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Limited dorsal myeloschisis associated with intramedullary infantile hemangioma in the conus medullaris: illustrative case

Yoko Nakanishi, Noritsugu Kunihiro, Ryoko Umaba, Yasuhiro Matsusaka, Takeshi Inoue, and Hiroaki Sakamoto

BACKGROUND

Limited dorsal myeloschisis (LDM) and intramedullary infantile hemangioma rarely coexist in the spinal cord.

OBSERVATIONS

The authors describe the case of a 3-month-old girl who, despite lacking neurological symptoms or signs, had a cigarette burn-like mark at the lumbosacral area and skin dimpling in the gluteal area. Magnetic resonance imaging showed a low-set conus due to a thickened filum and an abnormal subcutaneous stalk connected to the conus medullaris. In combination with the skin lesions, these findings strongly implied nonsaccular-type LDM. An intramedullary mass in the conus medullaris was also shown on magnetic resonance imaging and was homogenously enhanced with isointensity on T1- and T2-weighted images. We prophylactically untethered the spinal cord and partially removed the intramedullary mass, which had no clear borders, for a safe surgical dissection. Histologically, the intramedullary mass was an infantile hemangioma, and the subcutaneous stalk was a lesion associated with LDM. The patient remained neurologically intact after surgery, and then 2 years later, there was spontaneous regression of the residual tumor.

LESSONS

Although rare, nonsaccular type LDM may appear concurrently with intramedullary infantile hemangioma at the conus medullaris. The authors present a possible mechanism behind this concurrent presentation in the same area.

InJournal of Neurosurgery: Case Lessons Volume 5 (2023): Issue 17 (Apr 2023)

Open access

Operative V2 decompression for traumatic vertebrobasilar insufficiency: illustrative case

Mats L. Moskopp, Lennart W. Sannwald, Michael Burbelko, and Dag Moskopp

BACKGROUND

Blunt vertebral artery injuries after cervical trauma due to the close anatomical relationship of the vertebral artery to the cervical spine may have fatal consequences because of posterior circulation ischemia and vertebrobasilar insufficiency. While the standard of care remains medical treatment by anticoagulation or antiplatelet therapy, surgical decompression of the vertebral artery is rarely indicated.

OBSERVATIONS

The authors present a case of selective decompression of a traumatically constricted vertebral artery within the transverse foramen of C2 presenting with vertebrobasilar insufficiency due to bilateral aplasia of the posterior communicating arteries and contralateral hypoplasia of the vertebral artery.

LESSONS

因为他们的克罗se relationship to the cervical spine, the vertebral arteries are at risk for blunt injury, which may present asymptomatically or with symptoms of posterior circulation ischemia or vertebrobasilar insufficiency either immediately or after a latency phase. The anatomical variability of (1) the vertebral arteries, (2) collateral brainstem perfusion, and (3) the individual injury pattern demands individualized treatment strategies. If endovascular treatment of hemodynamically relevant stenosis of the V2 segment of the vertebral artery poses too high a risk for vessel injury, decompression of the transverse foramen can be performed safely and without risk to the biomechanical stability of the cervical spine.

InJournal of Neurosurgery: Case Lessons Volume 5 (2023): Issue 17 (Apr 2023)

Open access

Surgical management of Hirayama disease in a pediatric patient presenting with severe cervical kyphosis and focal myelopathy: illustrative case

David B. Kurland, Sean Neifert, Hammad Khan, and Darryl Lau

BACKGROUND

Hirayama disease (HD) is a rare, nonfamilial neuromuscular disease causing cervical myelopathy and deformity, most commonly effecting pubertal Asian males. Patients whose nonoperative treatment fails and who cannot tolerate long-term cervical immobilization, experience relapse after arrest of symptoms, or present with severe features warrant surgical treatment. Here, the authors present an unusual case of HD that resulted in rapid progression of severe cervical kyphosis and discuss surgical management strategies.

OBSERVATIONS

A 15-year-old male presented with unprovoked neck pain, progressive chin-on-chest phenomenon, and cervical myelopathy. Imaging revealed a severe subaxial cervical kyphosis of 88° and severe spinal cord compression secondary to changes within the thecal sac, ligaments, and bony elements. He underwent a multistage surgery involving halo gravity traction, C3–6 anterior cervical discectomy and fusion, and C2 to T2 posterior instrumented fusion with C3–5 Smith-Petersen osteotomies. Cervical subaxial pedicle screws facilitated deformity correction through a cantilever technique.

