An isolated cavernous malformation of the sixth cranial nerve: A case report and review of literature

Background

Isolated cavernous malformation (CM) of the abducens nerve has not been reported in the literature. Herein, the authors address the clinical importance of these lesions and review the reported cases of CM from 2014 to 2020.

Case Description

A 21-year-old man presented with binocular diplopia and headache from 2 months before his admission. The neurological examination revealed right-sided abducens nerve palsy. The brain MRI revealed an extra-axial pontomedullary lesion suggestive of a CM. The lesion was surgically removed. During the operation, the abducens nerve was resected considering the lesion could not be separated from the nerve and an anastomosis was performed using an interposition nerve graft and fibrin glue. Pathological examination of the resected lesion revealed that it was originated from within the nerve. The patient's condition improved in postoperative follow-ups.

Conclusion

Surgical resection of the cranial nerves CMs is appropriate when progressive neurological deficits are present. If the lesion is originated from within the nerve, we suggest resection of the involved nerve and performing anastomosis. Novel MRI sequences might help surgeons to be prepared for such cases and fibrin glue can serve as an appropriate tool to perform anastomosis when end-to-end sutures are impossible to perform.

Desmoid tumor after resection of cerebellar hemangioblastoma

Desmoid tumors are histologically benign but locally invasive tumors that rarely can occur in the head and neck. In this article, we illustrate a rare case of desmoid tumor formation in intracranial posterior fossa after suboccipital craniotomy for hemangioblastoma. A 43-year-old woman presented with headaches, dizziness, equilibrium disorders, nausea, and vomiting due to a hemangioblastoma in posterior fossa. A gross total resection was achieved. Three years postoperatively, the patient developed a growing mass at the intracranial intradural regions in posterior fossa near the previous incision. Surgical resection of the lesion was performed and the mass was totally resected. Postoperative imaging demonstrated no residual evidence of tumor and the pathological review of the surgical tumor specimen demonstrated desmoid tumor in intracranial posterior fossa. As desmoid tumors seem to arise at the location of a previous surgical site, they should be considered in the differential diagnosis for superficial masses occurring in the surgical bed after posterior surgery. Additionally, identifying the relationship between the basic effects of tumor surgery and desmoid tumor formation is considerably needed.

Solitary aneurysm of the filum terminale artery: A case report and review of the literature

BACKGROUND

We report a rare case of aneurysmal dilatation of filum terminale artery after resection of filum terminal myxopapillary ependymoma.

CASE DESCRIPTION

The authors report a rare aneurysmal dilatation of the filum terminale artery following removal of a filum terminal myxopapillary ependymoma in a 10-year-old male. The patient presented with 6-month history of increasing back pain without a focal neurological deficit. Magnetic resonance (MR) showed an intradural filum terminale lesion that was completely excised. Three months later, the MR again revealed a lesion involving the filum terminale. During the second surgery, however, an aneurysmal dilation of the filum artery was found, which was coagulated and resected. Following the secondary surgery, the patient's symptoms gradually resolved, and he remains intact.

CONCLUSION

Although rare, a true aneurysm after spinal surgery should be considered among the differential diagnostic consideration in the region of the filum terminale.

Spontaneous corynebacterium spondylodiskitis in an immunocompetent patient: A case report and literature review

BACKGROUND

Spontaneous Corynebacterium spondylodiskitis is an unusual diagnosis of spondylodiskitis, especially in healthy patients without any significant past medical history.

MATERIALS AND METHODS

We describe the case of a 78-year-old man with progressive low back pain for 3 months, irradiating down the lower limbs through L5 and S1 root pathways, associated with distal muscle weakness in both lower limbs. He had no history of trauma or medical problems. Laboratory investigation revealed elevated serum C-reactive protein (CRP) and erythrocyte sedimentation rate, without leukocytosis. The magnetic resonance findings demonstrated an extensive L5-S1 spondylodiskitis and L4-L5 anterolisthesis. Prior to spinopelvic fixation and posterolateral fusion, a substantial debridement was performed. The obtained tissue samples were submitted to pathological and microbiological studies, which identified Corynebacterium infection.

RESULTS

One month after surgery, the pain diminished dramatically and the CRP titer diminished significantly.

CONCLUSION

Although cases are very rare, spontaneous Corynebacterium spondylodiskitis, with substantial invasion of the spine, may develop in patients lacking any history of medical or surgical problems.

