World Neurosurg
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Case Reports
De novo cavernoma formation in a patient with Cowden syndrome and Lhermitte-Duclos disease.
Cowden syndrome (CS) is an autosomal dominant genodermatosis with a predisposition for the development of multiple cancers, benign hamartomas, and extracranial vascular malformations. Rarely, intracranial lesions like meningiomas and vascular malformations can also be present with CS. These vascular malformations include developmental venous anomalies, arteriovenous fistulae and cavernomas. Most cases of cavernomas are thought to be congenital, although in recent literature they have been shown to occur de novo with other conditions (e.g., other vascular malformations, trauma, postcranial surgery, viral infection, and genetic disorders). ⋯ We present a case of a patient with CS and LDD who had de novo cavernoma development several years after the initial diagnosis, as well as a review of the literature. We highlight the need of surveillance neuroimaging for patients with CS, as there is the risk of new development of vascular abnormalities (particularly cavernomas).
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A detailed understanding of the anatomy of Sylvian veins preoperatively is needed for venous-preserving Sylvian dissection. Better visualization of the venous architecture will facilitate surgical strategies for Sylvian dissection. This study evaluated and compared the image quality of the Sylvian veins and their tributaries using high-resolution cone-beam computed tomography angiography (CBCT-A) and three-dimensional computed tomography angiography (3D-CTA). ⋯ CBCT-A was superior to 3D-CTA for visualizing the Sylvian veins and their tributaries. CBCT-A will provide important information on the anatomy of the Sylvian veins preoperatively.
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The term "pediculolysis" encompasses rare, chronic pedicular changes characterized by pedicle hypertrophy, sclerosis, and pseudoarthrosis, which develop secondary to recurrent microfractures from repeated stress injuries. These stress injuries to pedicles can be insufficiency fractures, commonly reported in elderly patients with associated osteoporosis, or fatigue fractures, which occur in young adolescents involved in heavy sports. These pedicular lesions have been reported in association with defects in other components of the neural arch, including the pars interarticularis and lamina. ⋯ We have reported the present case to bring awareness to spine surgeons regarding the existence of this rare entity even in middle-age individuals. From our experience with the present patient, we believe that for patients with L5 pediculolysis and spondylolisthesis, the option of L5 medial pediculectomy and extension of instrumentation to L4 level should be considered.
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Spinal arteriovenous fistulas have abnormal connections between spinal arteries and veins. Early diagnosis and management are essential for preventing permanent neurologic deficits. Although symptoms of myelopathy are commonly related to established types of spinal arteriovenous fistulas within the spine, extraspinal arteriovenous anomalies may also result in similar pathology and pose challenges to conventional endovascular treatment. ⋯ Extraspinal vascular malformations with vascular myelopathy are extremely rare. They include a broad spectrum of complex vascular disorders and often require alternate endovascular approaches.
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We sought to analyze the clinical data and imaging features from a rare case presenting an intravertebral mobile nerve sheath tumor of the lumbar spine, review the relevant literature, discuss the imaging features and possible causes of the tumor, and propose preventive measures and solutions. ⋯ Intravertebral mobile nerve sheath tumors are rare, and the marked distortion and elongation of the carrier nerve seen on MRI are important imaging features of this disease. The possible causes of tumor movement include tumor texture, location, positional changes, and altered cerebrospinal fluid dynamics. Acute changes in intraabdominal pressure caused by forceful defecation may be a high-risk factor for tumor migration. Multiple preoperative MRIs to localize the tumor are particularly important.