World Neurosurg
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Primary non-Hodgkin's lymphoma arising from the skull base is a rare entity most commonly subclassified as diffuse large B-cell lymphoma (DLBCL). This lesion often arises from the clivus and demonstrates a cranial nerve (CN) VI palsy. In this case report and literature review, we document the clinical presentation and management of a case of clival DLBCL, along with a review of current literature pertaining to DLBCL of the skull base. ⋯ DLBCL arising from the skull base often originates from the clivus and results in CN VI palsy. Current publications indicate a unique clinical presentation and immunohistochemical profile. Treatment generally involves biopsy, followed by chemo and/or radiotherapy.
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Multinodular and Vacuolating Neuronal Tumors of the cerebrum (MVNTs) are rare, seizure-related, low-grade tumors of the Central Nervous System (CNS) which usually affect young adults. First described by Huse et al. in 2013, these neoplasms are usually located within the deep cortical ribbon and the superficial white matter and have a characteristic cytoarchitecture of cells with neuronal and glial differentiation that form multiple nodules with conspicuous vacuolation. Due to their benign nature and indolent clinical course, its radiological-based differentiation from other entities is of paramount importance to avoid unnecessary surgical intervention. ⋯ Their most frequent initial clinical manifestation was either seizures or headaches. On conventional Magnetic Resonance Imaging (MRI) techniques, they usually appear hypointense in T1-weighted images and hyperintense in T2-weighted and FLAIR images, while lacking perilesional edema or post-contrast enhancement. MVNTs do not appear to change size or recur, even after partial resection of the tumor, indicating their indolent course and thus, surveillance with serial MRI scans immerses as the most appropriate management technique for these lesions.
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As a common clinical disease, lumbar spinal stenosis (LSS) is currently the preferred surgical treatment, and there are various opinions. We conducted a study on whether fusion should be performed simultaneously with decompression for LSS caused by low-grade degenerative lumbar spondylolisthesis and compared the efficacy and safety of the 2 surgeries. ⋯ In this article, decompression alone has shorter surgical and hospitalization time and less intraoperative bleeding compared to decompression plus fusion. And there was no significant difference in pain score and disability index between the 2 surgeries during follow-up. Therefore, we can say that for patients with LSS caused by low-grade lumbar spondylolisthesis, decompression alone is not inferior to decompression plus fusion.
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A case series analysis was performed of upper brachial plexus injuries (BPIs) from low-impact trauma in patients ≥60 years old to assess the effectiveness of nerve transfers, particularly the Oberlin technique, in restoring elbow flexion and to refine clinical decision making for managing traumatic BPIs in this age group. ⋯ Positive outcomes were achieved with the Oberlin technique in patients >60 with upper BPIs from low-energy trauma. However, delayed surgery, significant atrophy, and low testosterone levels may affect results. Evaluation of each patient's medical history is crucial before performing this procedure.
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The minimally invasive (MI) lateral approach to the TL junction for treating various spinal pathologies is quite challenging for spine surgeons due to this region's unfamiliar and complex anatomical structures. In addition, controversy still exists regarding approach selection, the need for rib resection, and diaphragm manipulation. ⋯ Intercostal subdiaphragmatic retroperitoneal access without rib resection is an alternative MI lateral approach to the upper lumbar spine. These reproducible techniques could help surgeons access the L1/2 disc level without unnecessary rib resection. Surgeons can utilize this technique for performing a single-level lateral approach at L1/2 or incorporate this MI technique with a standard lateral approach to the lower lumbar spine for performing sequential multilevel lateral fusion for patients diagnosed with adult spinal deformity (ASD).