Congenital Posterior Spinal Agenesis Leads to L2-L3 Instability: a Case Report and Review of the Literature

Congenital absence of posterior elements of the lumbar column is an extremely uncommon anomaly and we found no any reported cases of incomplete congenital absence of the posterior elements of lumbar vertebra in the literature.  Here, we present a case with congenital absence of posterior elements of lumbar vertebra. The patient was a 51-year-old man with a history of 20 years of back pain. Imaging of the lumbar spine revealed instability in L2 and L3 and there was evidence of retrolisthesis, agenesis of pars interarticularis, spinous processes, lamina, transverse processes and facets at L2 and L3. The patient underwent lumbar discectomy and posterior spinal fixation and instrumentation was then done using pedicle screw fixation. Four pedicle screws, two rods, and one cross link were employed to bilaterally fix the L2 and L3 and then we used autograft and allograft bone for interbody fusion, substitutes from iliac crest for posterior fusion. There were no postoperative complications, and at 6, 12 and 24 months of follow-up, his leg and back pain had improved, and the patient did not need any analgesic for pain relief. Complete congenital absence of the lumbar posterior element has been rarely reported in the literature. Patients whose congenital anomalies lead to segmental instability are surgical fusion candidates, but if these anomalies occur in pars interarticularis such as spondylolysis isthmus, fixation and inter segmental fusion techniques are useful.

An aneurysm at the site of the fenestration of the middle cerebral artery in a patient with multiple aneurysms: A case report

Background:

Middle cerebral artery (MCA) fenestration is a very rare anatomical variant of the MCA, incidentally found during magnetic resonance or computed tomography angiography. It has an incidence of 0.6%. Unlike fenestration of the posterior cerebral arterial circulation, fenestration of the anterior cerebral arterial circulation has not been well described.

Methods:

We present the rare case of a patient who was admitted for a ruptured aneurysm of the MCA arising at the site of the fenestration of the MCA and also an unruptured fusiform aneurysm of the right posterior communicating artery and a distal anterior cerebral artery (ACA) aneurysm.

Results:

The patient underwent craniotomy with microsurgical aneurysm clipping and the previously undiagnosed ruptured aneurysm, at the site of the fenestration of the MCA, arose immediately. Postoperatively, the patient awoke without a deficit. After treatment of postoperative bacterial meningitis, he was discharged on the 26^th postoperative day in good condition without any neurologic deficit. Six months after the first surgery, he was operated for the distal azygos ACA aneurysm.

Conclusion:

Anomalies of the intracranial vasculature are common, and we describe a rare case of left MCA fenestration with an associated ruptured aneurysm at the site of the fenestration. In the literature, cases of fenestration of the MCA are sporadically reported and are only incidental findings.

Hard calcified intrasellar schwannoma mimicking pituitary adenoma: a case report and review of the literature

BACKGROUND

Intrasellar location of schwannoma is extremely rare, although intracranial schwannomas are common in the central nervous system. The aim of the present study is to describe a calcified intrasellar schwannoma case.

MATERIALS AND METHODS

We represent a 45-year-old woman who had suffered from headaches; right side facial pain and visual disturbance which had worsen during the last week prior to admission. Physical examinations were normal except for the bitemporal visual field hemianopia which match with perimetry examination. MRI demonstrated an unusual seemingly calcified mass lesion in the sellar region which was mimicking pituitary macro adenoma.

RESULT

Total resection of the tumor achieved through endoscopic transnasal transsphenoidal approach by extracapsular dissection and pathologic examination of the tumor revealed calcified schwannoma.

CONCLUSION

The differential diagnoses of sellar and suprasellar lesions include pituitary adenomas, craniopharyngiomas, meningiomas, and many others. However, schwannoma is not usually included, because the occurrence of schwannoma in the sellar or suprasellar region is extremely rare. Only few cases of intrasellar schwannomas have been reported in the literature, all of which presented a suprasellar extension similar to that of our case. Fascinating surgical point is managing very firm tumor through transsphenoidal corridor which we handle it by very sharp, debulking and extracapsular removal.

Endoscopic Surgery in Nonhydrocephalous Third Ventricular Colloid Cysts: A Feasibility Study

BACKGROUND

The aim of this study was to investigate the feasibility and effectiveness of endoscopic neurosurgery for patients with third ventricular colloid cysts but without ventriculomegaly.

METHODS

Seventy-one patients with third ventricular colloid cysts were identified and recruited to this study. Eighteen of these patients did not have concomitant hydrocephalus and underwent primary endoscopic surgery for cyst resection. The surgical technique, the success rate, and patients' outcome were assessed and compared with another 53 patients with hydrocephalus who underwent similar procedures. Our study was performed in a retrospective basis, although in middle of our work we decided to study and follow nonhydrocephalus cases prospectively.

RESULTS

The ventricular compartments were successfully cannulated and gross total resection and near total resection of the colloid cysts was achieved in all patients. There were no persistent operative complications related to the endoscopic procedure. The success rate for endoscopic surgery in patients without hydrocephalus was similar to its value in patients with hydrocephalus.

CONCLUSIONS

Endoscopic resection of third ventricular colloid cyst in patients without hydrocephalus seems to be feasible, effective, and not contraindicated.