World Neurosurg
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Case Reports
Aberrant Vessel with potential catastrophic vascular complications in a patient with Chiari Malformation.
Craniovertebral junction anomalies are known to be associated with many bony, soft tissue, and vascular anomalies. We encountered a case of Chiari malformation type 1 with C2-D2 syrinx, in which computed tomography angiography showed an aberrant vessel (probably vein) coursing through the soft tissue along the posterior aspect of C1-C7 vertebral bodies along the right-sided joints, superiorly coursing posterior to C1-C2 joint and curving anteriorly over C1 to enter into the foramen magnum. Had this abnormality not been detected, catastrophic vascular consequences could have occurred.
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The understanding of white matter (WM) was revolutionized by the emergence of tractography based on diffusion tensor imaging (DTI). Currently, DTI simulations are implemented in preoperative planning to optimize surgical approaches. The reliability of these simulations has been questioned and investigated seeking for correlation between neurological performance and anomalies in DTI parameters. However, the ability of preoperative WM simulations to predict a surgical injury has not been thoroughly evaluated. Our objective was to assess the reliability of preoperatively simulated WM injuries for conventional neurosurgical procedures. ⋯ Presurgical simulation of WM fascicles based on DTI is consistent with postoperative DTI studies. These findings require further validation by neurophysiological and clinical correlation.
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Distal middle cerebral artery (dMCA) aneurysms are very rare. Most ruptured dMCA aneurysms lead to subarachnoid hemorrhage (SAH) coexisting with intracerebral hematoma (ICH), resulting in a deteriorating state. The risk factors of rupture of dMCA aneurysms remain unknown. To elucidate the risk of rupture, we studied differences between 4 ruptured and eleven unruptured dMCA aneurysms. ⋯ Distal MCA aneurysms, even if they are small, may be likely to rupture leading to SAH complicated by ICH and result in a poor neurological state and unfavorable outcomes. We recommend aggressive treatment for dMCA aneurysms considering morphological factors such as the size ratio even if they are small and unruptured.
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To analyze surgical outcomes and tumor characteristics of 49 patients with thyrotropin-secreting pituitary adenoma, a rare functional pituitary adenoma subtype with challenging surgery, who underwent endoscopic endonasal transsphenoidal surgery. ⋯ Endoscopic endonasal transsphenoidal surgery is the first-line treatment in thyrotropin-secreting pituitary adenoma and should be performed in a tertiary center. Gross total resection is the goal, and early diagnosis is essential for surgical success.
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In this study, a large diameter visible trephine was designed and used in percutaneous endoscopic lumbar interbody fusion to increase endoscopic bone decompression efficiency. Large diameter visible trephine-related technical notes and preliminary clinical experience are described. ⋯ For percutaneous endoscopic lumbar interbody fusion, the large diameter visible trephine is a safe and efficient endoscopic bone decompression tool under fluoroscopic guidance.