Search

Schwannomas are common benign neoplasms of the myelinating cells surrounding peripheral nerve axons. Though uncommon, lesions arising in the cervical spine may produce radicular pain and myelopathic weakness. Multiple sclerosis (MS) is a common autoimmune disorder with the capacity to mimic nearly any neurologic disease, including spinal cord neoplasms. We report the third case of synchronously presenting primary progressive MS and spinal schwannoma. A 65-year-old man presented with six months of progressive weakness and pain of the right shoulder, forearm, and hand. MRI demonstrated a contrast-enhancing transforaminal lesion at C7, most consistent with a benign nerve sheath tumor. Additional history disclosed several years of worsening fatigue, accompanied by bilateral weakness and lancinating leg pain. MRI of the neuraxis demonstrated abnormalities consistent with chronic demyelinating disease intracranially and within the spinal cord; cerebrospinal fluid (CSF) analysis revealed nine oligoclonal bands and an elevated IgG index, resulting in the diagnosis of MS. Given the symptomatic C7 lesion, the patient subsequently underwent right C6-C7 facetectomy, gross total resection of the tumor, and C6-T1 posterior instrumented fusion. Postoperatively, the patient rapidly recovered normal right upper extremity function, and pathology confirmed benign schwannoma. Synchronously presenting co-morbid neurologic diagnoses are exceedingly rare. Nonetheless, the high incidence and protean nature of MS make it particularly susceptible to such confounding clinical cases. Correspondingly, MS should be considered when neurologic abnormalities are not compatible with a focal radiographic lesion, and the present report emphasizes the value of a good history and exam in unraveling similarly challenging cases.

Introduction  Large and even moderate sized, extra-axial cerebellopontine angle (CPA) tumors may fill this restricted space and distort the regional anatomy. It may be difficult to determine even with high resolution magnetic resonance imaging (MRI) if the tumor is dural-based, or what the nerve of origin is if a schwannoma. While clinical history and exam are helpful, they are not unequivocal, particularly since many patients present with a myriad of symptoms, or conversely an incidental finding. We present an atypical appearing, asymptomatic CPA tumor, ultimately identified at surgery to be a trigeminal schwannoma. Case History  A 40-year-old man presented with new-onset seizure. MRI identified an incidental heterogeneously contrast-enhancing CPA lesion ( Fig. 1A - D ). The tumor was centered on the internal auditory canal (IAC) with no tumor extension into Meckel's cave, IAC or jugular foramen. Audiometry demonstrated 10db of relative left-sided hearing loss with 100% word recognition. Physical examination was negative for focal neurologic deficits. A retrosigmoid craniotomy was performed and an extra-axial, yellow-hued mass was encountered and resected, which was ultimately confirmed to originate from the trigeminal nerve ( Video 1 ). Gross total resection was achieved, and the patient recovered from surgery with partial ipsilateral trigeminal sensory loss and no other new neurologic deficits. Conclusion  Pure CPA trigeminal schwannomas are rare, but should be considered in the differential for enhancing CPA lesions. Although, Meckel's cave involvement is frequently observed, it is not universal, and pure CPA schwannomas of all cranial nerves IV-XII have been reported in the literature. The link to the video can be found at: https://youtu.be/AlodYCu70F8 .

Introduction Although many neuroanatomic atlases have been published, few have detailed complex cranial approaches and pertinent anatomic considerations in a stepwise fashion intended for rapid comprehension by neurosurgery students, residents, and fellows. Methods Five sides of formalin-fixed latex-injected specimens were dissected under microscopic magnification. The frontotemporal and orbitozygomatic approaches were performed by neurosurgical residents and fellows at different training levels with limited previous experience in anatomical dissection mentored by the senior authors (M.P.C. and M.J.L.). Meticulous surgical anatomic dissections were performed until sufficient visual and technical completion was attained, with parameters of effectively demonstrating key surgical steps for educational training purposes. Following the completion of dissection and three-dimensional photography, illustrative case examples were reviewed to demonstrate the relative benefits and optimal applications of each approach. Results The frontotemporal and orbitozygomatic approaches afford excellent access to anterior and middle skull base pathologies, as well as the exposure of the infratemporal fossa. Key considerations include head positioning, skin incision, scalp retraction, fat pad dissection and facial nerve protection, true or false MacCarty keyhole fashioning, sphenoid wing drilling and anterior clinoidectomy, completion of the craniotomy and accessory orbital osteotomy cuts, dural opening, and intradural neurovascular access. Conclusion The frontotemporal and orbitozygomatic approaches are core craniotomies that offer distinct advantages for complex cranial operations. Learning and internalizing their key steps and nuanced applications in a clinical context is critical for trainees of many levels. The orbitozygomatic craniotomy in particular is a versatile but challenging approach; operative-style laboratory dissection is an essential component of its mastery and one that will be powerfully enhanced by the current work. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, examines the extended long-term outcomes of single-fraction stereotactic radiosurgery (SRS) as a primary treatment for sporadic meningiomas. The study included 679 patients who underwent SRS for meningiomas at a single institution from 1997 to 2022. The results showed that SRS is a well-tolerated treatment option with excellent long-term tumor control rates. The study found a 96% tumor control rate at a mean follow-up of 107 months, with only a small percentage of patients experiencing complications or requiring additional interventions. [Extracted from the article]

This article discusses the occurrence of hypothyroidism following endoscopic endonasal resection of thyrotropin-secreting pituitary adenomas (TSHomas). The study conducted a retrospective review of patients who underwent this surgical procedure and found that postoperative hypothyroidism was a common outcome. The article emphasizes the importance of recognizing this potential outcome for appropriate postoperative management and patient counseling. The authors suggest that further research and larger case series are needed to gain more insights into the mechanism and peri-operative management of these patients. [Extracted from the article]

This article, titled "The Infundibulochiasmatic Angle Indicates Favorability of Endoscopic Endonasal Approach in Type IV Craniopharyngioma: Case Study and Technical Note," discusses the use of the midline transsphenoidal route as an alternative approach for tumors of the third ventricle. The authors introduce the concept of the "infundibulochiasmatic angle," which is a measurement that supports the feasibility of the trans-lamina terminalis endoscopic endonasal approach (EEA) for resection of type IV craniopharyngiomas. The article is authored by Guilherme Finger, Maria Jose C. Ruiz, Eman H. Salem, Matthew D. Marquardt, Kyle C. Wu, Lucas P. Carlstrom, Ricardo L. Carrau, Luciano M. Prevedello, and Daniel M. Prevedello. [Extracted from the article]

This article discusses the surgical techniques and clinical outcomes of resecting vestibular schwannomas (VS) with posterior displacement of the facial nerve (CN VII). The study involved a retrospective review of patients who underwent microsurgery for VS with posterior displacement of CN VII. Out of 962 patients, seven were identified with posterior displacement. The study found that achieving gross total resection (GTR) and preserving acceptable CN VII function is challenging in these cases, and therefore, the authors recommend attempting near total resection (NTR) or subtotal resection (STR) to preserve CN VII function. [Extracted from the article]