Perineural tumor spread of bladder cancer causing lumbosacral plexopathy: an anatomic explanation.

We present two cases of biopsy-proven neoplastic lumbosacral plexopathy from perineural spread of bladder cancer: one patient presented with predominantly sciatic nerve involvement and the second predominantly with obturator nerve involvement. These two patterns of perineural spread from bladder cancer were supported by imaging in our cases and solidified by review of the literature. Based on the innervation of the bladder, we provide an anatomic explanation for this observation. To our best knowledge, such an anatomic, mechanistic basis for perineural tumor spread in bladder cancer has not yet been described.

Utility of the LevelCheck Algorithm for Decision Support in Vertebral Localization.

STUDY DESIGN: An automatic radiographic labeling algorithm called "LevelCheck" was analyzed as a means of decision support for target localization in spine surgery. The potential clinical utility and scenarios in which LevelCheck is likely to be the most beneficial were assessed in a retrospective clinical data set (398 cases) in terms of expert consensus from a multi-reader study (three spine surgeons). OBJECTIVE: The aim of this study was to evaluate the potential utility of the LevelCheck algorithm for vertebrae localization. SUMMARY OF BACKGROUND DATA: Three hundred ninety-eight intraoperative radiographs and 178 preoperative computed tomographic (CT) images for patients undergoing spine surgery in cervical, thoracic, lumbar regions. METHODS: Vertebral labels annotated in preoperative CT image were overlaid on intraoperative radiographs via 3D-2D registration. Three spine surgeons assessed the radiographs and LevelCheck labeling according to a questionnaire evaluating performance, utility, and suitability to surgical workflow. Geometric accuracy and registration run time were measured for each case. RESULTS: LevelCheck was judged to be helpful in 42.2% of the cases (168/398), to improve confidence in 30.6% of the cases (122/398), and in no case diminished performance (0/398), supporting its potential as an independent check and assistant to decision support in spine surgery. The clinical contexts for which the method was judged most likely to be beneficial included the following scenarios: images with a lack of conspicuous anatomical landmarks; level counting across long spine segments; vertebrae obscured by other anatomy (e.g., shoulders); poor radiographic image quality; and anatomical variations/abnormalities. The method demonstrated 100% geometric accuracy (i.e., overlaid labels within the correct vertebral level in all cases) and did not introduce ambiguity in image interpretation. CONCLUSION: LevelCheck is a potentially useful means of decision support in vertebral level localization in spine surgery. LEVEL OF EVIDENCE: N/A.

Penetrating brain injury after suicide attempt with speargun: case study and review of literature.

Penetrating cranial injury by mechanisms other than gunshots are exceedingly rare, and so strategies and guidelines for the management of PBI are largely informed by data from higher-velocity penetrating injuries. Here, we present a case of penetrating brain injury by the low-velocity mechanism of a harpoon from an underwater fishing speargun in an attempted suicide by a 56-year-old Caucasian male. The case raised a number of interesting points in management of low-velocity penetrating brain injury (LVPBI), including benefit in delaying foreign body removal to allow for tamponade; the importance of history-taking in establishing the social/legal significance of the events surrounding the injury; the use of cerebral angiogram in all cases of PBI; advantages of using dual-energy CT to reduce artifact when available; and antibiotic prophylaxis in the context of idiosyncratic histories of usage of penetrating objects before coming in contact with the intracranial environment. We present here the management of the case in full along with an extended discussion and review of existing literature regarding key points in management of LVPBI vs. higher-velocity forms of intracranial injury.