Journal of Neurological Surgery Reports最新文献

A 70-year-old man with transient ischemic attacks (TIAs) due to left internal carotid artery (ICA) occlusion underwent external carotid to ICA bypass which occluded postoperatively. He developed aphasia which resolved with induced hypertension optimized by using serial transthoracic echocardiography in the setting of left ventricle outflow tract obstruction.

Background: Symptomatic intracranial hypertension is a rare presentation of meningiomas associated with compression and/or invasion of the dural venous sinuses. Establishing a clear link between tumor-induced venous outflow obstruction and elevated intracranial pressure is essential to determine the appropriate management strategy.

Case description: A 59-year-old female presented with headaches, imbalance, pulsatile tinnitus, and horizontal binocular diplopia secondary to bilateral abducens nerve dysfunction in the setting of a small tentorial meningioma compressing the dominant right transverse sinus. Venous manometry demonstrated elevated sinus pressures and a large pressure gradient across the lesion. Microsurgical resection improved the caliber of the transverse sinus and normalized intracranial pressures without the need for permanent venous stent placement.

Conclusion: Tentorial meningiomas infrequently result in venous outflow obstruction and symptomatic intracranial hypertension. Thorough workup including diagnostic angiography, venous manometry, and temporary stenting can be used to confirm the diagnosis. Surgical resection with or without permanent stent placement can restore venous drainage and alleviate debilitating symptoms.

Objective: Occasionally, repair of tegmen defects can be complicated by the ossicular chain protruding above the floor of the middle fossa, which traditionally requires disarticulation and reconstruction of the ossicles to manage. This manuscript describes modifications of previously described techniques to address this surgical problem.

Design: Case series.

Participants: In this case series we present three patients with tegmen defect and encephalocele where the ossicles protruded over the floor of the middle fossa. In one instance, a "manhole cover" was created by concentrically layering hydroxyapatite cement around the tegmen defect and placing a piece of calvarium harvested from the bone flap over the defect. In another case, a "bony igloo" was drilled into harvested bone flap and placed over the defect, effectively creating a neo-epitympanum.

Main outcome measures: Hearing preservation, CSF leak recurrence.

Results: No patients had recurrence of their encephalocele and/or CSF leak. No patients required manipulation of the ossicular chain intraoperatively. Hearing returned to normal in one case. Hearing worsened in one case, thought to be related to injury to the inner hair cells of the cochlear or cochlear nerve. Hearing did worsen in another case, thought to be related to pneumolabyrinth.

Conclusions: The "manhole cover" and "bony igloo" techniques are pragmatic solutions to this rare but complex surgical problem.

Ewing's sarcoma, though rare, primarily affects children and young adults, commonly manifesting in long bones. Cranial involvement, particularly in the frontal bone, is exceptionally uncommon, posing diagnostic and therapeutic challenges. Meticulous pathological assessment is crucial for recognizing and managing such atypical presentations. A 16-year-old male presented with left frontal swelling and neurological symptoms. Imaging revealed a space-occupying lesion involving the left frontal bone with intracranial extension. Histopathology confirmed Ewing's sarcoma based on characteristic findings and positive immunohistochemical markers. Differential diagnoses include metastatic neuroblastoma, primitive neuroectodermal tumors, and chordomas, highlighting the importance of comprehensive evaluation. Ewing's sarcoma involving the skull necessitates a multidisciplinary approach for accurate diagnosis and management. This case underscores the significance of clinical, radiological, and pathological assessments in recognizing rare manifestations. Collaboration among teams is crucial for tailored management strategies and optimal patient outcomes.

Introduction: Pituitary abscess is a rare but potentially life-threatening condition with an incidence of 0.2 to 1.1% of operative pituitary lesions. Preoperative diagnosis is difficult because it shares many similarities with other pituitary lesions in terms of signs and symptoms and radiographic findings. The author would like to share a case of primary pituitary abscess due to Cutibacterium acnes infection, which is probably the first case reported in an adult patient.

Case presentation: A 60-year-old woman with having medical history of diabetes mellitus who suffered from severe headache, fever, chillness, and vomiting in January 2024. She had been admitted to the Infectious Diseases Department; however, no definite infection source was found, but hypopituitarism was detected. Her brain magnetic resonance imaging (MRI) showed a rim-like enhanced sellar lesion with suprasellar extension. She underwent an endoscopic endonasal transsphenoidal approach with the removal of the lesion and skull base reconstruction. During the surgery, pus-like material and some solid tissue, which was yellowish white in color, were found. The culture of the pus revealed the growth of Cutibacterium acnes, and the histological report of the solid tissue proved nonneoplastic pituitary gland tissue, admixed with fibrous tissue and marked chronic inflammation. She recovered well after surgery and completed antibiotic treatment.

