitating factors. We present a rare case of RCVS concomitant with cerebral venous sinus thrombosis (CVST) in a woman who underwent resection of an ovarian tumor.
Case description: Case 1 - A 42-year-old woman was admitted to our hospital with severe headache radiating to the neck, with associated vomiting. She revealed a medical history of ovarian cancer and underwent an operation for the resection of the tumor, a month before presentation. After resection, her estradiol (E2) levels were reduced from 288 pg/ml to 31 pg/ml (normal range, 0-49 pg/ml). Initial imaging on admission to our hospital revealed the left posterior convexity subarachnoid hemorrhage. Magnetic resonance angiography (MRA) showed findings consistent with RCVS affecting the left posterior cerebral artery. Magnetic resonance venography (MRV) showed CVST of the left transverse and sigmoid sinuses. Single-photon emission computed tomography (SPECT) showed a left posterior ischemic lesion. These findings improved following treatment with nimodipine and anticoagulant. Case 2 - A 39-year-old woman presented with holocranial headache associated with vomiting. She was diagnosed with an ovarian tumor. She underwent an operation 3 months before presentation. After tumor resection, her E2 level decrease from 193 pg/ml to 19 pg/ml (normal range, 0-49 pg/ml). Magnetic resonance angiography (MRA) confirmed the presence of a vasospasm involving the right anterior cerebral artery. Magnetic resonance venography (MRV) confirmed the presence of thrombosis involving the superior sagittal sinus. She was discharged on postpartum day 31 without neurological deficits after treatment with anticoagulants. At her 3-month follow-up, both MRA and MRV were within the normal limits.
Conclusion: This is the first report of two women diagnosed with RCVS with concomitant CVST following ovarian tumor resection. Marked reductions in postoperative E2 levels could have contributed to the development of CVST and RCVS.
Keywords: Cerebral venous sinus thrombosis; Edoxaban; Ovarian tumor; Reversible cerebral vasoconstriction syndrome; Single-photon emission computed tomography.
Copyright: © 2020 Surgical Neurology International.
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14
Case Reports Surg Neurol Int
. 2020 Jun 6;11:143. doi: 10.25259/SNI_193_2020. eCollection 2020.
Supratentorial Convexity Schwannoma Unrelated to Cranial Nerves: Case Report and Review of the Literature
Daisuke Wajima 1, Shuta Aketa 1, Taiji Yonezawa 1
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PMID: 32547830 PMCID: PMC7294175 DOI: 10.25259/SNI_193_2020
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Abstract
Background: Intracranial schwannoma not related to cranial nerves is rare entity, and difficult to be diagnosed preoperatively. Here, we experienced a case of convexity schwannoma mimicking convexity meningioma, and discuss about the characteristics of such cases based on the past published reports.
Case description: A 48-year-old man presented with a sudden onset of seizures. Brain magnetic resonance image (MRI) revealed a small mass lesion in the peripheral aspect of the right parieto-frontal lobe. The mass was isointense on T1-weighted and hyperintense on T2-weighted MRI, with homogenous enhancement after contrast medium administration. After the feeder embolization on the previous day, removal of the tumor was performed. The tumor revealed a well-demarcated, firm, spherical tumor beyond, and beneath the dura and was relatively easy to be separated from the brain. Histologically, the tumor was observed to be in subarachnoid space extending to outer space of dura-mater, intimately attached to the pia mater. The histological diagnosis was schwannoma.
Conclusion: In our case, MRI findings are similar to convexity meningioma; however, the pathological diagnosis was schwannoma. Cerebral convexity is an extremely rare location for schwannoma. We emphasize that schwannoma, not related to cranial nerves, may arise in the subdural convexity space.
Keywords: Convexity schwannoma; Review; Unrelated cranial nerve origin.
Copyright: © 2020 Surgical Neurology International.
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There are no conflicts of interest.
60 references4 figures
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15
Case Reports Surg Neurol Int
. 2020 May 30;11:129. doi: 10.25259/SNI_2_2020. eCollection 2020.
Risk Factors of Diffuse Alveolar Hemorrhage After Acute Ischemic Stroke Treated With Tissue-Type Plasminogen Activator. The Effectiveness of Activated Recombinant Factor VII Treatment
Yu Shimizu 1, Katsuhiro Tsuchiya 1, Norihiro Fujisawa 1
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PMID: 32547816 PMCID: PMC7294161 DOI: 10.25259/SNI_2_2020
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Abstract
Background: Diffuse alveolar hemorrhage (DAH) is a rare and frequently life-threatening complication of a variety of conditions. DAH may result from coagulation disorders, inhaled toxins, or infections. We report a series of patients who developed DAH after receiving a tissue-type plasminogen activator (tPA) for acute cerebral infarction. We aimed to find risk factors of DAH in patients receiving tPA and the effectiveness of activated recombinant factor VII (rFVIIa) treatment for the same.
Case description: A total of 1023 acute ischemic stroke (AIS) patients who received tPA in our department from January 2006 to December 2018 were enrolled in this study. Four of the 1023 patients (0.39%) developed DAH. The modified Rankin scale was used to assess clinical severity. Infarction volume was assessed upon follow-up using DWI (diffusion-weighted imaging). Atherothrombotic brain infarction cases were excluded from the study. The age, sex, occlusion site, area of infarction, emphysema, intracranial hemorrhage, and neurological outcomes were analyzed. Patients who developed DAH were more likely to have a history of emphysema. We administered rFVIIa to three DAH patients with good prognosis.
