Background:Solitary fibrous tumors (SFTs) are uncommon in the central nervous system (CNS) and tend to mimic meningioma, based on the symptoms and imaging findings. Falcotentorial location is rare. There is almost no evidence regarding resection using a 3D-4K exoscope. Methods:We present the case of a 59-year-old female patient with a tumor adjacent to the falx and tentorium, with extension to the pineal region. Falcotentorial meningioma was considered the first diagnostic possibility. A parieto-occipital interhemispheric transtentorial approach was chosen, guided by neuronavigation and using a 3D-4K robotic arm exoscope (3DRAE); gross total resection was achieved. Postoperatively, the patient presented no complications, and magnetic resonance imaging confirmed complete resection. However, the pathology report indicated a grade 3 SFT. Results:This case highlights the importance of an appropriate approach based on the morphology and anatomical location of the tumor lesion in the CNS. It also highlights the usefulness of neuronavigation and the 3DRAE in tumors located in areas that are highly complex to approach. On the other hand, it is important to remember the difficulty in differentiating a meningioma from an SFT preoperatively, which could lead to complications during surgery. Finally, to the best of our knowledge, this is the first reported case of a falcotentorial SFT intervened via a parieto-occipital interhemispheric transtentorial approach using 3DRAE. Conclusion:Neuronavigation and the 3DRAE were useful for adequate tumor localization, with complete resection and fewer complications. We believe that, in this specific approach, the exoscope proved extremely useful.
Background:An infraoptic course of the anterior cerebral artery (ACA) is a rare congenital vascular anomaly that may be associated with intracranial aneurysms and other segmental anomalies. The endovascular experience in this setting remains limited. Case Description:A 66-year-old man was incidentally found to have an unruptured 8.0-mm aneurysm arising at the proximal apex of a fenestrated left infraoptic ACA. The precommunicating segment of the left infraoptic ACA formed a fenestration whose thick left and thin right limbs each gave rise to an A2 segment before rejoining into a common trunk that continued as a well-developed median artery of the corpus callosum (MACC); the right A1 and right A2 segments were hypoplastic. A second 2.5-mm aneurysm was present on the thick left limb between the left A2 origin and the MACC. Stent-assisted coil embolization was performed with a Neuroform Atlas stent deployed from the MACC through the thick left limb into the left infraoptic ACA, achieving complete occlusion of the larger aneurysm while the thick left limb and its branches were preserved and the thin right limb was not opacified. Confirmatory digital subtraction angiography at 12 months demonstrated stable complete occlusion, a patent stent without in-stent stenosis, and no interval change in the untreated smaller aneurysm. Conclusion:Stent-assisted coil embolization is a feasible treatment for a fenestration-related aneurysm of an infraoptic ACA, achieving durable complete occlusion with preservation of the dominant parent pathway.
Background:Tentorial meningioma resection is among the most challenging neurosurgical procedures. Various surgical approaches must be considered, including subtemporal, lateral suboccipital, occipital interhemispheric supratentorial, and supracerebellar transtentorial (SCTT) techniques. However, performing tentorial meningioma resections in the SCTT approach using operative microscopy often requires awkward positioning for the neurosurgeon. In this study, we report two cases of tentorial meningioma resection and discuss the utility and limitations of the 4KHD 3D operating room layout, showing the use of the exoscope (ORBEYE) system for this procedure. Methods:At our institution, we use the ORBEYE system (Olympus, Tokyo, Japan) for resecting tentorial meningioma. Peri-embolization and perioperative clinical and surgical data were retrospectively analyzed. Results:Our preferred exoscope system not only enhances visualization during neurosurgical procedures but also improves surgeon ergonomics during surgery. Conclusion:Exoscopic surgery using ORBEYE may help simplify complex neurosurgical procedures, including the resection of surgically challenging lesions such as tentorial meningiomas, although limitations remain in the management of large tumors.
