World Neurosurg
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Rheumatoid arthritis (RA) is a chronic inflammatory polyarthropathy that affects many synovial joints favoring the hands, knees, and vertebral articulations. Joint laxity manifests as subaxial instability, atlantoaxial instability, and cranial settling (CS). ⋯ Intracranial rod migration and hemorrhage secondary to CS is a rare complication that must be brought to the attention of surgeons operating on patients with RA.
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Case Reports
Anterior Distraction and Reduction with Posterior Stabilization for Basilar Invagination: A Novel Technique.
Introduction of a posterior spacer for atlantoaxial joint distraction followed by posterior stabilization is a commonly performed procedure for irreducible atlantoaxial dislocation. We present a unique case in which posterior distraction was associated with increased risk of injury to the vertebral artery (VA) owing to its anomalous course, and hence a novel anterior distraction technique was used. ⋯ The craniovertebral junction has a unique pathoanatomy, and the course of the vertebral artery is variable. Appropriate investigations, including computed tomography angiography, with adequate surgical planning will provide a desirable long-term outcome. Our novel technique has the potential to add a new dimension to the management of irreducible atlantoaxial dislocation.
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Congenital midline spinal hamartoma is a very rare tumor-like proliferation that mostly occurs during childhood. It consists of mature, well-differentiated ectodermal and mesodermal elements that present in an abnormal location and are mostly associated with neurofibromatosis type 1 and spinal dysraphism. ⋯ Congenital midline spinal hamartoma is very rare and seldom addressed. Most patients present with a cosmetic defect and rarely with associated symptoms. Tissue biopsy is still the best modality to definitively diagnose hamartoma and to exclude other diagnoses. Surgical excision of the tumor is still the mainstay treatment, especially for patients who are not neurologically intact and to correct the cosmetic skin defect.
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We simulated the trajectory for an L5/S1 percutaneous endoscopic transforaminal discectomy (PETD) to guide decision-making for the surgery approach. ⋯ Preoperative simulation of the trajectory for L5/S1 PETD was helpful in the decision-making for the surgical approach.
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Case Reports
Spontaneous Rupture of a Huge Presacral Tarlov Cyst Leading to Dramatic Neurologic Recovery.
This manuscript discusses the case of huge presacral Tarlov cysts (TCs) and the substantial neurologic recovery noted in the patient following spontaneous rupture of the most prominent cyst. Perineural or TCs are nerve root cysts, which are usually incidental findings on magnetic resonance imaging (MRI) and are most frequently observed in the sacral spine. Symptomatic lesions are rarely encountered. ⋯ To our knowledge, this is the first report of spontaneous cyst rupture and resultant neurologic improvement in a case of symptomatic presacral TCs.