A rare case of posterior reversible encephalopathy syndrome following posterior fossa ependymoma resection a surgical case report.

INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) is a rare complication following surgical intervention, with varied neurological manifestations. The inherent pathophysiology is diverse and risk factors include certain medical co-morbidities. PRESENTATION OF CASE: A previously well 24-year-old female, presented with signs of elevated intracranial pressure, with further investigations highlighting a posterior fossa tumor. She was scheduled for resection of this intracranial lesion and the surgical procedure was uneventful. However, moderate but significant labile increases in blood pressures were noted intra- and post- operatively. Following surgery, a clinical presentation of limb weakness and gaze deviation was observed, leading to investigative imaging demonstrating PRES. She was treated expeditiously by a multi-disciplinary team. There was complete resolution of her symptomology once the underlying cause was identified. DISCUSSION: PRES is not a typical complication of a neurosurgical patient. Moreso, in a young patient without any medical comorbidities. Deviation of her blood pressures from the normal lead to the formation of vasogenic edema along the cerebral hemispheres. The manifestation of this clinically made it arduous to pinpoint a definitive diagnosis. With the aid of different specialists, a diagnosis was clenched, and treatment was successfully implemented. CONCLUSION: The major learning point of this case history is the recognition of alterations from a patient's baseline vital signs (blood pressure) during and following surgical procedures. Additionally, the resultant consequences of these deviations, which may manifest as rare neurological conditions, such as PRES. The importance of a multi-disciplinary team in the management of this case was paramount.

A rare case of cavernous malformation of the cauda equina a case report.

INTRODUCTION: Cavernous malformation of the cauda equina is a rare neurosurgical condition. We sought to highlight one of these cases and its resultant diagnosis and management. Additionally, to recommend the need for raised clinical suspicion of these rare masses when an extramedullary lesion is noted on imaging. PRESENTATION OF CASE: A 42-year-old female presented to our institution with a 9-month history of lower back pain. Her examination findings revealed a loss of right ankle jerk reflex. Magnetic resonance imaging (MRI) of her lumbosacral spine demonstrated an intradural, extramedullary tumor involving the cauda equina, at the L4/L5 level. The main differential diagnosis at this time was an ependymoma. An L4/5 laminectomy and resection of the cauda equina mass was scheduled. Intra-operatively, a mulberry - like mass was noted involving a single nerve root. A gross total resection was performed, with resolution of most of her symptoms. Histopathological diagnosis of a cavernous malformation was ascertained. DISCUSSION: The accurate diagnosis of a cavernous malformation of the cauda equina was only suspected intra-operatively, following gross inspection. Cauda equina masses usually include myxopapillary ependymomas and schwannomas, making this vascular extramedullary lesion low on the possible differentials list. Very few cases have been published in modern literature. CONCLUSION: Cavernous malformations of the cauda equina are an extremely uncommon, benign vascular malformation. These malformations have key characteristics on MRI that can aid its differentiation from other intradural lesions. However, because it is so rare, it does not usually make the list of differentials when considering likely extramedullary lesions.

Examining the surgical backlog due to COVID-19 in Latin America and the Caribbean: insights from a scoping review.

This scoping review assessed the surgical backlog in Latin America and the Caribbean (LAC) due to COVID-19 and identified mitigation strategies. We searched seven databases for citations from December 2019 to December 2022, focusing on LAC patients with cancelled or postponed procedures. We registered our protocol at Open Science Framework (https://osf.io/x2nd8) and adhered to PRISMA-ScR guidelines. We included 83 citations covering 23 LAC countries and 19 surgical specialities, with Brazil (67%, 56/83) and transplant surgery (24%, 20/83) being the most documented. Surgical backlogs were mainly reported at the hospital (44%, 37/83) and national levels (38%, 32/83). We identified 58 citations that reported a total of 42 strategies to mitigate the backlog, the most cited being establishing prioritisation criteria for surgical cases (41%, 24/58). Our findings highlight challenges across differing healthcare systems in LAC, including disparities in data availability, surgical capacity, and resource allocation. For instance, while countries like Brazil had extensive data on national surgical backlogs, others lacked comprehensive national-level data. Our review can help inform policymakers and healthcare stakeholders to implement targeted interventions to prepare LAC-based surgical systems for future health emergencies.

Can we build better? Challenges with geospatial and financial accessibility in the Caribbean. Illustrative case.

BACKGROUND: Within the Caribbean, Curaçao provides a neurosurgical hub to other Dutch Caribbean islands. At times, the inefficiency of neurosurgical referrals leads to unsatisfactory patient outcomes in true emergency cases. OBSERVATIONS: This article reports an illustrative case of a patient in need of emergency neurosurgical care, who was referred to a tertiary health institution in Curaçao. This case highlights the challenges of timely neurosurgical referrals within the Dutch Caribbean. LESSONS: Highlighting this case may provide a foundation for further discussions that may improve neurosurgical care and access. Limiting long-distance surgical referrals in the acute care setting will aid in saving lives.

