World Neurosurg
-
To evaluate access to the technologies and education needed to perform minimally invasive spine surgery (MISS) in Latin America. ⋯ Most surgeons in Latin America have limited resources to perform MISS, even in private practice. The main constraints are implant costs, access to technologies, and limited face-to-face educational opportunities.
-
Review Case Reports
Giant Sacral Schwannoma Causing Bilateral Hydronephrosis: A Case Report and Review of the Literature.
Giant sacral schwannomas are very rare, and less than 1%-5% of spinal schwannomas are found in the sacral region. These frequently grow to considerable size because of permissive anatomic location and benign, slow growth of tumor. They can be unnoticed before reaching a huge size. ⋯ We report the second case of a completely resected giant sacral schwannoma with bilateral hydronephrosis in the literature. Performing a 2-stage procedure is important in giant sacral schwannomas. Morbidity can be minimized, and extent of resection can be maximized with the help of combined anterior/posterior approach.
-
Sellar lesions with large suprasellar extension represent a neurosurgical challenge because of their nature and anatomic complexity. The goal of the extended transphenoidal-transtuberculum approach is enlarging the transsphenoidal route superiorly and laterally allowing for a surgical adequate exposure and offering a remarkable versatility in many sellar pathologies. ⋯ This case demonstrates how the endoscopic approach can be attempted as a first and possibly stand-alone option for the surgical management of large sellar-suprasellar lesions. The endoscopic route is not associated with high rates of major complications and is safe when performed by experienced surgeons. In fact, it guarantees an enhanced control of the vascular feeders reaching the tumor from the anterior and middle fossa and results in a satisfactory manipulation of lesions invaginating into the floor of the third ventricle. A careful preoperative assessment of Knosp grade, tumor volume, hemorrhagic components, suprasellar extension, and sphenoid sinus invasion should always guide the management plan and suggest a staged or a combined (with transventricular or pterional approach) removal in particularly challenging cases.
-
Case Reports
Cerebral venous sinus thrombosis in a patient with appendicular abscess: a case report.
Acute appendicitis is a common abdominal emergency, while cerebral venous sinus thrombosis (CVST) is a rare cerebral vascular disease. Cases of CVST in patients with appendicitis have not been reported in the literature. We present a case of CVST in a patient with appendicular abscess. ⋯ CVST after acute appendicitis is rare, and clinicians should be aware of this complication when suspicious symptoms occur. The underlying mechanisms require further investigation.
-
Case Reports
L1/2 intradural disc herniation with compression of the proximal cauda equina nerves: a surgical challenge.
Intradural disc herniation (IDH) in the upper lumbar spine is rare. Preoperative radiologic diagnosis can be difficult, making operative planning challenging. We report on a 74-year-old female patient who was diagnosed with an L1-L2 IDH intraoperatively. This case report aims to highlight and discuss the radiological features of IDH and operative challenges when approaching IDH. ⋯ Upper lumbar IDH represent a surgical challenge. Intraoperative considerations include identification of the disc, intentional or incidental durotomy, intradural discectomy, and anatomical restrictions of operating at the level proximal to the cauda equina.