Use of Wiltse approach in lumbar plexus schwannoma: A technical note.

Background: Lumbar plexus schwannomas are a rare occurrence in neurosurgery, with few reported cases and no standard surgical approach. This study describes a successful surgical resection with no complications using the Wiltse approach. Methods: Patient presented with an intra-psoas tumor suggesting schwannoma. We described the surgical technique involved step by step. Results: The patient recovered from the surgery with no complications. The anatomopathological examination confirmed the schwannoma diagnosis. The post operatory magnetic resonance imaging showed complete resection. Conclusion: This study shows that the use of Wiltse approach, mainly used for classical herniated disc extraforaminal, can be used successfully on Lumbar plexus schwannomas.

Remote Hemorrhagic Complications of Glioma Surgery: Systematic Review of the Literature and Report of a Case of Distant Wounded Glioma Syndrome, a Rare Neurosurgical Complication.

BACKGROUND: Hemorrhage following glioma resection usually happens in tissues that were surgically manipulated. Remote bleeding is a rare and serious complication that is still poorly understood. Distant wounded glioma syndrome is a special type of this complication, where bleeding happens in a glioma lesion that was not surgically manipulated. METHODS: A systematic review was conducted on the MEDLINE and Scielo databases. A new case of distant wounded glioma syndrome was reported and added to the results. RESULTS: We identified 501 articles using the search strategy and screened them. We reviewed the full text of 58 articles, of which 4 met the eligibility criteria. Including our new case, only 5 articles reported hemorrhage in locations remote from the resection site, with a total of 6 patients. CONCLUSIONS: Remote bleeding, including distant wounded glioma syndrome, is a rare complication that should be considered in cases of postoperative deterioration, especially in cases of symptoms not congruent with the operated site.

Lymphoplasmacyte-Rich Meningioma of the Third Ventricle: Case Report

Introduction Meningiomas are the most common primary intracranial tumors, accounting for up to 35% of the neoplasms in this category. Approximately 10­20% of these neoplasms are histologically atypical, and the lymphoplasmacyte-rich meningioma (LPM) corresponds to a very rare subtype of meningioma that is characterized histopathologically by massive infiltrates of inflammatory cells. The case described in the present study is the sixth case of an intraventricular LPM found in the literature and the first case considering the location in the third ventricle. Case Description A 21-year-old male without previous comorbidities sought medical attention due to visual impairment (complaining of intermittent visual blur) for 2 months. A magnetic resonance imaging of the brain confirmed the presence of a well-delimited solid mass in the third ventricle of 3.0 2.3 cmwith a cystic component that extended itself inferiorly and distorted the visual pathway anatomy. Neurosurgeons decided to access the lesion using an interhemispheric transcallosal approach with a transforaminal access, and the lesion was resected completely. The patient has an ambulatorial endocrinological follow-up and is neurologically stable 6 months after the procedure. No new visual deficits were noted. Conclusion Lymphoplasmacyte-rich meningioma is a very rare intracranial tumor, and the involvement of the third ventricle make this case unique.

Cerebellar hemorrhage as a complication of spine surgery.

BACKGROUND: The association between remote cerebellar hematoma (RCH) and spinal surgery is poorly understood and rarely reported. We present seven cases of RCH after spinal surgery. METHODS: Seven patients were diagnosed with RCH utilizing computed tomography and/or magnetic resonance, between 2012 and 2016. Their clinical presentations, imaging data, treatment modalities, and outcome were analyzed. There were five females and two males with an average age of 55.8 ± 8.4 years. The age of onset ranged from 43 to 67 years and the time to clinical presentation ranged from 3 h to 5 days. Patients presented with: diplopia/strabismus (one patient), dysphagia/urinary incontinence (one patient), respiratory arrest (one patient), meningismus (one patient), and dysarthria (two patients), along with other symptoms/signs. RESULTS: Three patients were successfully managed without surgery, two required external ventricular drainage, and two were treated with posterior fossa decompression plus ventriculostomy. Four patients recovered completely, two showed mild residual deficits at discharge, while one expired 7 days postoperatively. CONCLUSION: RCH is an uncommon and underdiagnosed complication of spine surgery. It should be suspected when intracranial symptoms occur after spinal procedures.

Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data.

OBJECTIVE: To study the impact of surgery on pain, disability, quality of life, and patient satisfaction in a sample of patients with Degenerative Lumbar Disease (DLD). METHODS: Retrospective analysis of prospectively collected data. Comparison between pre and postoperative (6 - 12 months) ODI and SF-36, plus postoperative Patient Satisfaction Index. RESULTS: From a total of 216 patients included, improvement was observed in average scores of pain (201.2%), disability (39.7%), physical quality of life (42%), and mental quality of life (37.8%). Among these patients, 57.7% reached or surpassed the minimal clinically important difference (MCID) for ODI, 57.7% for the SF-36 pain component, 59.7% for the SF-36 physical component summary, and 50.5% achieved or surpassed the MCID for the SF-36 mental component summary. CONCLUSIONS: Surgery produced a significantly positive impact on pain, disability, and quality of life of patients. Overall, 82.5% of the patients were satisfied.

