Pub Date : 2016-08-01DOI: 10.1097/WNQ.0000000000000171
Aydemir Kale, Evren Aydogmus, B. Açıkgöz
Traumatic leptomeningeal cysts, also known as growing skull fractures, are a rare but serious complication of childhood cranial fractures and a very rare complication following head traumas in adults. We present the case of a 35-yearold woman with drug-resistant epileptic seizures caused by a traumatic leptomeningeal cyst from the head injury she suffered at the age of 18 months. Surgical treatment was performed with the removal of the leptomeningeal cyst, dural repair, and cranioplasty. She had no more epileptic seizures at her follow-ups. Although it is rare, after head trauma in childhood, adult patients have often complained of epileptic seizure. Surgical treatment is necessary to control the illness.
{"title":"Clinically Adult Onset of a Leptomeningeal Cyst After Head Trauma in Childhood: Case Report and Review of the Literature","authors":"Aydemir Kale, Evren Aydogmus, B. Açıkgöz","doi":"10.1097/WNQ.0000000000000171","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000171","url":null,"abstract":"Traumatic leptomeningeal cysts, also known as growing skull fractures, are a rare but serious complication of childhood cranial fractures and a very rare complication following head traumas in adults. We present the case of a 35-yearold woman with drug-resistant epileptic seizures caused by a traumatic leptomeningeal cyst from the head injury she suffered at the age of 18 months. Surgical treatment was performed with the removal of the leptomeningeal cyst, dural repair, and cranioplasty. She had no more epileptic seizures at her follow-ups. Although it is rare, after head trauma in childhood, adult patients have often complained of epileptic seizure. Surgical treatment is necessary to control the illness.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"259-262"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000171","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61885030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.1097/WNQ.0000000000000158
N. Azarpira, B. Bageri, A. Rasekhi, B. Geramizadeh
Idiopathic orbital inflammation syndrome is a rare inflammatory disease, with unknown etiology. We present a 72-year-old man with unilateral medial rectus mass lesion. Histologically, the mass composed of dense fibrotic tissue with infiltration of lymphocytes, plasma cells, and few eosinophils. Management was done by surgical debulking with good result and no complications.
{"title":"Idiopathic Orbital Inflammation Syndrome: A Case Report","authors":"N. Azarpira, B. Bageri, A. Rasekhi, B. Geramizadeh","doi":"10.1097/WNQ.0000000000000158","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000158","url":null,"abstract":"Idiopathic orbital inflammation syndrome is a rare inflammatory disease, with unknown etiology. We present a 72-year-old man with unilateral medial rectus mass lesion. Histologically, the mass composed of dense fibrotic tissue with infiltration of lymphocytes, plasma cells, and few eosinophils. Management was done by surgical debulking with good result and no complications.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"263-265"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000158","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61884296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.1097/WNQ.0000000000000165
H. Yi, H. Hwang, J. Choi, I. Shin, I. Choi
Objective:This study presents 48 patients, with special attention given to the clinical and radiologic characteristics, as well as the outcomes of surgical and endovascular treatment. Materials and Methods:A total of 1941 patients with cerebral aneurysms were treated from January 2003 to June 2011. Data reviewed included the patient’s age, sex, Hunt-Hess grade, characteristics of the imaging study, procedure-related complications, and clinical outcomes. Aneurysm locations were divided into 3 groups [group I: pericallosal-callosomarginal (PerA-CMA) superior (above the genu of corpus callosum) type; group II: pericallosal-callosomarginal (PerA-CMA) inferior (below the genu of corpus callosum) type; group III: pericallosal-frontobasal (PerA-FPA) type]. Results:A total of 48 patients with distal anterior cerebral artery aneurysms were included in the study. Conventional or computed tomography-angiography revealed that group I 18 (37.5%), group II 24 (50%), and group III 6 (12.5%), respectively. Fifteen (31.3%) patients underwent endovascular coiling and 33 (68.7%) patients underwent microsurgical treatment. Initial mean Glasgow Coma Scale of group of coil embolization was 14.0 and group of microsurgical treatment was 11.2 and the Glasgow Outcome Scale score after coiled patients was 4.6 and 3.7 after clipping. Conclusions:There are no statistical significant difference of clinical outcomes in 3 different anatomic locations, but 6 mortalities with initial poor grade were treated by clipping and were caused by severe cerebral vasospasm, sepsis, and pneumonia(P=0.0388). Therefore, if initial Glasgow Coma Scale was good and the dome to neck ratio of aneurysm was >2.0, endovascular coil embolization may be the best option of treatment of distal anterior cerebral artery aneurysms.
