World Neurosurg
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Intracranial epidermoid cysts are developmental central nervous system abnormalities that arise from erroneous ectodermal inclusion during neural tube closure. Epidermoids are relatively common representing 1% of all intracranial masses and are particularly predominant in the cerebellopontine angle (CPA), where they are the 3rd most prevalent diagnosis, after schwannomas and meningiomas. ⋯ Using a two-surgeon four-hands technique, the mass was dissected from the surrounding neurovascular structures, and a gross total removal was achieved with no postoperative neurologic deficits. Our video highlight critical nuances pertinent to the fully endoscopic resection technique, with special attention to the relative restrictions of a small working corridor parallel to the tentorium and the petrous bone.
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Malignant transformation of a mature intracranial teratoma into an adenocarcinoma is an extremely rare event and portends a poor prognosis. The clinical progression, radiographic changes, histopathology, and immunohistochemistry of these unique cases may provide clues as to this transformation. CDX-2 is a specific and robust marker for colonic adenocarcinomas and may also be used to identify differentiation of a mature intracranial teratoma into a colonic type adenocarcinoma; this is the first case report of the use of this specific marker for an intracranial malignancy. ⋯ Malignant transformation of a mature intracranial teratoma portends a poor prognosis. The exact histopathological diagnosis may facilitate treatment of these patients. CDX-2 is a specific robust marker to identify differentiation of a mature intracranial teratoma into a colonic adenocarcinoma; this positive staining is also observed in primary colonic and other adenocarcinomas. This is the first report of the use of CDX-2 in the diagnosis of an intracranial malignancy; the triangulation of clinical progression, radiographic findings, and histopathological and IHC studies, provide clues as to this unique transformation.
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To first explore the safety and efficacy of H2O2 in controlling blood loss and SSI after multi-segmental lumbar spine surgery. ⋯ The application of H2O2 in PLIF can reduce the blood loss and SSI after surgery, which is quite beneficial for controlling the increasing number of vancomycin-resistant bacteria.
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We performed a retrospective analysis in a cohort of 1,185 patients at our institution who were identified as undergoing one or more head CT exams during their inpatient stay on the neurosurgery service. To quantify the number, type, and associated radiation burden of head CT procedures performed on the neurosurgery service. ⋯ The median cumulative radiation burden from head CT imaging in our cohort equates roughly to a single chest CT scan, well within accepted limits for safe CT imaging in adults. Refined methods are needed to characterize the safety profile of the minority of pediatric patients identified in our study.
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Distal ophthalmic artery (OpA) aneurysms are a rare subset of vascular lesions with lack of optimal treatment. The management of these aneurysms may require complete occlusion of the parent vessel, carrying a risk of permanent visual impairment due to individual variations of extracranial collateral flow to the intraorbital OpA (iOpA). ⋯ This study demonstrates the feasibility of a novel revascularization technique of the iOpA using two different transorbital approaches. These techniques can be used in the management of intraorbital lesions such as OpA aneurysms, tumoral infiltrations or intraoperative injuries.