Background:Isolated local progression of breast cancer spinal metastases may occur despite adjunctive radiotherapy and systemic therapy. Here, a 71-year-old female underwent a salvage en bloc vertebrectomy for a locally progressive T12 breast cancer spinal metastasis that newly developed due to failure of prior adjunctive radiotherapy and systemic therapy. Case Description:A 71-year-old female developed a T12 spinal metastasis 10 years after surgery for breast cancer; she exhibited no other metastatic lesions. Despite endocrine therapy, chemotherapy, targeted therapy, and radiotherapy, the lesion progressed, resulting in severe spinal stenosis, severe back pain, and paraparesis. Salvage en bloc T12 vertebrectomy was performed; this required piecemeal removal of the involved posterior elements. Postoperatively, the patient's severe pain resolved, ambulation was restored, and no local recurrence was later documented for 6 months. Conclusion:Salvage en bloc vertebrectomy may be a valuable treatment option for carefully selected patients with isolated locally progressive breast cancer spinal metastasis after failure of radiotherapy and systemic therapy.
Background:Rigid cervical-thoracic sagittal and coronal plane deformities are uncommon but profoundly debilitating conditions, impairing horizontal gaze and diminishing quality of life. Progressive kyphosis can result from many etiologies, including interbody cage subsidence following anterior cervical discectomy and fusion (ACDF), resulting in loss of anterior column support and eventual fusion in a malaligned position. Surgical correction of these complex deformities requires meticulous planning, and an approach tailored to the severity of the deformity. Posterior-based approaches, including upper thoracic pedicle subtraction osteotomy, can be effective for many fixed cervical-thoracic deformities; however, they may not provide sufficient correction in select cases of severe combined sagittal and coronal malalignment. Case Description:We demonstrate a staged surgical approach for correction of a rigid cervical-thoracic deformity. Stage 1 consists of an anterior cervical approach entailing traction, removal of the subsided cages, multilevel corpectomy, and C7/T1 ACDF. Stage 2 utilizes posterior instrumented fusion of C2-L2 with multiple posterior column osteotomies to achieve definitive deformity correction and stabilization. Conclusion:The presented technique demonstrates how a staged anterior-posterior strategy can achieve correction of severe, rigid deformities that may not be amenable to a posterior-only approach. Careful patient selection and individualized surgical planning remain essential to optimize outcomes.
Background:Preoperative embolization for glioblastoma (GBM) is a relatively uncommon procedure, and few studies have described its role as an adjunct to surgery. Methods:PubMed, MEDLINE via Ovid, and ScienceDirect were searched following the Preferred Reporting Items for Scoping Reviews guidelines. Embolic agents, clinical contexts for embolization, embolizationcraniotomy interval, surgical resection outcomes, follow-up duration, and clinical outcomes were evaluated. Results:The preliminary search identified 844 records. After screening, 7 studies with 25 patients published between 2006 and 2026 were included in the final review. GBM was embolized under conscious sedation in 15 of 22 cases (68.2%). The transradial access route was the most frequent approach for embolization (15 of 17, 88.2%). Among the 24 patients with available data on embolic agents, liquid embolic agents were used in 13, while coils were used in 11 patients. The interval between embolization and craniotomy was 1 day in 96% cases. All cases underwent embolization without procedure-related complications and subsequently had maximal safe resection of GBM, with a median estimated blood loss of 354 mL. Subgroup analysis by embolic agent revealed a lower median EBL in patients receiving coils alone (295 mL), compared with those receiving liquid embolic agents (402 mL). Four of six patients with available resection data underwent gross total resection of the tumor, and two had near-total resection. In this review, embolization was performed in diverse clinical scenarios, and no established selection criteria were found for preoperative embolization in GBM surgery. Conclusion:Preoperative embolization in GBM surgery has been performed across distinct clinical scenarios. Currently, the literature does not provide universally established guidelines or patient selection criteria for preoperative embolization as an adjunct to hypervascular GBM surgery.
