World Neurosurg
-
Idiopathic spinal cord herniation (ISCH) is a treatable spinal disease. It is rare and often misdiagnosed, causing a delay in management. The etiology is multifactorial, with one of the causes being duplication of the ventral dura. The spinal cord herniates within this defect and becomes strangulated, causing neurological deficits. We report the duplication of a ventral spinal cord as an important cause of ISCH in our review. ⋯ Very few asymptomatic patients can be treated conservatively. The surgical outcomes have been favorable for symptomatic patients. Proper exposure, gentle manipulation while reducing the herniated spinal cord, enlargement of the defect, and the use of intraoperative monitoring will help limit the postoperative deficits. Duplication of the ventral dura is an important cause of ISCH. It prevents the formation of an anterior pseudomeningocele after surgery. Owing to the rarity of the disease and the lack of follow-up data with recurrence rates, it has not been possible to form clear guidelines for management.
-
Seizures are the second most common clinical presentation in patients with brain arteriovenous malformations (AVMs) and the most common presentation of unruptured AVMs. The aim of the present multicenter, retrospective cohort study was to identify the predictors of seizure presentation in patients with AVM who had undergone stereotactic radiosurgery (SRS). ⋯ We identified multiple factors associated with seizure presentation in patients with AVM to undergo SRS. Previous AVM resection, a cortical AVM location, and a lack of previous AVM hemorrhage were the strongest predictors of pre-SRS seizures. The Spetzler-Martin grade and Virginia radiosurgery AVM score might have a role in seizure risk stratification. For cortical AVMs, a temporal lobe location was predictive of seizure presentation.
-
Intracranial angiomatoid fibrous histiocytomas (AFHs) are very rare tumors. Histologically, classical cases have been reported exclusively in adults, with myxoid variants identified only in children. Here, we report the clinical presentation, treatment, biopsy, and molecular test results for 2 children with classical intracranial AFH and combine this with a literature review of published intracranial AFH and AFH-like cases. ⋯ This report describes the first 2 cases of nonmyxoid intracranial AFH in children; confirmed by molecular analysis. Our results suggest that a tumor spectrum incorporating classical and myxoid intracranial AFHs can occur in children and that gross total resection represents the treatment strategy of choice at diagnosis or following recurrence.
-
Frame-based stereotaxy represents the gold standard for biopsy of deep-seated lesions. Visual control of possible bleeding in these lesions is not possible. Neuroendoscopic biopsy represents an alternative procedure for tissue sampling in deep-seated intraventricular lesions. The authors present a technique for transventricular-navigated endoscopic biopsy of lesions that are located in the paraventricular region. ⋯ Endoscopically conducted biopsies with the aid of navigated tracking of the probe represent a possible additional technique in selected paraventricular intraparenchymal pathologies. The endoscopic approach enables the direct visualization of the intraventricular surface and its vessels. In contrast to standard stereotactic biopsy, direct visual control of hemostasis can be obtained even in paraventricular tumors.
-
Calcified intraspinal epidermoids are a rare entity. We discuss the various pathogenesis and the clinical implication of such a finding during surgery. ⋯ To our knowledge this is the first reported case of spinal intramedullary epidermoid with intralesional calcification.