World Neurosurg
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To investigate the biomechanical effect of C1 lateral mass-C2 pedicle screw-rod (C1LM-C2PS) fixation with and without transverse connectors (TC) in an atlantoaxial instability (AAI) model. ⋯ Adding TCs to C1LM-C2PS can effectively decrease the axial rotation ROM and enhance the stability of C1-C2 segment. Therefore, it is necessary to use TC-strengthened C1 lateral mass -C2 pedicle screw-rod fixation in patients with instability of C1-C2.
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In-stent thrombosis is a potentially dangerous complication of flow diversion for cerebral aneurysms. The optimal management strategy for such thrombosis is not known. Here we present a case of acute ischemic stroke caused by occlusion of a Pipeline Embolization Device (PED) construct placed 18 months earlier for treatment of a fusiform middle cerebral artery aneurysm. This was successfully treated with mechanical thrombectomy with good neurologic outcome. ⋯ Mechanical thrombectomy with a stent retriever and aspiration is a therapeutic option for treatment of delayed thrombosis of a flow-diverting stent.
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Case Reports
Isolated Bilateral Hypoglossal Palsy Complicating a Fourth Ventricle Ependymoma Surgery.
Isolated bilateral hypoglossal palsy is a rare condition that has never been described after surgery in the lower part of the fourth ventricle. In this article, we discuss various possible etiologies and relevant anatomy considerations of the rhomboid fossa. ⋯ Intraoperative neurophysiologic monitoring of hypoglossal nerves, in addition to facial nerves, should be performed for tumors in this location.
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Spinal arteriovenous fistula (AVF) may rarely associate with spinal dysraphism, that is, tethered spinal cord and spinal intradural lipoma. Spinal extradural angiolipoma coexisting with spinal AVF has not been reported in the literature. We reported an extremely rare case of sacral angiolipoma associated with tight filum terminale and sacral spina bifida coexisting with spinal AVF within this tumor. ⋯ Sacral extradural angiolipoma in the present case may be congenital in origin with development of an acquired spinal AVF within the tumor.