Neurosurgical training in the Caribbean.

•Neurosurgical training in the Caribbean has not been well-defined in published data.•Neurosurgical programs are the framework for the delivery of surgical care.•Maldistribution of the neurosurgery workforce is one of the challenges faced.•Facilitating partnerships within the Caribbean would enhance regional solidarity.

An Unsuspected Intraventricular Schwannoma.

Intraventricular schwannomas are rarely encountered in neurosurgical practice. The development and progression of a schwannoma within the ventricular system is still a hypothesised theory. Here, we present a case of a 59-year-old female who presented with a three-week history of headaches. Her symptoms progressively worsened, with resultant altered mental status within the last week. Imaging scans of the brain demonstrated a well-defined mass within the right lateral ventricle with associated midline shift and obstructive hydrocephalus. A parietal craniotomy and resection of the intraventricular mass was performed. Her postoperative course was uneventful. Histopathological assessment depicted a biphasic pattern of Antoni A and B, with a strongly positive S100. This was in keeping with an intraventricular schwannoma. The diagnosis of an intraventricular schwannoma does not fit within the classical differential framework for ventricular masses. These tumours are extremely uncommon but fortunately, they are typically benign. Therefore, adequate surgical resection remains the gold standard of care for these unfamiliar masses.

Multiple intracranial juvenile xanthogranuloma not a straightforward diagnosis (a case report).

INTRODUCTION AND IMPORTANCE: Juvenile xanthogranuloma (JXG) rarely presents as multifocal intracranial disease in the paediatric population. Therefore, this case of extensive tumour burden, primarily within the lateral ventricles, presented a neurosurgical challenge on numerous fronts. PRESENTATION OF CASE: This is the case of a 9-year-old male presenting with a 2-year history of visual disturbances. Radiographic imaging demonstrated extensive intracranial masses involving both lateral ventricles, the straight sinus and right cerebellum. A staged tumour resection was planned, targeting the lesions within the right lateral ventricle initially. Complete resection was achieved during surgery. Post-operative morbidity showed a decline in the patient's functional status with respect to mobility and communication, Glasgow outcome scale 3. Extensive immunohistochemical analysis ultimately revealed a diagnosis of JXG. The patient is undergoing chemotherapy, with subsequent surgical resection being dependent on overall recovery. CLINICAL DISCUSSION: JXG is the most common form of non-Langerhans histiocytosis and typically arises as a cutaneous disorder during early childhood. It is a rare cause of extensive intracranial tumour burden, with limited publications of this kind in the literature. This is even more atypical given the absence of any of the classic cutaneous morphology seen in JXG. CONCLUSION: JXG involving the central nervous system is a rare encounter. Therefore, a clear algorithm for the management of a case of extensive intracranial tumours resulting from JXG has not been defined. This only amplifies the difficulty in treating these cases.

Spontaneous Cerebrospinal Fluid Rhinorrhea: A Case Report.

Cerebrospinal fluid (CSF) rhinorrhea refers to the loss of CSF through the nasal cavity. Its causes can be classified as either spontaneous or non-spontaneous. Spontaneous causes of CSF rhinorrhea include congenital anatomical defects and are extremely rare, accounting for less than 4% of reported cases. Following failure of conservative management, definitive treatment most commonly involves an endoscopic transsphenoidal repair of the defect. We present a case of spontaneous CSF rhinorrhea in a previously well 52-year-old female, which required surgical intervention due to failure of conservative management.

Mesial temporal lobe epilepsy: A West Indian Neurosurgical Experience.

INTRODUCTION: We sought to highlight a case of refractory mesial temporal lobe epilepsy managed via an anterior temporal lobectomy. To our knowledge, this is the first of its kind to be performed and published in the English-speaking Caribbean. PRESENTATION OF CASE: A 44-year-old female, known seizure disorder for 25 years was referred to the outpatient clinic. Several trials of varying anti-epileptic drugs failed to provide remittance of her frequent partial seizures over the last two decades. Magnetic resonance imaging displayed asymmetry of the hippocampus, with a prominent right temporal horn of lateral ventricle, in keeping with right anteromesial temporal lobe sclerosis. She underwent a right anterior temporal lobectomy after exhaustive counselling; with the guidance of a multidisciplinary team. The post-operative period was uneventful and currently, the patient has been seizure-free since operation. DISCUSSION: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used anti-epileptic drug schedules to attain sustained seizure freedom. Medical management of mesial temporal lobe epilepsy has a relatively poor long-term outcome, with 30 % of patients falling into the category of pharmaco-resistant. CONCLUSION: Surgical management of these cases have been proven to be a safe and effective alternative but is currently greatly underutilized. In our literature review, we present the first published case of epilepsy surgery in the English-speaking Caribbean for temporal lobe epilepsy.