Low-Grade Astrocytoma Causing Dural and Calvarial Destruction.

Most of the literature on intra-axial lesions causing calvarial and dural destruction comes from case reports for glioblastoma, lymphoma, metastasis, and aggressive meningioma. Destruction of dura and calvaria by low-grade gliomas is extremely uncommon; cases reported so far have been mostly oligodendrogliomas. This article describes the unusual case of a 23-year-old male patient with a left-sided intra and extracranial tumor involving the frontal lobe, destroying the overlying dura and calvaria, who underwent maximal safe resection. Histopathology showed the tumor to be a low-grade astrocytoma. The calvarial thinning or remodeling caused by low-grade gliomas is thought to result from their chronic mass effect, by displacing the overlying layer of cerebrospinal fluid and transmitting brain pulsations directly to the inner table of the skull. Pressure thinning of the inner table of the skull may be caused by Pacchionian granulations close to the midline. Although this is extremely uncommon, magnetic resonance imaging may include low-grade astrocytoma in the differential diagnosis in such cases.

Hydatid Cyst of the Cerebellopontine Cistern: Report of Two Cases with Literature Review.

Posterior fossa localization of a hydatid cyst is uncommon; in these cases, the cyst usually locates in the cerebellum. Localization within the subarachnoid spaces or the cerebrospinal fluid ventricular system is exceptional. In the present report, which appears to be the seventh in the literature, we describe two cases of a hydatid cyst in the cerebellopontine cistern. Magnetic resonance imaging findings revealed a nonneoplastic cystic lesion mimicking an arachnoid cyst. The hydatid nature of the cyst was unexpected preoperatively. In both cases, the cyst was successfully removed using the puncture, aspiration, irrigation, and resection technique via a retrosigmoid approach. Histopathological examination confirmed the cysts to be Echinococcus granulosus in nature. Hydatid cyst may be considered in the differential diagnosis of arachnoid cysts of the cerebellopontine cistern to determine which surgical procedure to perform and to avoid unexpected complications. Previous published cases were also discussed.

Remote bifrontal epidural hematoma following hemispheric glioma resection. A rare life-threatening postoperative complication.

Background: Postoperative acute epidural hematoma (EDH) is a well-known serious complication that usually occurs at the operated site after cranial surgery. However, epidural bleeding, distant from the site of the previous craniotomy, is relatively rare and may sometimes cause significant neurological morbidity or even mortality. We report such a case. Case Description: A 35-year-old woman, previously healthy, was operated on for a left temporo-parieto-fronto-insular anaplastic astrocytoma. Between 2 and 4 h after the surgery, the patient had trouble waking-up following the general anesthesia. Emergent computed tomography (CT) scan revealed an acute bifrontal EDH away from the initial surgical field. The patient underwent an immediate reoperation, a decompressive bifrontal craniotomy, and the evacuation of the hematoma. Despite the neurologic improvement, she died 24 days after the surgery due to severe sepsis caused by pulmonary infection with pseudomonas aeruginosa. Conclusion: The pathophysiology of postoperative remote EDH is poorly understood, although various hypotheses have been suggested including the loss of tamponade effect, the vasomotor mechanisms, and the coagulopathy. As seen in the present case report, we suspected that the intensive use of perioperative mannitol may also promote this complication. In the early postoperative period, every patient with neurological deterioration should have a rapid cranial CT-scan because early detection and removal of postoperative acute EDH can be life-saving.

Iatrogenic Vascular Injury Associated with Cervical Spine Surgery: A Systematic Literature Review.

BACKGROUND: Iatrogenic vascular injury is an uncommon complication of anterior and/or posterior surgical approaches to the cervical spine. Although the results of this injury may be life-threatening, mortality/morbidity can be reduced by an understanding of its mechanism and proper management. METHODS: We conducted a literature review to provide an update of this devastating complication in spine surgery. A total of 72 articles including 194 cases of vascular lesions following cervical spine surgery between 1962 and 2021 were analyzed. RESULTS: There were 53 female and 41 male cases (in addition to 100 cases with unreported sex) with ages ranging from 3 to 86 years. The vascular injuries were classified according to the spinal procedures, such as anterior or posterior cervical spine surgery. The interval between the symptom of the vascular injury and the surgical procedure ranged from 0 to 10 years. Only two-thirds of patients underwent intra- or postoperative imaging and the most frequently injured vessel was the vertebral artery (86.60%). Laceration was the most common lesion (41.24%), followed by pseudoaneurysm (16.49%) and dissection (5.67%). Vascular repair was performed in 114 patients. The mortality rate was 7.22%, and 18.04% of patients had 1 or more other complications. Most presumed causes of vascular lesions were by instrumentation/screw placement (31.44%) or drilling (20.61%). Sixteen patients had an anomalous artery. Direct microsurgical repair was achieved in only 15 cases. CONCLUSIONS: Despite increased anatomical knowledge and advanced imaging techniques, we need to consider the risk of vascular injury as a surgical complication in patients with cervical spine pathologies.

