World Neurosurg
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Isolated lower segment sacral fracture is very rare. To the best of our knowledge, there is only one case report of S4 stable fracture that was treated conservatively. ⋯ Sacral fracture is difficult to diagnose, especially when the patient has multiple injuries. This is because the emergency doctor may not perform a neurologic examination of the perineum and may miss its diagnosis. Another reason for its misdiagnosis is that the routine anteroposterior plain X-ray may not detect it. Trauma patients with sacrococcygeal pain and tenderness should raise concerns about sacral fracture, and a lateral plain X-ray and/or computed tomography of the sacrococcygeal spine should be performed. Neurologic deficit is rare in lower sacral segment fracture; hence, a trial of conservative management (same as for coccygeal fracture) should be tried first. If the patient does not respond and there is displacement, surgical intervention can be used, because it has a very good response from the patient. In the presence of a neurological deficit, however, surgical intervention should be attempted as soon as possible.
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The precise mechanism of nucleus pulposus proliferation in the degeneration of the intervertebral disk pathogenesis remains to be implicated. MicroRNAs (MiRNAs) are a class of 18-22 nucleotides, which are small, noncoding RNAs that inhibit protein translation by binding to the 3'-UTR of target gene. Recent studies have shown that miRNAs play a crucial role in various cell biologies such as cell proliferation, invasion, migration, and cell cycle. However, the role of miR-184 in nucleus pulposus proliferation is still unknown. ⋯ These results demonstrated that miR-184 and the GAS1/Akt pathway may be a potential therapeutic target for intervertebral disc degeneration.
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The basic necessities for surgical procedures are illumination, exposure, and magnification. These have undergone transformation in par with technology. One of the recent developments is the compact magnifying exoscope system. In this report, we describe the application of this system for surgical operations and discuss its advantages and pitfalls. ⋯ The magnifying exoscope is an effective and nonbulky tool for surgical procedures. In visualization around the corners, the exoscope has better potential than a microscope. With technical and technologic modifications, the exoscope might become the next generation in illumination, visualization, exposure, and magnification for high-precision surgical procedures.
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Case Reports
Mutational analysis of recurrent meningioma progressing from atypical to rhabdoid subtype.
Rhabdoid meningioma is rare aggressive meningioma histological subtype that develops predominantly through progression from less malignant tumors. Owing to its low incidence, this tumor's biological background is unknown. The aim of this study was to profile somatic mutations in 4 meningioma samples from the same patient, derived previously from 4 subsequent tumor resections. ⋯ The mutation of ARID1A that encodes the subunit of the SWI/SNF complex represents the most likely driver of the tumor's malignant potential. It also may be involved in the acquisition of the rhabdoid phenotype, given that mutations in chromatin remodeling proteins are the hallmark of atypical teratoid/rhabdoid tumors.
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Foix-Alajouanine syndrome is defined as acute neurologic deterioration in the setting of a spinal dural arteriovenous fistula. ⋯ Venous hypertension with subsequent rapid resolution after surgical treatment is the pathophysiological mechanism underlying a dural arteriovenous fistula, in contrast to historical views suggesting that these lesions result from irreversible venous thrombosis, resulting in necrotic myelopathy.