World Neurosurg
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Musculocontractural Ehlers-Danlos syndrome caused by pathogenic variants in CHST14 (mcEDS-CHST14) is a recently delineated connective tissue disorder characterized by multisystem congenital malformations and progressive connective tissue fragility-related manifestations. With only 2 cases of mcEDS-CHST14 containing precise information on surgical spinal correction being reported to date, there remains no consensus on treatment standards. This study describes the detailed clinical and radiologic outcomes of the third known patient with mcEDS-CHST14 who successfully underwent surgery for severe kyphoscoliosis. ⋯ On the basis of the present and 2 earlier reported cases, posterior spinal fusion may be a reasonable surgical option for severe progressive spinal deformities in patients with mcEDS-CHST14. However, careful attention is needed for possible massive blood loss from tissue fragility.
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The inferior temporal gyrus (ITG) is known to be involved in high-cognitive functions, including visual and language comprehensions and emotion regulation. A detailed understanding of the nature of association fibers could significantly improve postoperative morbidity related to declining capacity. Through diffusion spectrum imaging-based fiber tracking, we have characterized these connections on the basis of their relationships to other cortical areas. ⋯ This study highlights the principal white-matter pathways of the ITG and demonstrates key underlying connections. We present a summary of the relevant clinical anatomy for this region of the cerebrum as part of a larger effort to understand it in its entirety.
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Case Reports
Deceptive Features on Surveillance Imaging of Intraneural Metastatic Deposits In Metastatic Renal Cell Cancer.
Spinal renal cell metastases are a common insidious pathological manifestation of the oncological process but less common are intramedullary and intraneural spinal metastases. The differential diagnosis of such pathological features can be difficult in the presence of conflicting radiological evidence. ⋯ To the best of our knowledge, the present report is the first documented case of intraneural metastatic deposits from renal cell carcinoma that showed benign radiographic features and demonstrated a stable appearance on surveillance imaging studies for a significant period. These findings suggest that clinicians should have a high index of suspicion for a metastatic process in symptomatic patients with a known renal cell cancer regardless of the lesion's radiographic or temporal characteristics.
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Case Reports
Case Report of An Anterior Thoracic Myelomeningocele - a multidisciplinary approach to surgical management.
Cervicothoracic myelomeningocele (MMC) is a rare entity with only 2 reported cases in the literature of anterior thoracic MMC. ⋯ This case highlights the unique multidisciplinary surgical management of the rare entity of anterior thoracic MMC without scoliosis correction for radiologic progression.
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Although surgeries for intracerebral hemorrhage remain controversial, endoscopic surgery is considered a promising surgical treatment. The most fatal type of thalamic hemorrhage is the medial type, which is always combined with expansion of the hematoma into the third ventricle. The current endoscopic approach to this lesion involves injury to the mediodorsal nucleus of the thalamus (MDT). ⋯ The endoscopic-assisted translateral ventricular transchoroidal fissure approach is a safe and effective approach for evacuation of a medial thalamic hemorrhage with third intraventricular involvement. This approach allows parenchymal hematoma evacuation through the rupture of the third ventricle without incising the MDT in the lateral ventricle.