{"title":"Anatomic Features and Clinical Outcomes of 48 Distal Anterior Cerebral Artery Aneurysms","authors":"H. Yi, H. Hwang, J. Choi, I. Shin, I. Choi","doi":"10.1097/WNQ.0000000000000165","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000165","url":null,"abstract":"Objective:This study presents 48 patients, with special attention given to the clinical and radiologic characteristics, as well as the outcomes of surgical and endovascular treatment. Materials and Methods:A total of 1941 patients with cerebral aneurysms were treated from January 2003 to June 2011. Data reviewed included the patient’s age, sex, Hunt-Hess grade, characteristics of the imaging study, procedure-related complications, and clinical outcomes. Aneurysm locations were divided into 3 groups [group I: pericallosal-callosomarginal (PerA-CMA) superior (above the genu of corpus callosum) type; group II: pericallosal-callosomarginal (PerA-CMA) inferior (below the genu of corpus callosum) type; group III: pericallosal-frontobasal (PerA-FPA) type]. Results:A total of 48 patients with distal anterior cerebral artery aneurysms were included in the study. Conventional or computed tomography-angiography revealed that group I 18 (37.5%), group II 24 (50%), and group III 6 (12.5%), respectively. Fifteen (31.3%) patients underwent endovascular coiling and 33 (68.7%) patients underwent microsurgical treatment. Initial mean Glasgow Coma Scale of group of coil embolization was 14.0 and group of microsurgical treatment was 11.2 and the Glasgow Outcome Scale score after coiled patients was 4.6 and 3.7 after clipping. Conclusions:There are no statistical significant difference of clinical outcomes in 3 different anatomic locations, but 6 mortalities with initial poor grade were treated by clipping and were caused by severe cerebral vasospasm, sepsis, and pneumonia(P=0.0388). Therefore, if initial Glasgow Coma Scale was good and the dome to neck ratio of aneurysm was >2.0, endovascular coil embolization may be the best option of treatment of distal anterior cerebral artery aneurysms.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"194–199"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61884725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.1097/WNQ.0000000000000166
Bon-Jour Lin, Hsin-I. Ma
Low-pressure hydrocephalus (LPH) after skull base surgery is rare. We report a 52-year-old man with sphenoidal planum meningioma who underwent a pterional approach for tumor excision. After surgery, consciousness disturbance and intraventricular hemorrhage with associated hydrocephalus were observed. Clinical expression revealed poor response to apparently adequate cerebrospinal fluid drainage through external ventricular drain and functioning ventriculoperitoneal shunt with persisted ventriculomegaly on brain computed tomography scans. A diagnosis of LPH was made, and then combination of external ventricular drain with subatmospheric drainage and endoscopic third ventriculostomy were performed. Finally, the patient recovered clear consciousness with recovery of normal ventricular size. This report highlights the postulated mechanism of LPH formation after skull base surgery and advocates some treatment options for this rare entity.
