Journal of Neurological Surgery Reports最新文献

Background and Importance  Tegmen defects associated with cerebrospinal fluid (CSF) leaks are a rare pathology that can result in severe complications if left untreated. There is no universal optimal surgical algorithm for repair, although the most common techniques are the middle fossa craniotomy (traditionally 25 cm ² in area), the transmastoid approach, or both. Here, we describe successful use of a keyhole mini-craniotomy, only 6 cm ² in area, without mastoidectomy or days of lumbar drainage. Clinical Presentation  Three patients presented with right-sided CSF otorrhea and hearing loss, with varying sizes of tegmen defects and associated encephaloceles. Keyhole craniotomies measuring 3 × 2 cm were used to perform a multilayer repair comprising an intradural collagen dural substitute, extradural fascial graft, extradural collagen dural substitute, fibrin sealant, and sometimes bony reconstruction using partial thickness craniotomy grafting. All patients were discharged on postoperative day 1 or 2, with no recurrence of symptoms at 6 months. Conclusion  The keyhole craniotomy approach does not sacrifice the extent of operative access for this pathology. This minimally invasive approach can likely be used more often without need for concomitant mastoidectomy, ultimately enabling shorter hospital stays and more rapid recovery.

Introduction  Cerebellopontine angle (CPA) tumors frequently present with hearing loss, which influences whether a hearing-preservation versus hearing ablative surgical approach is chosen. We discuss a case of complete hearing recovery after resection of a jugular foramen schwannoma (JFS) in a patient who also had a small intracanalicular vestibular schwannoma (VS). Case  A 46-year-old woman presented with left ear fullness, tinnitus, and imbalance for 9 months. She had no lower cranial nerve dysfunction. Audiometry demonstrated Class D hearing with 4% word recognition on the left. Vestibular testing showed absent caloric response on the left and subtle central findings. Magnetic resonance imaging demonstrated a left 3.3-cm JFS and separate left 1-cm intracanalicular VS. A retrosigmoid approach was performed for a radical subtotal resection of the JFS, relieving the mass effect on the vestibulocochlear nerve. The small intracanalicular VS was not manipulated. Pathology confirmed schwannoma with neurofibromatosis type 2 (NF2) mutation in the tumor but normal NF2 germline. Postoperative audiometry at 6 weeks showed normal audiometric thresholds with 100% discrimination. Subtle left caloric response was noted on postoperative vestibular testing and central oculomotor findings improved. Discussion  The presented case describes the management of concurrent ipsilateral VS and JFS in the absence of NF2 and demonstrates a unique complete and rapid recovery of hearing following JFS resection without manipulation of concurrent VS. This case supports the use of a hearing-preservation approach in similar cases and corroborates previous reports of hearing recovery following resection of non-VS CPA tumors with hearing-preservation approaches.

Nasopharyngeal stenosis is a challenging condition characterized by a narrowed nasopharynx, leading to nasal congestion, impaired breathing, and recurrent sinus issues. In this report, we present a unique surgical approach that combines the use of both the Da Vinci Xi robot and a 70-degree nasal endoscope in a patient with a type II stenosis of the nasopharynx. The benefits of improved visualization, maneuverability, and precision of this novel combined approach are highlighted. It also highlights the benefit of using mitomycin C in minimizing the risk of re-stenosis. This previously undescribed technique can not only improve patient outcomes, but it also paves the way for future advancements and broader applications in robotically assisted procedures involving the skull base and oropharynx.

Although osteosarcomas are the most frequent primary malignant bone tumors, the primary cranial manifestation of this condition is very rare with only a limited number of cases presented in the literature. We present the case of a 20-year-old male patient who underwent single-session surgical intervention for resection of right frontal osteosarcoma with a tailor-made craniotomy and cranioplasty using virtually designed 3D-printed templates and molds. Subsequently, the patient was treated according to the EURAMOS protocol and received adjuvant systemic chemotherapy. At 18-month follow-up, the patient was clinically asymptomatic, and both the magnetic resonance imaging scan of the head and the staging computed tomography showed no signs of tumor recurrence or metastases. The case presented shows that the use of 3D-printed molds facilitate a safe preoperative planning of the resection area and a single-session surgery including a custom-made cranioplasty responding to the highest esthetical standards.

