World Neurosurg
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To analyze clinical and radiologic features of pathologic atlantoaxial displacement (PAAD) in pediatric patients and to compose a treatment algorithm for anomaly-related PAAD. ⋯ We present a unified treatment algorithm of pediatric anomaly-related PAAD. Syndromic AAD are often accompanied by anterior and central dislocation and myelopathy and atlantooccipital dissociation. These patients require early aggressive surgical treatment. Nonsyndromic and Klippel-Feil syndrome AAD, atlantoaxial subluxation, and atlantoaxial fixation often manifest by local symptoms and need to eliminate CVJ instability. Existing classifications of symptomatic atlantoaxial displacement are not always suitable for patients with CVJ abnormalities.
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Stereotactic radiosurgery (SRS), particularly Gamma Knife radiosurgery (GKRS) is an established treatment option for residual and recurrent pituitary adenoma tumors. It helps in the preservation of surrounding normal neuronal, vascular, and hormone-producing structures and causes fewer neurologic deficits. The aim of this research was to evaluate the efficacy and define the role of GKRS in the treatment of nonfunctioning (NFA) and hormonal active (HAA) pituitary adenoma. ⋯ GKRS plays a significant role in the treatment of NFA and HAA. It affords a high rate of tumor control and offers a low risk of collateral neurologic or endocrine axis injury. Our study shows that control of tumor growth was achieved in 90% of patients, shrinkage of tumor in 54%, and arrest of progression in 36% after GKRS treatment. The biochemical remission rate in growth hormone secreting adenoma was 57%, in adrenocorticotropic hormone adenoma 67%, and prolactinoma 40%. Age below 50 years and tumor volume less than 5 cm3 were associated with a favorable radiosurgical outcome.
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Clinical and radiographic degenerative spondylolisthesis (CARDS) classification defines a distinct subset of patients with kyphotic angulation at the involved segment (type D). Research using CARDS classification to investigate motion characteristics at involved segments or patient-related outcomes (PROs) following surgical intervention is sparse. We investigated the relationship between CARDS type D spondylolisthesis and dynamic instability and PROs in type D versus non-type D spondylolisthesis. ⋯ CARDS type D spondylolisthesis is a distinct subset associated with dynamic instability and worse PROs. Higher improvement in PROs can be achieved in CARDS type D spondylolisthesis after surgery.
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Low-grade glioma (LGG) of the neurohypophysis is an extremely rare tumor arising from the pituicytes of the posterior pituitary or the infundibulum. The preoperative imaging findings of these tumors mimic those of pituitary adenomas, and radical resection is often challenging in affected patients due to the hypervascularity of the tumor. Here we describe the clinical and radiologic features of this clinical entity. ⋯ Anterior displacement of a thick anterior pituitary by a tumor combined with evidence of flow voids on preoperative MRI is helpful in the preoperative diagnosis of LGG of the neurohypophysis. Radical resection should be attempted in these tumors, especially during primary surgery, even though it is associated with postoperative pituitary dysfunction.
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Spinal epidural lymphoma with compressive myelopathy is a rarely found condition. The aims of this study are to describe the clinical features and to analyze its treatment outcome and prognostic factors. ⋯ Spinal epidural lymphoma with compressive myelopathy is a serious disease in children necessitating urgent treatment. Preserved motor power is a meaningful prognostic factor of neurologic improvement. Treatment should be individualized based on the patient's neurologic condition.