{"title":"A Rare Case of Low-pressure Hydrocephalus After Skull Base Surgery","authors":"Bon-Jour Lin, Hsin-I. Ma","doi":"10.1097/WNQ.0000000000000166","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000166","url":null,"abstract":"Low-pressure hydrocephalus (LPH) after skull base surgery is rare. We report a 52-year-old man with sphenoidal planum meningioma who underwent a pterional approach for tumor excision. After surgery, consciousness disturbance and intraventricular hemorrhage with associated hydrocephalus were observed. Clinical expression revealed poor response to apparently adequate cerebrospinal fluid drainage through external ventricular drain and functioning ventriculoperitoneal shunt with persisted ventriculomegaly on brain computed tomography scans. A diagnosis of LPH was made, and then combination of external ventricular drain with subatmospheric drainage and endoscopic third ventriculostomy were performed. Finally, the patient recovered clear consciousness with recovery of normal ventricular size. This report highlights the postulated mechanism of LPH formation after skull base surgery and advocates some treatment options for this rare entity.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"9 1","pages":"256–258"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61884926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.1097/WNQ.0000000000000172
İ. Atcı, N. Uçler, Omer Ayden, S. Albayrak, H. Bitlisli, S. Kılıç, H. B. Altınsoy
Objective:The aim is to evaluate the efficiency of ultrasonograhy-guided lower lumbar facet injection. Materials and Methods:Fifty cases admitted to Department of Neurosurgery, Elazig Education and Research Hospital, had no surgical pathology in lumbar magnetic resonance imaging, and whose pain was thought to be related to facet joint and in whom facet joint injection was performed, were included in the study. The injection was performed with C-arm fluoroscopy for 25 of patients, the other 25 were injected with ultrasonography control. The initial injection levels, average age, sex, and body mass indexes of the patients were recorded. Oswestry disability scale (ODI) and the Visual analog scores (VAS) were repeated at the sixth hour and 12th week were recorded. The results were statistically compared. Results:Pain management was considered achieved at a statistically significant level when the preoperative and postoperative degrees of ODI and the VAS were compared with P<0.05. When the postoperative early and 12th week ODI and the VAS are compared, no statistically significant differences between groups 1 and 2 was present (P>0.05). Conclusion:The ultrasonography-guided facet intra-articular injections, like fluoroscopy-guided injections, are efficient and successful at diagnosis and short-term pain management and should be kept in mind as a safer, cheaper alternative method to computed tomography, fluoroscopy-guided algological injections.
{"title":"The Comparison of Pain Management Efficiency of Ultrasonography-guided Facet Joint Injection With Fluoroscopy-guided Injection in Lower Lumbar Facet Syndrome","authors":"İ. Atcı, N. Uçler, Omer Ayden, S. Albayrak, H. Bitlisli, S. Kılıç, H. B. Altınsoy","doi":"10.1097/WNQ.0000000000000172","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000172","url":null,"abstract":"Objective:The aim is to evaluate the efficiency of ultrasonograhy-guided lower lumbar facet injection. Materials and Methods:Fifty cases admitted to Department of Neurosurgery, Elazig Education and Research Hospital, had no surgical pathology in lumbar magnetic resonance imaging, and whose pain was thought to be related to facet joint and in whom facet joint injection was performed, were included in the study. The injection was performed with C-arm fluoroscopy for 25 of patients, the other 25 were injected with ultrasonography control. The initial injection levels, average age, sex, and body mass indexes of the patients were recorded. Oswestry disability scale (ODI) and the Visual analog scores (VAS) were repeated at the sixth hour and 12th week were recorded. The results were statistically compared. Results:Pain management was considered achieved at a statistically significant level when the preoperative and postoperative degrees of ODI and the VAS were compared with P<0.05. When the postoperative early and 12th week ODI and the VAS are compared, no statistically significant differences between groups 1 and 2 was present (P>0.05). Conclusion:The ultrasonography-guided facet intra-articular injections, like fluoroscopy-guided injections, are efficient and successful at diagnosis and short-term pain management and should be kept in mind as a safer, cheaper alternative method to computed tomography, fluoroscopy-guided algological injections.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"14 1","pages":"246–250"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000172","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61885529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-01DOI: 10.1097/WNQ.0000000000000176
B. Dalm, S. Viljoen, G. Gillies, H. Oya, M. Howard
Objective:This report describes a new method for reducing the risk of postoperative obliteration of the subdural space and spinal cord tethering that frequently occurs following resection of intradural spinal tumors. Methods:A 66-year-old patient underwent resection of a T1 to T2 intradural meningioma. A duraplasty procedure was performed to reconstruct the thecal sac and create a capacious cerebrospinal fluid (CSF)-filled space around the spinal cord. To prevent subsequent inward compression of the thecal sac from dorsally located soft tissue, a titanium strap was fashioned to span the laminectomy defect. Dural tack-up stitches were secured to the titanium strap and the laminoplasty construct was secured in place using standard bone screws. Results:The combined duraplasty-titanium laminoplasty procedure was technically straightforward and there were no complications following surgery. Postoperative MR imaging 6 weeks following surgery demonstrated that the goal of creating a capacious CSF-filled space around the spinal cord, without inward compression of the thecal sac by scar tissue, was achieved. MR images of the spinal cord and dura were not degraded by the presence of the overlying titanium strap. Conclusions:This simple method that combines a duraplasty and titanium laminoplasty procedure seems to be a safe and effective approach to achieving the objective of maintaining a capacious CSF-filled space surrounding the spinal cord following intradural surgery.
