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Erol G, Çavuşoğlu N, Sevgi UT, Fidan S, Canbolat Ç, Doğruel Y, Luzzi S, Cohen Gadol AA, Güngor A. Occipital Sinus-Sparing Linear Paramedian Dural Incision: A Technical Note and Case Series for Median Suboccipital Approach. World Neurosurg 2024; 184:e121-e128. [PMID: 38244681 DOI: 10.1016/j.wneu.2024.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Durotomies, traditionally used during the midline suboccipital approach, involve sacrificing the occipital sinus (OS) with consequent shrinking of the dura, risk of venous complications, difficulty performing watertight closure, and a higher rate of postoperative cerebrospinal fluid (CSF) leaks. The present technical note describes the OS-sparing linear paramedian dural incision, which leads to a decrease in the risk of complications during the median suboccipital approach in our case series. METHODS The OS-sparing linear incision technique involves a dural incision placed 1 cm lateral to the OS. The angle of view of the microscope is frequently changed to overcome the narrowed exposure of the linear durotomy. Copious irrigation with saline prevents drying of the dura. A running watertight closure of the dura is performed. The overall results of 5 cases are reviewed. RESULTS The cases were 3 tumors and 2 cavernomas. The OS was preserved in all 5, and no duraplasty was needed. The average dura closure time was 16.8 minutes. No CSF leak occurred, and no wound complications were observed. A gross total resection of the lesion was achieved in all the patients. The mean follow-up was 10.2 months, and there were no late complications related to the dura closure. CONCLUSIONS In comparison to the types of durotomies conventionally used for the midline suboccipital approach, the OS-sparing linear paramedian dural incision entails lower risks of bleeding, venous complications, CSF leaks, and infections by avoiding duraplasty. Validation of this technical note on a larger patient cohort is needed.
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Affiliation(s)
- Gökberk Erol
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Neslihan Çavuşoğlu
- Department of Neurosurgery, Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Umut Tan Sevgi
- Department of Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Semih Fidan
- Department of Neurosurgery, Bakırköy Mazhar Osman Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Çağrı Canbolat
- Department of Neurosurgery, Liv Hospital Vad istanbul, Istanbul, Turkey
| | - Yücel Doğruel
- The Neurosurgical Atlas, Carmel, Indiana, USA; Department of Neurosurgery, Tunceli State Hospital, Tunceli, Turkey
| | - Sabino Luzzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Aaron A Cohen Gadol
- The Neurosurgical Atlas, Carmel, Indiana, USA; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Abuzer Güngor
- Department of Neurosurgery, Liv Hospital Vad istanbul, Istanbul, Turkey; Faculty of Medicine, Department of Neurosurgery, Istinye University, Istanbul, Turkey.
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Zielinski E, Beutler G, Hajewski CJ, Sasso R. A Subdural Dissection of Cerebrospinal Fluid Causing Cauda Equina Centralization After Durotomy: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00016. [PMID: 38241431 DOI: 10.2106/jbjs.cc.23.00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
CASE A 61-year-old woman with recurrent left L5 radiculopathy underwent revision L4-5 decompression complicated by incidental durotomy requiring primary repair. Postoperative course was complicated by wound drainage and headache. Repeat magnetic resonance imaging demonstrated cerebrospinal fluid dissecting a plane deep to the dura mater but superficial to the arachnoid, with the collection compressing the cauda equina in an atypical horizontal and linear fashion. Nonoperative treatment was ineffective, and she required revision decompression and dural repair. CONCLUSION Spine surgeons should recognize this finding on postoperative imaging as a potential sign of an incomplete dural repair necessitating return to the operating room.
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Affiliation(s)
- Emily Zielinski
- Department of Orthopedic Surgery, IU Health University Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Graham Beutler
- Department of Orthopedic Surgery, IU Health University Hospital, Indiana University School of Medicine, Indianapolis, Indiana
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Su J, Ren Q, Li P, Wei W, Liu J, Feng Y, Huang X, Cao Y, Wang W, Wu M, Zhang Q, Wang Z. Clinical Observation of Various Types of Idiopathic Hypertrophic Cranial Pachymeningitis. World Neurosurg 2024; 181:e493-e503. [PMID: 37898275 DOI: 10.1016/j.wneu.2023.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND To assist doctors in making better treatment decisions and improve patient prognosis, it is important to determine which therapy modalities are suitable for various forms of idiopathic hypertrophic cranial pachymeningitis (IHCP). METHODS All cases were received from the hospital medical record system, and some follow-up information was gathered through telephone follow-up. RESULTS A total of 26 patients, 14 men and 12 women, with ages ranging from 20 to 73 years and a mean of 47.42 years, were included in the research. Regular types were less likely to recur than irregular and nodular types, focal types were less likely to recur than diffuse types, and corticosteroid-refractory types were more likely to recur than corticosteroid-sensitive types. CONCLUSIONS The extent and shape of the lesion and susceptibility to corticosteroids are potential factors that could influence recurrence. Futhermore, this paper also proposes the fibroblasts as a new therapeutic target which may improve the quality of prognostic survival of patients.
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Affiliation(s)
- Jinfei Su
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qinzhan Ren
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Pu Li
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Junqi Liu
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanjun Feng
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xu Huang
- Department of Rheumatism and Immunity, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanxiang Cao
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Min Wu
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qiuhang Zhang
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlin Wang
- Skull Base Surgery Center and Department of Otorhinolaryngology-Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Glinka P, Sobstyl M, Rymkiewicz G, Wierzba-Bobrowicz T, Paszkiewicz-Kozik E, Grajkowska W. Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue of the dura mimicking meningioma: a case report and literature review. Folia Neuropathol 2024; 62:102-107. [PMID: 38741437 DOI: 10.5114/fn.2024.135291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
MALT lymphoma of the dura is a very rare type of low-grade B-cell lymphoma. Little more than 100 cases have been reported in the literature to date. We report a 43-year-old woman who was referred to hospital because of a series of three tonic-clonic seizures on the day of admission. Neurological examination revealed confusion and aphasia. Magnetic resonance imaging (MRI) showed a contrast-enhanced, broad-based lesion along the dura in the left parieto-occipital area. The suspicion of an en plaque meningioma was raised. The tumour invaded the brain parenchyma with visible extension into the brain sulci. There was a marked brain oedema surrounding the lesion and causing the midline shift 8 mm to the right. After stabilization of neurological condition (intravenous diuretics and steroids), the operation was performed. The diagnosis of dural MALT lymphoma was established. During the pathological examination, it was especially problematic to distinguish MALT lymphoma from follicular lymphoma, but the final diagnosis was MALT lymphoma. Surgical partial removal with additional R-CVP immunochemotherapy (rituximab, cyclophosphamide, vincristine and prednisone) resulted in complete remission. The follow-up period is 1 year. Our presented case of a MALT lymphoma highlights the fact that surgical partial removal with additional immunochemotherapy is an available option in these rare intracranial tumours.
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Affiliation(s)
- Piotr Glinka
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Grzegorz Rymkiewicz
- Flow Cytometry Laboratory, Department of Cancer Pathomorphology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Ewa Paszkiewicz-Kozik
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Wiesława Grajkowska
- Department of Neuropathology, Institute of Psychiatry and Neurology, Warsaw, Poland
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Walusinski O. Fungous tumour in the dura mater, first description of meningioma by the surgeon Antoine Louis (1723-1792). Rev Neurol (Paris) 2024; 180:117-123. [PMID: 37718214 DOI: 10.1016/j.neurol.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 09/19/2023]
Affiliation(s)
- O Walusinski
- Private practice, 20, rue de Chartres, 28160 Brou, France.
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Li J, Zhao J, Sun S, Shen S, Zhong B, Dong X. Peptidomics insights: neutrophil extracellular traps (NETs) related to the chronic subdural hemorrhage. PeerJ 2023; 11:e16676. [PMID: 38144176 PMCID: PMC10749094 DOI: 10.7717/peerj.16676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Chronic subdural hemorrhage (CSDH) refers to a hematoma with an envelope between the dura mater and the arachnoid membrane and is more common among the elderly. It was reported that the dura mater, which is highly vascularized with capillary beds, precapillary arterioles and postcapillary venules play an important role in the protection of the central nervous system (CNS). Numerous evidences suggests that peptides play an important role in neuroprotection of CNS. However, whether dura mater derived endogenous peptides participate in the pathogenesis of CSDH remains undetermined. In the current study, the peptidomic profiles were performed in human dura of CSDH (three patients) and the relative control group (three non-CSDH samples) by LC-MS (liquid chromatography-mass spectrometry). The results suggested that a total of 569 peptides were differentially expressed in the dura matter of CSDH compared with relative controls, including 217 up-regulated peptides and 352 down-regulated peptides. Gene Ontology (GO) analysis demonstrated that the precursor proteins of those differentially expressed peptides were involved in the various biological processes. Interestingly, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis suggested that NETs participated in the pathogenies of CSDH. Further investigate showed that H3Cit was significantly elevated in the dural and hematoma membranes of patients with CSDH compared to patients without CSDH. Taken together, our results showed the differentially expressed peptides in human dura mater of CSDH and demonstrated that NETs formation in the dural and hematoma membranes might be involved in the pathogenesis of CSDH. It is worth noting that pharmacological inhibition of NETs may have potential therapeutic implications for CSDH.
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Affiliation(s)
- Jie Li
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhao
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuchen Sun
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sen Shen
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bincheng Zhong
- Department of Emergency, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohua Dong
- Department of Neurosurgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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7
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Rattanawong W, Tekarnjnavanit A, Marukatat C, Hemachudha P, Pongpitakmetha T, Anukoolwittaya P. Teaching NeuroImage: Branching Dura Mater in Primary CNS ALK-Positive Anaplastic Large Cell Lymphoma. Neurology 2023; 101:766-768. [PMID: 37536956 PMCID: PMC10624487 DOI: 10.1212/wnl.0000000000207752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Wanakorn Rattanawong
- From the Department of Medicine (W.R., C.M.), Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok; Burapha University Hospital (A.T.), Chonburi; Charoenkrung Pracharak Hospital (A.T.), Bangkok; Division of Neurology (A.T., C.M., P.H., T.P., P.A.), Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok; Thai Red Cross Emerging Infectious Diseases Health Science Centre (P.H.), World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; Chula Neuroscience Center (T.P., P.A.), King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; and Department of Pharmacology (T.P.), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Arnant Tekarnjnavanit
- From the Department of Medicine (W.R., C.M.), Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok; Burapha University Hospital (A.T.), Chonburi; Charoenkrung Pracharak Hospital (A.T.), Bangkok; Division of Neurology (A.T., C.M., P.H., T.P., P.A.), Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok; Thai Red Cross Emerging Infectious Diseases Health Science Centre (P.H.), World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; Chula Neuroscience Center (T.P., P.A.), King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; and Department of Pharmacology (T.P.), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chayoot Marukatat
- From the Department of Medicine (W.R., C.M.), Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok; Burapha University Hospital (A.T.), Chonburi; Charoenkrung Pracharak Hospital (A.T.), Bangkok; Division of Neurology (A.T., C.M., P.H., T.P., P.A.), Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok; Thai Red Cross Emerging Infectious Diseases Health Science Centre (P.H.), World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; Chula Neuroscience Center (T.P., P.A.), King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; and Department of Pharmacology (T.P.), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pasin Hemachudha
- From the Department of Medicine (W.R., C.M.), Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok; Burapha University Hospital (A.T.), Chonburi; Charoenkrung Pracharak Hospital (A.T.), Bangkok; Division of Neurology (A.T., C.M., P.H., T.P., P.A.), Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok; Thai Red Cross Emerging Infectious Diseases Health Science Centre (P.H.), World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; Chula Neuroscience Center (T.P., P.A.), King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; and Department of Pharmacology (T.P.), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanakit Pongpitakmetha
- From the Department of Medicine (W.R., C.M.), Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok; Burapha University Hospital (A.T.), Chonburi; Charoenkrung Pracharak Hospital (A.T.), Bangkok; Division of Neurology (A.T., C.M., P.H., T.P., P.A.), Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok; Thai Red Cross Emerging Infectious Diseases Health Science Centre (P.H.), World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; Chula Neuroscience Center (T.P., P.A.), King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; and Department of Pharmacology (T.P.), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Prakit Anukoolwittaya
- From the Department of Medicine (W.R., C.M.), Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok; Burapha University Hospital (A.T.), Chonburi; Charoenkrung Pracharak Hospital (A.T.), Bangkok; Division of Neurology (A.T., C.M., P.H., T.P., P.A.), Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok; Thai Red Cross Emerging Infectious Diseases Health Science Centre (P.H.), World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; Chula Neuroscience Center (T.P., P.A.), King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok; and Department of Pharmacology (T.P.), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Yu H, Lu C, Duan W, Dong Y, Wang Z, Wang X, Jian F. A selected case series of idiopathic hypertrophic pachymeningitis in a single center: Pathological characteristics and case-oriented review. J Neuroimmunol 2023; 383:578191. [PMID: 37660537 DOI: 10.1016/j.jneuroim.2023.578191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/06/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
Hypertrophic pachymeningitis (HP) is a relatively rare disease of the central nervous system characterized by local or diffuse fibrous thickening of the dura mater. At present, there is still insufficient research on the pathogenesis and treatment strategies of this disease. We reported a continuous case series of seven patients with idiopathic HP (IHP), and also details one case of immunoglobulin G4-related HP requiring surgical intervention. Early diagnosis and appropriate surgical intervention for IHP could prevent the progression of permanent neurological damage and spinal cord paraplegia.
