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Open access

Apraxia of speech with phonological alexia and agraphia following resection of the left middle precentral gyrus: illustrative case

黛博拉·f·利维,亚历山大·b·席尔瓦特里l .苏格兰人t, Jessie R. Liu, Sarah Harper, Lingyun Zhao, Patrick W. Hullett, Garret Kurteff, Stephen M. Wilson, Matthew K. Leonard, and Edward F. Chang

BACKGROUND

Apraxia of speech is a disorder of speech-motor planning in which articulation is effortful and error-prone despite normal strength of the articulators. Phonological alexia and agraphia are disorders of reading and writing disproportionately affecting unfamiliar words. These disorders are almost always accompanied by aphasia.

OBSERVATIONS

A 36-year-old woman underwent resection of a grade IV astrocytoma based in the left middle precentral gyrus, including a cortical site associated with speech arrest during electrocortical stimulation mapping. Following surgery, she exhibited moderate apraxia of speech and difficulty with reading and spelling, both of which improved but persisted 6 months after surgery. A battery of speech and language assessments was administered, revealing preserved comprehension, naming, cognition, and orofacial praxis, with largely isolated deficits in speech-motor planning and the spelling and reading of nonwords.

LESSONS

This case describes a specific constellation of speech-motor and written language symptoms—apraxia of speech, phonological agraphia, and phonological alexia in the absence of aphasia—which the authors theorize may be attributable to disruption of a single process of “motor-phonological sequencing.” The middle precentral gyrus may play an important role in the planning of motorically complex phonological sequences for production, independent of output modality.

InJournal of Neurosurgery: Case Lessons Volume 5 (2023): Issue 13 (Mar 2023)

Open access

Endoscopic endonasal transclival approach for a ventral brainstem epidermoid cyst: illustrative case

Blake M. Hauser, Saksham Gupta, Tejas S. Athni, David J. Segar, Ravindra Uppaluri, and Omar Arnaout

BACKGROUND

Intracranial epidermoid cysts are benign, slow-growing malformations that most commonly arise at the skull base. Maximizing resection of the cyst contents and the capsule reduces long-term recurrence but can be made difficult by cyst wall adherence to critical neurovascular structures. Expanded endonasal approaches (EEAs) offer an alternative to traditional open transcranial approaches for accessible epidermoid cysts. In this case report, the authors demonstrate a transclival EEA for a large, ventral brainstem epidermoid cyst.

OBSERVATIONS

A 41-year-old woman who presented with progressive headaches, diplopia, malaise, and fatigue was found to have a 4.7-cm midline, ventral brainstem epidermoid cyst. She underwent an expanded endonasal transclival approach that exposed the brainstem from the level of the dorsum sella to the tip of the basion. A near-total resection was completed with removal of all cyst contents and most of the capsular wall. Reconstruction was completed with Duragen, an autologous fat graft, and a nasoseptal flap. Postoperatively, she had a partial left cranial nerve VI palsy that remained stable 8 weeks after surgery.

LESSONS

The expanded endoscopic transclival approach can facilitate effective resection of midline, ventral epidermoid cysts.

InJournal of Neurosurgery: Case Lessons Volume 5 (2023): Issue 13 (Mar 2023)

Open access

Extraoral anterior approach for the treatment of os odontoideum: illustrative case

Jacob M. Farrar, Mackenzie Grasso, and Rick J. Placide

BACKGROUND

Os odontoideum is typically treated with instrumented fusion through a posterior cervical approach. When this approach fails, limited options for revision are available. Occipitocervical fusion and transoral anterior fusions have been utilized in the past but are associated with high morbidity and complications.

OBSERVATIONS

Here the authors report a case of os odontoideum that was treated with an anterior cervical extraoral approach after failed posterior instrumented fusion. They discuss the challenges that can be encountered with the failure of fusion and the limited options when it comes to approach and fixation of os odontoideum.