{"title":"A Novel Dural Reconstruction Method Following Spinal Tumor Resection","authors":"B. Dalm, S. Viljoen, G. Gillies, H. Oya, M. Howard","doi":"10.1097/WNQ.0000000000000176","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000176","url":null,"abstract":"Objective:This report describes a new method for reducing the risk of postoperative obliteration of the subdural space and spinal cord tethering that frequently occurs following resection of intradural spinal tumors. Methods:A 66-year-old patient underwent resection of a T1 to T2 intradural meningioma. A duraplasty procedure was performed to reconstruct the thecal sac and create a capacious cerebrospinal fluid (CSF)-filled space around the spinal cord. To prevent subsequent inward compression of the thecal sac from dorsally located soft tissue, a titanium strap was fashioned to span the laminectomy defect. Dural tack-up stitches were secured to the titanium strap and the laminoplasty construct was secured in place using standard bone screws. Results:The combined duraplasty-titanium laminoplasty procedure was technically straightforward and there were no complications following surgery. Postoperative MR imaging 6 weeks following surgery demonstrated that the goal of creating a capacious CSF-filled space around the spinal cord, without inward compression of the thecal sac by scar tissue, was achieved. MR images of the spinal cord and dura were not degraded by the presence of the overlying titanium strap. Conclusions:This simple method that combines a duraplasty and titanium laminoplasty procedure seems to be a safe and effective approach to achieving the objective of maintaining a capacious CSF-filled space surrounding the spinal cord following intradural surgery.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"251–255"},"PeriodicalIF":0.0,"publicationDate":"2016-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61886280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.1097/WNQ.0000000000000152
Hong-wei Wang, Huqing Li, Chuanwei Wang, Yu-guang Liu
Objective:We reviewed 17 cases of primary intracranial extradural meningiomas (PIEMs) (including our 5 cases) reported in the literature so as to develop a better understanding of their clinical characteristics, treatment, and prognosis. Materials and Methods:The clinical data of 17 cases of PIEMs, including our 5 cases, were analyzed on their demographic features, presenting symptoms and duration, imaging and surgical findings, surgical results, pathologic grades, histologic subtypes, and follow-up results. Results:PIEMs accounted for 0.04% to 0.14% of all meningiomas. The most common presenting symptom (41.2%) was a painless, gradually expanding mass in the region of the lesion. PIEMs being located in skull convexities constituted 88.2% of all cases, whereas skull bases only 11.8%. All PIEMs patients were uneventful perioperatively after complete resection of tumor except 1 who died of primary cardiac arrest during operation. A total of 88.2% of PIEMs were grade I, 11.8% grade II. Ten cases of PIEMs were given a mean 2.16-year follow-up. As a result, no recurrence and death were found. Conclusions:PIEMs have some marked clinical characteristics. Total tumor removal together with a wide excision of all involved tissues followed by the reconstruction of tissue defects is the best surgical project. The prognosis is excellent after surgical complete resection.
