Surgical neurology international
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Typical aneurysmal bone cysts (ABCs) are osteolytic, multicystic lesions with parietal sclerosis and blood-filled cysts. In rare instances, the cystic components may be completely absent. Such solid variants in ABC (s-ABC) exhibit a solid architecture; making the clinical, radiological, and histological differentiation from other solid bone tumors like osteosarcoma (especially giant cell rich osteosarcoma) and giant cell tumor, a difficult task. ⋯ We aim to discuss the clinical, radiological, and histological findings of solid ABC (a rare benign entity) vis-à-vis the common neoplastic entities of osteosarcoma and giant cell tumor. The histopathological nuisances in making the diagnosis of s-ABC are put forth, along with its impact on management of such giant bony spinal lesions.
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Craniometric studies have shown that both Chiari malformation (CM) and basilar invagination (BI) belong to a spectrum of malformations. A more precise method to differentiate between these types of CVJM is desirable. The Chamberlain's line violation (CLV) is the most common method to identify BI. The authors sought to clarify the real importance of CLV in the spectrum of craniovertebral junction malformations (CVJM) and to identify possible pathophysiological relationships. ⋯ CM's CLV is discrete and similar to the normal subjects. BI1 and BI2 presented with at least of 0.95 cm CLV and these violations were strongly correlated with a primary cranial angulation (clivus horizontalization) and an acute clivus canal angle (a secondary craniocervical angle).
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Case Reports
Carotico-clinoid foramina and a double optic canal: A case report with neurosurgical implications.
The lesser wing of the sphenoid is a clinically important structure, particularly with regard to its anatomical relationship with neurovascular structures including the optic nerve, ophthalmic artery, and internal carotid artery. Anterior clinoidectomy, a neurosurgical procedure utilized to access paraclinoid aneurysms and neoplasms, is often complicated by the presence of anatomical variants including the carotico-clinoid foramen and the accessory optic canal. ⋯ The presence of an accessory optic canal may be misconstrued as a carotico-clinoid foramen or pneumatization of the anterior clinoid process, lesser sphenoidal wing, or optic strut. The case report documents two clinically important variant structures occurring ipsilaterally, each with the potential to masquerade as the other radiographically and present complications to both neurosurgeons and radiologists. Knowledge of the unique combination of anatomical variants presented in this report may prevent adverse surgical events during anterior clinoidectomy procedures including hemorrhage of the ophthalmic artery or internal carotid artery and subsequent vision loss or death.
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Coccidioidomycosis is a fungal infection that is endemic to parts of the Southwestern United States. When infection involves the spine, the treatment strategies can be challenging. We have devised a management protocol for spinal coccidioidomycosis based on a review of the literature and our experience. ⋯ This work provides a working protocol involving assessment and reassessment for the management of spinal coccidioidomycosis. Medical management with antifungal agents in some cases can provide satisfactory disease control. However, in patients with mechanical instability, neurologic deficit, medically intractable pain or disease progression disease control may only be achieved with surgical debridement and stabilization.
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Review
Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned?
Intracranial hypertension, defined as an intracranial pressure (ICP) >20 mmHg for a period of more than 5 min, worsens neurologic outcome in traumatic brain injury (TBI). While several mechanisms contribute to poor outcome, impaired cerebral perfusion appears to be a highly significant common denominator. Management guidelines from the Brain Trauma Foundation recommend measuring ICP to guide therapy. In particular, hyperosmolar therapy, which includes mannitol or hypertonic saline (HTS), is frequently administered to reduce ICP. Currently, mannitol (20%) is considered the gold standard hyperosmolar agent. However, HTS is increasingly used in this setting. This review sought to compare the efficacy of mannitol to HTS in severe TBI. ⋯ While all seven studies found that both mannitol and HTS were effective in reducing ICP, there was heterogeneity with regard to which agent was most efficacious.