Dustin M. Hayward

Jugular foramen syndrome as initial presentation of metastatic lung cancer.

Metastatic involvement of the cranial base and jugular foramen generally presents with headache and lower cranial neuropathy but may escape early diagnosis. In this report, a patient developed a jugular foramen syndrome as the initial presentation of metastatic lung cancer soon after being diagnosed and treated surgically for extracranial atherosclerotic internal carotid artery disease. With the appropriate diagnosis established, he underwent local fractionated radiation therapy and systemic chemotherapy but succumbed to the disease. This report analyses metastatic disease affecting the cranial base and in particular, the jugular foramen, with a discussion of the clinical syndromes that accompany this rare condition.

Bilateral supplementary motor area syndrome causing akinetic mutism following parasagittal meningioma resection

The supplementary motor area (SMA-proper) is important for the programming and execution of motor, speech, and other elaborative functions. Unilateral SMA syndrome is well described. We present two patients who underwent resection of a large parasagittal meningioma in proximity to the SMA-proper in both hemispheres. Following surgery, these patients developed akinetic mutism; the maximal clinical deficit was not immediately evident, but manifested at 48 hours and 1 week respectively. Both patients showed complete recovery of neurological function but the process was slow. Initial return to near normal function was noted at approximately 3 months with a specific pattern; return of strength was first noted in the upper extremities followed by the lower extremities and speech and cognitive function was the last to recover. The unique occurrence of akinetic mutism secondary to bilateral SMA involvement by parasagittal meningiomas of the posterior frontal region is rare. We discuss the clinical and neuropsychological outcomes in these patients along with an analysis of the possible underlying neurophysiological mechanisms of this unique phenomenon.

Balloon-Occlusion Catheter Onyx Embolization of a Spinal Dural Arteriovenous Fistula Presenting with Subarachnoid Hemorrhage in a Pediatric Patient.

OBJECTIVE Spinal dural arteriovenous fistulas (DAVFs) are insidious pathologies that, if left untreated, harbor potentially devastating consequences to the central nervous system. Spinal DAVFs are rare in the adult population and exceedingly uncommon in the pediatric population. In this report, we describe a spinal DAVF in a 3-year-old child whose initial presentation is subarachnoid hemorrhage (SAH). Balloon-test occlusion and balloon-catheter-assisted embolization of DAVF have not been previously described, and their advantages over alternative embolic and surgical techniques are discussed. METHODS We performed a literature search on MEDLINE/PubMed to review current reports describing the epidemiology, clinical presentation, and treatment of spinal DAVFs. In this report, we describe a spinal DAVF in a 3-year-old child whose initial presentation is SAH. RESULTS A spinal DAVF was diagnosed after deciding to image not only the brain but also the spine. Using a balloon-occlusion catheter, we confirmed that the DAVF arterial feeding vessel could be safely embolized. We then proceeded to effectively treat the DAVF with balloon-catheter-assisted Onyx-18 embolization. CONCLUSION Based on our report and an analysis of the literature, we propose that pediatric patients presenting with nontraumatic SAH should undergo at least a magnetic resonance imaging of the brain and cervical spine as part of their initial workup. In addition, we describe a balloon-occlusion catheter embolization technique that allows not only excellent embolic penetration of the fistula but also prevention of microcatheter reflux and lessening of the need for a tedious plug-and-stack technique.

Bilateral Through-and-Through Trajectory of a Low-Velocity Transcranial Penetrating Foreign Object in a Twelve-Month-Old

A 12-month-old girl sustained a penetrating intracranial trauma of a thin aluminum rod traversing from the left frontal bone and exiting the right occipital bone. The rod entered the left anterior frontal lobe, traveled through the ventricular system, narrowly missed the right posterior cerebral artery by less than 1 mm and exited through the right cerebellum. The rod was surgically extracted, and the child remained neurologically intact. Pre- and postoperative vascular imaging, antibiotics, seizure prophylaxis and surgical planning are paramount to successful care of these delicate cases.

Myoepithelioma of the Orbital Apex and Middle Cranial Fossa: Case Report and Review of the Literature

Abstract Myoepitheliomas are rare tumours that originate from glandular tissues such as the parotid or salivary glands, and less commonly from soft tissues of the head, neck, and other parts of the body. Intraorbital myoepitheliomas generally arise from the lacrimal gland. Intracranial myoepitheliomas are rare. We report a myoepithelioma of the orbital apex that did not originate from the lacrimal gland. It extended to the middle cranial fossa from the orbital apex and involved the dura and adjacent bone. A diagnostic biopsy via a lateral orbitotomy preceded resection. We review the natural course and histopathology of myoepithelial neoplasms, the surgical nuances of approaching an orbital apex tumour with maximal functional preservation, and the optimal management practices of these rare lesions.

Aneurysmal Bone Cysts of the Neuraxis: Part 1—Clinical Presentation and Pathogenesis

Aneurysmal bone cysts (ABCs) are rare, benign, nonneoplastic lesions that occur in long bones such as the femur and humerus, or in the pelvic bones. They may also be seen in the vertebral column, but cranial (calvarial or cranial base) ABCs are rare. ABCs were fi rst described as a distinct pathologic entity by Jaffe and Lichtenstein in 1942, after whom they were initially eponymously known. ABCs represent approximately 1% of all bone tumors, with an incidence of 0.14 per 100,000 individuals. They are usually sporadic, although rare familial cases have been reported. They may arise de novo or evolve from other preexisting lesions. ABCs are most commonly seen in patients younger than 20 years and are slightly more prevalent in women. Orthopaedic surgeons are familiar with these lesions and usually treat patients with a combination of curettage and allograft or autograft bone instillation into the cavity, with relatively good results. ABCs that involve the cranial bones or spine may necessitate a more complex management plan, particularly when there is epidural extension and neurologic compromise. In this 2-part series, we review ABCs from a neurosurgical perspective and discuss management options germane to these areas.