Background:Surgical management of hemifacial spasm (HFS) may be contraindicated in medically unfit patients or declined because of the potential risks associated with surgery. Therefore, minimally invasive and non-invasive alternatives merit investigation. This preliminary study aims to evaluate the safety, efficacy, and optimal technical parameters of CyberKnife radiosurgery for HFS. Methods:We present the first observational study using CyberKnife for HFS in non-tumor HFS cases, including idiopathic, vascular, post-COVID, post-palsy, and co-existing trigeminal neuralgia (TN). An extensive literature review was conducted. Results:CyberKnife radiosurgery resulted in significant reductions in the severity, frequency, and duration of HFSs, increased voluntary suppressibility, with clinical improvement typically observed within a short time frame and without treatment-related complications. Trigger-induced spasms were markedly reduced, while continuous spasms showed the greatest responsiveness to treatment. A parallel improvement in HFS and TN was noted. This literature review has enabled us to identify and discuss optimal radiation doses and targeting strategies for this novel technique in treating HFS, providing clearer radiosurgical parameters for future studies. Conclusion:The results indicate efficacy and safety with the recommended radiosurgical parameters for treating various types of HFS through radiosurgery. We encourage larger studies to establish robust, comprehensive evidence, particularly in patients with coexisting TN.
Background:Nonmissle penetrating brain injuries (PBIs) are rare in civilian settings and present significant diagnostic and surgical challenges, particularly when involving the skull base and orbit. Case Description:A 28-year-old male sustained a penetrating stab wound to the left temporal region following an interpersonal assault. Imaging revealed a transcranial trajectory extending to the orbital apex and ethmoidal cells in proximity to the internal carotid artery and optic nerve, without definitive vascular injury. The patient underwent emergency frontotemporal craniotomy with controlled removal of the foreign body and evacuation of intracranial hematoma. Postoperatively, neurological deterioration necessitated reoperation and placement of an external ventricular drain. Following intensive care management, the patient stabilized and was transferred to a specialized rehabilitation center. Conclusion:PBIs require rapid imaging, careful surgical planning, and multidisciplinary management. Even in the absence of major vascular injury, involvement of the skull base necessitates vigilant monitoring for complications.
Background:Intracranial dermoid cysts are rare congenital lesions arising from ectodermal inclusions during neural tube closure. They are usually located along the midline and most commonly present as intradural lesions. Posterior fossa localization is uncommon in children, and interdural localization in this region is exceptionally rare. Case Description:A 12-year-old female patient presented with worsening headache, nausea, and vomiting. Neurological examination revealed no focal deficit. Cranial magnetic resonance imaging demonstrated a large, well-circumscribed posterior fossa mass containing fatty components, producing marked mass effect, extending through the foramen magnum, and compressing the brainstem. Magnetic resonance venography showed nonvisualization of the left transverse sinus, considered secondary to mass compression. Computed tomography demonstrated a dermal sinus tract traversing a midline occipital osseous defect toward the subcutaneous tissue. There was no history of occipital discharge or recurrent infection. The patient underwent surgery through a median suboccipital approach. Intraoperatively, the tract was followed from the subcutaneous tissue through the osseous defect to the cyst capsule and excised with the lesion. The cyst was located in the interdural plane and contained gelatinous material and hair-like structures. Total excision was achieved, and opening of the inner dural layer confirmed no intradural extension. Histopathology confirmed a dermoid cyst. The postoperative course was uneventful, with complete symptom resolution and no residual lesion. Conclusion:Posterior fossa interdural dermoid cysts are exceptionally rare in children. A dermal sinus tract traversing a midline occipital osseous defect supports a dysraphic origin. Careful preoperative evaluation and complete excision provide favorable outcomes.
