Nigel Mendoza

Recurrent craniopharyngioma in the posterior fossa

Craniopharyngioma situated in the posterior fossa is rare. It has been unclear whether such lesions arise primarily in this site or represent direct spread from a suprasellar focus. We report a patient with recurrent craniopharyngioma which had extended into the posterior fossa as far as the cerebellopontine angle through the tentorial hiatus with evidence that it had done so directly. A further separate lesion of similar signal characteristics on MRI scan, lying in the prepontine area, probably represented a seeding from the suprasellar area.

Spinal extradural solitary fibrous tumor with retiform and papillary features

We report a 66-year-old man with a spinal, extradural solitary fibrous tumor showing unique retiform and papillary architecture. The patient presented in May 2008 with worsening right-sided lower back pain and urinary frequency. Magnetic resonance imaging of the spine documented a heterogeneously enhancing dumbbell-shaped extradural lesion causing cord compression at T11/12 level. The tumor extended to the paravertebral soft tissue and invaded the right adjacent vertebral pedicles and laminae. An angiogram showed prominent vascular supply mainly from the right T11 radicular artery. The patient underwent surgery to relieve cord compression in May 2008 and a second operation following embolization with coils in October 2009. No recurrence was observed at the last neuroimaging follow-up in June 2012. The tumor was composed of vimentin, CD34, Bcl-2, and CD99-positive rounded or slightly elongated cells with scant cytoplasm and oval to spindle nuclei. Several pseudovascular spaces reminiscent of the rete testis were present, and several of them contained papillary projections. Cytologic atypia was minimal, and mitotic activity was low. Focal infiltration of the paraspinal adipose tissue was seen at microscopic level. To our knowledge, retiform and papillary features have never been reported in a solitary fibrous tumor.

Clinical outcomes in patients with nonfunctioning pituitary adenomas managed conservatively

The natural history and the optimum management of patients with nonfunctioning pituitary adenomas (NFPAs) are unclear.

Obesity and posterior spinal fat content: impact on complications in non-complex lumbar spine surgery

Abstract Aim: Obesity is increasing in prevalence across the world with a potentially very significant impact in spine surgery. This study aimed to characterise this in the setting of neurosurgical spine practise at a single centre in UK. Uniquely, we assess the contribution of posterior spinal fat content to intraoperative complications. Materials and methods: All cases of lumbar spine surgery in 1 year were investigated. Case note review was carried out documenting patient demographics, comorbidities, operative details, complications and length of stay. Ninety-four complete datasets were compiled from 128 cases. The posterior spinal fat content was recorded from T2-weighted MRI. Body mass index (BMI) was correlated with each measure using logistic multiple regression and contingency table analysis. Results: Mean BMI was 28.3 (SD: 5.2) comprising one underweight (BMI <18.5), 26 normal weight (BMI: 18.5–24.9), 32 overweight (BMI ≥25), 33 obese (BMI ≥30) and two morbidly obese patients (BMI ≥40). BMI (coefficient: 0.03, SE: 0.01, p = 0.005) and posterior spinal fat content (coefficient: 0.01, SE: 0.005, p = 0.042) correlated significantly with increasing length of stay. Procedure (p = 0.006) and complication rate (p = 0.010) also correlated with length of stay. Neither BMI nor posterior spinal fat content had a significant effect on the incidence of perioperative complications (p = 0.932, p = 0.742), operating time (p = 0.454, p = 0.748) or blood loss (p = 0.127, p = 0.692). There were three non-operative complications in the obese and overweight groups compared with none in the normal weight group, but this was not significant. Overall complication rate was 15%. Conclusion: Obesity and posterior spinal fat content correlate with the length of stay in simple spine surgery. There is a non-significant trend towards increased non-operative complications in overweight and obese patients, which could reach significance with larger numbers and prospective data. Excess posterior spinal fat is not associated with increased operative complications, operating time or blood loss.