World Neurosurg
-
Diagnosis and management of congenital anomalies of the spine can be a challenge because of their complex presentations. We present an uncommon case of congenital deformity of the spine with L4-L5 vertebral fusion, mimicking a single vertebra, and L3 spondylolisthesis treated by oblique lumbar interbody fusion (OLIF). ⋯ OLIF is a promising technique that can be applied in the management of degenerative disk diseases and also for deformities that may be formidable to treat by adopting the traditional posterior approach.
-
Resection and remission rates are low in pituitary adenomas that invade the cavernous sinus (CS) because of the complexity of the region. In this study, the authors describe the invasion patterns and surgical approaches for these corridors. ⋯ Medial wall defect has no importance in the invasion. Similarly, seeing the existence of pitholes is not an invasion criterion. Pituitary adenomas invade 4 compartments: the superior, anteroinferior, posterior, and lateral compartments of the CS via 2 corridors. Increased experience, novel approaches, and endoscopic developments have contributed immensely to this field.
-
Moyamoya syndrome (MMS), distinguished from definite moyamoya disease (MMD), is characterized by moyamoya vasculopathy thought to develop secondary to underlying conditions (e.g., hyperthyroidism). Recent studies have shown that a proportion of East Asian (EAS) patients with MMS possess the p.R4810K variant of RNF213 (rs112735431), the foremost susceptibility variant among EAS patients with MMD. We evaluated the association between hyperthyroidism-associated MMS (hMMS) and sequence variants in RNF213. ⋯ Rare and low-frequency missense variants in RNF213 confer susceptibility to both MMD and hMMS. This finding indicates that susceptibility variants in RNF213 may require additional clinical factors with an effect equivalent to hyperthyroidism in order to develop moyamoya vasculopathy.
-
Intracranial dural arteriovenous fistulas (DAVFs) are an uncommon pathology, and a sphenoparietal drainage pattern is certainly rare. We present a case of a de novo sphenoparietal DAVF in a prepubescent patient previously treated for a cerebellar arteriovenous malformation (AVM) 10 years before. ⋯ This case highlights the different array of presentations that sphenoparietal fistulas may display. Even though most DAVFs are acquired, secondary lesions and spontaneous malformations must be considered in a differential diagnosis.
-
Cerebrospinal fluid (CSF) leak is a frustrating complication of skull base surgery. Published methodologies using national surgical databases to assess CSF leak have not accounted for variability between skull base operations. ⋯ Based on NSQIP data analyzed using a rational skull base/anatomic framework, risk factors for postoperative CSF leak include chronic obstructive pulmonary disease, operative time, anterior fossa meningioma, and middle/posterior fossa schwannoma or TN. Although databases such as NSQIP can be extensively manipulated to generate surrogate results that may provide limited insight, applications beyond their design should be approached carefully.