Objective: This study evaluated the effectiveness of changing the surgical approach direction to enable rapid and accurate identification of the surgical plane, thereby allowing relatively intact separation of the temporalis muscle from the epidural space without dural injury. Outcomes were compared between this method and other surgical approaches.Methods: A total of 90 patients who met the inclusion criteria and underwent cranioplasty were included in the study. The patients were divided into a temporal approach group and a frontal approach group. Demographic characteristics and surgical, clinical, and functional outcomes were collected for all patients and compared between the two groups.Results: Among the 90 patients, 24 were assigned to Group 1 and 66 to Group 2. No statistically significant differences in demographic variables were observed between the two groups. Among surgery-related factors, operative time was shorter in Group 1 than in Group 2; specifically, operative time was more than 21 minutes longer in Group 2 than in Group 1 (p=0.01). Regarding postoperative pain, the visual analogue scale score was temporarily lower in Group 1 than in Group 2 on postoperative day 5 (p=0.03), but no statistically significant difference was observed after 2 weeks. Although masticatory impairment was more frequent in Group 2, the between-group difference was not statistically significant.Conclusion: This study examined the utility of approach direction during cranioplasty. Although the temporal approach was associated with reduced operative time, it did not significantly affect postoperative pain or functional outcomes.
Objective: To characterize global, regional, and local radiological changes after single-level anterior cervical discectomy and fusion (ACDF), focusing particularly on changes in spinal canal anteroposterior (AP) diameter and ligamentum flavum (LF) thickness quantified by magnetic resonance imaging (MRI) at the index and adjacent levels
Radiation-induced meningiomas (RIMs) are exceptionally rare in the spine compared with the cranium. Evidence on long-term outcomes after childhood spinal-axis irradiation for extensive spinal ependymoma remains limited. In 1988, a 7-year-old boy underwent subtotal debulking of a spinal tumor historically diagnosed as myxopapillary ependymoma and received approximately 30 Gy of whole-spine irradiation. He regained the ability to walk and remained clinically stable for decades. In 2026, 38 years after irradiation, he presented with progressively worsening gait and sphincter dysfunction. Cervical magnetic resonance imaging showed a new left posterolateral intradural extramedullary mass at C1–C2 that severely compressed the atrophic spinal cord. After gross total resection, histopathological examination confirmed transitional meningioma, central nervous system World Health Organization grade 1, with a low proliferative index. This case documents a rare spinal RIM that developed after childhood whole-spine irradiation. It highlights the lifelong risk of delayed second neoplasms even after moderate-dose spinal irradiation and the need to suspect new focal compressive lesions in long-term survivors with late neurological decline.
Immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis (IgG4-RHP) is a rare manifestation of IgG4-related disease (IgG4-RD) that can mimic other space-occupying lesions and may go unrecognized without a high index of suspicion. We describe a 74-year-old woman who presented with progressive bilateral lower-extremity weakness caused by a dorsal epidural mass at T1–6. An epidural hematoma was initially suspected, and emergency laminectomy was performed. Histopathological examination revealed nonspecific fibrous tissue. IgG4-RD was not considered, and IgG4 immunohistochemical staining (IHC) was not performed. Approximately 20 months later, lesions recurred at T8 and T12, with extensive dural hypertrophy extending from the skull base to C2 and surrounding the cerebellum. The patient underwent further surgical decompression at T8. IHC of both the recurrent and archived specimens revealed dense infiltration of IgG4-positive plasma cells; an elevated serum IgG4 level further supported the diagnosis. After surgery and corticosteroid therapy, magnetic resonance imaging at 2 months showed marked regression of the dural lesions. No clinical or serological evidence suggestive of recurrence was documented during approximately 3 years of follow-up. This case illustrates the difficulty of diagnosing IgG4-RHP and the importance of considering it in patients with recurrent or unexplained dural lesions, particularly when initial histopathological findings are nonspecific.