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Affiliation(s)
- Huaxiao Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Chunli Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Yachao Dong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Zuowei Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China
| | - Xingwen Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China.
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, PR China; Neurospine Center, China International Neuroscience Institute (China-INI), PR China; Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, PR China; National Center for Neurological Disorders, PR China.
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9
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Abstract
OBJECTIVE The objective of this review was to describe the immunological changes that take place in the dura mater in response to metastatic disease that seeds the CNS. The authors hypothesized that the dura's anatomy and resident immune cell population play a role in enabling metastasis to the brain and leptomeninges. METHODS An extensive literature search was conducted to identify evidence that supports the dura's participation in metastasis to the CNS. The authors' hypothesis was informed by a recent upsurge in studies that have investigated the dura's role in metastatic development, CNS infections, and autoimmunity. They reviewed this literature as well as the use of immunotherapy in treating brain metastases and how these therapies change the meningeal immune landscape to overcome and reverse tumor-promoting immunosuppression. RESULTS Evidence suggests that the unique architecture and immune cell profile of the dura, compared with other immune compartments within the CNS, facilitate entry of metastatic tumor cells into the brain. Once these tumor cells penetrate the dural barrier, they propagate an immunosuppressive tumor microenvironment. Therefore, immunotherapy may serve to overcome this immunosuppressive environment and liberate proinflammatory immune cells in an effort to combat metastatic disease. CONCLUSIONS Within the next few years, the authors expect the addition of several more scientific studies into the literature that further underscore the dura as a chief participant and neuroanatomical barrier in neuro-oncology.
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Affiliation(s)
- Francesca M Cozzi
- 1Department of Neurosurgery, Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Leonel Ampie
- 2Neurosurgical Oncology Unit, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
- 3Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Maxwell T Laws
- 2Neurosurgical Oncology Unit, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
- 3Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Desmond A Brown
- 2Neurosurgical Oncology Unit, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
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10
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King NC, Guastaldi FPS, Khanna AR, Redmond RW, Winograd JM. Photosealing of dural defects using a biocompatible patch. Acta Neurochir (Wien) 2023; 165:2293-2298. [PMID: 37284839 DOI: 10.1007/s00701-023-05653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/27/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE Photosealing of many biological tissues can be achieved using a biocompatible material in combination with a dye that is activated by visible light to chemically bond over the tissue defect via protein cross-linking reactions. The aim of this study was to test the efficacy of photosealing using a commercially available biomembrane (AmnioExcel Plus) to securely close dural defects in comparison to another sutureless method (fibrin glue) in terms of repair strength. METHODS Two-millimeter diameter holes were created in dura harvested from New Zealand white rabbits and repaired ex vivo using one of two methods: (1) in n = 10 samples, photosealing was used to bond a 6-mm-diameter AmnioExcel Plus patch over the dural defect, and (2) in n = 10 samples, fibrin glue was used to attach the same patch over the dural defect. Repaired dura samples were then subjected to burst pressure testing. Histological analysis was also performed of photosealed dura. RESULTS The mean burst pressures of rabbit dura repaired with photosealing and fibrin glue were 302 ± 149 mmHg and 26 ± 24 mmHg, respectively. The increased repair strength using photosealing was statistically significant and considerably higher than the normal intracranial pressure of ~ 20 mmHg. Histology demonstrated a tight union at the interface between the dura surface and patch with no disruption of the dura structure. CONCLUSION The results of this study suggest that photosealing performs better than fibrin glue for the fixation of a patch for ex vivo repair of small dural defects. Photosealing is worthy of testing in pre-clinical models for the repair of dural defects.
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Affiliation(s)
- Nicholas C King
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 435, Boston, MA, 02114, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Fernando P S Guastaldi
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
| | - Arjun R Khanna
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Robert W Redmond
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan M Winograd
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WACC 435, Boston, MA, 02114, USA.
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11
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Abstract
Parasagittal dura (PSD) is located on both sides of the superior sagittal sinus and harbours arachnoid granulations and lymphatic vessels. Efflux of cerebrospinal fluid (CSF) to human PSD has recently been shown in vivo. Here we obtain PSD volumes from magnetic resonance images in 76 patients under evaluation for CSF disorders and correlate them to age, sex, intracranial volumes, disease category, sleep quality, and intracranial pressure. In two subgroups, we also analyze tracer dynamics and time to peak tracer level in PSD and blood. PSD volume is not explained by any single assessed variable, but tracer level in PSD is strongly associated with tracer in CSF and brain. Furthermore, peak tracer in PSD occurs far later than peak tracer in blood, implying that PSD is no major efflux route for CSF. These observations may indicate that PSD is more relevant as a neuroimmune interface than as a CSF efflux route.
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Affiliation(s)
- Erik Melin
- Department of Radiology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Ringstad
- Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
- Department of Geriatrics and Internal medicine, Sorlandet Hospital, Arendal, Norway
| | - Lars Magnus Valnes
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Per Kristian Eide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
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Hwang JK, Park EK, Shim KW, Kim DS. Effectiveness of C1 Laminectomy for Chiari Malformation Type 1: Posterior Fossa Volume Expansion and Syrinx-Volume Decrease Rate. Yonsei Med J 2023; 64:191-196. [PMID: 36825345 PMCID: PMC9971440 DOI: 10.3349/ymj.2022.0506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE This study aimed to analyze the effect of foramen magnum decompression with C1 laminectomy (C1L) for Chiari malformation type 1 (CM-1) in terms of improving clinical symptoms, expanding posterior fossa volume, and decreasing syrinx volume. MATERIALS AND METHODS Between January 2007 and June 2019, 107 patients with CM-1 were included. The median patient age was 13±13 years (range: 9 months-60 years), female-to-male ratio was 1:1, and average length of tonsil herniation was 13±5 mm (range: 5-24 mm). Surgical techniques were divided into four groups based on duraplasty or C1L usage. Among the study subjects, 38 patients underwent duraplasty and had their syrinx volumes measured separately on serial magnetic resonance imaging. A three-dimensional visualization software was used to evaluate the syrinx-volume decrease rate. RESULTS Bony decompression exhibited a mere 20% volume expansion of the lower-half posterior fossa. C1L offered a 3% additional volume expansion, which rose to 5% when duraplasty was added (p=0.029). There were no significant differences in complication rate when C1L was combined with duraplasty (p=0.526). Syrinx volumes were analyzed in 38 patients who had undergone duraplasty. Among them, 28 patients who had undergone duraplasty without C1L demonstrated a 5.9% monthly decrease in syrinx volume, which was 7.5% in the remaining 10 patients with C1L (p=0.040). CONCLUSION C1L was effective in increasing posterior fossa volume expansion, both with and without duraplasty. A more rapid decrease in syrinx volume occurred when C1L was combined with duraplasty.
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Affiliation(s)
- Jun Kyu Hwang
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Eun Kyung Park
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Won Shim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Argouarch AR, Schultz N, Yang AC, Jang Y, Garcia K, Cosme CG, Corrales CI, Nana AL, Karydas AM, Spina S, Grinberg LT, Miller B, Wyss-Coray T, Abyzov A, Goodarzi H, Seeley WW, Kao AW. Postmortem Human Dura Mater Cells Exhibit Phenotypic, Transcriptomic and Genetic Abnormalities that Impact their Use for Disease Modeling. Stem Cell Rev Rep 2022; 18:3050-3065. [PMID: 35809166 PMCID: PMC9622518 DOI: 10.1007/s12015-022-10416-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/24/2022]
Abstract
Patient-derived cells hold great promise for precision medicine approaches in human health. Human dermal fibroblasts have been a major source of cells for reprogramming and differentiating into specific cell types for disease modeling. Postmortem human dura mater has been suggested as a primary source of fibroblasts for in vitro modeling of neurodegenerative diseases. Although fibroblast-like cells from human and mouse dura mater have been previously described, their utility for reprogramming and direct differentiation protocols has not been fully established. In this study, cells derived from postmortem dura mater are directly compared to those from dermal biopsies of living subjects. In two instances, we have isolated and compared dermal and dural cell lines from the same subject. Notably, striking differences were observed between cells of dermal and dural origin. Compared to dermal fibroblasts, postmortem dura mater-derived cells demonstrated different morphology, slower growth rates, and a higher rate of karyotype abnormality. Dura mater-derived cells also failed to express fibroblast protein markers. When dermal fibroblasts and dura mater-derived cells from the same subject were compared, they exhibited highly divergent gene expression profiles that suggest dura mater cells originated from a mixed mural lineage. Given their postmortem origin, somatic mutation signatures of dura mater-derived cells were assessed and suggest defective DNA damage repair. This study argues for rigorous karyotyping of postmortem derived cell lines and highlights limitations of postmortem human dura mater-derived cells for modeling normal biology or disease-associated pathobiology.
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Affiliation(s)
- Andrea R. Argouarch
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Nina Schultz
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Andrew C. Yang
- Department of Neurology and Neurological Sciences, School of Medicine, Stanford University, Stanford, CA 94304 USA
| | - Yeongjun Jang
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Kristle Garcia
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA 94158 USA
- Department of Urology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Celica G. Cosme
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Christian I. Corrales
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Alissa L. Nana
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Anna M. Karydas
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Salvatore Spina
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Lea T. Grinberg
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
- Department of Pathology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Bruce Miller
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, School of Medicine, Stanford University, Stanford, CA 94304 USA
| | - Alexej Abyzov
- Department of Quantitative Health Sciences, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905 USA
| | - Hani Goodarzi
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA 94158 USA
- Department of Urology, University of California San Francisco, San Francisco, CA 94158 USA
| | - William W. Seeley
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
- Department of Pathology, University of California San Francisco, San Francisco, CA 94158 USA
| | - Aimee W. Kao
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94158 USA
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Wang H, Wang S, Yu H, Chen Y, Zheng L, Ma J. Surgical treatment of recurrent postoperative discal pseudocyst: A case report and literature review. Medicine (Baltimore) 2022; 101:e31756. [PMID: 36397328 PMCID: PMC9666085 DOI: 10.1097/md.0000000000031756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Postoperative discal pseudocyst (PDP) is rare. Few studies have reported on the recurrence of PDPs, and there is a lack of understanding of their clinical features and treatment methods. This study discusses the clinical characteristics and treatment of recurrent PDPs. PATIENT CONCERNS A 25-year-old man presented with radiating pain and numbness in the lateral left calf and dorsum of the foot. DIAGNOSIS Postoperative discal pseudocyst. INTERVENTIONS He underwent lumbar discectomy, which provided immediate postoperative relief. However, the symptoms recurred 45 days later. Magnetic resonance imaging (MRI) showed a lesion compressing the dura and nerve roots at the site of the previous surgery. The lesion appeared hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging. The patient was treated conservatively for 1 month without significant relief. He then underwent lumbar discectomy and cyst removal, which immediately relieved his symptoms. However, 27 days later, the patient again developed the same symptoms. MRI examination showed recurrence of PDP. As 1 month of conservative treatment failed to relieve the patient's symptoms, we performed posterior instrumented lumbar fusion and cyst removal. OUTCOMES The patient's symptoms disappeared, and have not recurred for 1 year at the time of writing. CONCLUSIONS PDP is a rare complication of lumbar discectomy. Repeat lumbar discectomy can effectively treat PDP, but the cyst can recur. We, for the first time, used posterior instrumented lumbar fusion to successfully treat recurrent PDP.
