World Neurosurg
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Review Case Reports
Concomitant intracranial chronic subdural hematoma and spinal subdural hematoma: a case report and literature review.
Concomitant intracranial chronic subdural hematoma (CSDH) and spinal subdural hematoma (SDH) are rare, and the etiology has yet to be elucidated. However, migration of the hematoma intracranially to a spinal site or coincidence of both intracranial and spinal CSDHs have been proposed as etiologies. We report a case of concomitant intracranial CSDH and spinal SDH in which spinal hematoma might have migrated from the cranial lesion. ⋯ We reviewed the cases of 22 patients with concomitant intracranial CSDH and spinal SDH to discuss the features, etiology, and treatment strategy. Although surgical intervention was mainly selected for intracranial CSDH, conservative observation was mainly selected for spinal SDH. Outcomes were good in all patients. We created a new classification of spinal SDH shape using sagittal MRI. This classification indicates that cases with both ventral and dorsal SDH tend to require surgical intervention. This classification may help in deciding treatment strategies.
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Review Case Reports
Scalp arteriovenous malformation with concomitant, flow-dependent malformation and aneurysm.
Scalp arteriovenous malformations (sAVMs) are well-described congenital abnormalities for which co-occurrence with other vascular pathologies significantly alters management strategies. The authors describe a case in which congenital sAVM was found with concomitant intracranial, flow-dependent vascular malformation and schizencephalic developmental anomaly. ⋯ A review of the literature demonstrated a variety of endovascular and open surgical treatments with limited consensus on standard care. While sAVMs have been described in the literature, the combination of the diverse conditions seen in this case is unique.
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The median life expectancy after a diagnosis of glioblastoma is 15 months. Although chemotherapeutics may someday cure glioblastoma by killing the highly dispersive malignant cells, the most important contribution that clinicians can currently offer to improve survival is by maximizing the extent of resection and providing concurrent chemo-radiation, which has become standard. Strides have been made in this area with the advent and implementation of methods of improved intraoperative tumor visualization. ⋯ In this review, we briefly summarize nontargeted fluorescent tumor imaging agents before discussing several novel targeted fluorescent agents being developed for glioma imaging in the context of fluorescent-guided surgery or live molecular navigation. Many of these agents are currently undergoing preclinical testing. As the agents become available, however, it is necessary to understand the strengths and weaknesses of each.
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En bloc resection of high-cervical chordomas is a technically challenging procedure associated with significant morbidity. Two key components of this procedure include the approach and the method of spinal reconstruction. A limited number of reported cases of en bloc resection of high-cervical chordomas have been reported in the literature. ⋯ Labiomandibular glossotomy for approach to high anterior cervical chordomas followed by craniospinal reconstruction to the clivus with an expandable cage represents a novel technique for managing high cervical chordomas.
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The role of inflammatory response in the pathophysiology of subarachnoid hemorrhage (SAH) is being increasingly recognized. This study analyzed the impact of cellular and biochemical markers of early inflammatory response to ictus on outcome after SAH. ⋯ A leukocytosis response to ictus seems to have a significant independent association with both DCI and poor GOS score, and hs-CRP level had a significant independent association with poor GOS score, indicating preeminence of early cellular response in SAH pathophysiology.