World Neurosurg
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Review Case Reports
Acquired Spinal Arteriovenous Fistula Presenting as Brown Sequard Syndrome and Endovascular Treatment Outcome.
Brown-Séquard syndrome is typically caused by penetrating trauma to the cervical spinal cord; however, other compressive and vascular occlusive etiologies have been previously described. It is extremely uncommon to have a delayed presentation as an extramedullary compressive lesion from the venous varix of an acquired spinal arteriovenous fistula. ⋯ Subsequent treatment occurred with coil embolization with good outcome.
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Intrameatal cochleovestibular neurovascular conflict is a rare condition with specific clinical and therapeutic implications. Although surgery is commonly indicated in other neurovascular conflicts, for this subset of patients there is little evidence to guide treatment decisions. Moving from a case description, we performed a review of the literature on this topic to systematically present the best available evidence to guide clinical decisions. ⋯ Surgical treatment offers the best results for tinnitus and vertigo, but it seems to have no effect on hearing loss, not even at long-term follow-up. Microvascular decompression should be proposed to intrameatal symptomatic patients before the onset of hearing loss.
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Case Reports
Genetic characterization of a multifocal ganglioglioma originating within the spinal cord.
Gangliogliomas are rare, low-grade intra-axial tumors that exhibit both neuronal and glial components. Although the vast majority present as an intracranial lesion, a rare subset exist as isolated lesions of the spinal cord. Gangliogliomas have also been shown to harbor mutations in the p53 tumor suppressor gene and BRAF oncogene. Previous studies in ganglioglioma have correlated p53 mutations with histologic transformation and BRAF mutations with worse prognosis. ⋯ Importantly, this case contradicts previous reports of p53 and BRAF mutations portending worsened tumor behavior and prognosis and demonstrates that further studies are needed to delineate the role of genetic characterization in the biologic understanding and management of gangliogliomas.
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Case Reports
Seizure Freedom After Limited Hippocampal Radiofrequency Thermocoagulation: A Case Report.
Surgical interventions are often used for freedom from seizure in patients with drug-resistant mesial temporal lobe epilepsy. A patient with seizure foci in the left mesiotemporal region underwent limited-size stereotactic radiofrequency thermocoagulation (RF-TC) over the left hippocampus. ⋯ Favorable seizure control was achieved with minimally invasive RF-TC. Further use of this technique is warranted in cases of drug-resistant mesial temporal lobe epilepsy.
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While carotid angioplasty and stenting (CAS) have become an established procedure, outcomes of early CAS for symptomatic extracranial carotid stenosis (SECS) remain poorly understood. The present study aimed at determining the effectiveness of early CAS in SECS. ⋯ For SECS patients who cannot undergo early carotid endarterectomy, early CAS is effective and safe if selectively indicated considering disease severity. Early and delayed CAS provide comparable mRS scores, incidence of symptomatic thromboembolic complications, CHS, and intracranial bleeding.