World Neurosurg
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Case Reports
Amelanotic Meningeal Melanoma with Leptomeningeal Dissemination: A Case Report and Systematic Literature Review.
Meningeal melanoma is a rare tumor of the central nervous system, whose amelanotic variant is called "amelanotic meningeal melanoma" (AMM). AMM does not produce melanin and therefore does not exhibit typical short T1 and short T2 signal on magnetic resonance imaging and thus can be easily misdiagnosed and be inappropriately managed. To date, only 4 AMM cases have been reported in the English literature. Here, we report the fifth case. ⋯ Our experience with this case demonstrated that meningeal melanoma should be included in the differential diagnosis when an intracranial mass is accompanied by leptomeningeal dissemination, and especially when proton magnetic resonance spectroscopy and dynamic susceptibility contrast perfusion-weighted imaging indicate a malignant tumor whereas diffusion-weighted imaging does not. And the loss of a typical melanin signal should not server as an excluding criterion for meningeal melanoma.
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To present a case of spontaneous cerebrospinal fluid (CSF) otorrhea from a fallopian canal meningocele involving the geniculate fossa and review all cases of fallopian canal CSF leak reported in the literature with discussion of management and outcomes. ⋯ Fallopian canal meningocele is an exceedingly rare cause of CSF otorrhea. Successful repair requires precise packing of the dilated facial canal to occlude the leak without injuring the facial nerve. For refractory CSF leak, subtotal petrosectomy and closure of the external auditory canal warrants consideration.
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Case Reports
Clinical Perspective on Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease).
Dysplastic gangliocytoma of the cerebellum, also called Lhermitte-Duclos disease (LDD), is known as a rare, benign brain tumor. Around 200 cases have been reported. ⋯ Preoperative diagnosis based on magnetic resonance imaging is 50% in adults and 16.7% in pediatrics. Diagnostic tiger stripes are not always seen in pediatric cases. The prognosis of the disease is good if total resection can be achieved. Further examinations for PTEN mutation and other comorbidities are recommended.
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Case Reports
Ankylosing Spondylitis Manifested by Extensive Cervical Erosions with Spontaneous Anterior Atlantoaxial Subluxation.
Atlantoaxial instability owing to bone erosions in a patient with ankylosing spondylitis (AS) is rare. We describe the radiographic characteristics, pathology, and treatment of a patient with this rare clinical manifestation and review the literature. ⋯ Extensive cervical erosions with spontaneous atlantoaxial subluxation in AS is extremely rare. The erosive change of atlantoaxial bone may be an early feature of AS. Cervical spine radiographs are essential for patients with AS who present with neck pain. Complete decompression and internal fixation are necessary to prevent serious neurologic morbidity from spinal cord injury in such patients.
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Bow hunter syndrome describes a mechanical compression of the vertebral artery on head rotation leading to reversible symptomatic vertebrobasilar insufficiency. Patients are commonly presenting with syncope, vertigo, dizziness, and visual disturbances. These symptoms usually resolve when the head is turned back into neutral position. Treatment options involve surgical decompression with or without fusion, bypass surgery, or endovascular intervention. ⋯ The reported case is unique as the bow hunter syndrome was further complicated by a pseudoaneurysm of the V3 segment. Surgical intervention proved to be an efficient treatment by stabilizing the affected segment in this patient.