World Neurosurg
-
Case Reports
Cavernous Malformation in the Trigeminal Distribution. Aggressive Presentation and Management: Case Report.
Cavernous malformation (CM) is a vascular malformation found in the encephalic parenchyma, spinal cord, nerve roots, and extraneural tissue. CM in the trigeminal distribution is exquisitely uncommon and its biological behavior not completely understood. The clinical picture might be diverse, depending on the affected sector of the trigeminal architecture, and literature debating its pathobiology is scarce. ⋯ We present an uncommonly aggressive progression of a CM of the trigeminal root, Gasserian ganglion, and cavernous sinus evolving to severe brainstem compression. The documentation of this unique case as well as its management is presented is discussed.
-
High-mobility group box 1 (HMGB1) was shown to be a major extracellular mediator involved in relayed neuro-inflammation in animals after subarachnoid hemorrhage (SAH). It is of interest to examine the effect of rhinacanthin-C (RCT-C, C25H30O5) on pro-inflammatory cytokines/HMGB1 in an SAH-related early brain injury model. ⋯ RCT-C exerts a neuroprotective effect by reducing cleaved caspase-3- and caspase-9a-related apoptosis. Decreased HMGB-1 mRNA and protein expression in the RCT-C groups corresponds to its anti-inflammatory effect. HMGB-1 recombinant protein administration impaired the neuroprotective and immunosuppressive effect of RCT-C. This finding lends credence that RCT-C modulates the HMGB-1-related pathway and attenuates brain apoptosis in the pathogenesis of SAH.
-
Several studies have shown excellent fusion rates in occipitocervical (OC) fusions, but very little is reported on mortality and reoperation rates in elderly patients. Our article reports these rates in elderly patients from a national spine registry with a >2-year follow-up period. ⋯ Mortality rate was 27.7% and the reoperations rate was 14.9% for patients who underwent OC fusions with age >65 years and were observed for >2 years. These numbers are much higher than in younger patients, but reflect a higher mortality due to their comorbidities and from progression of their disease for cases of metastasis to the spine.
-
The intercavernous sinuses (ICSs) connect the cavernous sinuses on both sides. Although the management of ICSs is an important aspect in extended transsphenoidal surgery (eTSS), there has been no report to evaluate ICSs in sellar lesions. In this study, we analyzed ICSs using computed tomographic digital subtraction venography (CT-DSV) in sellar lesions. ⋯ CT-DSV can be useful for evaluating ICSs in sellar lesions. Preoperative evaluation of ICSs may provide important information for eTSS.