NMC case report journal最新文献

Deep brain stimulation lead fracture may necessitate intracranial lead replacement. If deep brain stimulation was clinically effective before the fracture, reimplantation along the original trajectory to the same target is preferable; however, detailed technical descriptions remain limited. We present a 70-year-old woman with Parkinson disease who underwent subthalamic nucleus-deep brain stimulation. Two months after surgery, partial impedance abnormalities were detected on the left lead. At 12 months, all contacts demonstrated abnormal impedance, accompanied by worsening motor symptoms. Fourteen months after the initial surgery, we attempted to place a new lead by manually advancing it through the scar tissue that had formed along the original lead tract. Stereotactic reimplantation using a Leksell frame was prepared as a contingency if this scar-guided approach proved unsuccessful. After reopening the prior incision, the original lead was removed without resistance, and the cortical entry point was clearly identified. The preinserted stylet was removed from a new deep brain stimulation lead, which was then gently advanced through the original entry point along the pre-existing tract without reinsertion of the stylet. The lead progressed smoothly, and C-arm fluoroscopy confirmed that the tip corresponded to the prior position. Intraoperative test stimulation improved symptoms without adverse effects. Postoperative computed tomography confirmed that the reimplanted lead was positioned in an almost identical location to the prior lead. Stimulation was resumed with clinical benefit, and lead function remained normal at 6 months. Scar-guided reinsertion may represent a practical alternative; however, stereotactic backup should remain readily available, as adequate tract formation cannot be reliably predicted preoperatively.

Inflammatory pseudotumor involving the cranial nerves is extremely rare, and delayed diagnosis may cause irreversible neurological deficits. To our knowledge, this represents the third reported case of an inflammatory pseudotumor involving the cavernous sinus with extension along the oculomotor nerve. A 56-year-old woman presented with a visual field defect in her left eye, and her condition was initially managed conservatively because of her mild clinical presentation. Initial magnetic resonance imaging revealed a homogeneously enhanced dumbbell-shaped mass lesion extending from the left cavernous sinus through the superior orbital fissure into the intraconal orbital space. At 3-year follow-up, the patient's condition worsened during routine outpatient visits, with left visual acuity decreasing to light perception. Surgical biopsy revealed a fibrous mass involving the cisternal portion of left oculomotor nerve and extending into the cavernous sinus. Histopathological examination and laboratory findings confirmed the diagnosis of an immunoglobulin G4-related inflammatory pseudotumor. Oral corticosteroid therapy caused marked radiological regression of the lesion; however, visual impairment was not alleviated. This case highlights that delayed histopathological confirmation may produce irreversible neurological deficits despite a favorable radiological response to corticosteroid therapy.

Cervical calcification of the ligamentum flavum is a relatively rare disease that causes myelopathy due to calcification within the ligament. We recently encountered a patient with rapid progression of cervical calcification of the ligamentum flavum after anterior fixation surgery, resulting in spinal cord symptoms. An 81-year-old woman had a history of anterior decompression and fixation surgery (Williams-Isu method) at C3-4 and C5-6 at the age of 58 years, with no sequelae. Eighteen months preoperatively, the patient developed walking difficulties, arm pain, and weakness in both arms. Magnetic resonance imaging showed C4-5 anterior spinal cord compression, and C4-5 anterior decompression and fixation surgery were performed. Postoperatively, the patient's condition improved, and she was discharged from the hospital, able to walk unaided. However, 17 months postoperatively, the patient rapidly developed right arm pain, walking difficulties, and urinary and rectal incontinence. There was a rapid progression within 18 months in cervical calcification of the ligamentum flavum at the C6-7 level on magnetic resonance imaging and severe compression of the spinal cord; therefore, urgent laminectomy was performed. Postoperatively, the symptoms improved, and there was no recurrence for 3 years. In addition to the previously performed C3-4 and C5-6 fusion procedures, the addition of a C4-5 fusion resulted in a longer fusion spanning from C3 to C6, and it is thought that mechanical stress was concentrated on the adjacent intervertebral space of C6-7. Although the cause of cervical calcification of the ligamentum flavum has not been determined, this case strongly suggests that mechanical stimulation may exacerbate the condition.

Calvarial hemangiomas are rare benign vascular tumors originating from the skull bones, most commonly observed in the frontal and parietal bones of the cranium. Although most cases are asymptomatic, they can present with headache, cosmetic deformity, or, rarely, neurological deficit. The lesions are usually solitary; multicentric involvement and dural invasion are exceedingly rare phenomena. Here, we report a 22-year-old male patient who presented with frontal headache and a palpable scalp swelling. Imaging revealed two separate expansile lytic lesions in the right and left frontal bones with no connection between them. Surgical resection was planned. Intraoperatively, the lesion on the left side demonstrated findings highly suggestive of dural invasion, and both lesions were completely resected. This case highlights the rarity of the combination of multicentric involvement with dural invasion in the literature.

