2016年 · 第02卷第02期

Background: Giant colloid cysts (size > 3 cm) are very rare with only few reported cases in the literature. Case presentation: We report a case of 44 year female who presented with features of raised intracranial pressure, memory and gait disturbances. CT and MR imaging showed a large colloid cyst at foramen of Monro leading to obstructive hydrocephalus. The patient underwent right interhemispheric transcallosal-transforaminal approach and complete excision of the cyst. Conclusions: For a large size of colloid cyst complete surgical excision is recommended. However deep midline location, proximity to the vital structures and giant size of the lesions make surrounding vital structures vulnerable for injury.

Background: This research paper will discuss the surgical management and possible mechanisms, as well as enlighten other features which can explain meningioma and astrocytoma simultaneously occurrences including statistical coincidence, the role of common carcinogens, autocrine growth factors and their pathogenic correlations. Case presentation: We describe two patients with simultaneous presentation of meningioma with astrocytoma. A correct preoperative radiological diagnosis was made in both patients and their tumors were completely removed microscopically. Pathological examinations confirmed that one among them was meningioma and the other an anaplastic astrocytoma. We reviewed the studies carried out regarding meningioma associated with astrocytoma in China as well as in other countries. Conclusion: In the absence of phacomatosis or prior radiation therapy, the reason for the simultaneous occurrence of astrocytoma with meningioma is not clear, and these tumors could be merely a statistical coincidence. Careful preoperative radiological evaluation and surgical management is of great importance in these patients.

Background: Rosai-Dorfman disease (RDD) is an idiopathic histiocytic proliferative disorder characterized by sinus histiocytosis and massive lymphadenopathy. Extranodal and central nervous system (CNS) involvement is unusual. We describe two distinctly rare cases of isolated intradural RDD of the spine without cervical lymphadenopathy. Case presentation: We report our experience in the management of two patients with RDD. The first patient had two ventral intradural lesions, radiologically in favour of multiple spinal meningiomas, and the second patient presented an intradural extramedually lesion, extending into the right foramina, suggestive of a sacral perineural cyst. Treatments consisted of total excision and subtotal excision without steroids and radiotherapy, respectively. The definitive diagnosis was confirmed by histopathology and immunochemistry. Conclusions: RDD should be considered in the rare differential diagnosis of a spinal disease. Resection of the lesions is an effective treatment choice to relieve spinal compression symptoms. The efficacy of the adjuvant therapy to control the disease is unknown.

Background: Spinal extradural arachnoid cyst is extremely rare. The longest SEACs that have been reported in previous studies involved no more than 5 spinal segments. This study presents a case of SEAC diagnosed from T9 to L4 and excised through a novel laminectomy/laminoplasty. Case presentation: A 22-year-old female presented with a 5-year history of progressive paraparesis and numbness in both lower limbs. MRI revealed posterolateral epidural cystic mass extending from T9-L4 with a length of 190 mm and width of 15 mm. The cyst was totally removed through surgery. The patient's symptom was completely relieved 1 year after the surgery. There was no recurrence, compression on the spinal cord, or kyphotic deformity based on MRI and CT taken 1 year after. Conclusion: Spinal extradural arachnoid cysts are relatively uncommon but surgically curable causes of myelopathy. For symptomatic patients, early surgical intervention is suggested for restoring neurological functions. Performing laminectomy by using crainotome is safe and efficient.

