World Neurosurg
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Review Case Reports
Aortic injury by thoracic pedicle screw. When is aortic repair required? Literature review and three new cases.
Aortic injury by pedicle screw is rare but can cause serious complications. It has not been clearly determined when aortic repair is necessary in cases of screw impingement without perforation of the aortic wall. In this article, we review the treatment and clinical course of pedicle screw aortic impingement and attempt to clarify this issue. ⋯ In cases in which the screw impinges less than 5 mm into the aortic wall, hardware revision without aortic repair may be sufficient if recognized early and there are no sign of aortic leakage in vascular imaging. However, cases with more than 5 mm of screw impingement should undergo aortic repair first, even in the absence of aortic leakage, following by screw revision.
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Review Case Reports
Clinical vasospasm after an extended endoscopic assisted approach for recurrent pituitary adenoma. Illustrative case and systematic review of the literature.
Cerebral vasospasm causing delayed cerebral ischemia after transsphenoidal surgery is a rare but life-threatening complication. Reports in the literature after extended endoscopic endonasal approach (EEEA) are scarce. Considering the progressive use of this technique during recent years, a better understanding of the potential adverse effects after this procedure is needed. The aim of this report was to systematically analyze the current literature and discuss management and causes for cerebral vasospasm after EEEA surgery. ⋯ The threshold for DSA after unexplained neurologic deterioration after extended transsphenoidal surgery should be low, and cerebral vasospasm should be treated early and aggressively. Surgeons performing EEEA need to consider the possibility of this delayed complication.
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Review Case Reports
Spinal Atypical rhabdoid teratoid tumor in an adult woman. A rare case report and review of the literature.
Atypical rhabdoid teratoid tumors are very rare embryonal tumors that typically affect children younger than 3 years old and are encountered intracranially. ⋯ Atypical rhabdoid teratoids are exceptionally rare in adults and are seldom found in spine; only 8 such cases have been reported in the medical literature. They are invariantly characterized by multiple relapses and dismal prognosis. The clinician must be attentive of leptomeningeal disseminations and 22q11 deletion-associated comorbidities.
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Review Case Reports
Malignant Melanotic Schwannian Tumor Presenting with Spinal Cord Infarction Due to Occlusion of the Artery of Adamkiewicz: Case Report and Review of the Literature.
Malignant melanotic schwannian tumors (MMSTs) are rare peripheral nerve sheath tumors that typically exhibit benign clinical presentation and histopathology but malignant long-term behavior. ⋯ The anatomic location and rapid presentation of permanent deficits are suggestive of infarction of the spinal cord supplied by the artery of Adamkiewicz, a rare presentation of this disorder and of spinal schwannomas in general.
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Review Case Reports
Hormonal Fertility Therapy as a Potential Risk Factor for Cerebrospinal Fluid Leak After Endoscopic Endonasal Surgery: A Case Study and Literature Review.
Endoscopic endonasal approaches have been shown to be as effective as transcranial approaches for sinonasal malignancies involving the skull base. Although they are associated with less risk than an open cranial resection, cerebrospinal fluid (CSF) leaks remain a main concern. Some drugs can raise the intracranial pressure and exacerbate the risk of a postoperative CSF leak. In this case report, we present a 32-year-old woman who was treated via endoscopic endonasal approach for an olfactory neuroblastoma and later underwent fertility preservation treatment with leuprolide, which likely led to a delayed CSF leak. ⋯ Leuprolide or any drug that can potentially increase intracranial pressure should be held for 3 months after surgery or until after a skull base defect has fully healed.