LESSONS

高清是罕见的,通常是自限性。对于严重或refractory cases of HD, guidelines for surgical management have been suggested, with a variety of approaches deemed efficacious. This is the first case of a patient presenting with such severe cervical deformity; early diagnosis and recognition is the first step toward prompt, adequate management.

InJournal of Neurosurgery: Case Lessons Volume 5 (2023): Issue 17 (Apr 2023)

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Analysis of vascular perfusion territory using selective intraarterial injection CT angiography before and after revascularization surgery in patients with moyamoya disease

来ru Tateoka, Hideyuki Yoshioka, Takuma Wakai, Koji Hashimoto, Masakazu Ogiwara, and Hiroyuki Kinouchi

OBJECTIVE

In moyamoya disease (MMD), blood flow to the internal carotid artery (ICA) system is supplied via the basal fine vascular network, leptomeningeal anastomoses, and transdural collateral vessels from the external carotid artery (ECA). After revascularization, there is a dramatic change in cerebral perfusion to the ECA system. Understanding this shift in blood supply is important for evaluating treatment efficacy and elucidating the postoperative pathophysiology. However, anatomical and quantitative methods for doing so have not yet been established. In the present study, selective intraarterial injection CT angiography (iaCTA) was performed in patients with MMD, and blood supply changes in each arterial system before and after revascularization surgery were evaluated.

开云体育世界杯赔率

This study included 10 hemispheres in 10 patients who underwent combined revascularization surgery for adult MMD. Digital subtraction angiography was performed before and 3 months after surgery, and selective iaCTA was performed from the ICA, ECA, and vertebral artery (VA) at the same times in a hybrid CT/digital subtraction angiography suite. The anatomical distribution of each vessel was determined and perfusion volume was measured quantitatively on contrast-enhanced axial CT images.

RESULTS

Selective iaCTA clearly depicted the anatomical distribution of perfusion for each vessel. Conversion of blood supply from the ICA and VA to the ECA system was observed in the cerebral cortices and insulae but not in the basal ganglia. The mean volume of perfusion territories of the ECA (preoperative 0.9 cm3, postoperative 98.8 cm3); ICA (preoperative 225.7 cm3, postoperative 159.3 cm3); and VA (preoperative 244.0 cm3, postoperative 163.6 cm3) in the cerebral hemispheres changed significantly after revascularization. There was a correlation between increase in the ECA territory volume and decrease in the VA territory volume due to revascularization (R = −0.84, p < 0.005).

CONCLUSIONS

Selective iaCTA enabled clear visualization of anatomical changes in each vascular perfusion territory and quantitative measurement of each perfusion volume. Perfusion conversion to the ECA system after bypass surgery was observed in the cortical regions and in the insulae on the bypass operation sides, but not in the basal ganglia. Combined revascularization promoted the development of ECA-perfused territory, which correlated with a decrease in hemodynamic burden of the posterior cerebral artery.

InJournal of Neurosurgery Publish Before Print

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Analysis of YouTube videos on hydrocephalus in the local language: matching content with the needs of caregivers

Jinno Jenkin Sy, Angelica Mea, John Carlo B. Reyes, and Ronnie E. Baticulon

OBJECTIVE

Studies that evaluate YouTube videos on hydrocephalus often exclude non–English-language videos, even though hydrocephalus is more prevalent in low- and middle-income countries where English may not be widely understood. This study had two aims: to analyze the engagement, content, and quality of YouTube videos on hydrocephalus in the Filipino language, and to determine whether the videos’ content matched the information needs of caregivers of children with hydrocephalus in the Philippines.

开云体育世界杯赔率

The authors conducted an online survey among caregivers of patients with hydrocephalus, recruited through the Facebook page of the Hydrocephalus Foundation of the Philippines Inc. Data on demographics, social media use, and language and content preferences were collected. In parallel, the authors systematically evaluated the engagement and content of three groups of YouTube videos on hydrocephalus: 1) most viewed Filipino-language videos, 2) most viewed English-language videos, and 3) same-age English-language videos, matched to the first group based on upload date. The quality of the Filipino-language videos was assessed using the DISCERN criteria.