Background:Intracranial meningiomas usually appear as extra-axial tumors with distinctive radiological features that aid in diagnosis. However, a rare subset shows atypical imaging traits and can closely resemble gliomas, leading to diagnostic challenges and impacting surgical decisions and treatment. This review aimed to systematically analyze the literature on intracranial meningiomas that present like gliomas and to summarize their clinical, radiological, pathological, and outcome features. Methods:A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. Searches were conducted in PubMed, Scopus, Web of Science, and Google Scholar from inception to June 2026. The review included studies on intracranial meningiomas that were suspected to be gliomas based on radiological, clinical, or intraoperative assessments. Data on patient demographics, clinical presentation, imaging features, pathology results, treatments, and outcomes were collected and summarized descriptively. Results:A total of 17 studies involving 28 patients met the inclusion criteria. The median age was 47 years, with a range from 4 to 74 years, and 64.3% of the patients were male. Preoperative suspicion of glioma was noted in 85.7% of cases, with 42.9% specifically suspected of being high-grade gliomas. Most lesions appeared intra-axial (75.0%), were located intraparenchymally (96.4%), lacked dural attachment (89.3%), and showed peritumoral edema (67.9%). Cystic changes occurred in 46.4% of patients. Histopathology mainly identified World Health Organization Grade I meningiomas (78.6%), despite imaging suggesting a more aggressive nature. Gross total resection was achieved in 78.6% of patients and was generally associated with favorable outcomes. Recurrence and death were each reported in one patient (3.6%). Conclusion:Intracranial meningiomas that resemble gliomas are uncommon lesions often showing atypical radiological features such as an intra-axial appearance, lack of dural attachment, significant peritumoral edema, and cystic changes. Although they are frequently misdiagnosed before surgery, most of these lesions are low-grade meningiomas, which tend to have good postoperative results. Being aware of these unusual presentations can help improve diagnosis and support better surgical planning.
Background:Chronic low back pain (LBP) is a major healthcare burden that reduces quality of life and productivity. Vertebral segmental microinstability is considered a contributing factor in LBP, while radiological signs reflecting biomechanical dysfunction, including disc degeneration, Modic changes, muscle fatty infiltration, and facet joint (FJ) dilatation, remain insufficiently defined as clinical markers. Methods:This was a retrospective cohort study involving 168 adults with chronic LBP. Patients underwent clinical examination including passive lumbar extension (PLE), supine-sit, iliopsoas and quadratus muscle tests, along with lumbar spine magnetic resonance imaging. Imaging findings assessment included rating of FJ dilatation (grades 0-2), Modic changes (grades 0-2), disc degeneration (grades 1-5), and muscle fatty infiltration (grades 0-3). Pain intensity was measured using a 0-10 Visual Analog Scale. Results:Among 168 patients, 70.5% (n = 120) demonstrated some degree of FJ dilatation, while 16.7% (n = 28) had high-grade dilatation. Dilatation was significantly associated with Modic type 1 changes, grade 4/5 disc degeneration, muscle fatty infiltration grade 2/3, positive PLE test, and FJ asymmetry. Three factors that did not significantly impact FJ dilatation included disc protrusion, supine-sit test, and muscle dysfunction test. Conclusion:For patients with chronic LBP, FJ dilatation is significantly associated with vertebral degeneration and clinical indicators of lumbar microinstability.
Background:Bilateral vertebral artery dissection (VAD) is infrequent, and when it occurs, both sides typically dissect simultaneously or within days to weeks. Contralateral dissection after more than 1 year is extremely rare, with previously reported intervals frequently ranging from months to several years. This case demonstrates an unprecedented 14-year interval, highlighting the significance of extended surveillance. Case Description:A 55-year-old male with right VAD at 41 years old developed sudden left occipital headache and neck pain. His initial dissection had been conservatively managed with antihypertensive therapy and annual imaging. Despite a 14-year radiographic stability and maintained patency, high-resolution imaging consistently revealed a persistent intimal flap at the original site. New imaging confirmed left VAD with intimal flap and intramural hematoma. Workup for underlying arteriopathy was negative. Symptoms resolved with conservative management. Conclusion:This case describes contralateral VAD developing after an extraordinary 14-year interval, the longest reported to date. A persistent intimal flap was observed at the original site despite radiographic stability. While a causal relationship cannot be established from a single case, this observation raises the hypothesis that residual structural abnormalities may be associated with incomplete arterial healing. This report highlights that late contralateral recurrence is possible and suggests that imaging assessment of arterial wall integrity, in addition to luminal patency, may merit further investigation.
