bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oculomotor neuropathy from an unruptured arteriovenous malformation in the frontal operculum: A case report
Authors: Saiegh Fadi Al , Hines Kevin , Mouchtouris Nikolaos , Theofanis Thana , Jabbour Pascal , Rosenwasser Robert , Tjoumakaris Stavropoula 
Published: August 2019

Background:
Cerebral arteriovenous malformations (AVMs) are vascular lesions with a network of dysplastic vessels between an arterial and a venous tree with no intervening capillary bed. They most commonly present with an acute hemorrhage, seizures, or persistent headaches.

Case Description:
The authors report the case of a 62-year-old male who presented with diplopia for 5 days. Magnetic resonance imaging and angiography demonstrated a Spetzler-Martin Grade 2 AVM located in the right frontal operculum with deep drainage into the basal vein of Rosenthal causing ipsilateral oculomotor neuropathy. The patient underwent staged embolizations of the feeding pedicles, which were derived from the internal as well as external carotid circulation. This was followed by a right pterional craniotomy for resection of the AVM. The patient reported complete resolution of the diplopia over 4 weeks with no recurrence at the 6-month follow-up appointment.

Conlusion:
AVMs of the brain can present with atypical clinical symptoms that can be caused by the venous drainage pattern not the location. It is important to include vascular imaging studies in the work-up of patients who present with diplopia to rule out an AVM. Early diagnosis and treatment of the AVM can result in complete resolution of the diplopia.
Cranial migration of lumboperitoneal shunt: A case report and review of literature
Authors: AlBakry Amr , Taha Mahmoud M. , Al Menshawy Hassan A. 
Published: August 2019

Background:Lumboperitoneal shunt is an easy and effective way of managing benign intracranial hypertension (BIH) and other causes of increased intracranial pressure. Yet, it is associated with a relative high failure rate. Proximal migration of the shunt is rare and only few cases have been reported.Case Description:Here, we present a case of a 16-year-old female, diagnosed with BIH, who had a proximal shunt migration 4 months after surgery and was managed conservatively, along with the review of literature.Conclusion:Although it is associated with a high complication rate, lumboperitoneal shunt is very effective in the management of many disorders. One of the most common complications is shunt migration. While many mechanisms explaining shunt migration have been hypothesized, the most important single preventing factor for preventing shunt migration remains proper fixation of the shunt.
Risk factors for postoperative spinal infection: A retrospective analysis of 5065 cases
Authors: El-Kadi Matt , Donovan Erin , Kerr Laurel , Cunningham Coby , Osio Victor , Abdallah Samah , Kazan Joseph 
Published: August 2019

Background:
Multiple factors increase the risk for spinal surgical site infection (SSI): prior SSI, obesity, diabetes mellitus, advanced age, American Society of Anesthesiologists class, alcohol abuse, low prealbumin levels, smoking, history of cancer, chronic steroids, immunosuppressive drugs, rheumatoid arthritis, and hypothyroidism.

Methods:
Here, we performed a retrospective medical record review at one facility involving 5065 patients from 2010 to 2015. In 2011, there was an increase in the infection rate (1.07%) which prompted this analysis, resulting in the subsequent introduction of a protocol to reduce the infection risk.

Results:
The overall infection rate in this series was 0.59%. The lowest infection rate was 0.00% for anterior cervical discectomy and fusion. The highest rate of infections occurred among patients undergoing posterior cervical fusions, lumbar fusions, and tumor resections. Higher infection rates were also correlated with diabetes mellitus, obesity, and increased surgical time.

Conclusions:
Since 2011, we instituted a protocol to limit the risks of spinal SSIs, particularly for patients exhibiting increased medical comorbidities.
Multimodal treatment of an extremely rare desmoplastic small round cell tumor primary to the brachial plexus – A case report and review of literature
Authors: Guedes-Corrêa José Fernando , Amorim Rogério Pires , Pereira Maristella Reis da Costa , Cardoso Rodrigo Salvador Vivas , Costa Felipe D’Almeida , Bianchi Bruno de Souza , Siquara-de-Souza Ana Caroline 
Published: August 2019

