Understanding metastatic involvement of the conus medullaris: a systematic review of clinical presentations, diagnostic approaches, treatment options, and patient outcomes.

INTRODUCTION: Metastasis to the conus medullaris (CM) is a rare but devastating condition. This systematic review aimed to evaluate the clinical presentation, diagnostic workup, treatment options, and outcomes of patients with CM metastasis. By synthesizing the available evidence, this study seeks to improve our understanding of this condition and inform clinical practice. MATERIALS AND METHODS: A systematic review adhering to PRISMA guidelines analyzed literature on CM metastasis from 1997 to January 2024. Human studies in English were included, focusing on primary research articles. Screening criteria ensured a homogeneous study population, with data analyzed using SPSS 26 and assessed for quality using the JBI checklist. RESULTS: The study analyzed 88 patients with conus medullaris metastasis. Common symptoms included back pain (49.3%), sensory impairment (75%), and bladder dysfunction (60.3%). MRI was the primary diagnostic tool, revealing lesions above L1 (37%) or between L1 and L2 (29%). Treatment involved surgery with laminectomy, and combined therapy (surgery plus radiotherapy) in 81.3%. Postoperative outcomes showed improved motor function in 59.6% of patients, while combined therapy yielded better sensory and bowel/bladder function recovery. Median survival was 100 days. CONCLUSION: Metastasis to the conus medullaris is rare but significant. Surgical resection can improve motor function, while combined therapy (surgery plus radiotherapy) is effective in improving sensory manifestations and bowel/bladder functions. Despite these treatments, the median survival remains around 100 days, which is shorter compared to other types of intramedullary spinal cord metastases.

Bilateral cranioorbital foramina (Hyrtl foramina): crucial anatomical findings in the management of giant olfactory groove meningioma - a case report and literature review.

Presence of bilateral cranio-orbital foramina, AKA Hyrtl foramina is rare yet existing. They carry the risks of retinal artery emboli due to reflux embolization for the neurovascular interventionalists, navigating complexities in olfactory groove meningioma management. A 59-year-old woman with progressive frontal lobe syndrome presented a large olfactory groove meningioma primarily supplied by bilateral sphenopalatine arteries together with bilateral anterior cerebral arteries, necessitating risky preoperative embolization and meticulous resection. This case underscores the intricate nature of vascular supply in frontal skull base tumors, emphasizing the need for multidisciplinary approaches, thorough preoperative planning, and detective research to optimize treatment outcomes.

Pineal Apoplexy: Highlighting the Causes, Treatment, and Outcome.

BACKGROUND: Pineal apoplexy, alternatively referred to as pineal hemorrhage or pineal gland hemorrhagic stroke, is an infrequent pathologic condition characterized by bleeding within the pineal gland. In this review, we encompass the primary factors contributing to this uncommon ailment. METHODS: The retrieval of pertinent research, including patients with pineal apoplexy, was conducted through PubMed, Google Scholar, and Scopus databases. This study exclusively incorporated comprehensive articles written in the English language. The search encompassed the MeSH terms "pineal apoplexy" and "pineal hemorrhage." RESULTS: A total of 41 articles were identified, encompassing a collective sample size of 57 patients. The median age of the patients in the study was 30 years, with a range spanning from 1 to 73 years. There were 27 males, representing 47.4% of the participants. The study identified the most often reported symptoms as headache (49; 86%), nausea/vomiting (19; 33.3%), and Parinaud's syndrome (16; 28.1%). The treatment options encompass several approaches, including open resection, shunting, ventriculostomy, endoscopic aspiration, and conservative care. In the conducted study, a notable number of patients, amounting to 45 cases (78.9%), indicated an amelioration of their symptoms upon their discharge. CONCLUSION: Data from a cohort of 57 cases provide insights into symptoms, lesions, treatments, and outcomes. Management approaches range from conservative measures to surgical interventions, with prognosis hinged on timely intervention. This investigation serves as a valuable resource for clinicians and researchers, underscoring the need for early diagnosis before permanent neurologic dysfunction happens and tailored treatments for optimal outcomes in pineal apoplexy cases.

A case of anterior choroidal artery injury after resection of a pilocytic astrocytoma in the amygdale-a case report.

The anterior choroidal artery (AChA) arises from the last segment of internal carotid artery (ACI), the communicating C7 segment and comprises the terminal branch of ACI. Anatomical its origin located supraclionoidal after the ophthalmic C6 segment of ACI and after the rise of posterior communicating artery. The AChA gains greater importance because of its small size and its region of blood supply. With its perforating branches supplies important intracranial structures such as the optic tract, the posterior limb of the internal capsule, the lateral geniculate body, the medial temporal lobe and the medial area of the pallidum. The anterior choroidal artery is a fine artery and consists of two parts, a cisternal and a plexal one. There are only few studies published, which describe the exact anatomy and the impact of its damage. On the present report, we discuss a case of an iatrogenic injury of the anterior choroidal artery and its hazardous consequences.