Conclusion: The inclusion/exclusion criteria of tPA were based on the AHA/ASA Guidelines for the early management of patients with AIS.These patients had no evidence of infections, bronchoscopy, autoimmune diseases, HIV, and transplantations. Our study suggests that systemic administration of rFVIIa for DAH is effective. Emphysema may be a risk factor for the development of DAH following tPA. When we use tPA for emphysema patients, we must be careful about DAH enough.
Keywords: Activated recombinant factor VII; Acute ischemic stroke; Diffuse alveolar hemorrhage; National Institutes of Health Stroke Scale; Tissue-type plasminogen activator.
Copyright: © 2020 Surgical Neurology International.
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There are no conflicts of interest.
14 references3 figures
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16
Case Reports Surg Neurol Int
. 2020 May 30;11:137. doi: 10.25259/SNI_226_2020. eCollection 2020.
Hyperextension Thoracic Spine Fracture With Complete Neurological Recovery After Surgical Fixation: A Case Report
Arash Fattahi 1, Seyed Mohammad Reza Mohajeri 1, Abdolhadi Daneshi 1, Ardeshir Shahivand 1
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PMID: 32547824 PMCID: PMC7294168 DOI: 10.25259/SNI_226_2020
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Abstract
Background: Hyperextension thoracic spine fractures (HTSFs) typically involve the anterior ligamentous complex of the spine. These patients often present with paraplegia and warrant early surgical reduction/fixation even though few deficits resolve. Here, we present the unusual case of a 40-year-old male whose paraparetic deficit resolved following reduction/fixation of a T7-T8 HTSF.
Case description: A 40-year-old male presented with a thoracic computed tomography (CT) documented T7- T8 HTSF following a motor vehicle accident. His neurological examination revealed severe paraparesis, but without a sensory level (ASIA motor score 78). The chest CT angiogram scan revealed a hypodensity in the aorta, representing a small traumatic aortic dissection responsible for the patient's right hemothorax; 450 ml of blood was removed on chest tube placement. He underwent urgent/emergent thoracic spine reduction and fixation at the T7-T8 level. Within 5 postoperative months, he recovered fully neurological function (ASIA motor score 100).
Conclusion: We recommend urgent/emergent surgical reduction/stabilization for patients with thoracic HTSF to decrease offer the potential for neurological recovery and avoid secondary injury due to continued compression.
Keywords: Aortic dissection; Hyperextension thoracic spine fractures; Spinal cord injury; Traction; Trauma.
Copyright: © 2020 Surgical Neurology International.
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There are no conflicts of interest.
6 references1 figure
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17
Case Reports Surg Neurol Int
. 2020 May 30;11:133. doi: 10.25259/SNI_174_2020. eCollection 2020.
Cervical Epidural Neurosarcoidosis: A Case Report and Literature Review
Sami Khairy 1 2 3, N A Alharbi 1 2 3, Abeer Alaglan 1 2 3, Fahd Al Sufiani 2 3 4, Ahmed Alkhani 1 2 3
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PMID: 32547820 PMCID: PMC7294160 DOI: 10.25259/SNI_174_2020
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Abstract
Background: Neurosarcoidosis is a rare disease. In the spine, it commonly presents as an intramedullary lesion. Epidural spinal lesions are extremely rare.
Case description: A 29-year-old patient presented with a 22-month history of progressive neck, upper limb pain, and myelopathy. The cervical MRI showed a large epidural mass infiltrating the paraspinal soft tissue. After an open biopsy, the diagnosis of neurosarcoidosis was established and was followed-up by appropriate medical management.
Conclusion: To manage cervical epidural neurosarcoidosis, first, you must obtain a tissue diagnosis and then follow with appropriate medical management.
Keywords: Cervical; Epidural; Neurosarcoidosis.
Copyright: © 2020 Surgical Neurology International.
Conflict of interest statement
There are no conflicts of interest.
8 references4 figures
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18
Case Reports Surg Neurol Int
. 2020 May 30;11:132. doi: 10.25259/SNI_173_2020. eCollection 2020.
A Case of Cervical Myelopathy Following Chronic Hypertrophic Non-Union Type 2 Odontoid Fracture Managed With Posterior C1 Decompression and C1-3 Instrumentation: Case Report and Brief Review of Literature
Ahmed Taha Elsayed Shaaban 1, Ahmed Doomi 1, Sirajeddin Belkheir 1 2 3
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PMID: 32547819 PMCID: PMC7294179 DOI: 10.25259/SNI_173_2020
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Abstract
Background: Type 2 odontoid fractures are the most common type of fracture of the axis. In rare cases, nonunion of a type 2 odontoid fracture can be hypertrophic resulting in myelopathy due to cervical cord compression.
Case description: A 48-year-old male presented with hypertrophic nonunion of a chronic type 2 odontoid fracture resulting in cord compression/myelopathy. This was adequately treated utilizing a C1 decompression and C1-3 instrumented fusion; no anterior procedure was necessary.
Conclusion: Here, we successfully treated a patient with a hypertrophic nonunion of a chronic type 2 odontoid fracture utilizing a posterior only approach consisting of a C1 laminectomy with C1-C3 fusion.
Keywords: Fracture; Hypertrophic; Myelopathy; Non-union; Odontoid.
Copyright: © 2020 Surgical Neurology International.
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There are no conflicts of interest.
9 references5 figures
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Publication date: Available online 18 June 2020Source: Academic RadiologyAuthor(s): Dolly Y. Wu, Alberto de Hoyos, Dat T. Vo, Helena Hwang, Ann E. Spangler, Stephen J. Seiler
Thu Jun 18, 2020 15:09
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