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Affiliation(s)
- Hong Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Shuang Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Yu Chen
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Liang Zheng
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
| | - Junxiong Ma
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, Liaoning Province, China
- * Correspondence: Junxiong Ma, Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, No. 83 Wenhua Road, Shenhe District, Shenyang 110000, Liaoning Province, China (e-mail: )
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15
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Smaal JA, Postma AA, Beckervordersandforth J, Anten M. Primary bone destruction and extracranial metastases in an atypical glioblastoma with sarcomatoid features. BMJ Case Rep 2022; 15:e247248. [PMID: 35981750 PMCID: PMC9394198 DOI: 10.1136/bcr-2021-247248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A man in his early 40s was referred to the neurology department with headache, hemianopsia and a palpable fluctuating mass on the back of his head. Investigations revealed a right-sided parieto-occipital mass with involvement of dura, bone and subcutaneous tissue. After debulking, pathological examination revealed a primary high-grade glioma with sarcomatoid features and a small-cell component. Concurrent chemoradiation was initiated. 10 weeks postoperatively, symptomatic bone metastases were diagnosed. During the clinical course, local and systemic treatment was consecutively administered, in order to control both primary tumour site and metastatic lesions. Due to progression of both intracranial and extracranial tumour load treatment was eventually discontinued; the patient passed away 28 months after initial presentation. The combination of a high-grade glioma with local destruction of the skull and subsequent metastasis is extremely rare and, when these features do occur, warrant a tailored approach to control both intracranial and extracranial tumour load.
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Affiliation(s)
- Johanna A Smaal
- Department of Neurology, Maastricht UMC+, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology & Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands
| | | | - Monique Anten
- Department of Neurology, Maastricht UMC+, Maastricht, The Netherlands
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16
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Roopesh Kumar VR, Madhugiri VS, Karthikayan A, Ratha V, Bapu S. Simplifying the Surgical Strategy for Excising Medial Sphenoid Wing Meningiomas: A Stepwise Approach. Neurol India 2022; 70:928-933. [PMID: 35864620 DOI: 10.4103/0028-3886.349676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medial sphenoid wing meningiomas constitute 15%-20% of all intracranial meningiomas. These lesions have a propensity to encase the vessels of the circle of Willis and the surrounding cranial nerves. Thus, radical excision is a difficult proposition. OBJECTIVES In this paper, we analyzed our series of sphenoid wing meningiomas. We describe our surgical strategy, which was based on zone-wise dissection of the tumor. We describe the complications and outcomes of surgery. MATERIALS AND METHODS This case series is a retrospective analysis of a single surgeon series of medial sphenoid wing meningiomas operated over a 13-year period. Clinical, radiographic, and outcome variables were studied. The surgical videos were analyzed in detail. The meningioma and its extensions were divided into several zones and a zone-wise strategy for tumor excision was evolved. RESULTS Twenty-four patients with medial sphenoid wing meningiomas were operated. In 14 patients, Simpson grade 3 excision could be achieved; 5 patients had Simpson grade 4 and 1 patient, grade 5 excision. Four (of 24 patients, 16.7%) had vessel injuries. CONCLUSIONS Medial sphenoid wing meningiomas are difficult lesions to excise radically. Close follow-up of residual lesions (especially if attached to the basal dura) is warranted. Additional modalities of treatment like radiosurgery may be required in case of any progression and for higher-grade lesions.
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Affiliation(s)
- V R Roopesh Kumar
- Department of Neurosurgery, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Venkatesh S Madhugiri
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | | | - Vishwaraj Ratha
- Department of Neurosurgery, SRM Institute of Medical Sciences, Chennai, Tamil Nadu, India
| | - Suresh Bapu
- Department of Neurosurgery, SRM Institute of Medical Sciences, Chennai, Tamil Nadu, India
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17
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Wang X, Wang J, Wang L, Lin Y, Yang M, Chen X, Teng L, Guo H, Chen X. Surgical Resection of Dorsal Spinal Meningiomas with the Inner Dura Layer - an Improved Preservation Technique of Spinal Dura in 40 Cases. World Neurosurg 2022; 160:e250-e255. [PMID: 34999010 DOI: 10.1016/j.wneu.2021.12.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal meningiomas are the common benign tumors in intradural extramedullary spinal tumors. Simpson grade I resection is recommended to avoid tumor recurrence. However, the dura reconstruction increases a risk of cerebrospinal fluid leakage after this surgical resection. To address this concern, the inner dura layer resection and the long-term surgical outcomes of this technique were designed and examined after total tumor resection to preserve the outer dura layer. METHODS This study included 40 spinal meningioma patients undergoing the outer dura layer resection between 2002 and 2019. Clinical characteristics, radiological features, pre- and post-operative functional states, tumor recurrence and perioperative complications were described and evaluated. RESULTS A total of 40 spinal meningioma cases with the median age of 63 years (36-81 years) are enrolled in this study. The median postoperative follow-up period of all 40 cases is 96 months (34-193 months). About 82.5% of cases are located in the thoracic spine, while 16.5% of cases are located in the cervical spine. Of the symptomatic cases, 87.5% of cases follow with satisfactory outcomes, 12.5% of cases follow with unexpected outcomes. The local spinal meningioma recurrence rate was 2.5% (1 of 40 cases). None postoperative cerebrospinal fluid leak occurs in all 40 spinal meningioma cases. CONCLUSION A long-term of postoperative follow-up indicated this modified spinal dura preservation technique causes the good neurological improvement with rare recurrence. Therefore, we recommend this improved technique may be an alternative surgical option for total resection of spinal meningiomas with favorable prognosis.
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Affiliation(s)
- Xiaoxiong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China
| | - Jiabin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China
| | - Liankun Wang
- Department of Neurology, Heilongjiang Province Hospital, Harbin, People's Republic of China
| | - Yongdong Lin
- Department of Neurosurgery, Traditional Chinese Medicine Hospital, Jixi, People's Republic of China
| | - Mingchun Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China
| | - Xiaoli Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Lei Teng
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China
| | - Hua Guo
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xiaofeng Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China.
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18
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Murugan C, Kavishwar RA, Ramachandran K, Shetty AP, B T P, Rajasekaran S. Spinal Hypertrophic Pachymeningitis Causing Thoracic Myelopathy in a Patient of Takayasu Arteritis: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00053. [PMID: 34762610 DOI: 10.2106/jbjs.cc.21.00520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE A 52-year-old man presented with thoracic myelopathy, and his magnetic resonance imaging (MRI) was suggestive of T1-T4 hypertrophic-pachymeningitis. Incidentally, circumferential thickening of the infra-renal abdominal aorta and right common iliac artery was seen, which along with the findings in a contrast computed tomography was consistent with Takayasu arteritis (TA). The patient underwent T1-T4 laminectomy, thinning of dura, biopsy, and steroid therapy. At the 1-year follow-up, he was asymptomatic and MRI revealed resolution of the lesion. CONCLUSION This is the first report describing an association between TA and hypertrophic spinal pachymeningitis, emphasizing the unusual neurological manifestation of myelopathy and complete resolution of symptoms with timely and appropriate intervention.
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Affiliation(s)
- Chandhan Murugan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - Rohit Akshay Kavishwar
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - Pushpa B T
- Department of Radiology, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
| | - S Rajasekaran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India
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González-López P, Luna E, Abarca-Olivas J, Daniel RT. How I do it: paramedian supracerebellar transtentorial approach for a temporomesial glioma. Acta Neurochir (Wien) 2021; 163:1311-1316. [PMID: 33786685 DOI: 10.1007/s00701-021-04825-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Classical approaches to the temporomesial region (TMR) include transtemporal, transylvian, or subtemporal. The supracerebellar infratentorial, initially developed to access dorsolateral cavernomas, has of late shown its versatility to access areas around the central core. The TMR is one such area that can be accessed through this approach with the addition of a tentorial incision. METHOD The paramedian supracerebellar transtentorial approach (PSCTA) is described along with its advantages and limits compared to other approaches to treat TMR gliomas. CONCLUSION The PSCTA offers a basal panoramic view of the TMR without the need of retraction, cortical incision, and white matter transgression.
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Affiliation(s)
- Pablo González-López
- Department of Neurosurgery, Hospital General Universitario de Alicante, Avda. Pintor Baeza sn, 03010, Alicante, Spain.
| | - Enrique Luna
- Department of Neurosurgery, Hospital General Universitario de Alicante, Avda. Pintor Baeza sn, 03010, Alicante, Spain
| | - Javier Abarca-Olivas
- Department of Neurosurgery, Hospital General Universitario de Alicante, Avda. Pintor Baeza sn, 03010, Alicante, Spain
| | - Roy T Daniel
- Department of Neurosurgery, CHUV, Lausanne, Switzerland
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20
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Zhang X, Zhang P, Wang JJ, Dong S, Wu Y, Zhang H, Wang G. Intraspinal clear cell meningioma without dural attachment: A case report and literature review. Medicine (Baltimore) 2021; 100:e25167. [PMID: 33726004 PMCID: PMC7982228 DOI: 10.1097/md.0000000000025167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Clear cell meningioma (CCM) is one of the rarest but most aggressive forms of meningioma, with a tendency to occur at a high recurrence rate. Intraspinal CCM, especially the nondura-based type, is even rarer than the intracranial CCM. PATIENT CONCERNS We report a case of a 45-year-old woman who presented with a 1-month history of episodic pain in the lower back and in both thighs in the front side. Femoral nerve stretch tests were positive on both sides. Magnetic resonance imaging (MRI) demonstrated an intradural tumor at the L3 level, which was isointense on T1- and T2-weighted images (WI) and homogeneously enhanced on gadolinium-contrast T1 WI. DIAGNOSES The space-occupying lesion was pathologically confirmed as CCM. INTERVENTIONS During surgery, we found that the tumor adhered to a nerve root, without dural attachment. The nerve root was partially removed to achieve complete resection. OUTCOMES The pain disappeared after the operation. The 1 year follow-up MRI revealed no evidence of tumor recurrence or metastasis. LESSONS Nondura-based intraspinal CCM is easier to completely remove, and such complete removal should be achieved during the first operation. Although the recurrence rate of this particular type of meningioma appears to be lower than that of other types, close clinical and radiological follow-up is necessary.
