World Neurosurg
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Osteoradionecrosis (ORN) refers to the degenerative changes seen in bone after local radiation, particularly in head and neck cancer. ORN can present as neck or facial pain and may be confused with tumor recurrence. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are often inconclusive, requiring percutaneous biopsy to differentiate ORN from infection and recurrent disease. We reviewed the utility of preprocedural imaging in guiding the decision to biopsy in cases of ORN. ⋯ This case series highlights that PET scanning may not be useful in predicting which patients will benefit from biopsy for ORN because no patients with PET-positive lesions had histopathologic evidence of tumor recurrence or metastasis on biopsy.
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Middle cerebral artery (MCA) fenestration is a rare vascular variant of the MCA. When this occlusion occurs, it presents challenges to identification and recanalization. We describe a patient with a partially occluded MCA fenestration in whom recanalization was successfully achieved via mechanical thrombectomy using a stent retriever with an intermediate catheter. ⋯ Mechanical thrombectomy may be feasible and safe in MCA fenestration occlusion.
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Little is known about the biomechanical performance of various fixation constructs after oblique lumbar interbody fusion (OLIF). This study aimed to explore the stability of various fixation options for OLIF by using finite element analysis based on three-dimensional scanning models. ⋯ The BPS model provided the best biomechanical stability for OLIF; the stand-alone model could not provide sufficient stability. The LRS-CTLFS procedure increases the approximate stability and reduces stress at the cage-endplate interface; however, it causes an increase in screw stress.
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Case Reports
Treatment outcomes of incidental intracranial meningiomas: Results from the IMPACT cohort.
Incidental findings such as meningioma are becoming increasingly prevalent. There is no consensus on the optimal management of these patients. The aim of this study was to examine the outcomes of patients diagnosed with an incidental meningioma who were treated with surgery or radiotherapy. ⋯ The morbidity after treatment of incidental intracranial meningioma is not negligible. Considering most operated tumors are WHO grade 1, treatment should be reserved for those manifesting symptoms or demonstrating substantial growth on radiologic surveillance.
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Review Case Reports
Primary Brain Rhabdomyosarcoma Causing Extracranial Metastases. Case Report with Narrative Review of Atypical Presentations and Their Diagnostic Challenges.
Rhabdomyosarcoma is a rare malignant tumor originating from striated muscle cells. It accounts for only 3% of all soft tissue sarcomas in adults, and its metastases can also reach the central nervous system. Only sporadic cases of primary brain rhabdomyosarcoma (PBRMS) have been reported so far. ⋯ PBRMS can be hardly distinguished from other malignant brain tumors during preoperative radiologic workup; only histology can raise the suspicion of primary or metastatic rhabdomyosarcoma, depending on the presence of other distant lesions. Our review of the literature demonstrates that prognosis is poor: 44% of patients die within 1 year from diagnosis. Overall, survival seems to correlate with radical resection, tolerance of stereotactic or if necessary full neuraxis radiotherapy, and adjuvant chemotherapy. Given the high relapse rate, close monitoring and restaging are imperative.