Background:Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive malignant neoplasm typically located in the abdomen or pelvis. Other possible locations are the chest, pleura, scrotum, and central nervous system. DSRCT originally arising from the brachial plexus (BP) is extremely rare, to the best of our knowledge, only two cases have been previously described in the English scientific literature.Case Description:The authors present one new case of DSRCT arising from the left BP, the first in this location with rapid progression and in a female patient. We also highlight the importance of multimodal therapy, which included resection and both adjuvant radiation and chemotherapy. Macroscopic and microscopic characteristics of the lesion are detailed, as well as the patient’s status at 56-month follow-up.Conclusion:For primary BP DSRCT, aggressive subtotal resection followed by radiation and chemotherapy can be satisfactory for disease control and for maintaining or improving the neurological status.
Stent-assisted coil embolization of unruptured vertebral artery dissecting aneurysms with the low-profile visualized intraluminal support stent, with five techniques: Technical note and case report
Authors: Maeoka Ryosuke , Nakagawa Ichiro , Omoto Koji , Wada Takeshi , Kichikawa Kimihiko , Nakase Hiroyuki 
Published: August 2019

Background:
Intracranial vertebral artery dissecting aneurysm (VADA) is rare and shows high morbidity and mortality rates when the aneurysm ruptures. Endovascular treatment for VADA is one of the optimal treatments, but the dominant side VA and its branches or perforators need to be preserved. We report a novel and successful stent-assisted coil embolization technique using the low-profile visualized intraluminal support (LVIS) stent, with five technical notes in three consecutive cases of unruptured vertebral artery dissecting aneurysm (VADA).

Case Description:
We report three consecutive cases of unruptured VADA which involved a posterior inferior cerebellar artery (PICA), an anterior spinal artery, and perforators. Stent-assisted coil embolization with the LVIS stent was performed in all patients. The stent was carefully placed to obtain parent artery wall apposition at distal portion and with moderate pushing at aneurysm portion. The LVIS stent was placed with tailor-made wall apposition at perforating arterial side in the barrel view, and coil embolization was performed avoiding doughnut-like stent form to prevent perforator infarcts. All cases showed complete occlusion of the aneurysms with preservation of both parent artery and its branches and perforators patency. In three cases, clinical presentations were improved without ischemic complications. The median follow-up period was 1 year. At present, no recurrence and no complication have been observed.

Conclusion:
We demonstrate the coil embolization of VADA using LVIS stent with five techniques. Our techniques for the treatment of VADA using LVIS stent are safe and can minimize ischemic complications by creating suitable wall apposition to the orifices of branches or perforators.
Spinal cord stimulator failure: Migration of a thoracic epidural paddle to the cervical spine
Authors: Travers Sarah S. , Norregaard Thorkild V. 
Published: August 2019

Background:
Spinal cord stimulators successfully treat a number of pain syndromes but carry a risk of hardware complications. Here, we present a case of cranial migration of a thoracic epidural paddle to the cervical spine.

Case Description:
A 53-year-old male underwent uncomplicated spinal cord stimulator placement at the T10– T11 with initially favorable results. However, postoperatively, he complained of paresthesias in his arms. An X-ray demonstrated cranial migration of the thoracic epidural paddle to the cervical spine. The stimulator/new paddle was placed again at the T10–T11 level, but the leads were now secured to the caudal lamina utilizing a cranial plating system. The patient subsequently did well without further sequelae.

Conclusions:
A thoracic epidural paddle (T10–T11) migrated postoperatively into the cervical spine. It was subsequently removed and replaced into the thoracic region, but the leads were now secured in place with a novel caudal lamina/cranial plating system.
Spinal cord compression by multiple cysticercosis
Authors: Lopez Sebastian , Santillan Franklin , Diaz Juan Jose , Mogrovejo Pedro 
Published: August 2019

Background:Neurocysticercosis (NCC) is the most common parasitic infection involving the central nervous system in endemic areas. Notably, spinal involvement occurs in only 0.7%–3% of patients.Case Description:A 58-year-old female presented with progressive spinal cord compression attributed to multiple cystic intradural extramedullary thoracic lesions. She underwent laminectomy at two separate thoracic levels; this involved excision of the upper T4–T6, and just exploration of the lower T9–T11 lesions. One year postoperatively, she exhibited a residual paraparesis.Conclusion:Spinal NCC must be considered among the differential diagnostic considerations for patients presenting with spinal intramedullary or subarachnoid/extramedullary cystic lesions. Although they are typically found in endemic regions, those who have traveled to these locations are also susceptible. Even though it is considered a benign condition, spinal NCC may cause permanent and irreversible neurological damage. Public health policies should, therefore, be developed to help control the spread and transmission of NCC.
When to stop anticoagulation, anti-platelet aggregates, and non-steroidal anti-inflammatories (NSAIDs) prior to spine surgery
Authors: Epstein Nancy E. 
Published: August 2019

Background:
Based upon a select review of the literature, in my opinion, spine surgeons, not just our medical/cardiological colleagues, need to know when to stop anticoagulant, anti-platelet aggregates, and non-steroidal anti-inflammatory (NSAIDs) medications prior to spine surgery to avoid perioperative bleeding complications.