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21
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Casselli T, Divan A, Vomhof-DeKrey EE, Tourand Y, Pecoraro HL, Brissette CA. A murine model of Lyme disease demonstrates that Borrelia burgdorferi colonizes the dura mater and induces inflammation in the central nervous system. PLoS Pathog 2021; 17:e1009256. [PMID: 33524035 PMCID: PMC7877756 DOI: 10.1371/journal.ppat.1009256] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 02/11/2021] [Accepted: 12/22/2020] [Indexed: 02/06/2023] Open
Abstract
Lyme disease, which is caused by infection with Borrelia burgdorferi and related species, can lead to inflammatory pathologies affecting the joints, heart, and nervous systems including the central nervous system (CNS). Inbred laboratory mice have been used to define the kinetics of B. burgdorferi infection and host immune responses in joints and heart, however similar studies are lacking in the CNS of these animals. A tractable animal model for investigating host-Borrelia interactions in the CNS is key to understanding the mechanisms of CNS pathogenesis. Therefore, we characterized the kinetics of B. burgdorferi colonization and associated immune responses in the CNS of mice during early and subacute infection. Using fluorescence-immunohistochemistry, intravital microscopy, bacterial culture, and quantitative PCR, we found B. burgdorferi routinely colonized the dura mater of C3H mice, with peak spirochete burden at day 7 post-infection. Dura mater colonization was observed for several Lyme disease agents including B. burgdorferi, B. garinii, and B. mayonii. RNA-sequencing and quantitative RT-PCR showed that B. burgdorferi infection was associated with increased expression of inflammatory cytokines and a robust interferon (IFN) response in the dura mater. Histopathologic changes including leukocytic infiltrates and vascular changes were also observed in the meninges of infected animals. In contrast to the meninges, we did not detect B. burgdorferi, infiltrating leukocytes, or large-scale changes in cytokine profiles in the cerebral cortex or hippocampus during infection; however, both brain regions demonstrated similar changes in expression of IFN-stimulated genes as observed in peripheral tissues and meninges. Taken together, B. burgdorferi is capable of colonizing the meninges in laboratory mice, and induces localized inflammation similar to peripheral tissues. A sterile IFN response in the absence of B. burgdorferi or inflammatory cytokines is unique to the brain parenchyma, and provides insight into the potential mechanisms of CNS pathology associated with this important pathogen.
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Affiliation(s)
- Timothy Casselli
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
- * E-mail: (TC); (CAB)
| | - Ali Divan
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
| | - Emilie E. Vomhof-DeKrey
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
- Department of Surgery, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
| | - Yvonne Tourand
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
| | - Heidi L. Pecoraro
- Veterinary Diagnostic Laboratory, North Dakota State University, Fargo, North Dakota, United States of America
| | - Catherine A. Brissette
- Department of Biomedical Sciences, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, United States of America
- * E-mail: (TC); (CAB)
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Abstract
RATIONALE Idiopathic hypertrophic pachymeningitis (IHP) is a rare neurological disorder without a definite etiology. Diagnosis is mainly based on exclusion of other etiologies. PATIENT CONCERNS A 41-year-old male patient presented with insidious onset headache of 3-month duration. DIAGNOSES Contrast-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement over bilateral cerebral hemispheres and the tentorium cerebelli. Lumbar puncture showed increased pressure, lymphocytic pleocytosis, and elevated protein level with normal glucose concentration. Blood tests detected elevated erythrocyte sedimentation rate (ESR) and C-reactive protein. Pathological examination of the dura mater from the right frontal convexity disclosed coarse collagenous deposition with focal lymphoid aggregation. After malignancy and infectious etiologies were excluded, a diagnosis of IHP was made. INTERVENTIONS Oral prednisolone and azathioprine followed by methotrexate were administered. OUTCOMES During the 7-year follow-up period, although the patient was not totally headache-free, medical therapy significantly reduced the severity of headache. Follow-up MRI studies showed a reduction in meningeal enhancement and serial ESR measurements revealed a trend of improvement. LESSONS Methotrexate therapy may be considered in cases of steroid-resistant IHP. In addition to clinical evaluation, serial ESR testing may be considered to guide the treatment strategy and assess the response to therapy.
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Affiliation(s)
| | - Hung-Ping Wang
- Division of Rheumatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Taiwan
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Yu M, Ma L, Yuan Y, Ye X, Montagne A, He J, Ho TV, Wu Y, Zhao Z, Sta Maria N, Jacobs R, Urata M, Wang H, Zlokovic BV, Chen JF, Chai Y. Cranial Suture Regeneration Mitigates Skull and Neurocognitive Defects in Craniosynostosis. Cell 2021; 184:243-256.e18. [PMID: 33417861 PMCID: PMC7891303 DOI: 10.1016/j.cell.2020.11.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/28/2020] [Accepted: 11/16/2020] [Indexed: 01/20/2023]
Abstract
Craniosynostosis results from premature fusion of the cranial suture(s), which contain mesenchymal stem cells (MSCs) that are crucial for calvarial expansion in coordination with brain growth. Infants with craniosynostosis have skull dysmorphology, increased intracranial pressure, and complications such as neurocognitive impairment that compromise quality of life. Animal models recapitulating these phenotypes are lacking, hampering development of urgently needed innovative therapies. Here, we show that Twist1+/- mice with craniosynostosis have increased intracranial pressure and neurocognitive behavioral abnormalities, recapitulating features of human Saethre-Chotzen syndrome. Using a biodegradable material combined with MSCs, we successfully regenerated a functional cranial suture that corrects skull deformity, normalizes intracranial pressure, and rescues neurocognitive behavior deficits. The regenerated suture creates a niche into which endogenous MSCs migrated, sustaining calvarial bone homeostasis and repair. MSC-based cranial suture regeneration offers a paradigm shift in treatment to reverse skull and neurocognitive abnormalities in this devastating disease.
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Affiliation(s)
- Mengfei Yu
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA; Key Laboratory of Oral Biomedical Research, Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Li Ma
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Yuan Yuan
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Xin Ye
- Key Laboratory of Oral Biomedical Research, Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Axel Montagne
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Jinzhi He
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Thach-Vu Ho
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Yingxi Wu
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Zhen Zhao
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Naomi Sta Maria
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Russell Jacobs
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Mark Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90033, USA
| | - Huiming Wang
- Key Laboratory of Oral Biomedical Research, Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Berislav V Zlokovic
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, 1501 San Pablo Street, Los Angeles, CA 90033, USA
| | - Jian-Fu Chen
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA
| | - Yang Chai
- Center for Craniofacial Molecular Biology, University of Southern California, 2250 Alcazar Street, CSA 103, Los Angeles, CA 90033, USA.
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24
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Haghayeghi K, Robinson-Bostom L, Olszewski A, Jackson CL, Patel NR, Sewastianik T, Carrasco RD, Shanmugam V, Treaba DO. Aggressive CD4/CD8 Double-Negative Primary Cutaneous T-Cell Lymphoma With Dural Invasion: A Rare Presentation of Mycosis Fungoides? Am J Dermatopathol 2021; 43:63-66. [PMID: 32675473 DOI: 10.1097/dad.0000000000001725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Mycosis fungoides (MF) is primarily characterized by epidermotropic CD3+/CD4+/CD45RO+ memory T cells. CD4/CD8 double-negative MF is an uncommon variant with no presumed prognostic significance. Despite the variability in the clinical course and presentation of MF, most cases behave indolently. About 5% of patients, however, advance to stage IV with visceral organ involvement. Central nervous system metastasis in MF is rare with no known cases of direct central nervous system invasion by MF to date. We report an exceedingly rare locally aggressive case of CD4/CD8 double-negative MF with direct dural invasion and underline pertinent diagnostic challenges encountered in our case.
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MESH Headings
- Adult
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Dura Mater/immunology
- Dura Mater/pathology
- Female
- Head and Neck Neoplasms/genetics
- Head and Neck Neoplasms/immunology
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/therapy
- Humans
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Cutaneous/therapy
- Mycosis Fungoides/genetics
- Mycosis Fungoides/immunology
- Mycosis Fungoides/pathology
- Mycosis Fungoides/therapy
- Neoplasm Invasiveness
- Scalp/immunology
- Scalp/pathology
- Skin Neoplasms/genetics
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- Skin Neoplasms/therapy
- Treatment Outcome
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Affiliation(s)
- Koorosh Haghayeghi
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI
| | - Leslie Robinson-Bostom
- Department of Dermatology, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam Olszewski
- Division of Hematology Oncology, Rhode Island Hospital and Lifespan Cancer Center, Warren Alpert Medical School of Brown University, Providence, RI
| | - Cynthia L Jackson
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI
| | - Nimesh R Patel
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI
| | - Tomasz Sewastianik
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Department of Experimental Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland ; and
| | - Ruben D Carrasco
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vignesh Shanmugam
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Diana O Treaba
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI
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Omofoye OA, Lechpammer M, Steele TO, Harsh GR. Pituitary stalk gangliogliomas: Case report and literature review. Clin Neurol Neurosurg 2020; 201:106405. [PMID: 33340839 DOI: 10.1016/j.clineuro.2020.106405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/27/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Gangliogliomas rarely occur in the sella or suprasellar region and are almost never seen in the pituitary stalk. Seven cases of gangliogliomas occurring in this region have been reported; only one case involved a tumor within the pituitary stalk. Of the six tumors external to the pituitary stalk, two occurred in the neurohypophysis, one was in the adenohypophysis, the location of one was unspecified, and two extensively invaded the optic chiasm, hypothalamus and brainstem. This is only the second reported case of a pituitary stalk ganglioglioma, and it is unique in its use of an extended endoscopic endonasal approach for biopsy. CASE REPORT A 51-year old woman presented with an eleven-month history of polydipsia and polyuria leading to the diagnosis of diabetes insipidus. Magnetic Resonance Imaging of the brain revealed contrast-enhanced thickening and anterior bowing of the hypophyseal stalk. An extended endoscopic endonasal approach permitted midline removal of the tuberculum sella, opening of underlying dura, and exposure of the pituitary stalk. A firm, white, 4 mm diameter mass, integral to the right side of the enlarged pituitary stalk was seen and biopsied. Histopathological analysis was consistent with WHO grade 1 ganglioglioma. The patient tolerated the procedure well and required no endocrinologic treatment other than desmopressin. CONCLUSION Pituitary stalk gangliogliomas are extremely rare. The diagnosis should be considered in patients with pituitary stalk enlargement. Endoscopic endonasal approach is a safe surgical approach to establish a tissue diagnosis which is essential for pathologic certainty given the wide differential diagnosis of stalk lesions.
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Affiliation(s)
- Oluwaseun A Omofoye
- Department of Neurological Surgery, University of California Davis Health, 4860 Y Street Suite 3740, Sacramento, CA 95817, USA.
| | - Mirna Lechpammer
- Department of Pathology and Laboratory Medicine, University of California Davis Health, 4400 V Street, Sacramento, CA 95817, USA.
| | - Toby O Steele
- Department of Otolaryngology - Head and Neck Surgery, University of California Davis Health, 2521 Stockton Boulevard, Sacramento, CA 95817, USA.
| | - Griffith R Harsh
- Department of Neurological Surgery, University of California Davis Health, 4860 Y Street Suite 3740, Sacramento, CA 95817, USA.
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Polster SP, Dougherty MC, Zeineddine HA, Lyne SB, Smith HL, MacKenzie C, Pytel P, Yang CW, Tonsgard JH, Warnke PC, Frim DM. Dural Ectasia in Neurofibromatosis 1: Case Series, Management, and Review. Neurosurgery 2020; 86:646-655. [PMID: 31350851 DOI: 10.1093/neuros/nyz244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 04/06/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The natural history and management of dural ectasia in Neurofibromatosis 1 (NF1) is still largely unknown. Dural ectasias are one of the common clinical manifestations of NF1; however, the treatment options for dural ectasias remain unstudied. OBJECTIVE To investigate the natural history, diagnosis, management, and outcome of the largest case series of patients with NF1-associated dural ectasia to date. METHODS Records from our NF1 clinic were reviewed to identify NF1 patients with computed tomography or magnetic resonance imaging evidence of dural ectasia(s) to determine their clinical course. Demographics, symptoms, radiographic and histopathologic findings, treatment, and clinical course were assessed. RESULTS Thirty-four of 37 patients were managed without surgery. Of the 18 initially asymptomatic patients, 5 (27.8%) progressed to symptoms attributable to a dural ectasia (onset of 2.7% per patient-year). Three patients required surgical intervention because of extraspinal mass effect. All 3 initially improved but had symptom recurrence within 2 yr. Reoperation involved shunt placement for cerebrospinal fluid (CSF) diversion. On imaging review, 26 (76.5%) of the nonsurgical patients harbored an associated nearby plexiform neurofibroma. Pathology of one surgical case revealed dural infiltration by diffuse neurofibroma. CONCLUSION Using the largest NF1-associated dural ectasia group to date, we report the first symptom-onset rate for nonsurgical patients. In the few cases requiring surgery for decompression, primary resection, and patching of ectasias failed, subsequently requiring CSF shunting. We demonstrate imaging evidence of nearby plexiform neurofibroma in a majority of cases, which, when combined with histopathology, provides a novel explanation for the formation of dural ectasias.
