World Neurosurg
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Case Reports
Anterior Distraction and Reduction with Posterior Stabilization for Basilar Invagination: A Novel Technique.
Introduction of a posterior spacer for atlantoaxial joint distraction followed by posterior stabilization is a commonly performed procedure for irreducible atlantoaxial dislocation. We present a unique case in which posterior distraction was associated with increased risk of injury to the vertebral artery (VA) owing to its anomalous course, and hence a novel anterior distraction technique was used. ⋯ The craniovertebral junction has a unique pathoanatomy, and the course of the vertebral artery is variable. Appropriate investigations, including computed tomography angiography, with adequate surgical planning will provide a desirable long-term outcome. Our novel technique has the potential to add a new dimension to the management of irreducible atlantoaxial dislocation.
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Surgical management of thoracic ossification of the posterior longitudinal ligament (OPLL) remains challenging because of the fragility of the thoracic spinal cord. Posterior approach with long instrumentation has been predominantly performed. However, this procedure includes the risk of neurologic deterioration caused by the progression of OPLL during long-term follow-up and the need for long instrumentation to achieve dekyphosis, even for so-called beaked-type OPLL between 1 vertebra. ⋯ Microsurgery via the transthoracic anterolateral approach enables direct visualization of the thoracic ventral ossified lesion. Relatively narrow and little resection of the vertebral body under the presently demonstrated microsurgical procedures might negate the need for bone grafting or spinal instrumentation. The patient gave informed consent for surgery and video recording (Video 1).
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Case Reports
Molecular Association of Medulloblastoma and Sarcoidosis: Case Report and Review of the Literature.
Medulloblastoma (MB) is a malignant tumor of the central nervous system (CNS), and sarcoidosis is a chronic inflammatory disease of many organ systems, commonly affecting the lungs. No association between MB and sarcoidosis was described in the literature. MB and sarcoidosis have mutual molecular and signaling pathways that may predispose patients with sarcoidosis to develop MB. We describe a patient with sarcoidosis who developed MB. ⋯ The exceedingly rare coexistence of adult MB and sarcoidosis may have a causal relationship based on specific common molecules. Leukotrienes, stimulation of astrocytes and Purkinje neurons, and the sonic hedgehog signaling pathway can be considered. Further genetic and molecular studies are merited.
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A collision tumor is a rare entity consisting of 2 histologically distinct tumor types (benign or malignant) in the same anatomic location. This can occur from a tumor-to-tumor metastasis or as a result of 2 adjacent intracranial tumors colliding and growing together. To our knowledge, this is the first reported case of collision tumor with confirmed meningioma and uterine adenocarcinoma. Multiple mechanisms have been proposed for the facilitative growth of collision tumors, including local epigenetic signaling. Clinically, it is important to consider collision tumors in the differential diagnosis of a rapidly growing intracranial lesion in the setting of systemic cancer to provide optimal surgical and postoperative management. ⋯ It is important to consider a collision tumor when a patient with a benign intracranial lesion presents with rapid progression, even in the context of a systemic cancer that rarely metastasizes to the brain. Appropriate histopathologic assessment is crucial in these cases and can have a significant impact on treatment plan and prognosis.