World Neurosurg
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Case Reports
Successful Onyx embolization of a giant glomus jugulare: case report and review of nonsurgical treatment options.
Otorrhagia is an uncommon but severe symptom of patients with large glomus jugulare tumors that erode through the tympanic membrane. In this case report we describe the use of transarterial embolization for long-term palliative management of otorrhagia in a patient with an unresectable glomus jugulare tumor. ⋯ Long-term control of otorrhagia from glomus jugulare tumors can be safely achieved by intravascular embolization with Onyx.
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This study was designed to evaluate the clinical, radiologic, histologic, and surgical outcome characteristics of this disease treated in a single institution. ⋯ Primary adult infradiaphragmatic craniopharyngiomas are relatively rare lesions occurring in young adults. Pituitary dysfunction, visual acuity and/or field deterioration, and headache were the most common chief symptoms. Transsphenoidal surgery, including tearing the cyst walls off the diaphragma sellae and protecting normal pituitary tissue as much as possible, is recommended. Although at the risk of impairing the function of anterior pituitary, transsphenoidal surgery results in a high rate of both visual field and hyperprolactinemia improvement with a low associated risk of recurrence. In terms of pathological aspects, the adamantinous subtype was more common.
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Patients with cervical instability and intramedullary signal intensity changes on preoperative magnetic resonance imaging scans may benefit from not only cervical decompression but also from fusion surgery. Transarticular screw (TAS) fixation is a useful technique for posterior fixation. We first report treating a patient with cervical spondylosis and instability by cervical laminoplasty with TAS fixation using a bioabsorptive screw. ⋯ Our method has advantages over metal instrumentation. The treated area can be evaluated with the use of magnetic resonance imaging, and the space left after screw absorption is filled by newly formed bone. Because our screw contains hydroxyapatite, it is osteoconductive. This may increase the fusion rate and induce substitution with new bone. To our knowledge this is the first patient treated by cervical posterior TAS fixation via the use of a bioabsorptive screw. Our method is safe and economical and free of the complications elicited by the use of metal parts. TAS fixation with a bioabsorptive screw may be appropriate for one fixation in patients without severe instability.
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Schwannomas originating from the oculomotor nerve are extremely rare. We report our experience in the management of oculomotor schwannomas and other lesions mimicking them, and discuss operative strategy for these rare tumors emphasizing oculomotor nerve preservation. ⋯ The microsurgical resection of oculomotor schwannomas carries a risk of worsening preoperative oculomotor nerve function; however, this is often transient. Considerable technical training and microanatomical knowledge of the region is required to optimize outcome.
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Orbital lymphangiomas (OL) are rare benign lesions that represent less than 4% of all space-occupying orbital lesions. Total surgical resection is usually difficult because of its infiltrative nature. Our objective was to analyze the indications for surgical treatment, the selection of surgical approach, and the clinical outcome after surgical treatment of OL. ⋯ Subtotal resection of OL is an effective and safe treatment option, may prevent new hemorrhagic episodes, and is not associated with a high recurrence rate after a relatively short-term follow-up. Progressive proptosis, visual or oculomotor impairment, and repeated symptomatic hemorrhagic episodes are considered indications for surgery. Transcranial access should be performed in large tumors extending posteriorly.