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Affiliation(s)
- Sean P Polster
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Mark C Dougherty
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Hussein A Zeineddine
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Seán B Lyne
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Heather L Smith
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Cynthia MacKenzie
- Ambulatory Program for Neurofibromatosis, Department of Pediatrics and Neurology, University of Chicago Medicine, Chicago, Illinois
| | - Peter Pytel
- Department of Pathology, University of Chicago Medicine, Chicago, Illinois
| | - Carina W Yang
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | - James H Tonsgard
- Ambulatory Program for Neurofibromatosis, Department of Pediatrics and Neurology, University of Chicago Medicine, Chicago, Illinois
| | - Peter C Warnke
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - David M Frim
- Section of Neurosurgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
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27
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Sunderland AJ, Steiner RE, Al Zahrani M, Pinnix CC, Dabaja BS, Gunther JR, Nastoupil LJ, Jerkeman M, Joske D, Cull G, El‐Galaly T, Villa D, Cheah CY. An international multicenter retrospective analysis of patients with extranodal marginal zone lymphoma and histologically confirmed central nervous system and dural involvement. Cancer Med 2020; 9:663-670. [PMID: 31808316 PMCID: PMC6970027 DOI: 10.1002/cam4.2732] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022] Open
Abstract
Marginal zone lymphoma of the central nervous system (CNS MZL) is rare. The clinical features, treatment, and prognosis are not well characterized. We performed a multicenter retrospective study of CNS MZL. Twenty-six patients were identified: half with primary and half with secondary CNS involvement. The median age was 59 years (range 26-78), 62% female and 79% with ECOG performance status ≤ 1. The most common disease site was the dura (50%). Treatment was determined by the treating physician and varied substantially. After a median follow up of 1.9 years, the estimated 2-year progression-free (PFS) and overall survival (OS) rates were 59% and 80%, respectively. Secondary CNS MZL was associated with 2-year OS of 58%. CNS MZL is rare, but relative to other forms of CNS lymphoma, outcomes appear favorable, particularly among the subset of patients with dural presentation and primary CNS presentation.
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Affiliation(s)
| | | | - Musa Al Zahrani
- University of British Columbia and BC Cancer Centre for Lymphoid CancerVancouverBritish ColumbiaCanada
- Department of MedicineKing Saud University HospitalRiyadhSaudi Arabia
| | - Chelsea C. Pinnix
- Department of Radiation OncologyMD Anderson Cancer CenterHoustonTXUSA
| | | | | | | | | | - David Joske
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory Medicine WANedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
| | - Gavin Cull
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory Medicine WANedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
| | - Tarec El‐Galaly
- Department of HematologyAalborg University HospitalAalborgDenmark
| | - Diego Villa
- University of British Columbia and BC Cancer Centre for Lymphoid CancerVancouverBritish ColumbiaCanada
| | - Chan Yoon Cheah
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory Medicine WANedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
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28
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Kosaka T, Ikeda N, Furuse M, Nonoguchi N, Hiramatsu R, Yagi R, Kawabata S, Miyachi S, Kuroiwa T, Wanibuchi M. Refractory Chronic Subdural Hematoma Associated with Dural Metastasis of Lung Adenocarcinoma Treated with Endovascular Embolization for the Middle Meningeal Artery: A Case Report and Review of the Literature. World Neurosurg 2019; 133:256-259. [PMID: 31629135 DOI: 10.1016/j.wneu.2019.10.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/05/2019] [Accepted: 10/08/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endovascular embolization of the middle meningeal artery (MMA) is effective for recurrent chronic subdural hematoma (CSDH). CSDH associated with dural metastasis is generally refractory to burr hole surgery and has poor prognosis even if any interventions are applied. To the best of our knowledge, this study is the first to report a case of refractory CSDH associated with dural metastasis that was successfully treated with embolization of the MMA. CASE DESCRIPTION A 66-year-old man with a 1-year history of lung adenocarcinoma had also undergone whole-brain irradiation for multiple brain metastases 5 months before presentation, surgical removal of relapse of brain metastases 3 months prior, and stereotactic radiotherapy for the relapses 1 month prior. He was admitted to our institution with speech disturbance, severe headache, and right-sided motor weakness. Head computed tomography on admission revealed left-sided CSDH, and emergency burr hole irrigation surgery was performed. However, CSDH recurred twice in a short period after hospitalization. Histological examination revealed adenocarcinoma cells in the dura mater and in hematoma samples during the first surgery; therefore, the patient was diagnosed with refractory CSDH associated with dural metastasis of lung adenocarcinoma. We performed endovascular embolization of the MMA, followed by systemic chemotherapy at 1 month after embolization, and no recurrence of the CSDH was observed. CONCLUSIONS Embolization of the MMA has few surgical risks and could be a treatment option for refractory CSDH associated with dural metastasis because it might prolong the therapeutic time window until radical therapies are administered.
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Affiliation(s)
- Takuya Kosaka
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naokado Ikeda
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
| | - Motomasa Furuse
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naosuke Nonoguchi
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryo Hiramatsu
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryokichi Yagi
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shinji Kawabata
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shigeru Miyachi
- Department of Neurosurgery and Neuroendovascular Center, Aichi Medical University, Nagakute, Aichi, Japan
| | - Toshihiko Kuroiwa
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan; Department of Neurosurgery, Tesseikai Neurosurgical Hospital, Shijonawate, Osaka, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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29
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Oria M, Tatu RR, Lin CY, Peiro JL. In Vivo Evaluation of Novel PLA/PCL Polymeric Patch in Rats for Potential Spina Bifida Coverage. J Surg Res 2019; 242:62-69. [PMID: 31071606 DOI: 10.1016/j.jss.2019.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/20/2019] [Accepted: 04/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current therapeutic materials for spina bifida repair showed a limited number of options in the market, and none of them have all the requirements as the ideal patch. In fact, sometimes the surgical procedures pose substantial challenges using different patches to fully cover the spina bifida lesion. For this purpose, a tailored patch made of poly (L-lactic acid) and poly (ε-caprolactone) blend was designed and validated in vitro to accomplish all these requirements but was never tested in vivo. MATERIAL AND METHODS In our present study, the designed patch was analyzed in terms of rejection from the animal when implanted subcutaneously and as a dural substitute in the spinal cord. Inflammatory reaction (Iba1), astrogliosis (GFAP), was analyzed and functional interaction with spinal cord tissue assessing the (%motor-evoked potentials /compound motor action potential) by electrophysiology. RESULTS No evidence of adverse or inflammatory reactions was observed in both models of subcutaneous implantation, neither in the neural tissue as a dural substitute. No signs of astrogliosis in the neural tissue were observed, and no functional alteration with improvement of the motor-evoked potential's amplitude was detected after 4 wk of implantation as a dural substitute in the rat spinal cord. CONCLUSIONS Designed patch used as a dural substitute will apparently not produce inflammation, scar formation, or tethering cord and not induce any adverse effect on regular functions of the spinal cord. Further studies are needed to evaluate potential improvements of this novel polymeric patch in the spinal cord regeneration using spina bifida models.
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Affiliation(s)
- Marc Oria
- Division of Pediatric General and Thoracic Surgery, Center for Fetal and Placental Research, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio
| | - Rigwed R Tatu
- Department of Biomedical Engineering, Structural Tissue Evaluation and Engineering Laboratory, University of Cincinnati, Cincinnati, Ohio
| | - Chia-Ying Lin
- Department of Biomedical Engineering, Structural Tissue Evaluation and Engineering Laboratory, University of Cincinnati, Cincinnati, Ohio
| | - Jose L Peiro
- Division of Pediatric General and Thoracic Surgery, Center for Fetal and Placental Research, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio.
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30
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Nambirajan A, Sharma MC, Garg K, Sriram S, Boorgula MT, Suri V. Large dural-based mass with bony hyperostosis in a 16-year-old male: IgG4-related disease mimicking lymphoplasmacyte-rich meningioma. Childs Nerv Syst 2019; 35:1423-1427. [PMID: 31073682 DOI: 10.1007/s00381-019-04187-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/16/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND IgG4-related disease is an autoimmune process that presents with tumefactive lesions characterized by storiform fibrosis, a dense lymphoplasmacytic infiltrate rich in IgG4+ plasma cells, obliterative phlebitis, and often elevated serum IgG4 levels. Central nervous system IgG4-related disease is very rare and usually occurs in the form of hypertrophic pachymeningitis or hypophysitis. Presentation as a large solitary meningioma-like mass with overlying hyperostosis in a young adult has not been reported before. CASE SUMMARY A 16-year-old male presented with focal seizures for 5 months. Imaging showed a large, extra-axial, and contrast-enhancing mass lesion in the left frontoparietal region with focal calvarial thickening. Histopathology revealed a fibrosclerotic lesion involving dura with a polymorphic infiltrate of plasma cells, mature lymphocytes, histiocytes, and occasional eosinophils. Immunohistochemical workup excluded the possibilities of meningioma, lymphoproliferative neoplasms, and histiocytic lesions. Majority of plasma cells were IgG4+ rendering a diagnosis of IgG4-related disease. Further serological and imaging workup did not reveal any evidence of systemic involvement. His serum IgG4 levels were normal. Considering a gross total resection of the lesion, no further treatment was given and the patient has been asymptomatic since. CONCLUSION IgG4-related lesions of the CNS are under-recognized and accurate diagnosis, especially in those with isolated CNS disease and normal serum IgG4 levels, necessitates robust histopathological and laboratory workup to exclude mimics. They may occur as large dural masses with hyperostosis and differentiation from lymphoplasmacyte-rich meningiomas, in particular, can be challenging. While steroids are the mainstay of treatment in IgG4-related disease, surgical resection may be curative in solitary lesions presenting with compressive symptoms.
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Affiliation(s)
- A Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, First Floor, Teaching Block, AIIMS, New Delhi, 110029, India
| | - M Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, First Floor, Teaching Block, AIIMS, New Delhi, 110029, India
| | - K Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, First Floor, Teaching Block, AIIMS, New Delhi, 110029, India
| | - S Sriram
- Department of Pathology, All India Institute of Medical Sciences, First Floor, Teaching Block, AIIMS, New Delhi, 110029, India
| | - M Thej Boorgula
- Department of Neurosurgery, All India Institute of Medical Sciences, First Floor, Teaching Block, AIIMS, New Delhi, 110029, India
| | - V Suri
- Department of Pathology, All India Institute of Medical Sciences, First Floor, Teaching Block, AIIMS, New Delhi, 110029, India.
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31
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Baranowski P, Baranowska A, Baranowska J, Konieczny R. Intradural disc herniation - report of two cases. Pol Merkur Lekarski 2019; 47:28-30. [PMID: 31385944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
UNLABELLED Intradural disc herniation is a very rare condition, which occurs in up to 0.3% cases of all disc herniations. It mostly develops at L4-L5 level, which is caused by the presence of strong adhesions between the posterior longitudinal ligament and dura mater. These rare cases are included in the classifications, however, they are associated with diagnostic difficulties, both in physical examination and in the image visible in magnetic resonance. REPORT OF 2 CASES The presented patients were treated in the Neuroortopedic Department within the last two years. Despite previous examinations, the final diagnosis of intradural disc herniation occurred only during the surgery. CONCLUSIONS Rarely occurring hernias of the intervertebral disc require increased vigilance among surgeon's spine physicians. Preoperative diagnosis of intradural lesion would make it possible to develop a better surgical strategy.
