World Neurosurg
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Meningiomas arising in pediatric populations are rare neoplasms with distinct biological and clinical features. A rare case of a 2-year-old boy with extremely large intracranial parasagittal meningioma is presented. To our knowledge, this case is the largest parasagittal meningioma to be reported to date in the pediatric age group. ⋯ The patient's postoperative recovery was unremarkable, and the previously compressed brain rebounded. There was no evidence of recurrence after two years of follow-up. Every effort should be exerted to achieve radical resection of the tumor, which can result in a satisfactory prognosis and a low recurrence rate.
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Comparative Study
Management of Incidental Dural Tear During Lumbar Spine Surgery. To Suture or Not to Suture?
Incidental durotomy (ID) during lumbar spine surgery is a frequent complication of growing clinical relevance as the number and complexity of spinal procedures increases. Yet, there is still a lack of guidelines for the treatment of ID with a large heterogeneity of established surgical techniques. The aim of this study was to investigate the efficacy of dural suturing in patients having ID during degenerative lumbar spine surgery, compared with other dural closure techniques. ⋯ Based on our results, the dural closure technique after ID does not seem to influence revision surgery rates due to cerebrospinal fluid leakage and its complications. Further prospective randomized studies are needed to confirm our results.
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An exophytic tumor is defined as a tumor that has its epicenter in the nervous tissue but grows outside the anatomical superficial boundaries of the brain within an adjacent space. Exophytic extension of hemispheric gliomas is extremely rare. The object of this study is to describe the exophytic growth pattern of insular gliomas. ⋯ Radiologic features that define the exophytic growth pattern in insular gliomas are the posterior displacement of the middle cerebral artery and a sharp subarachnoid margin that separates the exophytic tumor from the temporal pole. Contrary to the tumor that infiltrates the anterior perforating substance, the exophytic tumor is amenable for safe and complete resection.
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Case Reports
Combined transzygomatic and pterional approach for resection of a dermoid cyst of the foreman ovale.
Dermoid cysts are rare, benign intracranial lesions commonly located in the posterior fossa. We describe a uniquely located dermoid cyst in the foreman ovale resected via a combined pterional and transzygomatic approach.
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Treatment of extremely large cerebral arteriovenous malformations (AVMs) is challenging. Although volume-staged stereotactic radiosurgery (SRS) is a possible multimodal treatment option for such lesions, reports of these procedures are scarce. We evaluated the efficacy and safety of volume-staged SRS in patients with AVMs >20 cm(3) with >3 years of follow-up. ⋯ In our series, volume-staged SRS for AVMs >20 cm(3) achieved a nidus obliteration rate of 35% at 5 years. There was still a high risk for hemorrhage (∼ 4% per year) after treatment, which seemed to be higher than the rate commonly observed in the posttreatment course of single-session SRS for average-size AVMs. Further cases will help determine whether volume-staged SRS could be routinely considered, based on its efficacy and risks, including comparison with the natural history of large AVMs.