World Neurosurg
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Review Case Reports
The Natural Course of Myxopapillary Ependymoma : An Unusual Case Report and Review of The Literature.
Spinal cord ependymomas are the most frequent primary intramedullary tumors of the cord in middle age (40-60 years of age). Myxopapillary ependymomas are low-incidence tumors and occur in the cauda equina and conus medullaris. They are typically described as fleshy, sausage-shaped, vascular lesions. ⋯ Myxopapillary ependymomas grow slowly and are well defined by MRI. Advancements in radiologic technology and surgical equipment have allowed this tumor type to be treated successfully. Unfortunately, if untreated, these lesions have poor prognosis and result in clinical symptoms such as paraparesis. Surgical treatment of these lesions using total resection was performed total resection and was associated with an excellent postoperative outcome. We highlight the natural course of myxopapillary ependymomas.
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Review
Retro-odontoid Pseudotumor Without Radiological Atlanto-axial Instability: a Systematic Review.
Retro-odontoid pseudotumor (RP) can be caused by several diseases, especially rheumatoid arthritis, and is usually associated with the presence of atlantoaxial instability. On the other hand, a different group of patients have been identified in whom RP is observed without radiologic findings of atlantoaxial instability. The pathophysiology, clinical characteristics, and prognosis of this latter group of patients are not well described in the literature. ⋯ The results of this review show that RPWRI has different causes such as hypermobility, deposition of substances, and perhaps disc herniation. Depending on the cause of RPWRI, the pathophysiologic mechanism is different. Treatment should be tailored based on the primary cause of RP and the degree of compression of the cervicomedullary junction. Different degrees of improvement are usually observed after surgical treatment in these patients regardless of the treatment used, but a higher rate of mass regression was observed in those patients in whom the atlantoaxial joint was stabilized.
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An anomalous vertebral artery is not a deterrent for posterior C1-C2 joint manipulation and reduction of atlantoaxial dislocation (AAD). However, presence of an incidental aneurysm in the aberrant segment of artery with concurrent AAD adds to the surgical challenge. ⋯ The association of an incidental aneurysm with an anomalous vertebral artery in congenital AAD is unusual. The etiology could be an underlying collagen defect or repeated shearing trauma to the vessel wall due to C1-C2 instability. It would be less risky to proceed with endovascular embolization followed by occipitocervical fusion without opening the joints in case the aneurysm is present on the dominant aberrant V3 segment. Ventral decompression can be supplemented for irreducible AAD. On the contrary, if the aneurysm is present on the nondominant aberrant V3 segment, the C1-2 joint can be opened and manipulated following an initial endovascular treatment of the aneurysm. If the circumstances demand, the nondominant artery can be ligated and sacrificed, although there is a small risk of formation of stump aneurysm.
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Review Case Reports
Retroclival Arachnoid Cysts: Case Series, Literature Review, and a New Classification Proposal.
The retroclival region is among the rarest locations for an arachnoid cyst (AC), with only a few reported cases. No accepted classification system is available for these rare cysts. Such a classification system would solve the nomenclature problem and could result in easier and more systematic management. We reviewed and analyzed data from databases and reported studies of retroclival ACs (RACs) and have proposed a classification system. ⋯ RACs can be more easily and systematically managed using a simple clinical classification system. Together with the previously proposed suprasellar AC classification, our proposed RAC classification should be adequate to classify all ACs in the ventral midline cistern, which could solve the nomenclature problem.
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Review Historical Article
The Siberian lancet, one more possible innovative example of scalpel's contribution to the evolution of surgical anatomy and neurosurgery.
Several primitive scalpels were used since the eve of surgical procedures. Numerous bronze knifes discovered in the Altai mountains region from the Xiongnu-Xianbei-Rouran period mold a hypotheses for a possible medical use. ⋯ Strong indications imply that those cutting tools, except for domestic usage, were one more example of scalpel's contribution to the evolution of surgical anatomy and neurosurgery.