Methods:
Typically, medical/cardiological consultants, who “clear our patients” are not as aware as we are of the increased risks of perioperative bleeding if anticoagulant, anti-platelet, and NSAIDs are not stopped in a timely fashion prior to spine surgery (e.g. excessive intraoperative hemorrhage, and postoperative seromas, hematomas, and wound dehiscence).

Results:
Different medications need to be discontinued at varying intervals prior to spinal operations. The anticoagulants include; Warfarin (stop at least 5 preoperative days), and Xa inhibitors (Eliquis (Apixaban: stop for 2 days) and Xarelto (Rivaroxaban: stop for 3 days)); note presently data vary. The anti-platelet aggregates include: Aspirin/Clopidogrel (stop >7-10 days preoperatively). The multiple NSAIDs should be stopped for varying intervals ranging from 1-10 days prior to spine surgery, and increase bleeding risks when combined with any of the anticoagulants or anti-platelet aggregates. NSAIDs (generic name/commercial names should be stopped preoperatively for at least; 1 day- Diclofenac (Voltaran), Ibuprofen (Advil, Motrin), Ketorolac (Toradol); 2 days- Etodolac (Lodine), Indomethacin (Indocin); 4-days-Meloxicam (Mobic) and Naproxen (Aleve, Naprosyn, Anaprox); 4 days- Nabumetone (Relafen); 6 days - Oxaprozin (Daypro); and 10 days- Piroxicam (Feldene).

Conclusions:
Spine surgeons need to know when anti-platelet, anticoagulant, and NSAIDs therapies should be stopped prior to spine surgery to avoid perioperative bleeding complications.
Atypical teratoid/rhabdoid tumor presenting with subarachnoid and intraventricular hemorrhage
Authors: Siddiqui Mehdi , Thoms Dewey , Samples Derek , Caron Jean 
Published: August 2019

Background:
Sellar masses comprise 14–18% of all intracranial tumors. Pituitary adenomas account for 85% of these lesions, while 15% of sellar masses stem from other etiologies. Intratumoral hemorrhage (apoplexy), while not exceptionally common, can be discovered at presentation. While the hemorrhage pattern is typically contained within the tumor, an extension of bleeding beyond the sella has been reported.

Case Description:
A 55-year-old female presented with an anterior interhemispheric subarachnoid hemorrhage and extensive intraventricular hemorrhage (IVH). Initially, the IVH was thought to be due to a ruptured aneurysm. After further workup, a hemorrhagic sellar mass was diagnosed. The patient underwent transsphenoidal resection of a pituitary adenoma. The patient returned to the emergency department6 weeks later with an atypical rapidly expanding sellar mass. After tumor debulking, the pathology revealed an atypical teratoid/rhabdoid tumor (ATRT). Here, we reviewed this and other such cases of sellar ATRT.

Conclusion:
The early diagnosis of sellar ATRT with lack of integrase interactor 1 expression and elevated Ki67 proliferation indices can prompt more aggressive attempted gross total resection, chemotherapy, and radiation treatments.
Understanding gamma ventral capsulotomy: Potential implications of diffusion tensor image tractography on target selectivity
Authors: Santos Bruno Fernandes de Oliveira , Gorgulho Alessandra , Saraiva Crystian W. C. , Lopes Antonio Carlos , Gomes João Gabriel Ribeiro , Pássaro Anderson M. , Hoexter Marcelo Q. , Miguel Eurípedes C. , De Salles Antonio A. F. 
Published: August 2019

Background:
The role of tractography in gamma ventral capsulotomy (GVC) planning is still unclear. This paper aims to describe the spatial distribution of medial orbitofrontal cortex (OFC) and lateral OFC fibers passing through the anterior limb of the internal capsule (ALIC) and analyze quantitative tractography parameters that differentiate obsessive-compulsive disorder (OCD) individuals from other neurosurgery functional patients (morbid obesity and Parkinson’s disease [PD]).

