World Neurosurg
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Case Reports
Unusual manifestation of the spinal epidural arteriovenous fistula as sudden paraplegia.
Spinal epidural arteriovenous fistulas (SEDAVFs) are a rare entity that cause gradual progression of neurological dysfunction. We present a case of SEDAVF with acute exacerbation of paraplegia that was successfully treated with emergency transarterial embolization. ⋯ SEDAVFs may result in acute exacerbation that can be treated with an endovascular intervention-a rapid and effective means of obliterating shunts.
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Typically, the clinical presentation of a spinal dural arteriovenous fistula (SDAVF) will be insidious, with patients' symptoms regularly attributed to other conditions. Although previous studies have characterized the neurologic outcomes after treatment for SDAVFs, little is known about the pretreatment patient characteristics associated with poor and/or positive patient outcomes. We sought to characterize the pretreatment patient demographics, diagnostic history, and neurologic outcomes of patients treated for SDAVFs and to identify the patient factors predictive of these outcomes. ⋯ Misdiagnosis has been relatively common in patients with SDAVFs and contributes to delays in treatment. Delays in diagnosis and treatment of SDAVFs appear to be associated with worse clinical outcomes for patients who, ultimately, receive treatment.
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Cyclooxygenase 2 (COX-2) is a key enzyme in the synthesis of prostaglandins. Recent studies have shown that overexpression of COX-2 can reduce the antitumor effect of the immune system by inhibiting the proliferation of B and T lymphocytes. Programmed cell death ligand 1 (PD-L1) was the first functionally characterized ligand of programmed cell death protein 1. It plays an important role in maintaining peripheral and central immune tolerance by combining with programmed cell death protein 1. Arginase 1 (ARG1) can process L-arginine in the local microenvironment and affect the function of T cells, resulting in immune escape. In this study, COX-2, PD-L1, and ARG1 expression in human pituitary adenoma (PA) and their relationship were investigated, which provided an initial theoretic basis for further study of the immune escape mechanism in PA in cellular and animal experiments. ⋯ These findings indicate that overexpression of COX-2, PD-L1, and ARG1 may be involved in the pathogenesis of PA. ARG1 plays a more important role in the development of NFPA. By upregulating the expression of PD-L1, COX-2 may promote the expression of ARG1, forming the COX-2/PD-L1/ARG1 signal pathway in promoting the occurrence and development of PA. Perhaps further study of the pathogenesis of PA can start with the mechanism of immune escape.
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Management of intracranial Langerhans cell histiocytosis generally includes surgical resection. ⋯ As part of multimodality management of this recurrent and refractory disease, Gamma Knife stereotactic radiosurgery should be considered an important salvage option that can control local disease and obviate the need for invasive surgery.
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The transpsoas lateral lumbar interbody fusion (LLIF) is a commonly used technique to manage various spinal conditions. LLIF is often performed in combination with posterior lumbar instrumentation, which requires patient repositioning or staging of the procedure. Here we present a step-by-step detailed description of a prone LLIF using an intraoperative laser level to guide orthogonal insertion of instrumentation. ⋯ The single position prone LLIF with posterior fixation offers a shorter operative room time by eliminating necessity to reposition the patient between stages of operation. The prone position of the patient optimizes LL correction. Further experience with this approach will allow for refining of the technique to overcome its limitations and facilitate its utilization.