World Neurosurg
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Giant cell tumor (GCT) of the spine is a benign tumor with local aggressiveness and potential for recurrence. No published study has discussed the prognostic role of preoperative D-dimer (D-D) level in spinal GCT. The purpose of this retrospective study was to evaluate the prognostic value of preoperative plasma D-D level and clinical factors. ⋯ Our study demonstrated that preoperative plasma D-D level, total spondylectomy, bisphosphonate treatment, and treatment history were powerful independent prognostic factors for DFS of patients with spinal GCT, suggesting that preoperative plasma D-D level may be a useful biomarker for predicting recurrence and prognosis of spinal GCT.
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The occurrence of isolated fourth ventricle and injury to the Guillain-Mollaret triangle in the setting of posterior fossa ependymoma represents a new association. In this case report, we discuss the clinical, theoretical, and therapeutic aspects of this problem. We describe a lateral transcerebellar trajectory and shunt valve configuration for safe fourth ventricle shunting in a patient with prior posterior fossa surgery. ⋯ Development of an isolated fourth ventricle and injury to the Guillain-Mollaret triangle in the setting of fourth ventricular ependymoma is a newly encountered complication. Choice of treatment modality and timing of intervention should be carefully considered on a case-by-case basis. The data presented in this report may assist in the selection of surgical treatment for isolated fourth ventricle.
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Cerebrospinal fluid (CSF) leak is a common complication after surgeries involving sellar reconstruction. Various techniques, including the nasoseptal flap, have been developed to limit postoperative CSF leak. However, the nasoseptal flap causes complications owing to donor site morbidity. A free mucosal graft may be just as effective in reducing CSF leaks as well as reducing postoperative nasal discomfort. This study aimed to assess operative outcomes of free mucosal graft after pituitary resection. ⋯ The free mucosal graft is a simple and effective means of sellar reconstruction in patients undergoing endonasal endoscopic pituitary resection, and its efficacy is similar to nasoseptal flaps. The free mucosal graft technique does not worsen sinonasal morbidity postoperatively.
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The purpose of the present study was to determine the learning curve for biportal endoscopic spinal surgery (BESS) for decompressive laminectomy in lumbar spinal stenosis using a learning curve cumulative summation test (LC-CUSUM). ⋯ The results of the present study have demonstrated that a substantial learning period could be needed before adequate performance can be achieved with lumbar decompressive laminectomy using BESS.
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Case Reports
Spontaneous Recovery Of Complete Foot Drop In A Case Of Lumbar Disc Herniation: Catcher In The Rye?
Foot drop is defined as inability to dorsiflex the foot at the ankle joint. Although a well-documented entity with a myriad of causes along the neuraxis, starting from parasagittal intracranial pathologies to peripheral nerve lesions, treatment has always remained uniform (i.e., elimination of the causative pathology. A conservative approach with complete recovery has never been documented with video evidence). ⋯ Spontaneous recovery of complete foot drop is possible, and there is a role for the conservative management even with dense neurologic deficit in cases of lumbar disk herniation. Careful repeated examination is the key for conservative management before jumping to aggressive surgical intervention.