A lumbar chondroma originating from the intervertebral disc

Background

Chondromas, benign cartilaginous primary bone tumors, seldom occur in the spine. Most spinal chondromas arise from the cartilaginous parts of the vertebra. Chondromas originating from the intervertebral disc are extraordinarily rare.

Case Description

A 65-year-old female experienced recurrence of low back pain and left-sided lumbar radiculopathy after microdiscectomy and microdecompression. A mass continuous with the intervertebral disc was found to be compressing the left L3 nerve root and was resected. Histologic examination revealed a benign chondroma.

Conclusion

Chondromas developing from the intervertebral disc are extremely rare; we could find only 37 reported cases. Identification of these chondromas is difficult because until surgical resection they are almost indistinguishable from herniated intervertebral discs. Here, we describe a patient with residual/recurrent lumbar radiculopathy caused by a chondroma originating from the L3-4 intervertebral disc. When a patient has recurrence of spinal nerve root compression after discectomy, a chondroma arising from the intervertebral disc is an uncommon but possible etiology.

Microsurgical Obliteration of Craniocervical Junction Dural Arteriovenous Fistulas: Multicenter Experience

BACKGROUND

Dural arteriovenous fistulas (dAVFs) located at craniocervical junction are extremely rare (1%-2% of intracranial/spinal dAVFs). Their angio-architectural complexity renders endovascular embolization to be challenging given multiple small feeders with risk of embolysate reflux into vertebral artery and limited transvenous access. The available literature discussing microsurgery for these lesions is limited to few case reports.

OBJECTIVE

To report a multicenter experience assessing microsurgery safety/efficacy.

METHODS

Prospectively maintained registries at 13 North American centers were queried to identify craniocervical junction dAVFs treated with microsurgery (2006-2021).

RESULTS

Thirty-eight patients (median age 59.5 years, 44.7% female patients) were included. The most common presentation was subarachnoid/intracranial hemorrhage (47.4%) and myelopathy (36.8%) (92.1% of lesions Cognard type III-V). Direct meningeal branches from V3/4 vertebral artery segments supplied 84.2% of lesions. All lesions failed (n = 5, 13.2%) or were deemed inaccessible/unsafe to endovascular treatment. Far lateral craniotomy was the most used approach (94.7%). Intraoperative angiogram was performed in 39.5% of the cases, with angiographic cure in 94.7% of cases (median imaging follow-up of 9.2 months) and retreatment rate of 5.3%. Favorable last follow-up modified Rankin Scale of 0 to 2 was recorded in 81.6% of the patients with procedural complications of 2.6%.

CONCLUSION

Craniocervical dAVFs represent rare entity of lesions presenting most commonly with hemorrhage or myelopathy because of venous congestion. Microsurgery using a far lateral approach provides robust exposure and visualization for these lesions and allows obliteration of the arterialized draining vein intradurally as close as possible to the fistula point. This approach was associated with a high rate of angiographic cure and favorable clinical outcomes.

Transradial access for embolization of cerebral aneurysms with the woven EndoBridge device: Case series and review of the literature

BACKGROUND

Transradial access is an increasingly utilized route for neurointerventions with benefits of lower rates of access site complications, earlier patient mobilization and increased patient satisfaction over transfemoral interventions. There is limited data on deployment of the Woven EndoBridge (WEB) via transradial access. We report a case series of consecutive patients undergoing cerebral aneurysm embolization with the WEB device via transradial biaxial access.

METHODS

A database of neuroendovascular procedures was queried for consecutive aneurysm embolization procedures involving the WEB device and intended via the transradial approach between August 2019 and July 2020. Patient demographics, radiological aneurysm characteristics and procedure details were recorded and statistically evaluated. Google Scholar and Pubmed were searched for previous reports of transradial WEB embolization.

RESULTS

Ten aneurysms were treated in ten patients. All aneurysms were treated with successful WEB deployment. Nine of the ten aneurysms were successfully treated via transradial biaxial access. One aneurysm required conversion to transfemoral access. There were no clinical complications and no morbidity or mortality.

CONCLUSIONS

Transradial embolization of cerebral aneurysms with the WEB device is safe and feasible with low rates of access failure or complications.