Intradural lumbar disc herniation is rare and frequently recognized only during surgery because its clinical and imaging features may resemble other intradural lesions. A 71-year-old man presented with progressive left-sided lumbosciatica without neurological deficit. Magnetic resonance imaging showed a pseudocystic intradural lesion at L4–L5 with marked displacement of the cauda equina, and computed tomography demonstrated focal gas in the ventral spinal canal at the same level. Extradural exploration did not reveal disc material sufficient to explain the compression. Dorsal durotomy released air and exposed a pseudocystic lesion containing disc material. After resection, a ventral dural defect communicating with the disc space was visualized and reinforced with a fibrin sealant patch. Histopathology confirmed degenerated disc tissue with granulation tissue and pseudocystic fibrous tissue. The patient remained neurologically intact and experienced complete resolution of the presenting radicular symptoms. Gas-containing cystic intradural disc herniation has been reported previously; the value of this case is the concordance of routine magnetic resonance and computed tomography findings with air release, direct visualization of the migration route, and histopathologic confirmation. Focal intraspinal gas does not establish intradural migration by itself, but in the appropriate anatomic setting it can strengthen diagnostic suspicion and surgical planning.
Background Moyamoya disease is a rare vascular disease that presents with stenosis of the internal carotid artery accompanied by formation of abnormal, fragile blood vessels at the base of the brain. This pathology often presents with aneurysms, which may cause ischemic or hemorrhagic complications. We present a case of posterior choroidal artery aneurysm in a moyamoya disease patient that ruptured following a 6-year asymptomatic period after the patient received superior temporal artery to middle cerebral artery bypass.
Duplicated inferior vena cava (IVC) is a rare congenital vascular anomaly that may complicate retroperitoneal surgical approaches, particularly anterior lumbar interbody fusion (ALIF), due to altered venous anatomy and increased risk of vascular injury. A 30-year-old male with chronic refractory low back pain and multilevel disc degeneration underwent three-level ALIF. Preoperative imaging identified a duplicated IVC (Type 2a). An extraperitoneal retroperitoneal approach was performed, allowing exposure of the L3–L4 and L4–L5 levels through the intercaval corridor. Although increased vascular complexity and enlarged venous tributaries were encountered, meticulous dissection and selective ligation enabled safe mobilization and adequate exposure. Estimated blood loss was 150 mL, operative time was 2 hours and 50 minutes, and the postoperative course was uneventful, with discharge on postoperative day three. Duplicated IVC does not represent a contraindication to ALIF, even in multilevel procedures. Careful preoperative identification, detailed anatomical understanding, and appropriate surgical technique are essential to minimize complications and achieve favorable outcomes.
Background Surgical management of traumatic cerebrospinal fluid (CSF) leakage traditionally requires extensive craniotomy. Here, we present a tailored supraorbital craniotomy using an endoscopic technique for complex skull base trauma.
Background McCune–Albright syndrome is a rare mosaic disorder caused by postzygotic activating mutations in GNAS, classically presenting with fibrous dysplasia (FD), hyperpigmented macules, and endocrinopathies. Craniofacial FD is common and typically follows a benign course. However, acute symptomatic changes with aggressive imaging features may mimic malignant transformation or secondary lesions such as aneurysmal bone cysts (ABCs), creating significant diagnostic uncertainty.