RESULTS

Among 280 respondents, 91% watched videos on hydrocephalus online and 89% preferred videos in Filipino. Compared with same-age English videos, Filipino videos had greater engagement, indicated by a higher median number of likes (40 vs 8, p = 0.005) and comments (8.5 vs 1, p = 0.007). English and Filipino videos emphasized similar topics on hydrocephalus, but the latter were more likely to discuss treatment cost and to solicit donations. Caregivers were most interested in the long-term care of patients with hydrocephalus, discussed only in 10 of 72 videos (14%) overall. The mean DISCERN score for Filipino videos was 30.1 ± 7.7, indicating poor quality.

CONCLUSIONS

There is a gap between the information needs of Filipino caregivers and the content of YouTube videos on hydrocephalus. Neurosurgeons can serve as creators, resource persons, or curators of content, ensuring that up-to-date, accurate, and credible health information on hydrocephalus is available to caregivers in their preferred language.

InJournal of Neurosurgery: Pediatrics Publish Before Print

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Cerebral blood flow in children with persisting postconcussive symptoms and posttraumatic headache at 2 weeks postconcussion

Feiven粉丝,理查德•贝尔西el Takagi, Nicholas Anderson, Silvia Bressan, Cathriona J. Clarke, Gavin A. Davis, Kevin Dunne, Fabian Fabiano, Stephen J. C. Hearps, Vera Ignjatovic, Georgia Parkin, Vanessa C. Rausa, Marc Seal, Jesse S. Shapiro, Franz E. Babl, and Vicki Anderson

OBJECTIVE

Persisting postconcussive symptoms (pPCS), particularly headache, can significantly disrupt children’s recovery and functioning. However, the underlying pathophysiology of these symptoms remains unclear. The goal in this study was to determine whether pPCS are related to cerebral blood flow (CBF) at 2 weeks postconcussion. The authors also investigated whether variations in CBF can explain the increased risk of acute posttraumatic headache (PTH) in female children following concussion.

开云体育世界杯赔率

As part of a prospective, longitudinal study, the authors recruited children 5–18 years old who were admitted to the emergency department of a tertiary pediatric hospital with a concussion sustained within 48 hours of admission. Participants underwent pseudocontinuous arterial spin labeling MRI at 2 weeks postconcussion to quantify global mean gray and white matter perfusion (in ml/100 g/min). Conventional frequentist analysis and Bayesian analysis were performed.

RESULTS

Comparison of recovered (n = 26) and symptomatic (n = 12) groups (mean age 13.15 years, SD 2.69 years; 28 male) found no differences in mean global gray and white matter perfusion at 2 weeks postconcussion (Bayes factors > 3). Although female sex was identified as a risk factor for PTH with migraine features (p = 0.003), there was no difference in CBF between female children with and without PTH.

CONCLUSIONS

Global CBF was not associated with pPCS and female PTH at 2 weeks after pediatric concussion. These findings provide evidence against the use of CBF measured by arterial spin labeling as an acute biomarker for pediatric concussion recovery.

InJournal of Neurosurgery: Pediatrics Publish Before Print

Free access

勘误表。动脉内村的起源和演化of identification of the vascular supply to the hippocampus

Mark C. Preul

InJournal of Neurosurgery Publish Before Print

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In memoriam: Jules Hardy, 1932–2022

William T. Couldwell and Ian E. McCutcheon

InJournal of Neurosurgery Publish Before Print

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Incremental benefits of circumferential minimally invasive surgery for increasingly frail patients with adult spinal deformity

Peter G. Passias, Peter S. Tretiakov, Pierce D. Nunley, Michael Y. Wang, Paul Park, Adam S. Kanter, David O. Okonkwo, Robert K. Eastlack, Gregory M. Mundis Jr., Dean Chou, Nitin Agarwal, Richard G. Fessler, Juan S. Uribe, Neel Anand, Khoi D. Than, Gregory Brusko, Kai-Ming Fu, Jay D. Turner, Vivian P. Le, Breton G. Line, Christopher P. Ames, Justin S. Smith, Christopher I. Shaffrey, Robert A. Hart, Douglas Burton, Renaud Lafage, Virginie Lafage, Frank Schwab, Shay Bess, and Praveen V. Mummaneni

OBJECTIVE

Circumferential minimally invasive surgery (cMIS) may provide incremental benefits compared with open surgery for patients with increasing frailty status by decreasing peri- and postoperative complications.