Methods:
Twenty patients undergoing functional stereotactic procedures, between 2013 and 2016, were included in this study. OCD patients underwent GVC (single shot 150 Gy and 4-mm collimators). PD and morbid obesity patients were submitted to deep brain stimulation implants. Diffusion tensor image tractography was reconstructed using Brainlab Elements software (Brainlab AG, Munich, Germany).

Results:
Nine PD, six morbid obesity, and five OCD patients were included with a mean age of 65.4 ± 9.1, 41.0 ± 8.2, and 31.2 ± 5.5, respectively, which are statistically different from each other (P < 0.001). Fourteen patients (70%) were men. A total of 40 cerebral hemispheres were analyzed. Medial OFC fibers are localized more inferior in the ALIC than the lateral OFC fibers in all hemispheres, but the level of intersection and exact topography of fiber bundles are variable among individuals. Both medial and lateral OFC fiber tracts of PD and morbid obesity patients have lower volume than, respectively, medial and lateral counterparts of OCD patients (P < 0.001).

Conclusions:
Medial and lateral OFC tract fibers have a general standard distribution in the anterior internal capsule (lateral OFC higher than medial OFC fibers). There are differences between obesity, Parkinson, and OCD patients regarding fiber tract statistics.
Minimally invasive posterior fossa decompression with duraplasty in Chiari malformation type I with and without syringomyelia
Authors: Caffo Maria , Cardali Salvatore M. , Caruso Gerardo , Fazzari Elena , Abbritti Rosaria V. , Barresi Valeria , Germanò Antonino 
Published: August 2019

Background:
Posterior fossa decompression (PFD), with and without duraplasty, represents a valid treatment in Chiari malformation Type I (CM-I) with and without syringomyelia. Despite a large amount of series reported in literature, several controversies exist regarding the optimal surgical approach yet. In this study, we report our experience in the treatment of CM-I, with and without syringomyelia, highlighting how the application of some technical refinements could lead to a good outcome and a lesser rate of complications.

Methods:
Twenty-six patients with CM-I, with and without syringomyelia, underwent PFD through a 3 cm × 3 cm craniectomy with the removal of the most median third of the posterior arch of C1 and duraplasty. Signs and symptoms included sensory deficits, motor deficits, neck pain, paresthesias, headache, dizziness, lower cranial nerve deficits, and urinary incontinence. Postoperative magnetic resonance (MR) was performed in all patients.

Results:
Signs and symptoms improved in 76.9% of cases. Postoperative MR revealed a repositioning of cerebellar tonsils and the restoration of cerebrospinal fluid circulation. In our experience, the rate of complication was 23% (fistula, worsening of symptoms, and respiratory impairment).

Conclusion:
PFD through a 3 cm × 3 cm craniectomy and the removal of the most median third of posterior arch of C1 with duraplasty represents a feasible and valid surgical alternative to treat patients with CM-I, with and without syringomyelia, achieving a good outcome and a low rate of complications.
Giant dumbbell C2C3 neurofibroma invading prebulbar cistern: Case report and literature review
Authors: Serrano Julia Pinheiro Martinez , Neves Maick Willen Fernandes , Marchi Cassiano , Nakasone Fabio Jundy , Maldaun Marcos Vinicius Calfat , Aguiar Paulo Henrique Pires de , Scappini Wilson 
Published: August 2019

Background:
Neurofibromatosis 1 (NF1) has a broad spectrum of clinical manifestations, most typically involving café-au-lait spots and skin neurofibromas. Only 2% of patients with NF1 have symptomatic spinal tumors.

Case Description:
A patient with a previous diagnosis of NF1 presented with cervicalgia, dysphagia/mild dysphonia, gait alteration, and progressive hypoesthesia involving all four limbs. The magnetic resonance documented a giant dumbbell neurofibroma arising between the C2 and C3 levels which extended toward the foramen magnum, causing medullary and bulbar compression. The major challenge of surgical management was the enormous size and location this C2–C3 (5 cm × 4 cm × 5.1 cm) lesion.