Conclusion: Preoperative diagnosis of pituitary abscess is difficult. The majority of pituitary abscesses are diagnosed during the operation or postoperatively. Prompt diagnosis and treatment of pituitary abscess yield a favorable prognosis. The mainstay of treatment is transsphenoidal surgical resection in combination with antibiotic therapy.

Background: Recent studies show potential benefits of albendazole in managing cisternal neurocysticercosis (NCC), which reduces parasitic burden. This systematic review and meta-analysis aim to evaluate the efficacy of albendazole and other pharmacological treatments in cisternal NCC, considering the heterogeneity of disease manifestations and the need for effective treatment strategies.

Methods: Comprehensive searches were conducted across PubMed, Web of Science, Scopus, CENTRAL, and Embase up to March 2024, focusing on RCTs and observational studies that examined albendazole's impact on cisternal NCC. Data were pooled using a random-effects model, adhering to the Cochrane handbook for systematic reviews and meta-analysis and the preferred reporting items for systematic reviews and meta-analyses guidelines, to calculate relative risks (RRs) for various outcomes, including cyst resolution and side effects.

Results: Eight studies with 2,001 patients treated with albendazole, comparing outcomes against placebo or no treatment. Findings indicated a statistically significant decrease in complete cyst resolution among albendazole recipients (RR = 0.69), with notable heterogeneity across studies. No significant differences were observed in persistent cysts, partial cyst resolution, seizures, nonneurological side effects, death, or calcification rates posttreatment. Adjustments for heterogeneity refined some associations, particularly with persistent cysts after excluding specific studies.

Conclusion: Albendazole demonstrates potential in reducing active cysts in cisternal NCC, though its efficacy varies across different clinical outcomes, necessitating personalized treatment approaches. The observed heterogeneity and the variable impact on cyst resolution and seizures underscore the complexity of managing NCC. Further high-quality, large-scale RCTs are essential to solidify these findings and guide treatment protocols, emphasizing the need for multidisciplinary strategies in addressing this challenging condition.

A 2-year-old female patient presented after experiencing a generalized tonic-clonic seizure accompanied by fever, followed by a loss of consciousness. She underwent an urgent right frontal external ventricular drain placement. Intraoperative cerebrospinal fluid analysis was negative for infectious patterns. MRI showed a predominantly cystic lesion in the midline posterior fossa, with a compressive mass effect. Subsequently, she underwent a suboccipital craniotomy for microscopic resection of a posterior cranial fossa lesion. Histopathology reported keratin flakes with severe active inflammation, and foreign body type giant cell reaction in scalp excision with free hair shafts through the inflammatory focus, consistent with pilonidal sinus. The patient was then discharged home in good health.

Carcinoma ex-pleomorphic adenoma (CXPA) of the lacrimal gland is rare, and its management can be complex given its anatomic location. In this case report, we describe our approach to multidisciplinary management of a CXPA with intracranial extension.

Introduction: Temporomandibular joint (TMJ) cysts extending through the skull base into the middle cranial fossa (MCF) are rare, with limited data on clinical progression and treatment. This study retrospectively analyzed three cases of TMJ cysts with MCF extension managed by a multidisciplinary team. Clinical presentation, imaging, surgical resection, outcomes, and a literature review are presented.

Case presentations: Three patients presenting with otalgia and TMJ tenderness were found to have intracranial cysts communicating with the TMJ. Two patients had been transferred with suspected intracranial abscesses; one presented for workup of headache and trigeminal neuralgia. All three demonstrated elevation of inflammatory markers. Two patients had TMJ aspiration, notable for leukocytosis and crystalline deposition, another had frank purulence. One patient demonstrated pneumocephalus within the cyst on imaging. The intracranial cysts ranged from 1.2 to 3.3 cm in maximum diameter, with their bony defects ranging from <1 to 4 mm. Two patients underwent craniotomy, cyst resection, and repair of the middle fossa defect, while the third opted for observation. Pathology of the white gelatinous fluid within the two resected growths demonstrated benign cysts.

Conclusion: TMJ cysts with intracranial extension, while rare, require careful differentiation from intracranial abscesses. Surgical urgency may be indicated in cases demonstrating clinical signs of infection. Additionally, TMJ cysts with intracranial extension benefit from surgical removal and skull base repair to relieve symptoms and prevent future complications.

Temporal bone en plaque meningiomas can present management challenges, particularly when accompanied by severe pain. We report the case of a 42-year-old woman who was initially diagnosed with chronic otitis media but was later found to have a painful left temporal bone en plaque meningioma. Despite conservative therapy, her pain progressed, prompting the decision to undergo surgical resection, which resulted in considerable pain relief. This report illustrates the influence of pain on surgical decision-making for temporal bone en plaque meningiomas and reviews the literature on their variable presentations and management strategies.