World Neurosurg
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Using proper surgical technique, schwannomas can be resected safely, with a low recurrence rate and high likelihood of improvement in symptomatology. There are multiple peritumoral tissue layers, and finding the correct plane is critical to safe tumor enucleation. The contents of the pseudocapsule tissue surrounding a schwannoma are not well described, and the consequences of resecting or leaving pseudocapsules are unknown. ⋯ The pseudocapsule surrounding a schwannoma occasionally contained nerve tissue and blood vessels. While a microscopic focus of tumor was often found in this tissue layer, recurrence is exceedingly rare and did not occur in this case series. The risk of undue pseudocapsule dissection likely outweighs any negligible benefit from microscopic cytoreduction.
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The pathogenesis of spinal posterior ring apophysis separation (PRAS) remains controversial, and spontaneous regression of PRAS has not been established previously. This is a case report about a 33-year-old man with a PRAS of the posterior superior end plate of S1 who presented with spontaneous low back pain followed by right leg pain. The patient was managed conservatively. A control lumbar spinal computed tomography scan performed 3 years later revealed complete spontaneous regression of the detached bony fragment.
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Superficial siderosis of the central nervous system is a rare neurologic disorder characterized by the superficial deposition of hemosiderin in the subpial layer resulting in iron-related progressive neurodegeneration. ⋯ The patient was successfully treated with T6-T8 transpedicular partial corpectomy, as well as diskectomy with decompression followed by watertight closure of the CSF leak. Intraoperative watertight closure of the CSF leak was achieved.
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Proximal junctional kyphosis (PJK) is a common phenomenon after long segmental fusion surgery of adolescent idiopathic scoliosis. However, the inability to reliably identify vertebral endplates on lateral upright radiographs has made an accurate measurement of proximal junctional angle (PJA) technically impossible in many patients. The aim of this study was to determine whether a grayscale inversion view is more reliable to measure PJA and to assess PJK accurately. ⋯ Grayscale inversion view can be a more reliable tool for the evaluation of PJK as compared with the conventional measurement. We recommend the application of a grayscale inversion view to measure PJA and assess PJK in clinical practice, particularly for patients instrumented to the upper thoracic spine.
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Spinal arteriovenous fistulas at the filum terminale (filum AVFs) are rare. Treatment strategies have not yet been established, particularly for cases of filum AVF with lipoma. ⋯ Caution is needed when identifying the spinal level of occlusion of the fistula, particularly in cases of a tethered spinal cord by lipoma, because the feeding artery is associated with the artery of Adamkiewicz, which supplies the low-lying spinal cord in the sacral region.