World Neurosurg
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Review Case Reports
Occult transorbital intracranial injury by a windscreen wiper handle: a case report and review of the literature.
We present the case of a 51-year-old male with an occult transorbital intracranial injury after a car accident. The identified foreign object was a windshield wiper handle. To our knowledge, this is the first case reported. ⋯ Occult TII is a rare subtype of penetrating brain injury. Diagnosis requires high suspicion as it can be missed during physical examination. Computed tomography (CT) scan, CT angiogram, and magnetic resonance imaging should be performed in order to design the optimal treatment for each patient. Magnetic resonance imaging should be avoided when metallic density on CT is observed. The use of a broad-spectrum antibiotic regimen is critical.
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Symptomatic spinal epidural lipomatosis (SSEL) is characterized by hypertrophy of adipose tissue within the spinal canal and consequent neural compromise. The exact pathogenesis remains enigmatic. The authors describe a retrospective case series, define the full clinical spectrum, and discuss possible pathogenetic mechanisms. ⋯ The clinician should be astute to the radiologic features of SEL, particularly in patients presenting with CES in the absence of acute disk herniation. The outcome of patients with CES and SEL after surgery is excellent regardless of symptom duration. Venous impedance related to increased body mass index and EF deposition may play the predominant role in addition to mechanical compression in the pathogenesis of SSEL.
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Atlantoaxial instability (AAI) is a common cause of neurologic dysfunction and pain in patients with Down syndrome (DS), frequently requiring instrumented fusion of the upper cervical spine. Despite this, optimal treatment strategy is controversial. ⋯ Numerous fixation strategies exist for AAI in patients with DS. Using a combination of screws, rods, and wiring in appropriately selected patients may help reduce the high rate of surgical complications in these patients.
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The purpose of this study was to provide a systematic and comprehensive review of the existing literature regrading postoperative ossification of posterior longitudinal ligament (OPLL) progression. ⋯ The lack of high-level evidence makes it difficult to draw definite conclusions and further research and long-term follow-up clinical studies are needed to better understand postoperative OPLL progression.
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De novo formation of arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is increasingly being reported in the neurosurgical literature, challenging the notion that AVMs are congenital in origin. Most of this literature centers around the pediatric population. After treatment of an AVM or AVF, recurrence, if any, appears to occur locally to the original insult. We present, to the best of our knowledge, the first case of a de novo direct AVF involving an anterior communicating artery aneurysm in a remote site from a prior ruptured AVM in a pediatric patient. ⋯ This case highlights the importance of long-term imaging surveillance in patients with AVMs. Further prospective studies are indicated to evaluate the long-term imaging surveillance necessary to detect early recurrence, thereby allowing doctors to institute earlier definitive treatment. The exact pathophysiology behind these lesions is not fully understood; however, this case lends support to an acquired etiology to vascular malformations.