Background  A rare variant of congenital aqueductal stenosis (CAS) is known as adult-onset CAS, characterized by the emergence of symptoms during adulthood. Case Description  A 35-year-old man presented complaining of acute-onset headache and vomiting. Magnetic resonance imaging of the brain revealed an acute hydrocephalus due to an aqueductal web. The patient was treated with a ventriculoperitoneal shunt and doing well. His condition was complicated by subdural hematoma as a result of overshunting, which was treated by frontoparietal craniotomy and eventually, he underwent valve revision to a programmable valve. Conclusion  Additional research is needed to gain a deeper understanding of the hypothesis related to adult aqueductal stenosis. This will help shed light on the asymptomatic childhood phase and potentially reduce complications by identifying late CAS early.

Human papillomavirus (HPV)-associated sinonasal squamous cell carcinoma (SNSCC) (HPV+ SNSCC) is a recently recognized entity that accounts for up to one-third of SNSCC. Although at present these cancers are not routinely tested for HPV, the incidence is increasing and HPV+ SNSCC is associated with superior survival outcomes compared with HPV- SNSCC. Here, we present the case of a patient with HPV+ SNSCC treated with endoscopic resection followed by postoperative radiation and review the literature summarizing epidemiology and management of this disease, with emphasis on the importance of HPV testing in SNSCC.

Spinal schwannomas are benign, slow-growing tumors originating from Schwann cells, constituting 25 to 30% of primary spinal neoplasms and most frequently arise from sensory nerve roots in the cervical or thoracic spine. 1 2 3 Although generally nonaggressive, their growth can result in significant neurological deficits due to compression of surrounding structures such as the spinal cord or nerve roots. 4 5 Patients commonly present with localized pain, muscle weakness, and sensory disturbances. 5 6 Imaging techniques such as MRI or CT assist in identifying these tumors, and surgical resection is recommended when they cause progressive symptoms or neurological decline. 7 8 Recent advances in surgical techniques have improved the precision of schwannoma resections, reducing intraoperative complications, facilitating patient recovery, and improving overall patient outcomes. 9.

Background and importance  Selective dorsal rhizotomy (SDR) is a surgical technique to treat spasticity, mainly in children with spastic cerebral palsy (CP). In this report, a unique case of a late arachnoid cyst, causing radiating pain in the left leg, is presented. This is relevant to clinicians managing the long-term follow-up of patients who underwent selective dorsal rhizotomy (SDR). Clinical presentation  A 25-year-old male with bilateral spastic CP, who underwent SDR at the age of 7, presented with symptoms of progressive radiating pain in the left leg. Magnetic resonance imaging (MRI) revealed the presence of a large arachnoid cyst and a remarkable dorsal position of the cauda equina. After dissection of the cyst, the previously experienced radiating pain immediately subsided; however, the patient developed urinary retention and constipation. Cauda compression was ruled out by MRI. The constipation subsided quickly, and the patient performed self-catheterization until 1 month postoperatively for the urinary retention after which there were no signs of ongoing bladder dysfunction. Conclusion  Arachnoid cyst formation can be a late complication of SDR and can cause lumbosacral radicular syndrome in the late postoperative course in select cases.

Introduction  Gliomas and meningiomas are two common primary brain tumors, but occurring simultaneously in the same patient is a rare entity. The authors would like to report a case of coexistence of a superior parietal lobule diffuse glioma, IDH-wild type, histologically CNS WHO grade 3 and a left posterior fossa transitional meningioma, WHO grade 1; both the tumors were successfully removed in one-stage operation. Case Presentation  A 68-year-old female having hypertension, who presented to us with the chief complaints of involuntary shaking of her left lower limb associated with her left upper limb tingle, dizziness, and neck soreness. She was found to have a lesion in her right parietal region and a tumor in her left cerebellar region. After detailed discussion with the patient and thorough preoperative evaluation, the authors performed a right parietal craniotomy and a left retrosigmoid approach in one-stage operation to remove both the tumors, which were proven to be of two distinct histological identities. Conclusion  The management for two tumors located far apart needs a case-by-case evaluation. An important aspect while dealing with such cases is to decide which tumor needs to be operated first or whether both lesions can be operated at the same time with one-stage operation.

The patient is a 51-year-old woman who had been experiencing syncope and near-syncopal events for at least 10 years with an otherwise benign neurological exam. Magnetic resonance imaging revealed an extra-axial mass consistent with a midline planum and tuberculum sellae meningioma, for which the patient opted to have resected. We demonstrate how performing a posterior orbitotomy with anterior clinoidectomy can enhance a lateral supraorbital craniotomy. The patient did well following surgery, with marked improvement in syncopal symptoms. Pertinent surgical anatomy and techniques are highlighted in this video demonstration.