{"title":"Primary Intracranial Extradural Meningiomas: A Report of 5 Cases and Literature Review","authors":"Hong-wei Wang, Huqing Li, Chuanwei Wang, Yu-guang Liu","doi":"10.1097/WNQ.0000000000000152","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000152","url":null,"abstract":"Objective:We reviewed 17 cases of primary intracranial extradural meningiomas (PIEMs) (including our 5 cases) reported in the literature so as to develop a better understanding of their clinical characteristics, treatment, and prognosis. Materials and Methods:The clinical data of 17 cases of PIEMs, including our 5 cases, were analyzed on their demographic features, presenting symptoms and duration, imaging and surgical findings, surgical results, pathologic grades, histologic subtypes, and follow-up results. Results:PIEMs accounted for 0.04% to 0.14% of all meningiomas. The most common presenting symptom (41.2%) was a painless, gradually expanding mass in the region of the lesion. PIEMs being located in skull convexities constituted 88.2% of all cases, whereas skull bases only 11.8%. All PIEMs patients were uneventful perioperatively after complete resection of tumor except 1 who died of primary cardiac arrest during operation. A total of 88.2% of PIEMs were grade I, 11.8% grade II. Ten cases of PIEMs were given a mean 2.16-year follow-up. As a result, no recurrence and death were found. Conclusions:PIEMs have some marked clinical characteristics. Total tumor removal together with a wide excision of all involved tissues followed by the reconstruction of tissue defects is the best surgical project. The prognosis is excellent after surgical complete resection.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"136–140"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61883860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.1097/WNQ.0000000000000149
N. Balak, Dogan Gundogan, M. Esfahani
Objective:The keyhole concept in neurosurgery has remained mostly limited to transcranial endoscope-assisted microsurgery or limited-sized keyhole craniotomies. In contrast, documentation of keyhole surgery, as described by Yaşargil, regarding no traumatization to the normal neural, arterial, and venous structures has appeared relatively less in the medical literature, under the term keyhole neurosurgery. Microsurgical resection of falcine meningiomas, although not infrequent, poses technical challenges related to the tumor’s anatomic relationships with the superior sagittal sinus, inferior sagittal sinus, callosomarginal arteries, pericallosal arteries, and neural structures of the medial aspects of the hemispheres. Case Description:A 35-year-old female patient with an anterior inner falcine meningioma and frontal multiple cortical veins draining into superior sagittal sinus is presented. The tumor was totally removed using a very small gap without scarifying any cortical vein. Postoperatively, the patient did very well. Conclusions:The microneurosurgical technique of navigation through aquatic cisternal corridors for surgical access is a minimally invasive technique permitting surgical manipulations through very small gaps and preserves normal neural and vascular structures.
{"title":"Keyhole Cisternal Navigational Resection of an Inner Falx Meningioma","authors":"N. Balak, Dogan Gundogan, M. Esfahani","doi":"10.1097/WNQ.0000000000000149","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000149","url":null,"abstract":"Objective:The keyhole concept in neurosurgery has remained mostly limited to transcranial endoscope-assisted microsurgery or limited-sized keyhole craniotomies. In contrast, documentation of keyhole surgery, as described by Yaşargil, regarding no traumatization to the normal neural, arterial, and venous structures has appeared relatively less in the medical literature, under the term keyhole neurosurgery. Microsurgical resection of falcine meningiomas, although not infrequent, poses technical challenges related to the tumor’s anatomic relationships with the superior sagittal sinus, inferior sagittal sinus, callosomarginal arteries, pericallosal arteries, and neural structures of the medial aspects of the hemispheres. Case Description:A 35-year-old female patient with an anterior inner falcine meningioma and frontal multiple cortical veins draining into superior sagittal sinus is presented. The tumor was totally removed using a very small gap without scarifying any cortical vein. Postoperatively, the patient did very well. Conclusions:The microneurosurgical technique of navigation through aquatic cisternal corridors for surgical access is a minimally invasive technique permitting surgical manipulations through very small gaps and preserves normal neural and vascular structures.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"180–184"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61884021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.1097/WNQ.0000000000000150
