World Neurosurg
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The Barrow Innovation Center comprises an educational program in medical innovation that enables residents to identify problems in patient care and rapidly develop and implement solutions to these problems. Residents involved in this program noted an elevated risk of iatrogenic spinal cord injury during posterior cervical and thoracic procedures. The objective of this study was to describe this complication, and a novel solution was developed through a new innovation training program. ⋯ This report demonstrates how programs like the Barrow Innovation Center can provide neurosurgery residents with a unique educational experience in medical device innovation and intellectual property development and can serve as an avenue of surgical quality improvement and problem solving.
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Case Reports
Thoracic Paraspinal Castleman Disease in a Young Mexican American Male with Postcoital Hematuria.
Castleman disease (CD) is an uncommon disorder of deregulated lymphoproliferation with unicentric (UCD) and multicentric forms based on extent of nodal involvement. Gross resection with histopathologic analysis remains the gold standard for diagnosis of UCD and is curative in most cases. Symptomatic paraspinal UCD is a rare presentation with potentially dangerous complications, and its tendency to mimic more common spinal tumors presents a significant diagnostic challenge. ⋯ Compared with previous reports, our case of postcoital hematuria and radiculopathy accompanying a paraspinal thoracic mass in a young Mexican-American man is a unique presentation. Awareness and early consideration of UCD in the work-up of a paraspinal mass may spare affected patients adverse and dangerous sequelae, such as spinal cord compression and excessive intraoperative hemorrhage.
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Cerebellar liponeurocytoma (cLNC) is a rare benign glioneuronal tumor with only ~60 cases reported since its first description in 1978. They have occurred largely as sporadic cases; however, familial cases with possible autosomal dominant inheritance have also been reported. Surgical excision has been considered the main modality of treatment, even for recurrent lesions. Uncertainties exist regarding the natural history, long-term outcomes, and optimal postoperative management and follow-up protocols for cLNC in general and multifocal cLNC in particular. Multifocality is exceedingly rare, with only 4 cases reported previously. ⋯ Surgical excision forms the cornerstone of management of cLNCs. However, it is necessary to vigilantly monitor these patients owing to the high recurrence rates of cLNC despite the innocuous histologic features.
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We present a case report of traumatic pseudomeningocele and a review of the literature and discussion of the neuro-cytoarchitecture to address the disproportionate weakness of extensor neurons seen in the case. ⋯ The patient was successfully treated with a subarachnoid-peritoneal shunt, which completely resolved the epidural pseudomeningocele and resulted in improvement but not resolution of his neurologic deficits.
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The effect of indirect decompression after lateral lumbar interbody fusion (LLIF) is widely acknowledged; however, its details remain unclear. This study aimed to evaluate the immediate effects of indirect decompression just after LLIF cage placement but just before posterior instrumentation, using intraoperative computed tomography myelogram (iCTM). ⋯ Detailed evaluation with iCTM revealed that adequate indirect decompression with LLIF was not always obtained, validating the intraoperative decision of further posterior decompression. This procedure, LLIF with iCTM, may reduce the risk of unnecessary direct decompression and reoperation after insufficient indirect decompression.