World Neurosurg
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Bony anomaly of axis (C2) vertebra is well known. However, expansion of the posterior element is less documented. We describe a case of additional bony ring attached to the posterior spinous process in a 10-year-old male who presented with the complaint of progressive swelling at the upper cervical region. ⋯ Complete surgical excision of the mass was done. Anomalous expansion of the spinous process of the C2 vertebra may remain silent. Surgery may be necessary for cosmetic purposes.
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The purpose of this study was to investigate the imaging characteristics of fenestrated anterior communicating artery (AcomA) aneurysm and clinical outcome of patients with fenestrated AcomA aneurysm. ⋯ Fenestrated AcomA aneurysms are associated with higher clinical complications, and identification of AcomA fenestration contributes to successful clipping of AcomA aneurysms.
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Case Reports
Cauda Equina Syndrome as the first Manifestation of von Hippel-Lindau Disease: A Case Report.
Von-Hippel Lindau (VHL) disease is rare neurocutaneous disorder arising from an inactivating mutation of the VHL gene on chromosome 3p35. The disease is inherited in an autosomal dominant fashion and predominantly involves tissues originating from the ectodermal germ layer. Although hemangioblastomas of retina and cerebellum are the most common clinical features, multiple-organ involvement in the form of renal cell carcinomas, spinal hemangioblastomas, renal cysts, and pancreatic cysts have also been reported. Hemangioblastomas of the spinal canal could present as cauda equina syndrome. ⋯ To the best of our knowledge, this is the first case with cauda equina syndrome as the first manifestation of VHL disease. Laminectomy and partial resection of hemangioblastoma are safe and effective treatments to resolve impingement of the spinal cord. VHL disease resulting in hemangioblastoma in the spinal canal is rarely seen but should be included in the differential diagnosis of cauda equina syndrome to facilitate genetic counseling for the proband and offspring.
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Spinal cord stimulation (SCS) is both relatively safe and reversible. Although SCS is generally regarded as a last resort, some of these patients will undergo additional spinal surgery after the device has been implanted or after its removal. We present a descriptive study of subsequent spinal surgery after SCS implantation. ⋯ To the best of our knowledge, the present study is the first to describe spine surgery in the setting of SCS implantation. Our results have indicated that spine surgery subsequent to, or concurrent with, SCS implantation appears to occur in few patients. Our study results suggest a modest improvement in quality of life outcomes. Therefore, clinicians should remember that patients might require further spine surgery despite the use of SCS implantation and, thus, might require reevaluation by the spine team.
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Few prognostic markers are available for patients with non-small-cell lung cancer (NSCLC) undergoing neurosurgical resection of symptomatic brain metastases. ⋯ Patients requiring surgical resection of an epidermal growth factor receptor-mutated NSCLC brain metastasis had an associated improved survival compared with patients without this mutation, independent of tyrosine kinase inhibitor use. Decreased survival was associated with older age, multiple previous brain radiation therapies, and extracranial metastasis.