A. Guo, Xi Chen, Fuyou Guo, Tagilapalli Shashikiran, Lai-jun Song
Object:To investigate the clinical features and radiologic findings in misdiagnosed intracranial infection. Methods:A series of 12 uncommon patients with misdiagnosed intracranial infection were enrolled in the present study from January 2004 to December 2013. Results:All patients with rare intracranial infections were confirmed by histopathologic examination; the misdiagnosis rate is 100% in the present series. The initial diagnosis included metastatic tumor, glioma, meningioma, cyst disease, hematoma, and epidermoid cysts. The features of magnetic resonance imaging were isointense (5/12), hyperintense (5/12), hypointense (2/12) on T1 weight, and hypointense (4/12) and hyperintense (8/12) on T2 weight, respectively, as well as nonspecific enhanced findings in the present study. The most common etiology of misdiagnosed intracranial infections was fungal abscess and neurocysticercosis that account for 25% (3/12) of the infections. Uncommon intracranial toxoplasmosis in 1 case and 1 case of cerebral alveolar echinococcosis in 1 case were also observed, respectively (8.3%). In addition, 2 cases (16.7%) of all patients were proved to have intracranial abscess with specific pathogen: one is Staphylococcus aureus, and the other is Serratia marcescens. Two intracranial abscesses (16.7%) with nonspecific pathogen were also found in the present study. The follow-up was conducted on all patients during a period of 3 to 96 months (average, 48 mo), of which 91.7% patients had a favorable outcome (Glasgow Outcome Scale 5 and 4) and 8.3% had an unfavorable outcome (Glasgow Outcome Scale ⩽3). ConclusionsPrimary diagnosis of rare intracranial infections should be emphasized; favorable outcome could be achieved by early microsurgical intervention and timely effective antibiotics.
{"title":"Clinical Characteristic of 12 Misdiagnosed Cases With Rare Intracranial Infection","authors":"A. Guo, Xi Chen, Fuyou Guo, Tagilapalli Shashikiran, Lai-jun Song","doi":"10.1097/WNQ.0000000000000150","DOIUrl":"https://doi.org/10.1097/WNQ.0000000000000150","url":null,"abstract":"Object:To investigate the clinical features and radiologic findings in misdiagnosed intracranial infection. Methods:A series of 12 uncommon patients with misdiagnosed intracranial infection were enrolled in the present study from January 2004 to December 2013. Results:All patients with rare intracranial infections were confirmed by histopathologic examination; the misdiagnosis rate is 100% in the present series. The initial diagnosis included metastatic tumor, glioma, meningioma, cyst disease, hematoma, and epidermoid cysts. The features of magnetic resonance imaging were isointense (5/12), hyperintense (5/12), hypointense (2/12) on T1 weight, and hypointense (4/12) and hyperintense (8/12) on T2 weight, respectively, as well as nonspecific enhanced findings in the present study. The most common etiology of misdiagnosed intracranial infections was fungal abscess and neurocysticercosis that account for 25% (3/12) of the infections. Uncommon intracranial toxoplasmosis in 1 case and 1 case of cerebral alveolar echinococcosis in 1 case were also observed, respectively (8.3%). In addition, 2 cases (16.7%) of all patients were proved to have intracranial abscess with specific pathogen: one is Staphylococcus aureus, and the other is Serratia marcescens. Two intracranial abscesses (16.7%) with nonspecific pathogen were also found in the present study. The follow-up was conducted on all patients during a period of 3 to 96 months (average, 48 mo), of which 91.7% patients had a favorable outcome (Glasgow Outcome Scale 5 and 4) and 8.3% had an unfavorable outcome (Glasgow Outcome Scale ⩽3). ConclusionsPrimary diagnosis of rare intracranial infections should be emphasized; favorable outcome could be achieved by early microsurgical intervention and timely effective antibiotics.","PeriodicalId":56275,"journal":{"name":"Neurosurgery Quarterly","volume":"26 1","pages":"129–135"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/WNQ.0000000000000150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61884126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.1097/WNQ.0000000000000135
B. Kaya, E. Kalkan, Fatih Erdi, F. Keskin, T. Altınok, H. Esen, I. Erayman
Hydatid cyst is a contagious disease formed by the pathogen Echinococus granulosus. Pulmonary and liver hydatidosis is the common form of the disease. However primary spinal hydatid cyst is rarely seen and compromise less than 1% of all hydatid cases. Primary spinal hydatid cyst and vertebral compression fracture association is very unusual. In this report we present a case of thoracic vertebral compression due to primary spinal hydatid cyst and discuss the important features of
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