L4–L5 traumatic spondylolisthesis has been rarely reported in the literature. At lumbar spine level traumatic dislocation lesion realizes "traumatic spondylolisthesis or traumatic bilateral lumbar facet locked syndrome" . The aim of the present paper is to report this rare lesion and discuss its mechanism and management. A case report is followed by Literature review made on Medline and scholar google database from 2000 to 2015. The case report concerned a 33-year-old man, who refused to wear a seat belt, injured his lumbar spine following a motor vehicle accident. L4-L5 spondylolisthesis occurred after the vehicle rolled over several times. Sixteen months after the accident the patient had a favorable outcome. Literature review on Medline and scholar google database from 2000 to 2015 was carried out and five cases of traumatic spondylolisthesis were found. The Sex ratio was 3/2. Surgical treatment consisted of posterolateral interbody fusion. Traumatic lumbar spine spondylolisthesis is rare. When it occurs, it is always associated with vertebral lumbar fracture. L4-L5 traumatic spondylolisthesis was caused by a high-energy mechanism and improper use of seat belt.

Background: Patients who have a cerebral arteriovenous malformation (cAVMs) in the motor cortex can have displaced function. The finding and its relationship to recovery from surgery is not known. Methods: We present the five cases with cAVMs involving precentral knob and/or paracentral lobule and without preoperative motor deficits. We used motor activation areas derived from Functional functional MRI (fMRI) as a region of interesting (ROI) to launch the plasticity of cerebrospinal tracts (CST). All the results were incorporated into the neuronavigation platform for surgical treatment. Intraoperative electric cortical stimulation (ECS) was used to map motor areas. Modified Rankin Scale (mRS) of hands and feets were performed on postoperative day 2, 7 and at month 3, 6 during follow-up period. All the patients suffered from motor deficits regardless of cortical activation patterns. Results: Three patients showed functionally seeded CST in or around the AVM, and were validated by intraoperative electrical stimulation (ECS). Patient 4 had two aberrant functionally seeded fiber tracts away from the lesion, but were proved to be non-functional by postoperative motor deficits. Patient 3 with motor cortex and fiber tract within a diffuse AVMs nidus, complete paralysis of upper extremity after operation and has a persistent motor deficit during 6-month follow-up period. Conclusions: The plasticity of motor cortex on fMRI doesn't prevent post-operative motor deficits. Functionally mapped fiber tract within or abutting AVM nidus predicts transient and persistent motor deficit.

A variety of cystic lesions may develop in spinal canal. These cysts can be divided into intramedullary, intradural, extradural, cervical, thoracic, lumbar, and sacral cysts according to anatomical presentation, as well as arachnoid, meningeal, perineural, juxtafacet, discal, neurenteric cysts, and cyst-like lesions according to different etiologies. Mechanisms of initiation and growth vary for different cysts, such as congenital, trauma, bleeding, inflammatory, instability, hydrostatic pressure, osmosis of water, secretion of cyst wall, and one-way-valve effect, etc. Up to now, many treatment methods are available for these different spinal canal cysts. One operation method can be applied in cysts with different types. On the other hand, several operation methods may be utilized in one type of cyst according to the difference of location or style. However, same principle should be obeyed in surgical treatment despite of difference among spinal canal cysts, given open surgery is melely for symptomatic cyst. The surgical approach should be tailored to the individual patient.

External lumbar drainage (ELD) has gained wide popularity in neurosurgical practice since its' first introduction by F. Vourc'h in 1963. It manifests encouraging prospects in control of refractory intracranial hypertension, prevention of complications secondary to aneurysmal subarachnoid hemorrhage, prediction of shunt respondency in normal pressure hydrocephalus, management of cerebrospinal fluid (CSF) leakage, and application in bacterial meningitis and ventriculitis. But many questions on the efficacy and safety of ELD are remained to be answered by future studies. CSF overdrainage and ELD-related meningitis are the two most common and fatal complications due to inappropriate usage of ELD. Randomized controlled trials are badly in need to more safely and rationally guide the clinical application of ELD.

Cerebral vasospasm (CVS) is a common and severe complication of aneurysmal subarachnoid hemorrhage (aSAH). Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. CVS begins most often on the third day after the ictal event and reaches the maximum on the 5th–7th postictal days. Several therapeutic modalities have been employed to prevent or reverse CVS. The aim of this review is to summate all the available drug treatment modalities for vasospasm.