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Affiliation(s)
- Paweł Baranowski
- Department of Neuroorthopedics, Mazovian Rehabilitation Center - STOCER, Konstancin-Jeziorna, Poland
| | - Alicja Baranowska
- Department of Neuroorthopedics, Mazovian Rehabilitation Center - STOCER, Konstancin-Jeziorna, Poland
| | - Joanna Baranowska
- Department of Neuroorthopedics, Mazovian Rehabilitation Center - STOCER, Konstancin-Jeziorna, Poland
| | - Rafał Konieczny
- Department of Neuroorthopedics, Mazovian Rehabilitation Center - STOCER, Konstancin-Jeziorna, Poland
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Vicente Lacerda RA, Teixeira Júnior AG, Sauaia Filho EN, de Macêdo Filho LJM, Antônio AS, Cabral JA, Ramos Júnior F, Valença Júnior JT. Dural-Based Frontal Lobe Hemangioblastoma. World Neurosurg 2019; 129:18-23. [PMID: 31150863 DOI: 10.1016/j.wneu.2019.05.175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hemangioblastomas are benign vascular neoplasms that may be associated with von Hippel-Lindau disease. They are more common in men, with a mean age of 36 years, and rarely affect the supratentorial region and, when present in this topography, do not have meningeal impairment. Diagnosis by the radiologic and histopathologic study is difficult, since they are rare and, therefore, forgotten diagnosis, besides they are differential diagnoses with other supratentorial neoplasms. CASE DESCRIPTION The present report describes a case of a frontal hemangioblastoma in a 64-year-old woman who presented with seizures. Our imaging studies had as a main hypothesis a frontal meningioma because of dural tail sign, lack of edema, contrast enhancement pattern, and extra-axial location in the supratentorial region, in the frontal lobe, which is uncommon for a hemangioblastoma. The patient underwent microneurosurgery for tumor resection, and the excised tissue was submitted for anatomopathologic evaluation. This study clarified the diagnosis as hemangioblastoma. We followed up the patient at the outpatient clinic for 2 years, with clinical improvement, without tumor recurrence. We also compared the clinical, radiologic, epidemiologic, and anatomopathologic data of the reported case with data from a literature review conducted through the PubMed portal. CONCLUSIONS Definitive treatment for these lesions is surgical resection. Physicians should be aware that supratentorial meningeal hemangioblastomas can be developed in a patient without von Hippel-Lindau disease and regular follow-up is mandatory.
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Affiliation(s)
| | | | | | | | | | - Jan Araújo Cabral
- Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Ceará, Brazil
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Gómez MA, Mieres M, Ariyama N, Alvelo CM. What Is Your Neurologic Diagnosis? J Am Vet Med Assoc 2019; 254:67-70. [PMID: 30668289 DOI: 10.2460/javma.254.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Takenaka S, Makino T, Sakai Y, Kashii M, Iwasaki M, Yoshikawa H, Kaito T. Dural tear is associated with an increased rate of other perioperative complications in primary lumbar spine surgery for degenerative diseases. Medicine (Baltimore) 2019; 98:e13970. [PMID: 30608436 PMCID: PMC6344202 DOI: 10.1097/md.0000000000013970] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Prospective case-control study.This study used a prospective multicenter database to investigate whether dural tear (DT) is associated with an increased rate of other perioperative complications.Few studies have had sufficient data accuracy and statistical power to evaluate the association between DT and other complications owing to a low incidence of occurrence.Between 2012 and 2017, 13,188 patients (7174 men and 6014 women) with degenerative lumbar diseases underwent primary lumbar spine surgery. The average age was 64.8 years for men and 68.7 years for women. DT was defined as a tear that was detected intraoperatively. Other investigated intraoperative surgery-related complications were massive hemorrhage (>2 L of blood loss), nerve injury, screw malposition, cage/graft dislocation, surgery performed at the wrong site, and vascular injury. The examined postoperative surgery-related complications were dural leak, surgical-site infection (SSI), postoperative neurological deficit, postoperative hematoma, wound dehiscence, screw/rod failure, and cage/graft failure. Information related to perioperative systemic complications was also collected for cardiovascular diseases, respiratory diseases, renal and urological diseases, cerebrovascular diseases, postoperative delirium, and sepsis.DTs occurred in 451/13,188 patients (3.4%, the DT group). In the DT group, dural leak was observed in 88 patients. After controlling for the potentially confounding variables of age, sex, primary disease, and type of procedure, the surgery-related complications that were more likely to occur in the DT group than in the non-DT group were SSI (odds ratio [OR] 2.68) and postoperative neurological deficit (OR 3.27). As for perioperative systemic complications, the incidence of postoperative delirium (OR 3.21) was significantly high in the DT group.This study demonstrated that DT was associated with higher incidences of postoperative SSI, postoperative neurological deficit, and postoperative delirium, in addition to directly DT-related dural leak.
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Affiliation(s)
- Shota Takenaka
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka
| | - Takahiro Makino
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka
| | - Yusuke Sakai
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka
| | - Masafumi Kashii
- Orthopaedic Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka
| | - Motoki Iwasaki
- Orthopaedic Surgery, Osaka-Rosai Hospital, Sakai, Osaka, Japan
| | - Hideki Yoshikawa
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka
| | - Takashi Kaito
- Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka
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Chmieliauskas S, Anuzyte JS, Liucvaikyte J, Laima S, Jurolaic E, Rocka S, Fomin D, Stasiuniene J, Jasulaitis A. Importance of effusion of blood under the dura mater in forensic medicine: A STROBE - compliant retrospective study. Medicine (Baltimore) 2018; 97:e12567. [PMID: 30278562 PMCID: PMC6181611 DOI: 10.1097/md.0000000000012567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Subdural hemorrhage is commonly associated with mechanical brain injury and has a correspondingly high mortality rate. Subdural hematomas may immediately provoke symptoms or may be initially asymptomatic, with further symptoms evolving rapidly and fatally.The data regarding forensic autopsy of victims were obtained from The State Forensic Medicine Service of Lithuania between the years 2013 and 2016. A retrospective study was performed including 110 patients, whose cause of death was subdural hemorrhage. 95% confidence intervals were calculated.It was calculated, that in cases of sudden death, after subdural hemorrhage was diagnosed, a higher concentration of ethyl alcohol in blood (mean 2.22 ± 1.3%) demanded a smaller amount of blood under the dura matter (mean 81.6 ± 60.5 g) in order for the patient to die. It was also noted that hospitalized patients with subdural hemorrhage had a smaller concentration of blood ethyl alcohol (mean 1.33 ± 1%) and a larger amount of blood under the dura (mean 135.6 ± 82.9 g).Due to the toxic effect of ethyl alcohol, even a small amount (81.6 ± 60.5 g) of blood under the dura matter can determine a sudden death.
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Affiliation(s)
- Sigitas Chmieliauskas
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
- State Forensic Medicine Service
| | - Joginte Saule Anuzyte
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
| | - Julita Liucvaikyte
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
| | - Sigitas Laima
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
- State Forensic Medicine Service
| | | | - Saulius Rocka
- Department of Neurology and Neurosurgery, Vilnius University, Vilnius, Lithuania
| | - Dmitrij Fomin
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
- State Forensic Medicine Service
| | - Jurgita Stasiuniene
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
| | - Algimantas Jasulaitis
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University
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Krenzlin H, Ta-Chih T, Lampe C, Lampe C, Knuf M, Horn P, Schwarz M. Stand-alone craniocervical decompression is feasible in children with mucopolysaccharidosis type I, IVA, and VI. Spine J 2018; 18:1455-1459. [PMID: 29649608 DOI: 10.1016/j.spinee.2018.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/03/2018] [Accepted: 04/02/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In patients with mucopolysaccharidosis (MPS), glycosaminoglycan deposits in the dura mater and supporting ligaments cause spinal cord compression and consecutive myelopathy, predominantly at the craniocervical junction. Disease characteristics of craniocervical stenosis (CCS) in patients with MPS differ profoundly from other hereditary and degenerative forms. Because of high periprocedural morbidity and mortality, patients with MPS pose a substantial challenge to the inexperienced medical care provider. As literature remains scarce, we present our experience with a large cohort of patients with MPS treated for CCS without atlanto-occipital instrumentation. PURPOSE The present study aimed to describe a safe and least traumatic approach for treating CCS in children with MPS, avoiding primary instrumentation. STUDY DESIGN This is a prospective follow-up (cohort) study. PATIENT SAMPLES We report 15 consecutive patients with CCS related to MPS, who were treated with stand-alone cervical decompression. OUTCOME MEASURES Myelopathy was assessed using magnetic resonance imaging (MRI), somatosensory evoked potentials, and clinical evaluation. Cervical instability was evaluated using plain x-ray and MRI. The disability status is quantified using either the Karnofsky or Lansky Performance Score. METHODS We describe 15 consecutive patients treated with craniocervical decompression. Data were collected prospectively. The mean follow-up is 6 years (5 standard deviation). The technique and treatment principles are described. RESULTS The overall clinical outcome in this patient cohort is good (mean Karnofsky Performance Score of 80). No patient developed signs of C0-C1-C2 instability or progressive myelopathy. Restenosis occurred in seven patients, requiring a total of eight reoperations. CONCLUSIONS Surgery in patients with MPS is associated with high morbidity and mortality of up to 4.2%. Because of the unique nature of the disease, recurring stenosis is inevitable. To shorten the procedure time and simplify the anticipated reoperation, we provide data that craniocervical decompression is feasible without the necessity of primary osteosynthesis. In the absence of craniocervical instability, decompression surgery without occipitocervical stabilization yields good postoperative results and challenges the long-standing paradigm of prophylactic craniocervical fixation.
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Affiliation(s)
- Harald Krenzlin
- Department of Neurosurgery and Paediatric Neurosurgery, HELIOS Dr. Horst-Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Tan Ta-Chih
- Department of Neurosurgery and Paediatric Neurosurgery, HELIOS Dr. Horst-Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany; Department of Pediatrics, HELIOS Dr. Horst-Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
| | - Christina Lampe
- Center for Rare Diseases, HELIOS Dr. Horst-Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
| | - Christian Lampe
- Department of Pediatrics, HELIOS Dr. Horst-Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
| | - Markus Knuf
- Department of Pediatrics, HELIOS Dr. Horst-Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
| | - Peter Horn
- Department of Neurosurgery and Paediatric Neurosurgery, HELIOS Dr. Horst-Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
| | - Manfred Schwarz
- Department of Neurosurgery and Paediatric Neurosurgery, HELIOS Dr. Horst-Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany; Department of Pediatrics, HELIOS Dr. Horst-Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
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Ju JH, Kim SJ, Kim KH, Ryu DS, Park JY, Chin DK, Kim KS, Cho YE, Kuh SU. Clinical relation among dural adhesion, dural ossification, and dural laceration in the removal of ossification of the ligamentum flavum. Spine J 2018; 18:747-754. [PMID: 28939168 DOI: 10.1016/j.spinee.2017.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Dural laceration frequently occurs during surgery in patients with ossification of the ligamentum flavum (OLF), mainly because of dural adhesion (DA) and dural ossification (DO) between the ligamentum flavum and the dura mater. However, the radiological predictive factors of DA in OLF have rarely been reported. PURPOSE The objective of this study was to determine the preoperative radiological signs for predicting intraoperative DA in OLF by using preoperative magnetic resonance imaging (MRI) and computed tomography (CT). STUDY DESIGN This is a retrospective study. PATIENT SAMPLE This study included 182 patients who underwent decompressive laminectomy and OLF removal from 2005 to 2014. OUTCOME MEASURE Demographic data, preoperative neurologic status, surgical procedure and results, and intraoperative and postoperative complications were analyzed. Clinical outcome was assessed with the Japanese Orthopaedic Association score. MATERIALS AND METHODS Depending on the morphologic appearance of OLF in preoperative radiographs, we aimed to investigate the prevalence of intraoperative DA and DO. We used the following factors of representative classifications: (1) surface appearance, (2) "double-layer" or "tram-track" sign, (3) cross-sectional area of the stenosed level, (4) Sato classification as axial classification, (5) Kuh classification as sagittal classification, and (6) high-signal-intensity change on T2-weighted MRI. RESULTS Intraoperative evidence of DA was observed in 52 patients (29%), and DO was observed in 23 patients (13%). Twenty-seven patients (15%) had dural laceration during surgery. Statistically, DA was closely associated with the non-uniform type of surface appearance (odds ratio 5.396, p=.001) and with the presence of either a double-layer sign or a tram-track sign (odds ratio 11.525, p<.001). In the preoperative CT and MRI, 21 out of 23 patients with DO showed a "double-layer sign" or a "tram-track sign." CONCLUSIONS This study identified two predictive factors of DA in OLF, which were the non-uniform surface appearance and the presence of a double-layer sign or a tram-track sign. The presence of DO in OLF was closely associated with a double-layer sign or a tram-track sign in the preoperative radiological images.