Intracranial Subdural Hematoma after Spinal Anesthesia: Report of Two Cases with different Outcomes

Spinal anesthesia is a technique commonly used for local anesthesia and in obstetric surgeries. Rarely, the formation of an intracranial subdural hematoma (SDH) may result from spinal anesthesia, constituting a serious condition that often leads to severe neurological deficits. The presentation and course of this pathology may occur in a completely different way, which makes its diagnosis and management difficult. In the present article, the authors report two cases of patients with intracranial SDH after spinal anesthesia with completely different presentations and outcomes, demonstrating the variability of the manifestations of this condition. A quick review of key points of its pathophysiology, symptomatology, diagnosis, and treatment was also performed.

Impact of surgery on pain, disability, and quality of life of patients with degenerative lumbar disease: Brazilian data / Impacto da cirurgia na dor, incapacidade e qualidade de vida de portadores de doença degenerativa lombar: dados brasileiros

ABSTRACT Objective: To study the impact of surgery on pain, disability, quality of life, and patient satisfaction in a sample of patients with Degenerative Lumbar Disease (DLD). Methods: Retrospective analysis of prospectively collected data. Comparison between pre and postoperative (6 - 12 months) ODI and SF-36, plus postoperative Patient Satisfaction Index. Results: From a total of 216 patients included, improvement was observed in average scores of pain (201.2%), disability (39.7%), physical quality of life (42%), and mental quality of life (37.8%). Among these patients, 57.7% reached or surpassed the minimal clinically important difference (MCID) for ODI, 57.7% for the SF-36 pain component, 59.7% for the SF-36 physical component summary, and 50.5% achieved or surpassed the MCID for the SF-36 mental component summary. Conclusions: Surgery produced a significantly positive impact on pain, disability, and quality of life of patients. Overall, 82.5% of the patients were satisfied.

RESUMO Objetivo: Descrever o impacto da cirurgia na dor, incapacidade, qualidade de vida e a satisfação global do paciente numa amostra unificada de pacientes portadores de DDL. Métodos: Análise retrospectiva de dados colhidos prospectivamente em pacientes operados no período de janeiro de 2014 a março de 2017, que tivessem avaliação pré-operatória e pelo menos uma avaliação pós-operatória entre 6 e 12 meses com os questionários de ODI, SF-36 e o ISP. Resultados: Um total 216 pacientes preenchia os critérios de inclusão. Houve melhora no escore médio de dor (201,2%), incapacidade (39,7%), qualidade de vida física (42%) e mental (37,8%). Da amostra, 57,7% alcançaram o MCID de dor, 59,7% de ODI, 59,7% 50,5% de PCS e 50,5% de MCS; 82,5% dos pacientes se consideraram "Satisfeitos". Conclusões: O efeito da cirurgia foi amplamente favorável na dor, incapacidade e qualidade de vida dos pacientes portadores de DDL. Estes dados podem servir de guia para aconselhamento pré-operatório quanto às perspectivas de sucesso.

Atypical spinal epidural capillary hemangioma: Case report.

BACKGROUND: Hemangiomas are benign vascular malformations that can involve the spine. Pure epidural hemangiomas are rare and represent only 4% of all epidural lesions. Most hemangiomas are of the cavernous type; the capillary variant is atypical, and only ten cases have been reported in the literature. CASE DESCRIPTION: A 69-year-old female presented with nonspecific dorsal pain. Magnetic resonance imaging (MRI) showed a spinal epidural tumor at the T9-T10 level. Following a T9-T11 laminectomy, the lesion was completely resected en bloc. Histopathologic analysis showed a pure epidural capillary hemangioma with adipose tissue mesenchyma. CONCLUSIONS: Although epidural capillary hemangiomas are extremely rare, they should be considered among the differential diagnoses of extradural, extramedullary spinal lesions. Further, they must be differentiated from other more common lesions such as meningiomas and schwannomas. The recommended surgical management is en bloc gross total excision.

Pseudotumor Cerebri Presenting Unilateral Papilledema Associated with Iron-deficiency Anemia

Pseudotumor cerebri is a relatively common pathology that is characterized by intracranial hypertension in the absence of mass lesions. It commonly affects young and obese women, and its presentation with visual loss and bilateral papilledema is well-described in the literature. We present a case of a 44-year-old, non-obese, female patient presenting with unilateral papilledema and iron-deficiency anemia. This case emphasizes this unusual presentation and the rare association with iron deficiency.

O pseudotumor cerebral é uma patologia relativamente comum, caracterizada pela hipertensão intracraniana na ausência de lesões causando efeito de massa. Frequentemente afeta mulheres jovens e obesas, e sua apresentação, com perda do campo visual e papiledema bilateral, é bem descrita na literatura. Nós apresentamos um caso de uma paciente de 44 anos, não obesa, com papiledema unilateral e anemia ferropriva. Esse caso destaca essa apresentação incomum e a rara associação com a deficiência de ferro.