开云体育世界杯赔率

手术患者成人脊柱畸形(如D) ≥ 18 years old with baseline and 2-year postoperative data were assessed. With propensity score matching, patients who underwent cMIS (cMIS group) were matched with similar patients who underwent open surgery (open group) based on baseline BMI, C7–S1 sagittal vertical axis, pelvic incidence to lumbar lordosis mismatch, and S1 pelvic tilt. The Passias modified ASD frailty index (mASD-FI) was used to determine patient frailty stratification as not frail, frail, or severely frail. Baseline and postoperative factors were assessed using two-way analysis of covariance (ANCOVA) and multivariate ANCOVA while controlling for baseline age, Charlson Comorbidity Index (CCI) score, and number of levels fused.

RESULTS

After propensity score matching, 170 ASD patients (mean age 62.71 ± 13.64 years, 75.0% female, mean BMI 29.25 ± 6.60 kg/m2) were included, split evenly between the cMIS and open groups. Surgically, patients in the open group had higher numbers of posterior levels fused (p = 0.021) and were more likely to undergo three-column osteotomies (p > 0.05). Perioperatively, cMIS patients had lower intraoperative blood loss and decreased use of cell saver across frailty groups (with adjustment for baseline age, CCI score, and levels fused), as well as fewer perioperative complications (p < 0.001). Adjusted analysis also revealed that compared to open patients, increasingly frail patients in the cMIS group were also more likely to demonstrate greater improvement in 1- and 2-year postoperative scores for the Oswestry Disability Index, SRS-36 (total), EQ-5D and SF-36 (all p < 0.05). With regard to postoperative complications, increasingly frail patients in the cMIS group were also noted to experience significantly fewer complications overall (p = 0.036) and fewer major intraoperative complications (p = 0.039). The cMIS patients were also less likely to need a reoperation than their open group counterparts (p = 0.043).

CONCLUSIONS

Surgery performed with a cMIS technique may offer acceptable outcomes, with diminishment of perioperative complications and mitigation of catastrophic outcomes, in increasingly frail patients who may not be candidates for surgery using traditional open techniques. However, further studies should be performed to investigate the long-term impact of less optimal alignment in this population.

InJournal of Neurosurgery: Spine Publish Before Print

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Trends in successfully matched neurosurgery residency applicants

Nina Yu, Jeffrey S. Hoch, Allan R. Martin, and Kiarash Shahlaie

OBJECTIVE

美国医学执照考试(USMLE) Step 1 recently transitioned to a pass/fail outcome, renewing interest in how programs select neurosurgical residents. This study investigates the association between match status and key academic metrics over time.

开云体育世界杯赔率

Data are from the National Resident Matching Program from 2009 to 2022 for matched and unmatched US allopathic (MD) seniors. Investigated metrics included the mean number of contiguous ranks; mean number of distinct specialties ranked; mean USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores; mean number of abstracts, presentations, and publications; mean number of research, work, and volunteer experiences; Alpha Omega Alpha status; attendance at a top 40 NIH-funded institution; PhD degree; and other degree. Multiple linear regression without an interaction term was used to evaluate how these have varied between the two groups during the study period and whether there is a difference between unmatched and matched MD seniors applying for a neurosurgical residency. Multiple linear regression with an interaction term was then used to test whether the difference in variables between the two groups changed over time.

RESULTS

Regardless of match status, MD senior neurosurgical residency applicants exhibited an increase in USMLE Step 1 and 2 scores; average research experiences; abstracts, presentations, and publications; and work and volunteer experiences (p < 0.001). The percentage of applicants from a top 40 NIH-funded school decreased (p = 0.018), and the percentage who held an additional degree increased (p = 0.007). Between groups, there were significant differences in all categories except work experiences and other degree obtained. Over time, the difference between USMLE Step 2 scores between matched and unmatched seniors diminished (p = 0.027); in contrast, the difference in abstracts, presentations, and publications between the two groups increased over time (p < 0.001).

CONCLUSIONS

From 2009 to 2022, neurosurgical residency applicants grew in their achievements across many metrics. In the advent of Step 1 becoming pass/fail, this study suggests that Step 2 is not viewed by programs as an adequate replacement. However, the Step 1 grading transition may serve as an opportunity for other factors to be considered that may better predict success in neurosurgical residency.

InJournal of Neurosurgery Publish Before Print

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