World Neurosurg
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Surgical resection of intramedullary tumors remains technically challenging. The role of intraoperative ultrasound and contrast-enhanced ultrasound (CEUS) in these surgeries has not yet been well defined. This study was aimed to evaluate the potential of intraoperative ultrasonography, especially CEUS, in visualizing intramedullary spinal cord tumors, and to assess the values for improving surgical outcomes. ⋯ Intraoperative ultrasound is of great value for localizing lesions and determining the extent of dural opening and myelotomy, therefore reducing the invasiveness of spinal surgery for intramedullary tumors. CEUS helps to delineate the tumor margins and perfusion features.
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Review Case Reports
Trochlear schwannoma arising from transition zone of nerve sheath in the pineal region: Case report and review of the literature.
This report presents the third case of trochlear schwannoma arising from the pineal region and the first case to be resected using a paramedian infratentorial supracerebellar approach. Schwannomas of cranial nerves have traditionally been thought to arise from the transitional point where the axonal envelopment switches from glial cells to Schwann cells; however, recent temporal bone histopathologic evidence from vestibular schwannomas challenges this view. Of the 38 cases of pathology-confirmed trochlear schwannoma in the literature, there are only 2 cases arising from the pineal region, where the nerve sheath transition zone is located. Here, we discuss an unusual case of trochlear schwannoma arising from this transition zone. ⋯ Trochlear schwannoma should be considered when a mass is identified in the pineal region. This diagnosis should still be entertained for mass lesions along the free tentorial edge because the tumor may arise distant from the glial-Schwann transition zone located by the dorsal midbrain. We propose a treatment algorithm for this rare tumor that seeks to maximize functional outcome.
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Review Case Reports
Iatrogenic common iliac vessels injury during routine degenerative lumbar spine surgery: report of 2 cases and review of literature.
Injury of the iliac vessels is a rare complication of lumbar spine surgery with potentially life-threatening consequences. We present 2 cases of iliac vessel injury that were treated with minimally invasive techniques. ⋯ This case series emphasizes the benefit of quick minimally invasive vascular repair available in multidisciplinary centers.
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Case Reports
Rare episode of cement leakage during vesselplasty in a case of vertebral compression fracture.
Osteoporosis has become an important issue owing to the increasing elderly population. It is the most common cause of vertebral compression fracture. Conservative treatment is often ineffective, whereas surgical treatment has a vital role in compression fracture. Vesselplasty is a new surgical alternative to traditional vertebroplasty and kyphoplasty. It uses a polyethylene terephthalate balloon that functions as both a vertebral body expander and a bone cement container. We present a rare but catastrophic case of cement leakage during vesselplasty resulting in devastating neurologic compromise. This case highlights the need for awareness of vesselplasty safety and the importance of using a low-temperature bone cement. ⋯ Though vesselplasty is claimed to be safe, cement leakage related to balloon rupture occurred in our case. Furthermore, thermal effects were difficult to observe during polymethyl methacrylate polymerization. Heat not only might cause irreversible complications but also might make the balloon rupture more easily.
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The present study evaluated the severity of syndesmophytes and its correlation with the spinopelvic and clinical outcomes in patients with ankylosing spondylitis (AS). ⋯ In advanced AS, old age and a long disease duration are risk factors for the progression of syndesmophytes. The progression of syndesmophytes might contribute to spinal sagittal malalignment. With serious syndesmophytes, pelvic retroversion seems to be the major compensatory mechanism for spinal sagittal malalignment.