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Surgical Neurology International

Sotirios Apostolakis, Athanasios Mitropoulos, Kalliopi Diamantopoulou, Konstantinos Vlachos
Background: Cavernomas are benign malformations of the vasculature. In the central nervous system, they are mostly located supratentorially. However, in adults, cavernomas also comprise about 3% of all subdural spinal cord tumors. Notably, cavernomas of the cauda equina are extremely rare, with only 23 cases reported in the literature. Here, we report the 24th case involving a 77-year-old male. Case Description: A 77-year-old male presented with low back pain for 3 years duration...
2018: Surgical Neurology International
Tomoyoshi Kuribara, Koichi Haraguchi, Shunya Ohtaki, Tadakazu Shimizu, Nobuki Matsuura, Kazumi Ogane, Yasunori Maruo, Noriyuki Yokoyama, Takeshi Mikami, Takeo Itou, Nobuhiro Mikuni
Background: The appearance of edematous lesions in the subacute phase is a rare complication following neuroendovascular therapy. Effective management of these lesions remains unclear. In this report, a case with progressive edematous lesions in the subacute phase after neuroendovascular therapy was described, and the clinical features and therapeutic strategies were discussed. Case Description: A 54-year-old female with a large, right cavernous internal carotid artery aneurysm was treated with a flow diverter...
2018: Surgical Neurology International
Hesham Mostafa Zakaria, Erinma Elibe, Mohammad Macki, Richard Smith, David Boyce-Fappiano, Ian Lee, Brent Griffith, Farzan Siddiqui, Victor Chang
Background: Treatment strategies for spinal metastases for myeloma range from conservative measures (radiation and chemotherapy) to invasive (surgical). Identifying better predictors of overall survival (OS) would help in surgical decision making. Analytic morphometrics has been shown to predict survival in oncologic patients, and our study evaluates whether morphometrics is predictive of survival in patients with multiple myeloma (MM) spinal metastases. Methods: For this observational retrospective cohort study, we identified 46 patients with MM spinal metastases who had undergone stereotactic body radiation therapy...
2018: Surgical Neurology International
R Shane Tubbs, Marios Loukas, Nicholas M Barbaro, Kushal J Shah, Aaron A Cohen-Gadol
Background: Accessing the hippocampus for amygdalohippocampectomy and minimally invasive procedures, such as depth electrode placement, require an accurate knowledge regarding the location of the hippocampus. Methods: The authors removed 10 human cadaveric brains from the cranium and observed the relationships between the lateral temporal neocortex and the underlying hippocampus. They then measured the distance between the hippocampus and superficial landmarks. The authors also validated their study using magnetic resonance imaging (MRI) scans of 10 patients suffering from medial temporal lobe sclerosis where the distance from the hippocampal head to the anterior temporal tip was measured...
2018: Surgical Neurology International
Joham Choque-Velasquez, Juha Hernesniemi
Background: In this video-abstract, we present one burr-hole craniotomy for the standard suboccipital midline approach developed in Helsinki neurosurgery for the microsurgical management of forth ventricle lesions, distal posterior inferior cerebellar artery aneurysms, and tumoral and vascular lesions of the vermis, cisterna magna region, and posterior brainstem as well. Case Description: We prefer to position the patient in sitting praying position. A midline straight single-layer incision starts on the inion and extends caudally toward the level of C2...
2018: Surgical Neurology International
Jonathon Cavaleri, Jennifer L Perez, Alp Ozpinar, Nima Alan, Edward Monaco
Background: Cerebrospinal fluid (CSF) leakage into the epidural space following lumbar puncture (LP) has been documented in pediatric patients, but there have been no reported cases in adults. Case Description: We report an epidural CSF leak in an adult who presented with back pain, positional headache, urinary retention, and constipation following an LP performed as a part of a research study. The patient's magnetic resonance (MR) scan showed an extensive epidural CSF collection...