LESSONS

To the authors’ knowledge and based on a review of the literature, this case represents the first use of an anterior extraoral prevascular approach to the high cervical spine to address os odontoideum. They demonstrate that this approach can be utilized as a reasonable alternative to transoral surgery and should be considered in cases where additional or alternative fixation is desired without the morbidity and complications associated with occipitocervical fusion or a transoral approach, especially in a younger patient population.

InJournal of Neurosurgery: Case Lessons Volume 5 (2023): Issue 13 (Mar 2023)

Open access

Spontaneous rhinorrhea: a possible concealing initial symptom of ecchordosis physaliphora. Illustrative case

Maria Jose Castello Ruiz, Mohammad Bilal Alsavaf, Michael Fadel, Eman H. Salem, Kittichai Mongkolkul, Pakjira Naksen, Saniya S. Godil, Bradley A. Otto, Ricardo L. Carrau, and Daniel M. Prevedello

BACKGROUND

Spontaneous rhinorrhea may be the initial manifestation of ecchordosis physaliphora (EP). There are currently 47 published cases of symptomatic EP, with spontaneous rhinorrhea being one of the most prevalent symptoms. The authors report 1 case as a cause of cerebrospinal fluid (CSF) fistula.

OBSERVATIONS

A 46-year-old woman presented to the authors’ clinic with meningitis secondary to nasal CSF leakage. The computed tomography (CT) scan indicated an imperceptibly thin/dehiscent focus along the posterior wall of the sphenoid air cell’s midline. A tumor was identified during endoscopic endonasal CSF repair surgery. EP was diagnosed in the frozen and final pathology.

LESSONS

EP should be considered as a potential cause of spontaneous rhinorrhea. This initial clinical manifestation accounts for 35% of symptomatic EP cases. The prepontine and posterior sphenoid sinus wall appear to be the locations with the highest susceptibility. Surgical therapy of the fistula without excision of the lesion may result in insufficient issue resolution and recurrence.

InJournal of Neurosurgery: Case Lessons Volume 5 (2023): Issue 13 (Mar 2023)

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ChatGPT versus the neurosurgical written boards: a comparative analysis of artificial intelligence/machine learning performance on neurosurgical board–style questions

Benjamin S. Hopkins, Vincent N. Nguyen, Jonathan Dallas, Pavlos Texakalidis, Max Yang, Alex Renn, Gage Guerra, Zain Kashif, Stephanie Cheok, Gabriel Zada, and William J. Mack

InJournal of Neurosurgery Publish Before Print

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Clinical outcomes of short-segment lumbar fusion in patients older than 85 years with a minimum 2-year follow-up

Takeru Tsujimoto, Ryo Itoga, Masahiro Kanayama, Fumihiro Oha, Yukitoshi Shimamura, Masaru Tanaka, Yuichi Hasegawa, Syotaro Fukada, Tomoyuki Hashimoto, Masahiko Takahata, and Norimasa Iwasaki

OBJECTIVE

Although the number of elderly patients requiring lumbar fusion for lumbar degenerative disorders has increased over time, the postoperative outcomes of lumbar fusion in very elderly patients (> 85 years) remains unknown. This study aimed to evaluate the comprehensive outcomes of lumbar fusion in elderly patients older than 85 years with mid-term follow-up.

开云体育世界杯赔率

The authors retrospectively researched patients older than 85 years who underwent single- or double-level posterior lumbar interbody fusion or transforaminal lumbar interbody fusion from 2012 to 2019. Twenty-nine patients who had at least 2 years of follow-up were included in this study. The average age was 86.4 years, and the average follow-up period was 42.2 months. Each patient was matched with 60- to 75-year-old controls. The Oswestry Disability Index (ODI) score; Roland-Morris Disability Questionnaire (RMDQ) score; Japanese Orthopaedic Association (JOA) score; JOA recovery rate; and low-back pain (LBP), leg pain, and leg numbness visual analog scale (VAS) scores were obtained. The spinopelvic parameters were measured using lateral standing radiographs of the whole spine.

