Journal of Neurological Surgery Reports最新文献

Juvenile psammomatoid ossifying fibroma (JPOF) is a type of fibro-osseous lesion in which normal bone is replaced by fibrous tissue. Most commonly, it involves the nasal sinuses or orbital bone. It is very important to differentiate it from other fibro-osseous lesions because these lesions have overlapping clinical features. Even though it is a benign condition, it is locally aggressive and rarely extends intracranially. A complete surgical resection is the key to avoid recurrence. We are presenting a case of JPOF in a 16-year-old boy with a large tumor involving the ethmoidal sinuses with large intracranial component.

Introduction: Diffuse midline glioma, H3 K27-altered (DMGHA), is an uncommon malignant primary brain tumor associated with a grave prognosis and limited treatment options. We report a unique case of an elderly woman who was initially treated for a right cerebellar DMGHA. She subsequently developed a distal recurrence at the septum pellucidum, hypothesized to be a result of retrograde cerebrospinal fluid (CSF) dissemination.

Case history: A 72-year-old woman initially presented with headache and dizziness. The subsequent workup revealed a right cerebellar mass. A diagnosis of DMGHA was confirmed by histological studies and molecular profiling, and she was treated with gross total resection followed by protocol-based chemoradiation. At 12 months after surgery and treatment, surveillance imaging showed a new isolated enhancing mass in the septum pellucidum. She underwent another gross total resection with an anterior interhemispheric approach. Pathology confirmed a diagnosis of DMGHA.

Conclusion: We report a novel case of recurrent distal spread of a right cerebellar DMGHA to the septum pellucidum. Although several putative mechanisms may be hypothesized to account for the very unique pattern of disease spread including simple multifocal disease, retrograde CSF dissemination may be the most likely mechanism. This is due to the lack of radiographic evidence for subcortical or hematogenous spread, and the interface between both enhancing masses and the CSF compartment.

Diaphragma sellae meningiomas are rare suprasellar tumors often misidentified as tuberculum sellae meningiomas. Their association with the optic nerve, chiasm, pituitary stalk, internal carotid, and superior hypophyseal arteries presents unique surgical challenges. These tumors are classified into three types based on dural attachment with precise subtype identification. We present a Type A diaphragma sella meningioma, located anterior to the pituitary stalk, managed via a pterional craniotomy with extradural anterior clinoidectomy and optic unroofing. Posterior attachment with ICA adhesion and multiple SHA involvement favored a transcranial route, with clinoidectomy and optic unroofing widening the optico-carotid triangle for safe resection.

Background: Differentiating craniopharyngiomas (CPs) from Rathke's cleft cysts (RCCs) is challenging due to overlapping features. RCCs with squamous metaplasia (SM) may represent a transition to CPs, complicating diagnosis. This study presents a recurrent RCC later confirmed as papillary CP, prompting a systematic review to identify early diagnostic markers. The goal is to improve RCC and CP differentiation, preventing radical resection of true RCCs, and predicting recurrence or transformation to CPs.

Methods: A systematic review was performed with adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using the PubMed/Medline databases, a search string was created with the keywords "RCC transformation or (RCC and CP) or (RCC to CP) or (RCC to CP) or (Rathke's and CP)." The initial search yielded 489 papers, narrowed by key data points including RCC recurrence with histologic CP confirmation.

Results: The final review included five studies, which detailed cases of initial pathological diagnosis of RCC that were later diagnosed as a CP upon repeat surgery and tissue sampling. Histological examination of primary and secondary surgical resections revealed RCC recurrence with transformation to CPs (two adamantinomatous CPs, two papillary CPs, and one ciliated CP).

Conclusion: RCCs and CPs share overlapping features, complicating preoperative diagnosis and treatment. RCC recurrence with subsequent CP is rare, as our review identified only five recorded cases. Definitive diagnosis requires pathology, though sampling bias poses challenges. Advanced imaging (contrast-enhanced 3D T2-FLAIR MRI) and biomarkers (BRAF V600E, beta-catenin, p53, Ki-67) show promise in improving diagnosis, predicting recurrence, and guiding treatment.

Background: Primary melanocytic tumors of the central nervous system (CNS) are rare neoplasms that range from benign melanocytomas to aggressive malignant melanomas. Although meningeal melanocytomas are generally considered indolent lesions, malignant transformation and distant metastasis can occur.

Case description: We report the case of a 33-year-old male with a bulbopontine meningeal melanocytoma who developed systemic metastases, culminating in a fatal outcome. Despite initial histopathologic features of benignity and absence of BRAF mutation, the lesion showed aggressive behavior.

Conclusion: This case underscores the diagnostic pitfalls associated with primary CNS melanocytic tumors and highlights the importance of long-term vigilance, even for histologically benign lesions.

Background: Gangliocytomas of the sellar region are rare, well-differentiated, benign tumors that may coexist with pituitary adenomas, forming so-called "collision tumors." These lesions often present with endocrine dysfunction, most commonly acromegaly.

