World Neurosurg
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The ventral elevation (VE) of the psoas from the vertebral column as seen on axial magnetic resonance imaging has been suggested as a preclusion of a safe working zone for lateral lumbar interbody fusion (LLIF) at L4-5. However, no quantitative study has been conducted to verify this. ⋯ LLIF is feasible in patients with ventrally elevated psoas, and the choice of cages does not appear to be influenced by the location of the psoas. Relying on the rising psoas sign on magnetic resonance imaging as a case selection criterion may unjustly exclude patients from LLIF.
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Case Reports
Rare transsellar collateral artery and secondary ophthalmic artery aneurysm in young adult with ICA aplasia.
Internal carotid artery (ICA) aplasia is a rare congenital abnormality in which the third aortic arch fails to develop. Most collateral circulation will originate from the circle of Willis, with other sites being rare. Changes in flow through the collateral vasculature result in aneurysm formation at a young age. ⋯ The present case demonstrates an extremely rare Lie type D collateralization pattern and secondary flow-rated aneurysm in the context of ICA aplasia. Patients identified with this anatomic variant should be monitored for subsequent aneurysm formation. Identification of this variant before endovascular and transsphenoidal procedures is crucial to prevent major intracranial vessel injury.
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Dural arteriovenous fistulas (DAVFs) are characterized by pathologic shunts between meningeal arteries and venous sinuses, without nidus. Although many lesions are considered idiopathic, there may be an association with inflammatory processes, including sinus thrombosis, venous hypertension, craniotomy, trauma, and infections. ⋯ Physicians should be aware of the possibility of DAVF formation after craniofacial infections. Better understanding of the etiopathogenesis of this type of lesion is required to avoid and treat potential complications.
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The neutrophil-to-lymphocyte ratio (NLR) has been investigated as an independent predictive marker for clinical outcomes in vascular diseases. This study aimed to investigate the peri-interventional behavior of the NLR in patients with ruptured and unruptured intracranial aneurysms (IAs). ⋯ The peri-interventional NLR was significantly different between patients with ruptured and unruptured IAs. In patients with ruptured IAs, elevated baseline NLR levels were associated with poor postoperative functional outcomes and decreased postoperatively, implying the potential prognostic value of NLR in patients with IAs.
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Hemangiopericytoma (HPC) is a rare mesenchymal tumor of the brain that occurs in the central nervous system as a solitary fibrous tumor. Surgical treatment of HPC is known to be beneficial, but results on the role of complete resection and adjuvant radiation are conflicting. However, it is often difficult to detect a central nervous system solitary fibrous tumor/HPC before surgery. We describe a presumed left trigeminal schwannoma that was histopathologically shown to be an HPC. ⋯ As solitary fibrous tumor/HPC requires gross total resection for effective resolution, it is imperative to consider it in the differential diagnoses of similar tumors. If an unusual pathologic image is found, we recommend rapid immunostaining for STAT6 to reach a definitive conclusion regarding the tumor type. This case highlights the importance of considering HPC when screening or diagnosing central nervous system lesions, especially in this rare location.