Background:Spinal epidural arteriovenous fistulas (SEDAVFs) are rare lesions characterized by shunting between arterial feeders and the epidural venous plexus. Type A SEDAVFs demonstrate secondary intradural drainage and may produce congestive myelopathy resembling a spinal dural arteriovenous fistulas (SDAVFs). We report a right L3 Type A SEDAVF initially classified and treated as a SDAVF, resulting in persistent epidural shunting and recurrent symptoms. Case Description:A 73-year-old male presented with progressive gait instability, lower-extremity spasticity, and paresthesia. Conventional spinal angiography demonstrated a right L3 arteriovenous fistula with intradural perimedullary drainage, initially classified as a SDAVF. Three-dimensional rotational angiography (3DRA) was not performed initially. The patient underwent intradural coagulation and transection of the arterialized draining veins, with temporary improvement. Symptoms recurred 1 year later, and progressed over 6 months. Repeat angiography demonstrated persistent shunting with initial epidural venous plexus drainage and secondary retrograde intradural reflux, consistent with a Type A SEDAVF. 3DRA localized the fistulous point and showed no spinal cord arterial contribution from the embolized pedicle. Transarterial embolization with 33% n-butyl cyanoacrylate achieved complete occlusion. Gait, strength, and spasticity improved, with occlusion maintained at 6-month angiographic follow-up. Conclusion:Type A SEDAVFs may mimic SDAVFs when secondary intradural reflux dominates the angiographic appearance. Intradural draining vein interruption without elimination of the epidural shunt may leave persistent fistulous flow. Careful localization of the fistulous point and drainage sequence is essential, and 3DRA should be considered when conventional angiography does not clearly distinguish a dural from an epidural shunt.
Background:Trigeminal neuralgia (TN) is a severely disabling facial pain disorder. When medical treatment fails, stereotactic radiosurgery (SRS) is an established option. The Gamma Knife is widely used but not always available. This study assessed the efficacy and safety of linear accelerator (LINAC)-based SRS, a more accessible alternative, for the management of classical or idiopathic TN. Methods:We conducted a retrospective review of 30 consecutive patients treated between January 2017 and April 2022 in a single oncology center. All patients received SRS delivered with a LINAC targeting the retrogasserian portion of the trigeminal nerve with doses of 80-90 Gy. Demographic, clinical, and treatment variables were collected. Pain outcomes were evaluated using the Barrow Neurological Institute pain scale. Results:The mean age was 57.2 years, with a female predominance. The mandibular branch was the most frequently involved division. Pain relief was achieved in 90% of patients, with a mean onset at 3.1 months. Complete pain relief was obtained in 60% of cases. Pain recurrence occurred in 30% (9/30) of patients within 2-24 months; three benefited from repeat radiosurgery. Adverse effects were mild, mainly facial hypoesthesia and ocular irritation, with no hearing impairment or dry eye. Conclusion:LINAC -based SRS is an effective and safe option for refractory TN. Its accessibility makes it a valuable alternative to Gamma Knife, particularly in centers without dedicated neurosurgical platforms and in low- and middle-income countries.
