World Neurosurg
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Intradural extramedullary (IDEM) metastatic spine tumors of nonneurogenic origin, excluding leptomeningeal seeding, are very rare. Most patients with IDEM metastatic spine tumors of nonneurogenic origin have coexisting brain metastasis. We report a case of IDEM metastatic malignant melanoma without antecedent or coexisting brain metastasis. ⋯ Although rare, even without brain metastasis, malignant melanoma can cause IDEM metastatic malignant melanoma. For neurologic recovery and maintaining quality of life of the patient, surgical treatment for decompression of the spinal cord and postoperative adjuvant treatment for IDEM metastatic malignant melanoma should be considered unless multiple lesions are present in different parts within the spinal column.
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Case Reports
Nasal Packing Causing Occlusion of Contralateral ICA during Control of Pseudoaneurysm Bleed.
Carotid pseudoaneurysm is a rare complication of pituitary surgery and can present with epistaxis. Nasal packing is considered first-line treatment for the control of carotid bleeding. We describe a case of complete occlusion of the contralateral cavernous carotid artery because of nasal packing placed to control hemorrhage from a cavernous carotid pseudoaneurysm. ⋯ To our knowledge, this is the only report that describes complete occlusion of the contralateral cavernous carotid artery because of extrinsic compression of the lateral sphenoid wall, in the setting of a symptomatic pseudoaneurysm.
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Osteoradionecrosis (ORN) refers to the degenerative changes seen in bone after local radiation, particularly in head and neck cancer. ORN can present as neck or facial pain and may be confused with tumor recurrence. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are often inconclusive, requiring percutaneous biopsy to differentiate ORN from infection and recurrent disease. We reviewed the utility of preprocedural imaging in guiding the decision to biopsy in cases of ORN. ⋯ This case series highlights that PET scanning may not be useful in predicting which patients will benefit from biopsy for ORN because no patients with PET-positive lesions had histopathologic evidence of tumor recurrence or metastasis on biopsy.
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Cerebral infarction because of parent artery stenosis represents a potential complication of microsurgical aneurysm clipping. ⋯ This case shows that relocation of the aneurysm clip in case of vessel stenosis can lead to penumbral salvage, even when performed more than 6 hours after symptom onset.