World Neurosurg
-
To present a case series of blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) and an assessment of diagnosis and treatment options, attempting to identify surgical or endovascular management of BBAs with a low complication rate and a functional outcome. ⋯ Preoperative diagnosis of BBAs is essential for proper management. Once the BBA has ruptured, the emergency clipping operation should be performed with caution. Moreover, based on lessons learned from direct clipping and a literature review, interventional therapy appears to be a more physiologic and more definitive treatment option for BBAs of the ICA, with a more favorable patient outcome.
-
Although indirect bypass surgery is an effective treatment option for patients with ischemic-onset moyamoya disease (MMD), the time point after surgery at which the patient's hemodynamic status starts to improve and the time point at which the improvement reaches a maximum have not been known. The objective of the present study is to evaluate the hemodynamic status time course after indirect bypass surgery for MMD, using dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI). ⋯ The amelioration of cerebral hemodynamics by indirect bypass surgery began soon after surgery and gradually reached a maximum at 3 months after surgery. DSC-MRI detected small changes in hemodynamic improvement, which are suspected to be caused by the initiation of angiogenesis and arteriogenesis in the early postoperative period.
-
In 2016, the World Health Organization updated its classification of tumors, adding genetic profiles to the conventional histopathologic typing. ⋯ The present case underscores the significant role of a molecular genetic analysis in the differential diagnosis of intramedullary spinal gliomas.
-
Case Reports
Extensive mirror-image neurofibromas of the entire spine resulting in spastic tetraplegia.
Neurofibromatosis 1 (NF1) is associated with increased incidence of spinal tumors including neurofibromas. The majority of NF1-associated spine neurofibromas are asymptomatic; however, a minority of patients will experience neurologic symptoms that can range from mild paresthesia, radiculopathy, myelopathy, and focal weakness to quadriplegia in extreme cases. We present a 21-year-old male diagnosed with NF1 in infancy and followed for multiple mirror-image neurofibromas involving the entire spine. ⋯ Emergent cervical decompression was performed at C1-C3 along with debulking of bilateral neurofibromas. Postoperatively he regained full strength with no signs of myelopathy several years postoperatively. This case demonstrates a dramatic neuroimaging finding and emphasizes the potential for significant neurologic deterioration in previously asymptomatic NF1 patients, highlighting the need for long-term follow-up.
-
Selection of the access myelotomy is a key issue in surgery for spinal intramedullary tumors. This study focused on surgical outcomes with the posterolateral sulcus (PLS) approach, equivalent to dorsal root entry zone myelotomy. ⋯ These findings suggest that the PLS approach can provide direct access to tumors with minimal tissue damage, when applied appropriately after careful case selection.