World Neurosurg
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Multicenter Study
Technique of Whole-Sellar Stereotactic Radiosurgery for Cushing's Disease: Results from a Multicenter, International Cohort Study.
Stereotactic radiosurgery (SRS) is used to manage patients with Cushing disease (CD) who have failed surgical/medical management. Because many patients with recurrent/persistent CD lack an identifiable adenoma on neuroimaging, whole-sellar SRS has been increasingly used. Thus, we sought to define the outcomes of patients undergoing whole-sellar SRS. ⋯ Whole-sellar GKRS is effective in controlling CD when an adenoma is not clearly defined on imaging or when an invasive adenoma is suspected at the time of initial surgery. Patients who undergo whole-sellar SRS have outcomes and rates of new pituitary hormone deficiency similar to those of patients who undergo discrete adenoma-targeted GKRS.
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Review Case Reports
Surgical Treatment for Odontoid Fractures in Patients with Long-Standing Ankylosing Spondylitis: A Report of 3 Cases and Review of the Literature.
Ankylosing spondylitis (AS) is classified as a chronic inflammatory seronegative rheumatic arthritis. Patients with AS are more likely to sustain a fracture of the cervical spine compared with the general population. Most fractures occur in the lower cervical spine and manifest at the level of the intervertebral disc. There have been few reports about the surgical treatment for upper cervical spine fractures in patients with AS, especially odontoid fractures. We present 3 cases of odontoid fracture in patients with long-standing AS. ⋯ Odontoid fracture with atlantoaxial dislocation in patients with long-standing AS is uncommon. Clinicians must be cautious in assessing such patients with any episode of trauma. Computed tomography and magnetic resonance imaging can be helpful in demonstrating occult odontoid fractures. Posterior occipitocervical fusion with internal fixation may benefit these patients, although at the cost of sacrificing the last motion segment.
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Review Case Reports
Endovascular Management of a Ruptured Basilar Perforator Artery Aneurysm Associated with a Pontine Arteriovenous Malformation: Case Report and Review of the Literature.
Arteriovenous malformation (AVM)-associated aneurysms are common, reported in 15% of cases. Regarding the ruptured posterior fossa AVMs, associated aneurysms are present in 48% of cases and are the cause of the bleed in 37%. We present a 75-year-old female who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm arising from a flow-related basilar perforator artery feeder of an anterior pontine AVM. We report the successful treatment of the aneurysm with coil embolization. ⋯ Basilar trunk perforator aneurysms are rare lesions, particularly in the setting of brainstem AVMs. We report successful endovascular treatment of a flow-related ruptured basilar perforator aneurysm associated with an anterior pontine AVM. To the best of our knowledge, this is the second report addressing this scenario. We hope that the information presented here serves to guide future surgical decision making and management.
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The available surgical options to control increased intracranial pressure and to limit secondary brain damage in the setting of severe traumatic brain injury (TBI) include decompressive craniectomy, cisternostomy, and other methods to divert cerebrospinal fluid (CSF) such as placement of an external ventricular drain. ⋯ Further clinical studies need to be performed to validate the efficacy of this emerging surgical procedure for severe TBI.
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Review Case Reports
Magnetic Resonance Imaging Features in Solitary Cerebral Langerhans Cell Histiocytosis: Case Report and Review of Literature.
In this study, we report a case of solitary Langerhans cell histiocytosis (LCH) without skull or systemic lesions including reviewing the initial magnetic resonance (MR) findings of cerebral LCH. ⋯ In conclusion, additional sulcal enhancement around the mass lesion might be a clue MR imaging feature of intracerebral LCH, and special MR imaging techniques such as perfusion imaging, diffusion-weighted imaging, and MR spectroscopy could be helpful in differential diagnosis.