World Neurosurg
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Review Case Reports
Improvement of Hypothalamic Hamartoma-related Psychiatric Disorder After Stereotactic Laser Ablation: Case Report and Review of the Literature.
Hypothalamic hamartomas (HHs) are nonneoplastic congenital malformations associated with refractory epilepsy and behavioral disorders. Improvement in behavioral functioning following resection of HHs has been reported. Stereotactic laser ablation (SLA), a minimally invasive technique, has been used for the treatment of HH-related epilepsy. We report the case of child with an HH, gelastic seizures, and severe psychiatric dysfunction who was successfully treated via SLA therapy. ⋯ Severe behavioral dysfunction in the setting of an HH may constitute an indication for surgical intervention. The outcome of this case suggests there may be a role for SLA in the management of HH-related psychiatric dysfunction, even in patients with good seizure control.
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Meta Analysis
Synovial Cyst as a Marker for Lumbar Instability: A Systematic Review and Meta-Analysis.
The pathogenesis of synovial cysts is largely unknown; however, they have been increasingly thought of as markers of spinal facet instability and typically associated with degenerative spondylosis. We specifically investigated the incidence of concomitant synovial cysts with underlying degenerative spondylolisthesis. ⋯ Patients with a combination of synovial cysts and degenerative spondylolisthesis are more likely to undergo spinal fusion surgery than laminectomy alone compared with patients with synovial cysts and no preoperative spondylolisthesis. Furthermore, patients with synovial cysts and spondylolisthesis are more likely to require additional fusion surgery. The results from the present review lend credence to the argument that synovial cyst herniation might be a manifestation of an unstable spinal level.
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Review Case Reports
Dengue Fever Presenting With Cervicodorsal Acute Spinal Spontaneous Subdural Hematoma-Case Report And Review Of Literature.
Neurologic complications are increasingly being reported in dengue epidemics. Intraspinal hematomas are rare, and those associated with dengue fever are still rarer with only 1 being reported in the literature. ⋯ Acute spontaneous spinal subdural hematoma (SSDH) is extremely rare but should be kept in mind in patients with dengue hemorrhagic fever. The radiologic findings could be deceptive and plain computed tomography and magnetic resonance imaging should be used as complementary studies to establish the diagnosis of acute spontaneous SSDH. The outcomes of SSDH are guarded, and elaborate patient counseling should be done preoperatively, keeping these in perspective.
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Review Case Reports
Retromedullary Hemangioblastoma Mimicking a PICA Aneurysm: Case Report & Literature Review.
Hemangioblastomas (HBMs) are benign vascular neoplasms that most commonly arise within the cerebellum. Although other vascular lesions should be considered in the differential diagnosis, HBMs rarely resemble aneurysms on neuroimaging and only 1 case of a cerebellar HBM mimicking a posterior fossa aneurysm has been reported. Here we describe a retromedullary HBM that masqueraded as a distal posterior inferior cerebellar artery (PICA) medullary branch aneurysm. ⋯ To our knowledge, this is the second case of HBM mimicking a PICA aneurysm. Given the rarity of PICA medullary branch aneurysms and their highly symptomatic nature, other etiologies, especially HBM, should be strongly considered when an apparent distal PICA aneurysm is diagnosed in an asymptomatic patient. If the lesion is unamenable to endovascular treatment, there should be high suspicion for HBM and subsequent craniotomy should be pursued.
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Review Case Reports
Trigeminocardiac Reflex: Case Report and Literature Review of Intraoperative Asystole in Response to Manipulation of the Temporalis Muscle.
The trigeminocardiac reflex is a sudden onset of bradycardia, hypotension, apnea, or gastric hypermotility in response to stimulation of the trigeminal nerve. ⋯ Our report describes an unusual and extreme example of the trigeminocardiac reflex and explores possible etiologies. This is the third reported surgical case in which manipulation of the temporalis muscle alone was sufficient to elicit bradycardia and asystole, and the first such case within the context of neurosurgery. We emphasize the importance of surgical teams to be cognizant of such extreme examples of this reflex.