World Neurosurg
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Case Reports
Association Between Klippel-Trenaunay Syndrome and Spontaneous Intracranial Hypotension: A Report of Four Patients.
Klippel-Trenaunay syndrome (KTS) is associated with a wide variety of vascular and neurologic abnormalities, including venolymphatic malformations. A recent report postulated that patients with KTS may also be predisposed to spontaneous intracranial hypotension. We reviewed brain magnetic resonance imaging from 67 patients with KTS and unexpectedly noted findings of cerebrospinal fluid (CSF) hypotension in 4 of them. ⋯ Patients with KTS have an increased incidence of CSF hypotension. While it is possible that intrinsic dural weakness may be responsible for this association, we hypothesize that these patients are also predisposed to developing CSF venous fistulas. Paraspinal and epidural venolymphatic malformations have been described in multiple patients with CSF venous fistulas. Such malformations were present in 2 of our 4 patients who underwent spine imaging. Patients with KTS with orthostatic headaches may benefit from brain and spine magnetic resonance imaging to assess for evidence of CSF hypotension and venolymphatic malformations. Decubitus digital subtraction myelography may also have a role in these patients if CSF venous fistulas are suspected.
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Resection of vestibular schwannomas with good functional outcome remains a neurosurgical challenge. In this study, we report on our initial experience with a suction spatula, which allows free bimanual dissection of small tumors in a clear, bloodless surgical field in supine position. ⋯ The main advantage of the suction spatula is in the treatment of small, mainly intrameatal vestibular schwannomas in supine patient position. It gives the surgeon a "third hand" while enabling a continuous bimanual dissection with 2 microinstruments without the use of a regular suction tip.
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To investigate mechanism of endoplasmic reticulum (ER) stress-mediated autophagy in spinal cord injury (SCI). ⋯ Our study showed that NGF-induced PC12 cells can induce autophagy and ER stress after mechanical injury. ER stress inhibitor 4-PBA obtained similar effects to PI3K inhibitor LY294002, enhanced autophagy via PI3K/AKT/mTOR signaling pathway.
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Microvascular decompression (MVD) is a commonly performed procedure to treat trigeminal neuralgia and hemifacial spasm. Knowledge of the variable anatomy of the cerebellopontine angle is crucial to avoid injury to cranial nerves. ⋯ Careful review of imaging before surgery is recommended in order to preempt such unusual anatomic variations.
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Case Reports
Lamino-pedicular osteotomy for en-bloc resection of a posterolateral thoracic osteoblastoma: A technical note.
Osteoblastomas are a type of primary osseous neoplasm that exhibit a proclivity for the spine, primarily the posterior elements. While generally considered benign, some variants of osteoblastoma exhibit aggressive growth with lytic osseous destruction and soft tissue invasion, with some recurring after initial treatment. Given their proximity to vital structures and potential for rapid growth, these tumors are often managed with aggressive surgery, with en-bloc resection preferred. ⋯ This case bolsters the growing body of literature that favors the outcomes of a more conservative approach to en-bloc resection of spinal tumors.