World Neurosurg
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Review Case Reports
Intracranial Inflammatory Pseudotumors Associated with Immunoglobulin G4-Related Disease Mimicking Multiple Meningiomas: A Case Report and Review of the Literature.
Immunoglobulin G (IgG)4-related disease is a syndrome that forms inflammatory pseudotumors with increasing IgG4-positive plasma cells and lymphocytes infiltrating the exocrine gland and other organs. The concept of this disease gradually has gained more recognition. However, reports of intracranial pseudotumors associated with IgG4-related disease are very rare. The purpose of this report is to provide further information helpful in distinguishing IgG4-related disease from multiple meningiomas. ⋯ There have been a growing number of reports of such multiple pseudotumors associated with IgG4-related disease. In differential diagnosis, this disease entity requires special attention when multiple dural-based tumors are observed. Preoperative presumption is very important because this disease is likely to respond to steroid therapy.
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Review Observational Study
Prevalence of Vitamin D Deficiency in Patients Undergoing Elective Spine Surgery: A Cross-Sectional Analysis.
Decreased bone density secondary to osteoporosis and osteomalacia represents a significant risk factor for bony fracture and spinal instrumentation failure. We evaluated the incidence of vitamin D deficiency in patients undergoing elective spinal instrumentation to investigate which patient-level risk factors are associated with deficient vitamin D levels. ⋯ Vitamin D deficiency was common in patients with degenerative spondylosis undergoing spinal fusion. Middle-aged patients, men, the morbidly obese, those with a history of diabetes, and those with no history of supplementation had a higher incidence of vitamin D deficiency.
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Fourth ventricle tumors have been traditionally approached by opening the cerebellar vermis. The "telovelar" approach is an alternative approach performed through the cerebellomedullary fissure to gain access to the fourth ventricle, avoiding neural tissue damage. We describe our experience with this approach and predictive factors for the extent of resection (EOR) and for outcomes. ⋯ Exposure of the fourth ventricle was satisfactory in all of the patients, and the floor of the fourth ventricle could be visualized early and be protected. EOR and outcomes were satisfactory in 90% of patients, including those harboring large tumors or lesions attached to the lateral or superolateral recesses of the ventricle. Deep rostral tumor attachment was the main limitation of the telovelar approach.
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Hemagioblastomas are highly vascular tumors that rarely present with hemorrhage. To date, the only factor reported to possibly influence the propensity of a tumor to bleed has been its size (>1.5 cm). Here, we present our series of hemorrhagic hemangioblastomas, which includes 2 very small tumors (<1.5 cm). We propose that other factors apart from size may predispose tumors to hemorrhage. ⋯ Our series suggests that small hemangioblastomas may represent a hemorrhagic risk. We speculate that other factors, such as genetic predisposition caused by single-nucleotide polymorphisms, may play a role in hemangiobalstomas that present with rupture.
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To analyze outcomes after the management of mild (<1 mm) and moderately severe (>1 mm and <5 mm) breaches of the posterior wall of the frontal sinus with a goal of maintaining or restoring the functional status of the sinus. ⋯ Many patients with mild to moderately severe breaches of the posterior wall of the frontal sinus can be managed safely and effectively by techniques that preserve the anatomy and function of the frontal sinus.