2018: Surgical Neurology International
Juan Pablo Borges Rodrigues Maricevich, Auricelio Batista Cezar, Edilson Xavier de Oliveira, Jose Arthur Morais Veras E Silva, Renata Souza Maricevich, Nivaldo Sena Almeida, Hildo Rocha Cirne Azevedo-Filho
Background: Cranial reconstruction with polymethyl methacrylate (PMMA) prosthesis is used for calvarial defects secondary to decompressive craniectomies. Seroma is one of the most frequent complications of this procedure and can lead to the dehiscence, extrusion, infection, and loss of the prosthesis. The objective of the study is to analyze the effectiveness of the tacking sutures between the prosthesis and the scalp flap in reducing the seroma. Methods: This is a prospective study with 63 patients submitted to cranioplasty between 2014 and 2017 for defects resulting from decompressive craniectomies...
2018: Surgical Neurology International
Álvaro Campero, Jorge Rasmussen, Julio Diloné, Pablo Ajler, Ramiro López Elizalde
Introduction: A retrosigmoid suboccipital approach is the route most commonly utilized to resect vestibular schwannomas (VS). However, the anterior inferior cerebellar artery (AICA) usually runs adjacent to internal auditory canal nerves, and its course may severely impede total tumor resection. Case Report: A 38-year-old male patient presented with presumed grade T3B VS, diagnosed by magnetic resonance imaging (MRI). Surgery was performed using a retrosigmoid approach, during which the AICA was identified to be completely covered by dural and bone tissue...
2018: Surgical Neurology International
Sofía Beltrame, Jorge Rasmussen, Pedro Plou, Moira Altszul, Claudio Yampolsky, Pablo Ajler
Background: With pituitary macroadenomas, there is a high incidence of visual loss from optic pathway compression. Surgical removal of the tumor usually prevents progression and allows visual recovery. Our objective was to evaluate if optical coherence tomography (OCT) predicts visual outcomes after surgical decompression. Methods: Patients with pituitary macroadenomas were prospectively recruited between February 2015 and November 2016. We evaluated preoperative and postoperative visual acuity, automated perimetry, and OCT...
2018: Surgical Neurology International
Christopher J Elia, Marc Cabanne, Zhe Piao, Andrew Lee, Todd Goldenberg, Vaninder Chhabra
Background: Teratocarcinosarcoma (TCS) is a rare malignant neoplasm with epithelial and mesenchymal components such as fibroblasts, cartilage, bone and smooth muscle. With less than 100 total reported cases, this malignant neoplasm is rarely encountered by neurosurgeons because it primarily involves the nasal cavity and paranasal sinuses. Case Description: A 55-year-old male with chronic frontal headaches was found to have a frontal mass with involvement of nasal sinus and right ethmoid sinus...
2018: Surgical Neurology International
Jurica Maraković, Tonko Marinović, Vjekoslav Jeleč, Domagoj Dlaka, Danko Muller, Andrea Blažević, Marina Raguž
Background: Subcutaneous calcinosis is a well-recognized manifestation of systemic sclerosis that usually involves multiple pressure points and may also be found in the paraspinal or intraspinal regions. In this case, intraspinal calcinosis uniquely led to a severe neurological deficit. Case Description: A patient with severe systemic sclerosis/calcinosis exhibited left greater than right lower extremity radiculopathy attributed to intraspinal left-sided L4-L5 calcinosis...
2018: Surgical Neurology International
Joham Choque-Velasquez, Juha Hernesniemi
Background: In this video-abstract, we present a one burr-hole craniotomy for the enough lateral approach (ELA) to the foramen magnum developed in Helsinki Neurosurgery, a less invasive variant of the classical far lateral approach. ELA does not require the resection of the occipital condyle nor the exposure of the extracranial/intraosseal course of the lower cranial nerves. The vertebral artery is not transposed and the sigmoid sinus is not skeletonized. ELA allow us to access lesions that are close to the level of the foramen magnum (less than 10 mm)...
2018: Surgical Neurology International
Joham Choque-Velasquez, Juha Hernesniemi
Background: In this video-abstract, we present the Helsinki Neurosurgery one burr-hole craniotomy standard subtemporal approach to the floor of the middle fossa and the interpeduncular space. This procedure facilitates access to the multiple structures; the basilar artery bifurcation, the superior cerebellar artery, or the P1-P2 segments of the posterior cerebral artery, and lesions located around the posterior clinoid process/less than 10 mm above it. Even though the specific location and size of the lesion may vary, this approach accesses all mentioned structures with very minimal variation...
