Bow Hunter's Syndrome with Rotational Atlantoaxial Instability: A Rare Association.

Bow Hunter's syndrome (BHS) is a very rare condition in which there is rotational vertebral artery (VA) insufficiency. The association of BHS with rotational atlantoaxial instability is extremely rare. We are reporting a case of pediatric BHS who presented with features of VA insufficiency on neck rotation. Careful evaluation revealed rotational C1-C2 instability. Provocative digital subtraction angiography and dynamic neck computed tomography were the mainstay of our diagnostic armamentarium. Our case emphasizes the fact that VA abnormalities need special consideration in young patients with craniovertebral junction instability and a high degree of suspicion is necessary in most instances for accurate diagnosis.

Combined Exoscopic- and Endoscopic-Assisted Resection of an Interpeduncular and Middle Fossa Epidermoid Cyst via a Transcavernous Approach: Technical Note.

OBJECTIVE: The endoscope and exoscope are gaining momentum as alternative visualization tools in the neurosurgical field, trying to overcome the limitations of an operative microscope and support minimally invasive approaches. However, few case series are available in the literature regarding their use in skull base surgery, especially in combined assisted resection, and their usefulness still needs to be proved. METHODS: An illustrative case to present the feasibility and minimally invasive advantages of a combined exoscopic- and endoscopic-assisted resection is reported. RESULTS: A 22-year-old man presented with a history of seizures and dizziness. Brain imaging showed a lesion involving the anteromedial middle fossa invading the interpeduncular cistern and impinging the brainstem, suggestive of an epidermoid cyst. A combined exoscopic- and endoscopic-assisted resection through a pterional transcavernous approach was planned and performed. No neurologic deficit occurred after the surgery, providing further evidence about the usefulness and safety of this hybrid technique. CONCLUSIONS: Combined exoscopic and endoscopic resection is also feasible and safe in complex skull base surgery. Moreover, this technique seems to be effective for minimizing the surgical invasiveness in skull base lesions.

A True Mimicker to Plasmacytoma Clinically, Radiologically, and Pathologically - A Rare Case Report.

Lympho plasmacytoma is distinct type of diffuse large B cell lymphoma predominantly seen in HIV-positive patients. The diagnosis of lympho plasmacytoma could be a challenge due to its overlapping characterizes with those of myeloma and lymphoma. We report a case of a 50-year-old man who initially presented with a painful solitary destructive lesion at the second lumbar vertebra. Clinico-pathological findings were consistent with a solitary plasmacytoma, and he was treated with definitive radiotherapy. Eight months after completing radiotherapy, he was found to have similar lesions at D4 vertebral body, multiple ribs, and pelvis. Subsequent biopsy confirmed lympho plasmacytoma. Because of its rarity and heterogeneous presentations, lympho plasmacytoma could easily be overlooked clinically and pathologically in immunocompetent patients. The diagnosis of lympho plasmacytoma should be considered when there is coexpression of myeloma and lymphoma immune markers.