Idiopathic normal pressure hydrocephalus is a disease of unknown cause that occurs in people aged 60 years or older and causes gait disturbance, cognitive decline, and urinary problems. A 63-year-old man with untreated diabetes presented with unsteady gait and amnesia. Head magnetic resonance imaging revealed disproportionately enlarged subarachnoid-space hydrocephalus and brain herniation into the para-superior sagittal sinus arachnoid granulation. Although the patient experienced generalized convulsions immediately before surgery, a lumbo-peritoneal shunt was performed, and symptoms improved. These brain herniations into the arachnoid granulation might accelerate the pathology, and idiopathic normal pressure hydrocephalus with brain herniation into the arachnoid granulation of the lateral lacuna of the superior sagittal sinus is extremely rare and has not been reported previously.

Detailed evaluation of language function is important in the management of dominant temporal lobe lesions. Although spoken language is routinely evaluated in patients, disturbances in written language may remain undetected without detailed assessment. The Japanese writing system, consisting of logographic Kanji and phonographic Kana, provides a unique framework for identifying selective impairments of the ventral language stream. We report a 51-year-old right-handed Japanese male who presented with selective agraphia for Kanji following a left posterior temporal subcortical hemorrhage. Upon admission, spontaneous speech was fluent, and auditory comprehension was preserved, with no clinically apparent aphasia. However, comprehensive neuropsychological assessment revealed a profound impairment in Kanji writing. Although standard language scores improved significantly by the chronic phase (Day 87), qualitative assessment revealed persistent deficits in Kanji retrieval, characterized by frequent non-responses and morphologically related errors. Conversely, Kana writing and reading abilities were largely preserved. This case demonstrates that selective impairment of written language (pure agraphia for Kanji) may occur in association with posterior temporal lesions, despite preserved spoken language. Unlike typical cortical lesions that destroy the orthographic representation itself, we propose that this specific subcortical hemorrhage caused a transient disconnection within the ventral language stream, selectively disrupting the semantic access pathway to Kanji. From a functional and clinical perspective, systematic evaluation of writing function is essential for neurosurgeons and clinicians to prevent overlooked disabilities.

Currarino syndrome is a rare congenital disorder characterized by a triad of sacral agenesis, presacral mass, and anorectal malformation. Although it is typically diagnosed in infancy or childhood, adult presentation is rare and poses unique diagnostic and surgical challenges. We present the case of a 45-year-old woman diagnosed with Currarino syndrome during pregnancy after incidental discovery of a presacral mass associated with tethered spinal cord and sacral agenesis. Over time, the mass enlarged, causing rectal obstruction and abdominal pain. A combined neurosurgical and gastrointestinal surgical approach was used to perform tethered cord release and mass resection without cerebrospinal fluid leakage, owing to autologous omental flap placement. There were no postoperative complications except for transient urinary retention and numbness in the left foot. Adult cases of Currarino syndrome require individualized, multidisciplinary surgical management. A combined neurosurgical and gastrointestinal surgical approach, incorporating preventive techniques such as autologous omental flap placement, can result in favorable outcomes with minimal complications.

Endodermal cysts typically occur in intradural regions of the ventral spine or posterior cranial fossa. However, they are rarely found in supratentorial regions, especially within the frontal bone. Here, we report a rare case of an intraosseous endodermal cyst in the frontal convexity and discuss its potential pathogenesis in this unusual location. A 54-year-old woman presented with a gradually enlarging, soft, elastic mass in the left frontal region. Neurological abnormalities were not observed. Computed tomography revealed a cystic lesion within the left frontal bone, associated with a bulging contour. The cyst contents appeared hyperintense on T1-weighted magnetic resonance and showed a hypointense component on T2-weighted magnetic resonance imaging. The cyst wall was not enhanced with gadolinium. The cyst and its mucinous content were completely excised from the frontal bone. Intraoperatively, the cyst wall was completely separated from the frontal sinus by a thin bony structure. Histopathological examination revealed that the cyst wall consisted of inflammatory granulation tissue with a ciliated columnar epithelium, consistent with a diagnosis of endodermal cyst. Although the pathogenesis of supratentorial endodermal cysts remains unclear, the location of the cyst in the frontal convexity, as opposed to the anterior cranial base, may suggest a distinct pathogenesis for each endodermal cyst in terms of embryological aspects.