2018: Surgical Neurology International
Joham Choque-Velasquez, Juha Hernesniemi
Background: In this video-abstract, we present a one burr-hole craniotomy for the upper retrosigmoid approach developed in Helsinki Neurosurgery to access the lateral cerebellar hemisphere, the cerebellopontine angle, and lateral skull base (e.g. including the posterior petrous bone). This approach may be utilized to manage tumors of the lateral posterior fossa and to perform microvascular cranial nerve decompression of the V or VII cranial nerves. The upper portion of the vertebral-posterior cerebral artery complex, and the anterior inferior cerebellar artery may also be accessed with this technique...
2018: Surgical Neurology International
Joham Choque-Velasquez, Rahul Raj, Juha Hernesniemi
Background: In this video abstract, we present a one burr-hole craniotomy for the standard supracerebellar infratentorial (SCIT) paramedian approach developed in Helsinki Neurosurgery for the microsurgical management of pineal region lesions, tentorial meningiomas, as well as arteriovenous malformations, aneurysms, and intrinsic tumors of the superior surface of the cerebellum. In this regard, the use of praying sitting position in Helsinki Neurosurgery, which is a more ergonomic variant of the classic sitting position, offers several advantages such as lower intracranial pressure, good venous outflow, gravitational retraction, and straight anatomical orientation...
2018: Surgical Neurology International
Nancy E Epstein
Background: The tethered cord syndrome (TCS) accompanying Chiari-1 (CM-1) malformations and the occult tethered cord syndrome (OTCS) syndrome accompanying the low lying cerebellar tonsil (LLCT) syndrome may be treated with sectioning of the filum terminale (SFT). Methods: Utilizing PubMed, we reviewed the neurosurgical literature to determine how frequently spinal neurosurgeons diagnosed the TCS (e.g., conus terminating below the normal L1-L2 disc level) on lumbar magnetic resonance (MR) studies in patients with CM-1 malformations [e...
2018: Surgical Neurology International
Joham Choque-Velasquez, Roberto Colasanti, Julio C Resendiz-Nieves, Rahul Raj, Ann-Christine Lindroos, Behnam Rezai Jahromi, Juha Hernesniemi
Background: Nowadays, the sitting position has lost favor among neurosurgeons partly due to assumptions of increased complications, such as venous air embolisms (VAEs) and hemodynamic disturbances. The aim of our study is to describe the importance of some anesthetic considerations and the utility of antigravity trousers as well, together with a skillful neurosurgery and an imperative proper teamwork, in order to prevent the risk of severe VAE during pineal region surgery. We routinely use them for the variant of the sitting position we developed, the "praying position...
2018: Surgical Neurology International
Ramsis F Ghaly, Thomas Zouki, Aby Pynadath, Kenneth D Candido, Nebojsa Nick Knezevic
Background: Chronic low back pain (LBP) is highly prevalent and costly in our society. The use of epidural steroid injections (ESIs) for the treatment of radicular LBP is very widespread and continues to rise. The most popular injection is the lumbar/sacral transforaminal epidural steroid injection (TFESI). Here, we present a serious neurological complication resulting from such a TFESI that was only reversed by timely neurosurgical intervention. Case Description: A 49-year-old male presented with a 5-year history of progressive neurogenic claudication and right lower extremity pain/radiculopathy...
2018: Surgical Neurology International
Arash Fattahi, Abdoulhadi Daneshi
Background: There are multiple surgical treatment options for traumatic thoracic spine spondyloptosis, a three-column spinal injury typically attributed to high-energy trauma. Case Description: A 20-year-old male presented with back deformity attributed to a fall. On neurological examination, he had complete spinal cord injury below the T6 level. Magnetic resonance and computed tomography imaging documented a T8 vertebral fracture and complete T7/T8 spondyloptosis...
2018: Surgical Neurology International
Arpan Patel, Evgenii Belykh, Eric J Miller, Laeth L George, Nikolay L Martirosyan, Vadim A Byvaltsev, Mark C Preul
Background: Gene sequencing has played an integral role in the advancement and understanding of disease pathology and treatment. Although historically expensive and time consuming, new sequencing technologies improve our capability to obtain the genetic information in an accurate and timely manner. Within neurosurgery, gene sequencing is routinely used in the diagnosis and treatment of neurosurgical diseases, primarily for brain tumors. This paper reviews nanopore sequencing, an innovation utilized by MinION and outlines its potential use for neurosurgery...
2018: Surgical Neurology International
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