RESULTS

Although there were no significant differences in the ODI, RMDQ, JOA recovery rate, and leg pain and leg numbness VAS scores at 2 years postoperatively between the very elderly and control groups, the VAS LBP score was significantly lower in the very elderly group than in the control group. Preoperative and postoperative sagittal vertical axes were significantly higher and sacral slopes were significantly lower in the very elderly group than in the control group. The incidences of postoperative delirium and new lumbar vertebral fracture were significantly higher in the very elderly group (17.2%) than in the control group (4.6%).

CONCLUSIONS

本研究表明,腰椎融合性能ormed in patients older than 85 years with satisfactory postoperative outcomes at the 2-year follow-up. In contrast, progressive spinopelvic sagittal imbalance, the incidence of lumbar vertebral fracture up to the final follow-up, and postoperative delirium were greater in the very elderly group than in the control group.

InJournal of Neurosurgery: Spine Publish Before Print

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Cryopreserved human umbilical cord as a meningeal patch during in utero spina bifida repair in a modified ovine model

Lovepreet K. Mann, Jong H. Won, Jeannine Garnett, Rajan P. Patel, Ponnada A. Narayana, Ranu Jain, Stephen A. Fletcher, and Ramesha Papanna

OBJECTIVE

Despite in utero spina bifida (SB) repair, more than two-thirds of patients with SB are unable to ambulate independently, and 1 in 4 children need surgery for tethered cord by school age. The objective of this study was to test the cryopreserved human umbilical cord (HUC) as an antiscarring material to reduce tethering and improve function in a modified in utero SB repair model.

开云体育世界杯赔率

An SB defect (L2–6 levels) without myelotomy was created in fetuses of timed-pregnant ewes at gestational day (GD) 75. On GD 96, the fetal defect was exposed, and the arachnoid layer was removed to disrupt the barrier and expose the spinal cord to simulate human in utero SB repair. The fetuses were randomly assigned to two groups according to the method used to cover the spinal cord: the conventional repair (CR) group, for which myofascial closure was used (n = 7), and the HUC meningeal patch group, for which HUC was used as a meningeal patch (n = 6), followed by primary skin closure. The lambs were delivered at GD 140. Blinded clinical assessment of spinal cord function was performed using the Texas Spinal Cord Injury Scale (TSCIS). Histology of the spine was performed for quantitative assessment of spinal cord tethering, inflammatory markers, and arachnoid layer regeneration.

RESULTS

我TSCIS得分都显著降低n the CR than the HUC meningeal patch group (p = 0.0015) and the controls (p = 0.0018). The loss of spinal cord function in the CR group was mainly due to ataxia and loss of proprioception (p = 0.01 and 0.005 vs control and HUC, respectively). The histology at the repair site showed higher rates of spinal cord tethering in the CR lambs than the HUC lambs at all levels of the repair site (p = 0.01 and 0.02 vs control and HUC, respectively). In the CR with tethering compared with the HUC repair, there was a lower arachnoid layer covering at the repair site (p = 0.001). There was greater astrocyte activation in the posterior column in the CR than in the HUC repair group (p = 0.01).

CONCLUSIONS

In a modified ovine SB model, the HUC as a meningeal patch allows regeneration of the arachnoid layer, prevents spinal cord tethering, and improves spinal cord function after in utero SB repair.

InJournal of Neurosurgery Publish Before Print

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Effect of workers’ compensation status on pain, disability, quality of life, and return to work after lumbar spine surgery: a 1-year propensity-matched analysis

Ummey Hani, Steve H. Monk, Deborah Pfortmiller, Gerry Stanley, Paul K. Kim, Michael A. Bohl, Christopher M. Holland, and Matthew J. McGirt

OBJECTIVE

Workers’ compensation (WC) and litigation have been shown to adversely impact prognoses in a vast range of health conditions. Low-back pain is currently the most frequent reason for WC claims. The objective of this study was to conduct the largest propensity-matched comparison of outcomes between patients with WC and non-WC status who underwent lumbar spinal decompression with and without fusion.