Background:Spontaneous intracranial hemorrhage (ICH), the second most common type of stroke, can be fatal or cause severe disability. A key technical goal while studying the surgical therapy of ICH should be the amount of hematoma evacuation. Multiple challenges are encountered while dealing with ICH cases, including the removal of a sufficient part of the hematoma with the least residual volume that can be considered acceptable for optimal functional outcome. Minimizing cortical damage and choosing the safest approach that can achieve maximal evacuation of the hematoma must be top priorities. For all the foregoing, intraoperative ultrasound (IOUS) has been proposed as a capable technique for the purpose of localizing the bleeding and tracking its evacuation in real-time. Methods:This is a retrospective study, including thirty patients with ICH treated in Neurosurgery departments in Fayoum and Cairo University hospitals from July 2017 to June 2024. Patients were operated upon with the help of IOUS. The benefit of using IOUS for achieving maximal evacuation was assessed according to the presence of residual hemorrhage in postoperative computed tomography (CT) or magnetic resonance imaging (MRI) compared to the preoperative radiological studies. Results:Regarding the epidemiological characteristics of the study group, the patients' mean age of 44.86 ± 19.5 years was observed, with ages ranging from 13 to 75 years. 60% of the participants were males, while 40% were females. Considering the site of the hematoma, clots were observed in 33% of the subjects within the parietal lobe. In 30%, they were in the frontal lobe. 17% of bleeds were temporal, 13% were in the basal ganglia, and 7% were seen in the posterior fossa. With a standard deviation of 15.4 cc and a range of 13-80 cc, the average hematoma size as determined by CT/MRI was 34.5 cc. Furthermore, according to the US, the average size of the hematoma was 34.62 cc, with a standard deviation of 15.5 cc, and a range of 12-81 cc. Ultrasound (US) findings: when compared to control CTs, US had a sensitivity of 91.6% and a specificity of 100% for detecting residual hematoma following surgery, for a total accuracy of 96%. Conclusion:Neuro-navigation using US is a simple, quick, and risk-free method of real-time imaging for a variety of neurosurgical operations. It reduces the amount of brain exploration, the extent of dural incisions, and, hopefully, surgical morbidity while accurately identifying and localizing intracranial hematomas. In the absence of sophisticated radiological equipment, it provides generally agreed guidelines for maximizing evacuation.
Background:Glomus tumors are uncommon benign tumors most commonly found in the subungual areas of the digits. Extradigital glomus tumors are rare and often present with nonspecific symptoms, which prolongs patient suffering and delays diagnosis. Case Description:We report two cases of glomus tumors located in the thigh; each associated with chronic, focal pain that went undiagnosed for several years. Both patients underwent extensive evaluations and failed multiple conservative treatments before surgical excision. Surgical resection resulted in complete symptom resolution. Conclusion:These cases demonstrate the difficulty in diagnosing extradigital glomus tumors and emphasize the importance of maintaining a broad differential for small tumors of the extremities and unexplained limb pain. Early imaging and interdisciplinary awareness are essential to reduce delays in diagnosis and ensure timely and curative treatment.
Background:Primary spinal cord gliomas are rare, with adult-onset diffuse midline glioma (DMG), H3K27-altered, representing an even smaller and highly aggressive subset. Recently classified as a World Health Organization (WHO) Grade 4 entity, these tumors typically arise in midline structures and carry a poor prognosis regardless of histological appearance. While more common in children, adult cases are increasingly recognized, though spinal involvement remains poorly characterized, often mimicking other intramedullary or extramedullary pathologies. Case Description:A 46-year-old morbidly obese male presented with a 3-month history of progressive paraparesis. Neurological examination revealed severe lower extremity weakness (2/5-0/5), hyperreflexia, and bilateral clonus. Magnetic resonance imaging showed a diffusely infiltrative, contrast-enhancing intramedullary lesion extending from T5 to T10. Diagnostic and surgical planning were significantly hindered by technical limitations related to the patient's obesity and claustrophobia. On the 10th day of admission, acute neurological deterioration prompted an emergency T5-T10 laminectomy and intramedullary biopsy. Intraoperatively, the spinal cord was markedly edematous and infiltrative. Postoperatively, the patient's condition worsened with new-onset upper extremity weakness. Repeat imaging eventually revealed cranial progression of the tumor into the cervical spinal cord. Despite intensive supportive care, the patient developed respiratory failure and deceased. Histopathological and immunohistochemical analysis confirmed the diagnosis of DMG, H3K27-altered (WHO Grade 4), characterized by H3K27M nuclear positivity and loss of H3K27me3. Conclusion:This case highlights the aggressive biological behavior and rapid clinical progression of adult spinal H3K27-altered DMG. It underscores the profound diagnostic and surgical challenges posed by patient-specific factors such as morbid obesity, which can delay critical imaging and intervention. Given the dismal prognosis and tendency for rapid rostral extension, early molecular diagnosis and multidisciplinary management are vital, though treatment remains largely palliative in advanced spinal cases.
