World Neurosurg
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Case Reports
Malignant Peripheral Nerve Sheath Tumor Arising in Schwannomatosis with Multiple Lung Metastases.
Malignant peripheral nerve sheath tumor (MPNST) is a kind of rare neurogenic malignancy, which usually arises from nerve fibers in any tissue and organ that have nerve fiber distributions, especially the trunk and extremities, but it is extremely rare in spinal canal. ⋯ Many cases of MPNST usually developed from neurofibromatosis type 1. However, the incidence of MPNST arising from schwannomatosis was extremely rare. More significantly, using genetic testing on her, we found a splice site mutation (c.1118+1G>A) that occurred between exons 8 and 9 of the SMARCB1 gene, which was first found in this MPNST patient and could lay the foundation for further study of its pathogenesis.
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Case Reports
Pipeline Embolization Device with Shield Technology for Intracranial Aneurysms: An Initial U.S. Experience.
Thromboembolic complications remain a major reason for morbidity and mortality after flow diversion, in addition to hemorrhagic complications not limited to the brain predicated on the prolonged need for dual antiplatelet therapy. Surface modification to decrease thrombogenicity and accelerate aneurysm occlusion is a promising alteration to mitigate those risks. The Pipeline embolization device with Shield Technology possesses such characteristics; however, it has not yet been approved in the United States. ⋯ Flow diverters with surface modification to decrease thrombogenicity and accelerate aneurysm occlusion are promising endovascular tools for patients at high risk of complications with dual antiplatelet therapy. The present case represents one of the first cases performed in the United States using such a device. Despite the favorable outcome in the present case, the question of whether such technology obviates the need for dual antiplatelet therapy remains to be determined.
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Percutaneous endoscopic lumbar diskectomy (PELD) has evolved over the last decades and has become an effective treatment for soft disk herniations. However, while its use increases, newer complications have been discovered. ⋯ PELD combined with foraminotomy is a relatively new and skill-demanding surgery which is indicated only in cases where foraminal disk herniation is combined with foraminal stenosis. This surgical strategy requires experience by the endoscopic surgeon to prevent procedure-related complications. Although rare, these complications can lead to increased morbidity.
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Intraosseous hemangioma is a rare bone tumor, accounting for 0.7%-1.0% of all bone tumors. It can occur at any age, but only 9% of cases are younger than 10 years old. Although this tumor is usually slow-growing and clinically silent, we experienced 2 pediatric patients undergoing surgery for skull hemangioma who presented with uncommon clinical manifestations. ⋯ Although skull hemangiomas show clinical heterogeneity, surgical removal is usually diagnostic and leads to good patient outcomes. On occasion, however, this tumor causes secondary changes in the dura, such that dural incision and dural plasty should be planned in advance of lesion removal.
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We have described the use of 3-dimensional (3D) virtual planning and 3D printed patient-specific osteotomy templates in the surgical correction of a complex spinal deformity. Pedicle subtraction osteotomies (PSOs) for the correction of severe spinal deformities are technically demanding procedures with a risk of major complications. In particular, operations of the severely deformed spine call for new, more precise, methods of surgical planning. The new 3D technology could result in new possibilities for the surgical planning of spinal deformities. ⋯ In addition to direct translation of the planned PSO for surgery, the 3D planning also facilitated a detailed preoperative evaluation, greater insight into the case-specific anatomy, and accurate planning of the required correction.