Case description: We report a 69-year-old female who presented with drug-resistant headaches, acromegalic features, and signs of Cushing's disease. Magnetic resonance imaging showed a sellar mass with extension into the clivus. Endoscopic transsphenoidal resection revealed a tumor composed of ganglion cells and adenohypophyseal components. Immunohistochemistry confirmed a diagnosis of gangliocytoma coexisting with a hormone-secreting pituitary adenoma. Postoperative hormonal normalization was achieved.

Conclusion: Sellar gangliocytomas with dual hormonal activity pose diagnostic challenges and highlight the importance of histological and immunohistochemical evaluation. Awareness of these rare entities can prevent misdiagnosis and support appropriate surgical management.

Introduction: Ionizing radiation is a known risk factor for various neoplasms, yet its link with vestibular schwannoma (VS) remains unclear. Given that VSs are benign tumors of the eighth cranial nerve, elucidating potential associations with radiation is of clinical interest. This study investigated the association between diagnostic and therapeutic head and neck radiation exposure and VS.

Methods: In a case-control design, we enrolled 137 patients with VS, matched by age and sex with 659 controls. Data were obtained through structured interviews, capturing sociodemographic factors and history of therapeutic head and neck radiation, as well as imaging examinations (X-ray, computed tomography [CT], and magnetic resonance [MR], excluding the last 2 years). Weighted distributions were used to account for up to six controls per case. We used conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: The mean age of participants was 53 ± 14.6 years, with 50.4% females. An initial significant association was observed between therapeutic radiation and VS (adjusted OR = 4.94, 95% CI: 2.49-7.98). However, excluding participants who recently underwent radiation therapy attenuated this association (adjusted OR = 2.32, 95% CI: 0.59-9.07; p  = 0.22). No significant associations were found for diagnostic imaging (ORs of 1.04 [0.86-1.25], 1.18 [0.73-1.92], and 1.19 [0.57-2.49] for X-ray, CT, and MR, respectively).

Conclusion: Our findings do not support a significant relationship between either therapeutic or diagnostic head and neck radiation exposure and the risk of VS, once recent treatments are excluded. Additional large-scale studies are necessary to confirm these observations and to examine potential dose-response effects.

Introduction: Arachnoiditis ossificans (AO) associated with syringomyelia (SM) is a rare pathology. Its clinical and image-based diagnostic features are challenging to identify. Only a limited number of cases have been published thus far. We present two new cases and offer a review of the literature.

Materials and methods: We conducted a systematic literature search using PubMed , Web of Science , and Google Scholar with the following keywords: Arachnoiditis ossificans, leptomeningeal calcification, and spinal meningeal calcification, in combination with syrinx, syringomyelia, hydromyelia, cord cavitation, and cystic necrosis of the spinal cord.

Results: AO-SM predominantly affected females (12 F, 7 M), with a mean age of 55.84 ± 14.7 years. The mean follow-up was 14.07 ± 9.01 months postoperatively. The main complaints included low back pain and progressive para-/tetraparesis, with or without urinary disturbances. Potentially causative events occurred 25.07 ± 13.75 years prior to diagnosis. Based on imaging findings, patients primarily experienced thoracic AO-SM. In seven studies, arachnoid cysts were reported in association with AO-SM. Surgical treatment mainly involved microsurgical AO resection, shunting, or draining of the SM, along with duraplasty and cystectomy or fenestration of the arachnoid cyst. A second surgical intervention was conducted on five patients. Approximately 57% of the patients showed improvement.

Discussion and conclusion: AO-SM remains one of the least understood causes of myelopathy. Clinical and imaging diagnostics continue to pose challenges. Preoperative evaluation using magnetic resonance imaging (MRI) and native CT may be regarded as the gold standard. CT myelography and, occasionally, Cine MRI should be considered to determine the best surgical option. Surgical treatment continues to be a dilemma.

Purpose: To present a low-cost posterior cervical fixation technique using sublaminar wiring for the management of a comminuted odontoid fracture (type IIA) in a young, neurologically intact patient, emphasizing its relevance in low-resource environments where advanced instrumentation is inaccessible.

Methods: A 21-year-old male sustained a comminuted fracture of the odontoid process of C2 following a high-impact motorcycle accident. Upon admission, he was alert, fully oriented, and neurologically intact. Imaging revealed a comminuted type IIA odontoid fracture without displacement. Due to the patient's economic limitations and the unsuitability of the fracture for anterior fixation, a posterior approach using double sublaminar wiring between C1 and C2 with autologous iliac crest bone graft was performed.

Results: The procedure was successfully completed with no intraoperative or postoperative complications. The patient was discharged on postoperative day 2 and demonstrated excellent recovery. Follow-up imaging at 3 months confirmed over 90% fracture consolidation. Imaging at 6 months was requested but not obtained due to loss of follow-up. Functional recovery was complete, with only a partial reduction in cervical range of motion as expected with C1-C2 fusion.

Conclusion: Sublaminar wiring offers a safe, effective, and affordable alternative for posterior fixation of comminuted odontoid fractures, particularly in young patients and in settings where access to advanced spinal instrumentation is limited.

[This corrects the article DOI: 10.1055/s-0044-1788037.].