World Neurosurg
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Dorsal arachnoid web (DAW) is a rare clinical entity with unknown etiology, and it can mimic other conditions on imaging.1,2 We present a surgical video of a patient with DAW that was misdiagnosed as ventral cord herniation. A 35-year-old woman presented with upper back pain and progressive bilateral lower extremity weakness and numbness for a few months. Magnetic resonance imaging (MRI) of the thoracic spine (T) showed ventral cord displacement with a syrinx that extended from T2-4. ⋯ On 4-month follow-up, the patient examination had demonstrated progressive improvement of her previous symptoms (weakness, numbness, and urinary retention), and the repeat MRI scan showed a significant reduction in the size of the syrinx. DAW can mimic other pathologies on preoperative imaging, such as ventral cord herniation and arachnoid cyst. The presence of "scalpel sign" and a syrinx on MRI with no arachnoid cyst on myelography support the diagnosis of DAW.
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Anatomical barriers (e.g., pedicles, narrow foramina) can hinder direct access to, and removal of, disc fragments that have migrated far downward. Using transforaminal full-endoscopic lumbar discectomy (FELD), we devised a modified technique, the suprapedicular retrocorporeal approach, for herniations in which the disc has migrated to the axilla of the traversing nerve roots. In the present report, we have described our preliminary results. ⋯ The suprapedicular retrocorporeal technique is a feasible and effective surgical option in transforaminal FELD for the treatment of herniation in which the disc has migrated to the axilla of the traversing nerve roots.
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Subarachnoid neurocysticercosis (NCC) is a form of NCC with cysticerci located in the subarachnoid space. This form of NCC can cause general and focal neurologic symptoms, and sometimes requires surgical intervention as a treatment. ⋯ At 8-month follow-up, the patient reported no recurrence of symptoms. To our knowledge, this is the first case reported to surgically manage hemifacial spasm secondary to NCC arachnoiditis.
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It is not known whether aspiration-specific catheters are necessary for successful mechanical thrombectomy, but if not, off-label use of more versatile catheters could offer significant cost savings over specialized aspiration catheters. The Syphontrak (Depuy Synthes, Raynham, MA, USA) support catheter is designed for introduction of devices into distal neurovasculature but is not specifically indicated for use in mechanical thrombectomy. We sought to compare our experience using this catheter to historical controls to show the non-inferiority of aspiration achieved. ⋯ These data support the off-label use of distal intracranial support catheters for this mechanical thrombectomy, which may result in significant cost savings over aspiration-specific catheters, especially in low-volume centers.
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Spinal epidural arteriovenous fistulas (SEAVFs) are rare lesions with a low risk of hemorrhage. Most patients with lumbosacral SEAVFs with hemorrhagic events will develop a spinal epidural hematoma from epidural venous pouches. To the best of our knowledge, we have reported the first case of a lumbosacral SEAVF presenting with remote intramedullary hemorrhage in the conus medullaris. ⋯ With the significant improvement of our patient after treatment of the SEAVF, we speculated that the intramedullary hemorrhage, which had occurred in the area of spinal cord edema, might have resulted from severe venous hypertension, rather than hemorrhagic infarction of the spinal cord. Careful evaluation of the angioarchitecture of SEAVFs is imperative to determine the most effective treatment modality.