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Affiliation(s)
- Jeong-Hyuk Ju
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Sung-Jun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Kyung-Hyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Dal-Sung Ryu
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Keun-Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Sung-Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, 211, Eonjuro Gangnam-gu, Seoul, 06273, Republic of Korea.
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Abstract
The case of a 42-year-old woman with aleukemic Bence Jones-type multiple myeloma who developed ocular abnormalities is described. Extramedullary plasmocytomas, either as solitary lesions or as manifestations of multiple myeloma, rarely involve the orbit and durai structures. Early detection of such lesions indicates an aggressive clinical course. In this paper we describe the magnetic resonance imaging findings of ocular and dural myelomatous involvement.
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Affiliation(s)
- Nermin Tuncbilek
- Department of Radiology, Trakya University School of Medicine, Edirne, Turkey.
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Noor Khairiah AK, Mohamad Nazrulhisham MN, John G. Lumbosacral osteosarcoma with dural spread, skip lesions and intravascular extension: A case report. Med J Malaysia 2018; 73:116-118. [PMID: 29703878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Primary osteosarcoma of the spine is indeed rare and only several sporadic cases have been reported. It tends to occur in a slightly older age group than those with appendicular skeleton tumours. We present here an unusual case of aggressive lumbosacral osteosarcoma in a young teenager complicated by extensive dural spread, skip lesions and intravascular extension. Although a histopathological examination is mandatory to establish the diagnosis, this case emphasises the need of imaging to ascertain the full extent of disease spread especially in deciding the type of treatment to be instituted and to evaluate the response to the treatment.
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Affiliation(s)
- A K Noor Khairiah
- Universiti Sains Malaysia, Advanced Medical and Dental Institute, Regenerative Medicine Cluster, Bertam, Kepala Batas, Pulau Pinang, Malaysia.
| | - M N Mohamad Nazrulhisham
- Hospital Pulau Pinang, Department of Cardiology, Jalan Residensi, Georgetown, Pulau Pinang, Malaysia
| | - G John
- University of Malaya, Faculty of Medicine, Department of Biomedical Imaging, Kuala Lumpur, Malaysia
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Kim H, Yi KS, Kim WD, Son SM, Yang Y, Kwon J, Han HS. Sequential spinal and intracranial dural metastases in gastric adenocarcinoma: A case report. World J Gastroenterol 2018; 24:651-656. [PMID: 29434454 PMCID: PMC5799866 DOI: 10.3748/wjg.v24.i5.651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/10/2017] [Accepted: 12/26/2017] [Indexed: 02/06/2023] Open
Abstract
Dural metastasis from primary gastric adenocarcinoma has been rarely reported, and its prognosis is very poor because it frequently leads to acute subdural hematoma. Here, we describe a case with sequential spinal and cranial dural metastases from gastric adenocarcinoma without subdural hematoma. A 43-year-old woman with gastric adenocarcinoma and well-controlled peritoneal carcinomatosis presented with back pain, right radiating leg pain, left facial palsy, and hearing loss. Magnetic resonance imaging of the spine and brain revealed dural masses at the lumbosacral junction with invasion to the L5 and S1 nerve roots and at the skull base with invasion to the internal auditory canal. She was treated with local radiotherapy, and her pain and neurologic symptoms improved after palliative radiotherapy. This is the first reported case of dural metastases of gastric adenocarcinoma of the spine and skull base but with a relatively indolent course and without subdural hematoma.
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Affiliation(s)
- Hongsik Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Seowon-gu, Cheongju 28644, South Korea
| | - Kyung Sik Yi
- Department of Radiology, Chungbuk National University Hospital, Seowon-gu, Cheongju 28644, South Korea
| | - Won-Dong Kim
- Department of Radiation Oncology, College of Medicine, Chungbuk National University, Seowon-gu, Cheongju 28644, South Korea
- Department of Radiation Oncology, Chungbuk National University Hospital, Seowon-gu, Cheongju 28644, South Korea
| | - Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Seowon-gu, Cheongju 28644, South Korea
| | - Yaewon Yang
- Department of Internal Medicine, Chungbuk National University Hospital, Seowon-gu, Cheongju 28644, South Korea
| | - Jihyun Kwon
- Department of Internal Medicine, Chungbuk National University Hospital, Seowon-gu, Cheongju 28644, South Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Seowon-gu, Cheongju 28644, South Korea
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Seowon-gu, Cheongju 28644, South Korea
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Su M, Ran Y, He Z, Zhang M, Hu G, Tang W, Zhao D, Yu S. Inhibition of toll-like receptor 4 alleviates hyperalgesia induced by acute dural inflammation in experimental migraine. Mol Pain 2018; 14:1744806918754612. [PMID: 29310498 PMCID: PMC5805005 DOI: 10.1177/1744806918754612] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/07/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022] Open
Abstract
Objective Although nociceptive sensitisation is an important pathophysiological process in migraine and migraine chronification, its underlying mechanisms remain unclear. Toll-like receptor 4 (TLR4), a pattern-recognition molecule, has a critical role in both neuropathic pain and morphine tolerance. The present study examined whether elements of the TLR4 pathway contribute to hyperalgesia induced by dural inflammation in rats. Methods A rat model of migraine was established by infusing a dural inflammatory soup. A group pretreated with TAK-242 was used to inhibit the activation of TLR4. The protein levels of TLR4 and its downstream molecules in the trigeminal pathway were examined by Western blot and immunofluorescence. The expression of activated microglia and astrocytes was also analysed. Levels of interleukin-1 beta, tumour necrosis factor-alpha, and brain-derived neurotrophic factor were measured by enzyme-linked immunosorbent assay. Results Acute inflammatory soup infusion induced time-dependent facial mechanical hyperalgesia, which was blocked by TAK-242 pretreatment. The inflammatory soup stimulus increased the production of TLR4 downstream molecules and interleukin-1 beta. Higher levels of microglia activation and brain-derived neurotrophic factor release were observed following the administration of the inflammatory soup but were alleviated by TAK-242. Conclusions These data suggest that the TLR4 signalling pathway promotes hyperalgesia induced by acute inflammatory soup delivery by stimulating the production of proinflammatory cytokines and activating microglia.
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Affiliation(s)
- Min Su
- Department of Neurology, Chinese PLA General Hospital, Beijing,
China
- School of Medicine, Nankai University, Tianjin, China
| | - Ye Ran
- Department of Neurology, Chinese PLA General Hospital, Beijing,
China
| | - Zizi He
- Department of Neurology, Chinese PLA General Hospital, Beijing,
China
| | - Mingjie Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing,
China
| | - Guanqun Hu
- Department of Neurology, Chinese PLA General Hospital, Beijing,
China
| | - Wenjing Tang
- Department of Neurology, Chinese PLA General Hospital, Beijing,
China
| | - Dengfa Zhao
- Department of Neurology, Chinese PLA General Hospital, Beijing,
China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing,
China
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Itaya S, Ueda Y, Kobayashi Z, Tomimitsu H, Kobayashi D, Shintani S. Bilateral Frontal Lobe Vasogenic Edema Resulting from Hypertrophic Pachymeningitis due to Granulomatosis with Polyangiitis. Intern Med 2017; 56:3353-3355. [PMID: 29021459 PMCID: PMC5790726 DOI: 10.2169/internalmedicine.8832-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 61-year-old woman presented with a 1-month history of decreased activities of daily living. Magnetic resonance imaging revealed abnormal intensities of the bilateral frontal lobes and enhancement of the thickened dura matter. A biopsy of the dura mater revealed multinucleated giant cells. She had sinusitis and hematuria; she was diagnosed with granulomatosis with polyangiitis. Hypertrophic pachymeningitis (HPM) was considered to have interrupted the venous flow and caused vasogenic edema. Bilateral frontal lobe edema resulting from HPM due to granulomatosis with polyangiitis has not been reported. A biopsy and examination for other organ complications were useful for the diagnosis and treatment of our patient.
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Affiliation(s)
- Sakiko Itaya
- Department of Neurology, JA Toride Medical Center, Japan
| | - Yasuhiro Ueda
- Department of Neurosurgery, JA Toride Medical Center, Japan
| | - Zen Kobayashi
- Department of Neurology, JA Toride Medical Center, Japan
| | | | - Daisuke Kobayashi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Japan
| | - Shuzo Shintani
- Department of Neurology, JA Toride Medical Center, Japan
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Sertbas I, Yilmaz A, Yildirim T, Karatay M, Celik H, Bayar MA. The role of pegaptanib sodium in the suppression of epidural fibrosis in a postlaminectomy rat model. ACTA ACUST UNITED AC 2017; 118:118-122. [PMID: 28814094 DOI: 10.4149/bll_2017_024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Spinal epidural fibrosis is a clinical condition that develops after laminectomy and can compress the spine. Many agents have been tried for the treatment, but none has entered clinical use at present. Pegaptanib sodium is an antiangiogenetic drug that prevents the development of new vessels and thus adhesion by inhibiting the effect of VEGF. MATERIAL AND METHOD 20 Wistar rats were used in this study. The rats were divided into 2 different groups as the control and pegaptanib sodium group. Three levels of laminectomy were performed. Only laminectomy was performed in the control group. A cotton ball soaked with 3 mg/kg Pegaptanib sodium diluted 1: 10 with 0.9 % NaCl was topically applied to the dura in the surgical field for 5 minutes in the pegaptanib sodium group. The rats were sacrificed 3 weeks later and histopathologically examined. The epidural fibrosis was graded. RESULTS The epidural fibrosis grade in the pegaptanib sodium was significantly lower than in the control group c2 = 11,65; (p = 0.004)CONCLUSION: Pegaptanib sodium blocked the VEGF through its anti-VEGF effect and decreased spinal epidural fibrosis in rats that had undergone laminectomy (Tab. 2, Fig. 3, Ref. 53).
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Lim YS, Mun JU, Seo MS, Sang BH, Bang YS, Kang KN, Koh JW, Kim YU. Dural sac area is a more sensitive parameter for evaluating lumbar spinal stenosis than spinal canal area: A retrospective study. Medicine (Baltimore) 2017; 96:e9087. [PMID: 29245329 PMCID: PMC5728944 DOI: 10.1097/md.0000000000009087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Narrowing of the dural sac cross-sectional area (DSCSA) and spinal canal cross-sectional area (SCCSA) have been considered major causes of lumbar central canal spinal stenosis (LCCSS). DSCSA and SCCSA were previously correlated with subjective walking distance before claudication occurs, aging, and disc degeneration. DSCSA and SCCSA have been ideal morphological parameters for evaluating LCCSS. However, the comparative value of these parameters is unknown and no studies have evaluated the clinical optimal cut-off values of DSCSA and SCCSA. This study assessed which parameter is more sensitive.Both DSCSA and SCCSA samples were collected from 135 patients with LCCSS, and from 130 control subjects who underwent lumbar magnetic resonance imaging (MRI) as part of a medical examination. Axial T2-weighted MRI scans were acquired at the level of facet joint from each subject. DSCSA and SCCSA were measured at the L4-L5 intervertebral level on MRI using a picture archiving and communications system.The average DSCSA value was 151.67 ± 53.59 mm in the control group and 80.04 ± 35.36 mm in the LCCSS group. The corresponding average SCCSA values were 199.95 ± 60.96 and 119.17 ± 49.41 mm. LCCSS patients had significantly lower DSCSA and SCCSA (both P < .001). Regarding the validity of both DSCSA and SCCSA as predictors of LCCSS, Receiver operating characteristic curve analysis revealed an optimal cut-off value for DSCSA of 111.09 mm, with 80.0% sensitivity, 80.8% specificity, and an area under the curve (AUC) of 0.87 (95% confidence interval, 0.83-0.92). The best cut off-point of SCCSA was 147.12 mm, with 74.8% sensitivity, 78.5% specificity, and AUC of 0.85 (95% confidence interval, 0.81-0.89).DSCSA and SCCSA were both significantly associated with LCCSS, with DSCSA being a more sensitive measurement parameter. Thus, to evaluate LCCSS patients, pain specialists should more carefully investigate the DSCSA than SCCSA.