Raphael Acquaviva: The Forgotten Pioneer of Modern Neurosurgery in Morocco.

For the young generations, it is important to state the values that define and recognize the role of leaders and pioneers in neurosurgery, especially in developing countries. This subject seems often overlooked. In Morocco, the real birth of modern neurosurgery as an independent surgical specialty was undoubtedly made thanks to Doctor Raphael Acquaviva during the 1950s and 1960s, when he founded the first neurosurgical department in Casablanca. Acquaviva was born during the First World War in Corsica (France). After finishing his undergraduate medical training in Beirut (Lebanon) in the 1940s, he joined the Maurice Gaud Hospital in Casablanca (Morocco). In 1954, Acquaviva received his medical degree from the Faculty of Medicine of Paris (France) with a thesis on brain tuberculomas. In 1960, Acquaviva became the first chief of neurosurgery at Casablanca and he accepted to train the first team of Moroccan neurosurgeons. Although the resources were limited, Acquaviva's skills and knowledge enabled him to achieve admirable results at those times. He managed to provide numerous clinical, radiologic, surgical, and pathologic descriptions in various fields of neurosurgery, especially in central nervous system infections. He was an excellent operator, very talented organizer, and fluent speaker. Moreover, he was involved in medical publications and education in his host country. In this article, the author reviews Acquaviva's career trajectory in its historical context, highlighting its impact on modern neurosurgery in Morocco and abroad. This contribution could be a good start to collect information to preserve the national neurosurgical memory in many developing countries.

Error publication (published erratum) in neurosurgical journals worldwide using PubMed during the last 30 years.

PURPOSE: The issue of error of scientific publications has recently attracted the interest of medical researchers. However, there was no similar evaluation of errata in the field of neurosurgical literature. The aim of this study is to evaluate published errata in neurosurgical journals and to discuss the strategies that can be used in order to reduce errata frequency and to prevent their dissemination. METHODS: A literature search of error publication in 28 main neurosurgical journals was performed using PubMed (1990-2019). Extracted data included authors' name, chronology, country of origin, journal impact factor, subject area, research type, reason for published error, and source of responsibility. RESULTS: A total of 441 published errata were identified and analyzed. Most studies were published within the last 6 years. The majority of publications had one single reason for the published erratum. The mean amount of time between the original publication date of the paper and the published erratum was 6.72 months. The most common reason given for published erratum was that of authorship, followed by text content, figures, and tables. The mean published error rate was 0.81% (2014-2019). CONCLUSION: Unlike other specialties, errors are infrequently observed in neurosurgical journals and mostly without altering the interpretation of study findings. However, improvement is still needed. With the development of online journal publishers and scientific social media platforms, new strategies must be studied in order to track and correct errors better and faster. Also, authors and publishers have to work better together in order to produce high-quality scientific papers.

Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review.

Iatrogenic vascular laceration is a rare but well-known complication of posterior lumbar disc surgery (PLUDS). We performed a review of the literature to evaluate the management of this life-threatening complication. A total of 54 papers containing 100 cases of vascular laceration following PLUDS between 1969 and 2018 were analyzed with our representative case with a left common iliac artery (CIA) laceration during a posterior approach for a far lateral L4-L5 disc herniation. There were 54 females and 35 males (12 cases with unreported gender) with ages ranging from 20 to 72 years. The most commonly involved spinal level was L4-L5 (n = 67). The duration from the causative surgery to the symptom of the vascular injury ranged from 0 to 50 h (mean, 7.3 h). Only 47.3% of patients underwent postoperative imaging and the most commonly injured vessel was the CIA (n = 49). Vascular repair, open surgery, and/or an endovascular procedure was performed in 95 patients. The most frequent complications were deep venous thrombosis in the leg and pulmonary emboli, where a complete recovery was seen in 75.3% of patients. The mortality rate was 18.8%. In hemodynamically unstable cases, an emergent exploratory laparotomy was life-saving even without vascular imaging, although angiography with/without endovascular intervention may be used in stable patients.

Rare Case of Hydatid Cyst in the Cerebellopontine Cistern.

Posterior fossa localization of a hydatid cyst is uncommon; in these cases, the cysts usually grow in the cerebellum. Localization within the subarachnoid spaces or the cerebrospinal fluid ventricular system is exceptional. In the present report, which appears to be the sixth in the literature, we describe a case of a hydatid cyst in the cerebellopontine cistern. Magnetic resonance imaging findings revealed a nonneoplastic cystic lesion mimicking an arachnoid cyst. The hydatid nature of the cyst was unexpected preoperatively. The cyst was successfully removed using the puncture, aspiration, irrigation, and resection technique via a retrosigmoid approach. Histopathologic examination confirmed the cysts to be Echinococcus granulosus in nature. Hydatid cyst may be considered in the differential diagnosis of arachnoid cysts of the cerebellopontine cistern to determine which surgical procedure to perform and to avoid unexpected complications.