开云体育世界杯赔率

Complete data sets for patients who underwent 1- to 4-level lumbar spinal fusion or decompression alone were retrospectively retrieved from the Quality Outcomes Database (QOD), which included 1-year patient-reported outcomes from more than 200 hospital systems collected from 2012 to 2021. Population demographics, perioperative safety, facility utilization, patient satisfaction, disability, pain, EQ-5D quality of life, and return to work (RTW) rates were compared between cohorts for both subgroups. Statistical significance was set at p < 0.05.

RESULTS

有29652例患者纳入研究。Laminectomy was performed in 16,939 with non-WC status and in 615 with WC, whereas fusion was performed in 11,767 with non-WC status and in 331 with WC. WC patients were more frequently male, a minority race, younger, less educated, more frequently a smoker, had a healthier American Society of Anesthesiologists grade, and with greater baseline visual analog scale (VAS) and Oswestry Disability Index (ODI) scores (p < 0.001). One-year postoperative improvements in VAS, ODI, quality-adjusted life years (QALYs), RTW rates, and satisfaction were all significantly worse for WC versus non-WC patients for both procedures. After adjusting for baseline differences via propensity matching, WC versus non-WC patients continued to demonstrate worse 3- and 12-month VAS and ODI scores, reduced 12-month QALY gain, and delayed RTW after both procedure types.

CONCLUSIONS

WC status was associated with significantly greater residual disability and pain postoperatively, a lower quality of life, and delayed RTW. Utilizing resources to identify the negative influences on outcomes for WC patients may be valuable in preoperative optimization and could yield better outcomes in these patients.

InJournal of Neurosurgery: Spine Publish Before Print

Free access

Erratum. Creation and validation of a predictive model for lumbar synovial cyst recurrence following decompression without fusion

Gillian Shasby

InJournal of Neurosurgery: Spine Publish Before Print

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经选择性冷却infusi打断了on combined with mechanical thrombectomy in patients with acute ischemic stroke: a prospective, nonrandomized observational cohort study

Hao Tian, Yue Wan, Haojie Zhang, and Jing Zuo

OBJECTIVE

The authors aimed to explore the feasibility and efficiency of an interrupted intraarterial selective cooling infusion (IA-SCI) combined with mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS).

开云体育世界杯赔率

This prospective, nonrandomized observational cohort study included consecutive patients with AIS who had undergone MT at a stroke center from December 2018 to April 2022. Subjects were classified into an interrupted IA-SCI group and MT-alone group. The primary outcome was a favorable functional outcome (modified Rankin Scale score 0–2) at 90 days, and safety outcomes comprised the incidence of vasospasm, abnormal hematocrit (HCT), abnormal blood coagulation, pneumonia, infection, symptomatic intracranial hemorrhage, and death at 90 days.

RESULTS

A total of 142 patients were ultimately enrolled in this study (62 in the interrupted IA-SCI plus MT group and 80 in the MT-alone group). Interrupted IA-SCI combined with MT reduced the final infarct core area volumes (28.4 ml, 95% CI 7.8–34.5, p = 0.025) and improved the clinical outcome at 3 months after stroke (mRS score 0–2, 54.8% vs 37.5%, aOR 2.4, 95% CI 1.4–3.5, p = 0.022). The incidence of vasospasm, abnormal HCT, pneumonia, abnormal blood coagulation, infection, symptomatic intracranial hemorrhage, and death at 90 days was not increased in the interrupted IA-SCI group.

CONCLUSIONS

Interrupted IA-SCI for patients with intracranial large vessel occlusion AIS symptoms treated with MT seems to be safe and associated with favorable functional outcomes.

InJournal of Neurosurgery Publish Before Print

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