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Affiliation(s)
- Young Su Lim
- Department of Anesthesiology and Pain Medicine, Institute for Integrative Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon
| | - Jong-Uk Mun
- Department of Orthopaedic Surgery, Changwon Gyeongsang National University Hospital, Republic of Korea
| | - Mi Sook Seo
- Department of Anesthesiology and Pain Medicine, Institute for Integrative Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon
| | - Bo-Hyun Sang
- Department of Anesthesiology and Pain Medicine, Institute for Integrative Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon
| | - Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, Institute for Integrative Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Jin Woo Koh
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Institute for Integrative Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary's Hospital, Incheon
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Abstract
RATIONALE We report the symptoms beginning with weakness and the clinical courses of a patient who was diagnosed with an intradural extramedullary bronchogenic cyst. PATIENT CONCERNS The patient was a 44-year-old man visited the Department of Physical Medicine and Rehabilitation for walking difficulties characterized by limping due to muscle weakness of left lower extremity for 5 months and atrophy in left calf muscle. DIAGNOSES Lumbar spine MRI was repeated, since radiating pain in the left hip and posterior thigh with low back pain developed 16 months later. Intraspinal mass of T12 and L1 levels that was not found in the first MRI was newly found in the follow-up MRI. INTERVENTIONS Total tumor removal was conducted with laminectomy. It was finally diagnosed as an intradural extramedullary bronchogenic cyst on the basis of the pathological analysis results. OUTCOMES His left calf circumference was increased compared to before surgery the radiating pain also disappeared. LESSONS If the patient's MRI findings are not correlated with the electrophysiologic and physical examination findings, additional MRI should be accompanied with other tests for an early detection.
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Affiliation(s)
| | | | | | - Yong Ko
- Department of Neurosurgery, Hanyang University College of Medicine, Seoul, Republic of Korea
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Fujisawa E, Shibayama H, Mitobe F, Katada F, Sato S, Fukutake T. [A case of primary central nervous system anaplastic lymphoma kinase positive anaplastic large cell lymphoma manifested as a unilateral pachymeningits]. Rinsho Shinkeigaku 2017; 57:705-710. [PMID: 29070753 DOI: 10.5692/clinicalneurol.cn-001030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There have been 23 reports of primary central nervous system anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma in the literature. Here we report the 24th case of a 40-year-old man who presented with occipital headache for one month. His contrast-enhanced brain MRI showed enhancement around the right temporal lobe, which suggested a diagnosis of hypertrophic pachymeningitis. He improved with steroid therapy. After discharge, however, he was readmitted with generalized convulsive seizures. Finally, he was diagnosed as primary central nervous system ALK-positive anaplastic large cell lymphoma by brain biopsy. Primary central nervous system lymphoma invading dura matter can rarely manifests as a unilateral pachymeningitis. Therefore, in case of pachymeningitis, we should pay attention to the possibility of infiltration of lymophoma with meticulous clinical follow-up.
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Affiliation(s)
| | | | - Fumi Mitobe
- Department of Neurology, Kameda Medical Center
| | | | - Susumu Sato
- Department of Neurology, Kameda Medical Center
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Tischfield MA, Robson CD, Gilette NM, Chim SM, Sofela FA, DeLisle MM, Gelber A, Barry BJ, MacKinnon S, Dagi LR, Nathans J, Engle EC. Cerebral Vein Malformations Result from Loss of Twist1 Expression and BMP Signaling from Skull Progenitor Cells and Dura. Dev Cell 2017; 42:445-461.e5. [PMID: 28844842 PMCID: PMC5595652 DOI: 10.1016/j.devcel.2017.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 05/04/2017] [Accepted: 07/31/2017] [Indexed: 12/20/2022]
Abstract
Dural cerebral veins (CV) are required for cerebrospinal fluid reabsorption and brain homeostasis, but mechanisms that regulate their growth and remodeling are unknown. We report molecular and cellular processes that regulate dural CV development in mammals and describe venous malformations in humans with craniosynostosis and TWIST1 mutations that are recapitulated in mouse models. Surprisingly, Twist1 is dispensable in endothelial cells but required for specification of osteoprogenitor cells that differentiate into preosteoblasts that produce bone morphogenetic proteins (BMPs). Inactivation of Bmp2 and Bmp4 in preosteoblasts and periosteal dura causes skull and CV malformations, similar to humans harboring TWIST1 mutations. Notably, arterial development appears normal, suggesting that morphogens from the skull and dura establish optimal venous networks independent from arterial influences. Collectively, our work establishes a paradigm whereby CV malformations result from primary or secondary loss of paracrine BMP signaling from preosteoblasts and dura, highlighting unique cellular interactions that influence tissue-specific angiogenesis in mammals.
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Affiliation(s)
- Max A Tischfield
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA; FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Neurology, Harvard Medical School, Boston, MA 02115, USA.
| | - Caroline D Robson
- Department of Radiology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Nicole M Gilette
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Shek Man Chim
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Folasade A Sofela
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Michelle M DeLisle
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA; FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Alon Gelber
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Brenda J Barry
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA; FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA; Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
| | - Sarah MacKinnon
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA
| | - Jeremy Nathans
- Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA; Department of Molecular Biology and Genetics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth C Engle
- Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Ophthalmology, Boston Children's Hospital, Boston, MA 02115, USA; FM Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Neurology, Harvard Medical School, Boston, MA 02115, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA; Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA.
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Abstract
RATIONALE Idiopathic hypertrophic pachymeningitis (IHP) is a rare condition, characterized by a chronic fibrosing inflammatory process usually involving either the intracranial or spinal dura mater, but rarely both. Here, we report a rare case of IHP affecting both the intracranial and spinal dura mater. We also discussed the diagnosis, management, and outcome of IHP. PATIENT CONCERNS We reviewed the case of a 60-year-old woman presenting with chronic headache, multiple cranial nerve palsies and gait disturbance. Magnetic resonance imaging (MRI) of her head revealed thickened and contrast-enhanced dura in the craniocervical region as well as obstructive hydrocephalus and cerebellar tonsillar herniation. The patient had a suboccipital craniectomy and posterior decompression through C1 plus a total laminectomy. The dura was partially resected to the extent of the bony decompression, and a duroplasty was performed. DIAGNOSES Microscopic examination of the surgically resected sample showed chronic inflammatory changes, lymphoplasmacytic cell infiltration, fibrous tissue hyperplasia, and hyaline degeneration. Blood tests to evaluate the secondary causes of hypertrophic pachymeningitis (HP) were unremarkable. INTERVENTIONS Steroid was used to treat suspected IHP. OUTCOMES Postoperatively, the patient showed gradual improvement in her headache, glossolalia, and bucking. Prior to discharge, a follow-up MRI showed improvement of the dura mater thickening. LESSONS IHP is a chronic inflammatory disorder of the dura mater that usually causes neurological deficits. Clinical manifestations of IHP, MRI findings, and laboratory abnormalities are the essential components for making an accurate diagnosis. When the radiological or laboratory evaluation is uncertain, but neurological deficits are present, a prompt surgical approach should be considered. Postoperative steroid therapy and close observation for recurrence are necessary to ensure a good long-term outcome.
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Affiliation(s)
| | - Jun Chen
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, The Third Military Medical University, Chongqing, China
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Wang BB, Xie H, Wu T, Xie N, Wu J, Gu Y, Tang F, Liu J. Controlled-release mitomycin C-polylactic acid film prevents epidural scar hyperplasia after laminectomy by inducing fibroblast autophagy and regulating the expression of miRNAs. Eur Rev Med Pharmacol Sci 2017; 21:2526-2537. [PMID: 28617531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To design a new controlled-release MMC-PLA film and explore whether and how this film could prevent epidural scar hyperplasia and adhesion in a post-laminectomy rat model. MATERIALS AND METHODS All procedures were performed under the approval and supervision of the Institutional Animal Care and Use Committee (IACUC) of Nanjing Medical University. A total of 120 Sprague-Dawley (SD) rats were randomly placed into four groups after laminectomy (each group=30 rats). In Group I, the laminectomy area was flushed with saline as a control; in Group II, 25 mg of PLA film was applied to the dura mater in the laminectomy area; in Group III, a cotton pad soaked with 0.01% MMC solution was kept on the laminectomy area; and in Group IV, 25 mg of PLA film containing 0.01% MMC was implanted on the laminectomy area. Magnetic resonance imaging (MRI), hematoxylin-eosin (HE) staining and Masson staining were used to evaluate scar adhesion and collagen deposition one month after the operation. Autophagy-related proteins, including autophagy-related gene 5 (ATG5), beclin 1, light chain-3B-2/1 (LC3B-2/1) and protein 53 (p53), were detected by Western blotting. A microRNA microarray analysis was performed to screen for scar tissue miRNAs, especially those associated with autophagy, and changes in expression were confirmed by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS A total of 112 rats recovered uneventfully from the surgery. MRI showed that the scar adhesion and scar area of the MMC-PLA group were significantly reduced compared with those of the PLA, MMC, and saline groups. Accordingly, scar adhesion and the deposition of collagen in the rats treated with MMC-PLA were also significantly reduced, as indicated by HE and Masson staining. In the scar tissue, the levels of autophagy-related proteins (ATG5, beclin 1, LC3B-2/1 and p53) were significantly elevated in the MMC-PLA group. Additionally, in the MMC-PLA group, the expression levels of miR-34a, miR-146a and miR-200 were significantly increased, while the levels of miR-16, miR-221 and miR-378a were significantly decreased. CONCLUSIONS The controlled-release MMC-PLA film could alleviate epidural scar hyperplasia after laminectomy; this outcome might be associated with increased autophagy and altered expression of miRNAs in the scar tissue.
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Affiliation(s)
- B-B Wang
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Jiangning District, Nanjing, China.
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Sakoda A, Yamashita KI, Hayashida M, Iwamoto Y, Yamasaki R, Kira JI. [A case of superficial siderosis ameliorated after closure of dural deficit detected by MRI-CISS (constructive interference in steady state) imaging]. Rinsho Shinkeigaku 2017; 57:180-183. [PMID: 28367945 DOI: 10.5692/clinicalneurol.cn-000960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 64-year-old male developed headache, dizziness, and difficulty hearing, two years after an operation for chronic subdural hematoma due to head injury. These symptoms gradually worsened over the following 15 years. As he showed bloody cerebrospinal fluid (CSF) and marginal hypointensity on the surface of the brain and spinal cord on T2/T2*-weighted MRI, he was diagnosed with superficial siderosis (SS), although the source of the bleeding was unclear and anti-hemorrhagic drugs were ineffective. When he was admitted to our hospital, neurological examination disclosed horizontal gaze-evoked nystagmus, severe bilateral hearing loss, scanning speech, and limb and truncal ataxia. CISS (constructive interference in steady state) MRI detected a dural defect at the Th2-3 level on the anterior side of the spinal canal. On operation, a 2 mm × 6 mm size dural defect with blood clots was found at the Th2-3 level. After closure of the dural defect, bloody CSF became transparent, and his persistent headache, dizziness, and hearing impairment improved. Brain and whole spine MRI, especially CISS imaging, should be considered for detecting the source of bleeding in intractable cases of SS.
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Affiliation(s)
- Ayako Sakoda
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Ken-Ichiro Yamashita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Mitsumasa Hayashida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
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