World Neurosurg
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Review Case Reports
Surgical outcome in Iniencephaly survivor: A case report and review of the literature.
Iniencephaly is an extremely rare congenital neural tube defect (NTD) involving the occipital region with rachischisis of the cervicothoracic spine and fixed retroflexion deformity of the head. It affects an estimated 0.1-10 out of 10,000 pregnancies and carries a dismal prognosis. Most affected children are either stillborn or perish within a few hours of delivery. Pathological and postmortem studies of iniencephaly significantly outnumber the limited amount of literature available on patients surviving with this disorder. To date, surgical repair has been attempted in only 3 of the 8 patients with iniencephaly who have survived long-term. Thus, a huge knowledge gap remains regarding the neurosurgical nuances and postsurgical outcomes in iniencephaly. ⋯ Iniencephaly is a complex NTD associated with high perinatal mortality that requires a vigilant antenatal diagnosis. Surgical repair may be attempted in the lucky few survivors after a thorough evaluation of the anomaly.
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Review Case Reports
Primary, dural-based, Ewing sarcoma manifesting with seizure activity: Presentation of a rare tumor entity with literature review.
Primary Ewing sarcoma arising from the calvarial bone and/or underlying dura matter are relatively rarely reported in the literature. Even rarer are considered to be those that originate from the dura and proliferate in both directions, toward the brain parenchyma and through the dura invading the overlying bone. ⋯ The patient had an uneventful neurologic recovery without persistent neurologic deficit. One year after the operation, with the patient under close clinical and radiologic surveillance, no recurrence of the disease was detected. This case illustrates an extremely uncommon location of primary Ewing sarcoma, along with a constellation of clinical signs and symptoms that are fairly uncommon for this location of this rare disease entity.
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Meta Analysis
Surgery For Clinoidal Meningiomas: Case Series And Meta-Analysis Of Outcomes And Complications.
Clinoidal meningiomas present specific characteristics related to their peculiar site of anatomic origin. Clinical series focusing on pure clinoidal meningiomas are not numerous. We performed a systematic review and meta-analysis, including our own case series, of the available literature to better identify the specific features of these tumors. ⋯ The rate of gross total resection is proportional to the dural origin of these tumors, which is intimately related to critical neurovascular structures. Complementary radiosurgery could represent a valid treatment strategy. Postoperative visual improvement remains less satisfying compared with other suprasellar meningiomas. The introduction of skull-base techniques, such as extradural anterior clinoidectomy, has enabled improvements in visual outcome without any increase in approach-related morbidity.
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Moyamoya is a rare, yet classic etiology of stroke in young adults, affecting predominately women of childbearing age. The impact of pregnancy on the natural history of symptomatic moyamoya remains a matter of extensive debate, however. ⋯ The risk of moyamoya-related stroke during pregnancy, delivery, and the postpartum period appears to be similar to or lower than that suggested by published natural history studies in symptomatic patients. A neuroprotective effect of pregnancy in moyamoya patients cannot be excluded.
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Review Case Reports
Herpes simplex encephalitis shortly after surgery for a secondary glioblastoma: a case report and review of the literature.
Herpes simplex encephalitis (HSE) and glioblastoma multiforme (GBM) co-occurrence has been described in few cases presenting immunocompromised status related to chemotherapy or chemoradiotherapy. Focal encephalitis over surgical edge of resection occurring shortly after GBM resection is rarely reported, and such infection has never been reported in low-grade glioma with secondary malignant transformation (i.e., secondary GBM). Here, we report a case of HSE misdiagnosed in the early postoperative course following a secondary GBM resection. We also provide a review of the literature about HSE occurring after glioma surgery. ⋯ Clinicians should be aware of the existing co-occurrence between HSV infections and GBM during the postoperative course. Cerebrospinal fluid analysis with HSV polymerase chain reaction testing should be promptly undertaken, and some keys clinical elements should justify early empirical treatment, including acyclovir administration. The significant prognostic implication of HSE complicating GBM must raise the attention of neurosurgeon and neuro-oncologist about this entity.