World Neurosurg
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We document the results of a protocol to reduce the incidence of cerebrospinal fluid (CSF) leak and other wound complications in patients undergoing tethered cord surgery (TCS). ⋯ Postoperative prone nursing with Trendelenburg position minimizes the incidence of CSF leak and other wound complications.
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Surgical approaches to pineal lesions present a challenge because of limited visibility and maneuverability within the posterior fossa. The supracerebellar infratentorial (SCIT) technique has emerged as an approach to pineal lesions. We aim to demonstrate the efficacy of the endoscopic SCIT technique through a case series conducted at our institution and highlight the advantages of the endoscopic technique over the microscopic alternative. ⋯ The purely endoscopic SCIT approach is a safe and effective approach for deep-seated pineal lesions. This approach allows for visibility and maneuverability around the lesion and facilitates high rates of GTR.
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Diffuse large B-cell lymphoma (DLBCL) is the most commonly diagnosed primary non-Hodgkin lymphoma of the spine and can induce spinal compression. Reports of lymphoma arising in bone adjacent to metallic prostheses are increasing. However, to our knowledge, DLBCL arising from a scar after lumbar fusion surgery has not been reported previously. ⋯ This case highlights the need to consider malignancy in the differential diagnosis and carefully examine surgical specimens in revision surgery. Further understanding of the role of metal implants in the development of lymphoma is required.
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The artery of Wollschlaeger and Wollschlaeger is a tentorial branch of the superior cerebellar artery that is usually not visualized on conventional cerebral angiography, unless it is pathologically enlarged. It can be recruited as part of the blood supply to tentorial dural arteriovenous fistulas (AVFs), although this occurs infrequently. ⋯ The anatomic discrepancy between the symptomatic spinal cord lesion and the etiologic intracranial fistula frequently results in delayed care in cases of myelopathy due to intracranial dural AVFs. Familiarity with these disorders and of their pathophysiologic mechanisms is important to avoid unnecessary diagnostic delays.
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Case Reports
Spinal cοrd compression secondary to a brοwn tumοr as a first manifestation of primary hyperparathyroidism.
Brown tumors (BTs) represent the typical nonmalignant lesions of hyperparathyroidism. Mandibles, ribs, and large bones are the most usual localization of BT. The diagnosis of these tumors requires biological and radiologic assessments. Their treatment is essentially based on parathyroidectomy. ⋯ The brown tumor, when localized at the level of the spine, can be life-threatening and must be managed as soon as possible.