Background:Brachial plexus schwannoma arising from the posterior cord is pretty rare. Approach to these tumors is not standardized. Case Description:A young male presenting with pain radiating along the left shoulder and subtle weakness of left shoulder abduction had a moderate-sized mass located in the infraclavicular region. Excision of the lesion was planned through the infraclavicular approach. Division of the pectoralis minor was done with retraction of the pectoralis major. Complete excision was done along with the infraclavicular component. Postoperative outcome was good with complete return of functionality of the arm. Histopathologically, the lesion was a benign schwannoma. Conclusion:Posterior cord Brachial Plexus Tumours are uncommon but can be easily approached via the infra-clavicular route with good outcomes.
Background:Concurrent trigeminal neuralgia (TN) and hemifacial spasm (HFS) arising from two separate offending vessels, each compressing a distinct cranial nerve, is an uncommon and markedly disabling presentation of neurovascular compression syndrome. Unlike cases in which a single artery accounts for both syndromes, this dual-vessel configuration demands individual identification and decompression of each conflict through a shared operative corridor. Case Description:A 71-year-old man presented with a 13-year history of pharmacologically refractory left V1-V3 TN (Barrow Neurological Institute [BNI] grade IV) and left HFS only partially controlled with quarterly botulinum toxin injections; pre-operative facial motor function was intact (House-Brackmann grade I). Fast Imaging Employing Steady-state Acquisition (FIESTA)-sequence magnetic resonance imaging identified a dolichoectatic basilar artery compressing the left trigeminal nerve and a separate conflict between the left anterior inferior cerebellar artery (AICA) and the facial nerve. Through a left retrosigmoid approach, both conflicts were addressed with independent Teflon pledget interposition secured with fibrin sealant. Lateral spread response (LSR) monitoring served as a continuous electrophysiological marker, with LSR abolition confirming adequate decompression following AICA mobilization. Conclusion:At 6-month follow-up, the patient maintained complete pain freedom (BNI I), sustained HFS resolution, and intact facial function (House-Brackmann I), having discontinued all anticonvulsant therapy and botulinum toxin injections. This case illustrates that dual microvascular decompression via the retrosigmoid approach can safely address concurrent TN and HFS caused by two anatomically distinct vessels, and reinforces intraoperative LSR monitoring as a reliable endpoint for decompression adequacy.
Background:Urinary dysfunction remains an underrecognized complication of spine surgery, despite its potential impact on postoperative quality of life. However, comparative data evaluating urinary outcomes by surgical approach among men undergoing single-level lumbar fusion remain limited. This study compared postoperative urinary dysfunction following anterior-only versus posterior-only single-level lumbar fusion. Methods:The TriNetX Research Network was queried to identify adult men who underwent single-level lumbar fusion between 2010 and 2023 with preoperative diagnoses of lumbar, lumbosacral, or thoracolumbar stenosis, spondylolisthesis, scoliosis, myelopathy, or radiculopathy. Patients were categorized by surgical approach as anterior-only or posterior-only fusion. Individuals with complex spinal pathology, preexisting urogenital disease, prior alternative exposure, or nonlumbar involvement were excluded. Propensity score matching balanced demographics and relevant comorbidities. The primary outcome was a composite of postoperative urinary complications assessed at 1, 3, 6, 9, and 12 months after surgery. Results:Of 12,369 eligible patients, 10,606 underwent posterior-only fusion and 1,763 underwent anterior-only fusion. After 1:1 propensity score matching, 1,761 well-balanced patients comprised each cohort. Relative to anterior-only fusion, posterior-only operations were associated with significantly higher odds of urinary complications at 1-month (odds ratio [OR] 1.84, 95% confidence interval [CI] [1.23-2.77]), 3-month (OR 1.86, 95% CI [1.29-2.70]), 6-month (OR 1.91, 95% CI [1.35-2.71]), 9-month (OR 1.65, 95% CI [1.21-2.27]), and 12-month (OR 1.49, 95% CI [1.10-2.00]). Conclusion:In this multi-institutional cohort of men undergoing single-level lumbar fusion, posterior exposure was associated with substantially higher odds of urinary dysfunction throughout the first postoperative year, suggesting the surgical approach may be an important determinant of postprocedural urinary outcomes.
