World Neurosurg
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Neuroglial cysts are rare intracranial lesions that are believed to originate from the sequestration of neural tube lining during embryogenesis. They can present anywhere within the neuraxis; however, their most common location is the frontal lobe. Cerebellopontine angle (CPA) neuroglial cysts are extremely rare and, to the best of our knowledge, there are no previous reports of a neuroglial cyst arising from cranial nerves. ⋯ The rising of a neuroglial cyst from the nerve sheath is a finding that brings other possible origins of neuroglial cysts into consideration.
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Catheter malposition represents one of the major causes of ventriculoperitoneal (VP) shunt dysfunction. The usefulness of intraoperative fluoroscopy using skull landmarks has already been proved to decrease catheter malposition and surgical revision rates. After introducing intraoperative computed tomography (iCT) in our department, our objective was to evaluate the accuracy of this imaging modality to decrease cranial catheter misplacement compared with intraoperative fluoroscopy. ⋯ Fluoroscopy may be the method of choice to intraoperatively assess ventricular catheter positioning. In our experience, iCT shows a tendency to be more time consuming and, in the beginning, was not associated with a steeper learning curve. Another consideration was the significant higher radiation exposure per patient. iCT did not improve the accuracy of catheter placement and did not decrease early revisions for VP placement patients.
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Cochleovestibular nerve compression syndrome due to intrameatal anterior inferior cerebellar artery (AICA) that causes tinnitus is an extremely rare condition with special therapeutic challenges and implications. Here we present the first surgically treated pediatric case of tinnitus showing microvascular conflict of the cochleovestibular nerve and intrameatal AICA loop. ⋯ Decompression of the cochleovestibular nerve including opening of the internal auditory canal and transposition of the AICA appears to be an effective treatment option for cases with radiologically confirmed intrameatal vascular compression of the eighth nerve causing unilateral pulsatile tinnitus.
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Infectious intracranial aneurysms are rare but encountered when associated with rupture or detected on screening of high-risk patients. The time course of the development of these aneurysms is unknown. Ultimately, the data published on mycotic aneurysms are in the form of case series, retrospective studies, with one recent systematic review, all of which have difficulty defining specifics regarding aneurysmal formation in these patients. We present a case that may help define the time frame of mycotic aneurysm growth. ⋯ The time course of infectious intracranial aneurysm development is not known and difficult to define. This case illustrates an example of the development of a new infectious intracranial aneurysm and subsequent rupture over the course of 5 days, showing that these types of aneurysms and subsequent neurologic sequelae can happen acutely.
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To identify clinical factors predicting the development of myelopathy in cervical ossification of the posterior longitudinal ligament (OPLL) patients with radiculopathy. ⋯ Nonmyelopathic OPLL patients with radiculopathy and a high occupying ratio were at higher risk of developing myelopathy, and surgical intervention should be recommended in these cases. However, for elderly patients with significant comorbid conditions, the risks and benefits of surgery should be carefully considered.