World Neurosurg
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Depression following resection of diffuse low-grade glioma has rarely been described. Location of the tumor and surgical route are potential causes. Lesion network mapping (LNM), leveraging high-quality resting-state functional magnetic resonance imaging data from large samples of healthy adults, has been used to explore the broader network connectivity for given lesions. However, LNM has not been applied to large intra-axial masses or surgical lesions. We used LNM to examine a potential cause of postoperative depression in a patient with a cingulate diffuse low-grade glioma (zones I-III). ⋯ Early postoperative development of major depressive disorder following resection of a cingulate region tumor, although likely multifactorial, should be considered and patients appropriately counseled preoperatively. Further validation of LNM as a viable methodology for correlating symptoms to lesions could make it a valuable tool in selection of surgical approach and patient counseling.
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Radiofrequency ablation (RFA) focally destroys abnormal or dysfunctional tissue using thermal energy generated from alternating current. The utilization of RFA has gained popularity as a minimally invasive procedure for the treatment of skeletal metastases with a particular focus on palliative pain treatments to the spine, pelvis, long bones, sternum, and glenoid. More recently, single-session procedures that combine RFA with vertebral augmentation techniques have allowed treatment to areas of pain associated with pathologic fractures secondary to metastatic disease. Although many studies have been done to investigate the safety and efficacy of RFA, there have been no reported cases to date in which the use of RFA for the treatment of spinal metastases has led to any major permanent neurological injury. ⋯ Postoperative magnetic resonance imaging and physical examination suggest RFA-induced thermal injury as the most likely mechanism of paralysis. In this report, a review of previous in vivo models used in studying the efficacy and safety of spine RFA is conducted. Additionally, the literature has been reviewed for any neurological events reported with the use of RFA in the treatment of patients with vertebral pathology.
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Case Reports
Giant presacral schwannoma in a man: report of a case with emphases on imaging findings.
Schwannoma is a tumor arising from peripheral nerve sheaths and commonly occurs in the head, neck, and upper and lower extremities. Schwannoma in the presacral space is relatively rare and is often misdiagnosed before pathologic diagnosis is made. ⋯ Solid and encapsulated, round or oval, with rich blood supply may be the characteristic imaging findings of presacral schwannoma, which may narrow the differential diagnosis of hypervascular pelvic lesions.
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Systemic mastocytosis is a hematopoietic disorder of mast cell deposits in various systemic tissues that can include skin, spleen, liver, and bone marrow. When accumulation occurs within bone it has been reported to cause osteoporosis, osteosclerosis, or sometimes a mixed pattern. In exceptionally rare circumstances, it has been reported to present as an exophytic mass causing neural compression. ⋯ We describe a rare case of systemic mastocytosis presenting as an extradural lesion causing compressive myelopathy and paraparesis. To our knowledge, this has only been described once before in literature. The patient underwent decompression surgery with improvement in neurology postoperatively. He was subsequently referred to the hematology team for further investigation and management.
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We performed a retrospective analysis in a cohort of 1185 patients at our institution who were identified as undergoing ≥1 head computed tomography (CT) examinations during their inpatient stay on the neurosurgery service, to quantify the number, type, and associated radiation burden of head CT procedures performed by the neurosurgery service. ⋯ The median cumulative radiation burden from head CT imaging in our cohort equates approximately to a single chest CT scan, well within accepted limits for safe CT imaging in adults. Refined methods are needed to characterize the safety profile of the few pediatric patients identified in our study.