Conclusions:
Compression of the foramen magnum attributed to a dumbbell giant spinal neurofibroma at the C2C3 level resulting in prebulbar cisterns should be among the differential diagnostic considerations for patients presenting with tetraparesis and underlying NF1.
A case of unilateral vertebral artery dissection progressing in a short time period to bilateral vertebral artery dissection
Authors: Tsuji Kiyoshi , Watanabe Akira , Nakagawa Nobuhiro , Kato Amami 
Published: August 2019

Background:
Vertebral artery dissection (VAD) is an important cause of stroke in young and middle- aged people. Bilateral occurrence of VAD is generally considered rare, but the number of reports of bilateral VAD has been increasing in recent years. In this paper, we report a case of de novo VAD on the contralateral side presenting with subarachnoid hemorrhage in the acute stage of cerebral infarction due to unilateral VAD.

Case Description:
A 52-year-old man developed sudden-onset left occipital headache, dizziness, dysphagia, and right-sided hemiparesthesia and was admitted to our hospital. Head magnetic resonance imaging on admission showed a left lateral medullary infarction due to the left VAD. At this point, the right vertebral artery was normal. However, on day 9 after onset, he suddenly presented with subarachnoid hemorrhage due to the right VAD. Emergency endovascular treatment was performed for the dissecting aneurysm of the right vertebral artery. The patient’s condition improved gradually after the procedure, and he was discharged with a modified Rankin Scale score of 1.

Conclusion:
Bilateral occurrence of VAD may be more common than previously believed. Even in cases of unilateral VAD, we need to pay attention to the occurrence of de novo VAD on the contralateral side.
A rare case of an intramedullary metastasis of a myxopapillary ependymoma
Authors: Fonseca Lino , Cicuendez Marta , Martínez-Ricarte Francisco , Martínez-Saez Elena , Cordero Esteban , Bescos Agustín 
Published: August 2019

Background:
Myxopapillary ependimoma (MPE) is a benign slow-growing tumor, and it has been designated histologically as a Grade I neoplasm according to the 2016 World Health Organization classification. Despite the benign character, dissemination and metastasis have occasionally been reported. The retrograde dissemination to other levels of the neuraxis is extremely rare, being more frequent to the intracranial compartment.

Case Description:
We hereby present a case of medullary metastasis of cauda equina MPE, with a history of having undergone a subtotal resection and postoperative adjuvant radiotherapy. The patient presents complaints of night dorsal pain attributable to intradural metastasis twenty-one years after the first surgical intervention.

Conclusion:
The case reported highlights the importance of long follow-up in patients with MPE, since the possibility of secondary seeding to distant craniospinal sites or local spinal sites after surgery, and radiotherapy should be considered in metastatic disease.
Intracranial anaplastic hemangiopericytoma presenting with simultaneous extra-cranial metastases: A case report and review of the literature
Authors: Reddy Sumanth , Plitt Aaron , Raisanen Jack , Patel Ankur R. , Gopal Purva , Timmerman Robert , Patel Toral R. 
Published: August 2019

Background:
Intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare mesenchymal tumor with a propensity to recur and metastasize extracranially years after treatment. Accordingly, there are no reported cases of a patient presenting with a simultaneous intracranial primary and extracranial metastases. We present the case of a patient presenting with an intracranial SFT/HPC and simultaneous liver metastases and propose a treatment paradigm.

Case Description:
A 74-year-old male smoker presented with confusion. An MRI of the brain revealed a heterogeneously enhancing left frontal extra-axial mass. Systemic workup revealed multiple small liver lesions concerning for metastases. The patient underwent gross total resection (GTR) of the intracranial lesion with adjuvant CyberKnife stereotactic radiotherapy to the resection cavity. Pathology was consistent with a WHO Grade III SFT/HPC (previously known as anaplastic HPC). The liver lesions were biopsied and confirmed to be metastases. They were subsequently treated with stereotactic body radiation therapy, temozolomide, and bevacizumab. Eighteen months postoperatively, the patient is alive with no evidence of intracranial malignancy and regression of the hepatic lesions.

Conclusion:
Several studies support GTR and adjuvant radiotherapy to treat intracranial SFT/HPC. The role of adjuvant chemotherapy is less clear. Metastatic disease is typically detected several years after the initial diagnosis, and there is no consensus regarding the optimal treatment strategy. We propose that the rare presentation of intracranial SFT/HPC with simultaneous extracranial metastases should be treated in a multidisciplinary fashion with surgical resection, adjuvant radiotherapy, and chemotherapy.