World Neurosurg
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Case Reports
Acute Foramen Magnum Syndrome following single diagnostic lumbar puncture: Consequence of a Small Posterior Fossa?
Type I Chiari malformation (CMI) is a rare complication of lumbar cerebrospinal fluid (CSF) drainage that is usually reported after lumbar drain or lumboperitoneal shunt placement. It usually remains asymptomatic; however, even if it becomes symptomatic, symptoms are usually mild. There are only a few reports of acute foramen magnum syndrome following continuous lumbar CSF drainage, and acute foramen magnum syndrome after a single diagnostic lumbar puncture (LP) has not been previously reported. We encountered this catastrophic complication in one of our patient. ⋯ The association of intracranial tumors and lumbar CSF drainage with CMI is uncommon. The documentation of a small posterior fossa signifies the importance of both developmental (small posterior fossa) and acquired (intracranial tumor/lumbar CSF drainage) factors in pathogenesis of CMI. Although the extreme rarity of acute deterioration following a single LP does not warrant LP to be contraindicated in such patients, documentation of resolution of CMI with postoperative MRI before performing lumbar CSF drainage (whether therapeutic or diagnostic), might be helpful in avoiding this rare complication.
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In early-generation hybrid biplane endovascular operating rooms, switching from surgical to angiographic position is cumbersome. In this report, we highlight the unique design of a new hybrid neuroendovascular operating suite that allows surgical access to the head while keeping the biplane system over the lower body of the patient. Current and future hybrid neuroendovascular operating suite applications are discussed. ⋯ Combined endovascular and surgical applications are facilitated by co-locating their respective technologies and refining the ergonomics of the system to ease transition between both sets of technologies. In so doing, hybrid neuroendovascular operating suites can be anticipated to improve patient outcomes, generate novel treatment paradigms, and improve time and cost efficiency.
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Meningiomas can present during pregnancy as the result of hormonal as well as fluid changes. Foramen magnum meningiomas are particularly rare. We present the first reported case successfully treated during pregnancy. ⋯ Large skull base tumors symptomatic in pregnancy can be safely treated with careful planning and close monitoring.
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The craniocervical junction is a complex anatomic location that contains the occipital bone, atlas, axis, and important complex ligamentous structures. The stability of this region is ensured only with the help of ligaments. ⋯ The occiput should not be involved in the fusion area when the alar ligaments are preserved during surgery for a C2 lesion.