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Fluorescence and immune-cell infiltration of nonneoplastic, postbrachytherapy brain tissue in 5-ALA–guided resection of recurrent anaplastic meningioma: illustrative case

Rishab Ramapriyan, Victoria E Clark, 1 PhD, Maria Martinez-Lage, Brian Hsueh, 1 PhD, Brian V Nahed, 1 MSc, William T Curry, Bryan D Choi, 1 PhD, Bob S Carter, and 1 PhD

5-Aminolevulinic acid (5-ALA) fluorescence-guided surgery (FGS) has gained prominence in recent years for its utility in high-grade glioma resection, allowing enhanced visualization and tumor removal. 1 The use of 5-ALA for meningioma surgery has also been reported. 2 Mechanistically, 5-ALA is preferentially taken up by cells of certain tumors, including meningiomas, and enters the heme biosynthesis pathway, where it is converted to heme precursor porphyrin PpIX, which then accumulates in cells due to various tumor-specific aberrations, such as altered

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Tumor characteristics guiding selection of channel-based versus open microscopic approaches for resection of atrial intraventricular meningiomas: patient series

Jeffrey J Feng, Stephanie K Cheok, Mark S Shiroishi, and Gabriel Zada

The atrium is by far the most common location of intraventricular meningiomas (80%), which account for 0.5%–3.0% of all meningiomas. 1 Atrial intraventricular meningiomas (AIMs) often grow insidiously until they reach a relatively large size 2 , 3 (>3 cm), often leaving resection as the main treatment modality available, as stereotactic radiosurgery (SRS) is often reserved for smaller tumors with diameters <3 cm. 1 , 4 , 5 When resection is indicated, several approach options are available to the neurosurgeon. Microsurgical resection through a transsulcal

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Intraosseous meningioma, a rare presentation of a common brain tumor: illustrative case

Sherif Elwatidy, Abdulaziz Alanazi, Rahaf F. Alanazi, and Khulood K. Alraddadi

Meningioma, also known as meningeal tumor, is a benign tumor that is typically slow growing. 1 , 2 It originates from the arachnoid cap cells from a highly metabolic active subtype that is involved in cerebrospinal fluid (CSF) resorption. 1 , 2 It is estimated to account for between 13% and 26% of all intracranial tumors, whereas extradural meningiomas constitute from 1% to 2% of all meningiomas. 2 Intraosseous meningioma is a subgroup of meningioma that arises in the skull. It can occur at any location of the skull, with the orbital cavity and

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5-ALA fluorescence–guided resection of a recurrent anaplastic pleomorphic xanthoastrocytoma: illustrative case

Lydia A. Leavitt, William Muñoz, and Pamela S. Jones

-ALA fluorescence in meningiomas, with fluorescence rates ranging from 83% to 94%. 9 , 14 , 19–22 5-ALA FGS has also been described for hemangioblastomas, which reportedly fluoresce well despite being low-grade vascular tumors. 9 , 23 , 24 Other studies report PPIX accumulation and positive fluorescence in CNS lymphomas, 25–27 germ cell tumors, 28 papillary glioneuronal tumors, 29 brain metastases, 27 , 30 , 31 medulloblastoma, 32 subependymomas, 33 and ependymomas. 33 , 34 A few case studies report using 5-ALA for the intraoperative visualization of

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Anterior cervical transvertebral approach for resection of an intraspinal ventral lesion: illustrative case

Dongao Zhang, Tao Fan, Wayne Fan, and Xingang Zhao

Resection of ventral intradural spinal canal lesions may affect the spinal cord and adjacent intradural structures; thus, the selection of an appropriate approach and adequate exposure are of great importance for totally removing these lesions. Most ventral cervical spinal canal lesions are benign nerve sheath tumors, meningiomas, and enterogenous cysts. 1 During the past 15 years, posterolateral approaches through hemilaminectomy have been common, and low-risk procedures are usually performed by spinal neurosurgeons. 2 , 3 Sometimes, partial resection of

Open access

Compressive myelopathy from diffuse spinal dural calcifications in a patient with end-stage renal disease: illustrative case

Alexis Malecki, Jacob Pawloski, Anthony Anzalone, Kelly Shaftel, Hassan Ali Fadel, and Ian Lee

. Other authors reported a similar case of a man with XLHR experiencing progressive lower-extremity weakness, who was found to have diffuse calcification of the posterior longitudinal ligaments causing severe central canal stenosis. 13 Because the ligamentous soft tissues of the spinal canal can also become calcified, it is important to differentiate these related pathologies during surgical planning. It is also important that these pathologies be differentiated from focal dural calcifications, which can occur from meningiomas, previous spinal subdural hemorrhages, or

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Disconnection of a jugular foramen dural arteriovenous fistula with cortical venous reflux via an intradural retrosigmoid approach: illustrative case

Richard Shaw, Johnny Wong, Hugo Andrade, and Ivan Radovanovic

consideration during embolization because of the risk of cranial nerve injury and embolization into the intracranial circulation. 20 Surgical disconnection of JFDAVFs has been described using a far lateral transcondylar approach. 9 , 10 This is a recognized method for accessing the lateral and ventral aspects of the foramen magnum for chordomas, clival and foramen magnum meningiomas, and aneurysms of the vertebral artery and its branches. 21–23 For JFDAVFs, an arterial transosseous supply occurs through occipital condyles and is therefore interrupted through extensive

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Extra-axial cavernous malformations of the foramen magnum: illustrative cases

Bo-Han Yao, Da Li, Liang Wang, and Zhen Wu

-axial lesions tend to be accompanied by uncontrollable massive bleeding during surgery. Neuroimaging plays a crucial role in the diagnosis and monitoring of CMs. On CT, the typical imaging characteristics of cerebral CMs usually appear as focal areas of increased density in the brain, often without mass effect. 15 MRI of extra-axial CMs generally shows hypointense signal on T1WI and hyperintense signal on T2WI with homogeneous enhancement. Most notably, extra-axial CMs can be misdiagnosed as meningiomas, especially when meningiomas have no obvious dural tail sign. The

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Trigeminal neuralgia secondary to vascular compression and neurocysticercosis: illustrative case

Mao Vásquez, Luis J. Saavedra, Hector H. García, Evelyn Vela, Jorge E. Medina, Miguel Lozano, Carlos Hoyos, and William W. Lines-Aguilar

tumors (meningiomas, epidermoid cysts, acoustic neuromas, etc.) and, less frequently, aneurysms and arteriovenous malformations, 5 and rarer still, neurocysticercosis (NCC). In secondary TN, pathophysiological changes similar to those in primary TN occur, although the structural lesion depends on the etiology; for example, in multiple sclerosis, it is due to demyelination plaques. 7 The standard treatment for TN is microsurgical decompression of the trigeminal nerve. We present a case in which neighboring NCC cysts, arachnoiditis, and vascular compression occurred in

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A multilevel posterior tension band–sparing laminectomy for intraspinal lesions: patient series

Ignacio J Barrenechea, Luis Márquez, Sabrina Miralles, Héctor P Rojas, Julián Pastore, Pablo Vincenti, and Telmo Nicola

recesses without compromising the facet joint. Our database contains 24 cases of spinal lesions operated on using our modified approach between January 2014 and January 2021. Of these 24 cases, 17 had at least 2 years of follow-up. There were 7 female and 10 male patients, with a mean age of 49.2 ± 3.8 years (mean ± standard deviation). We operated on five schwannomas, four meningiomas, two filum ependymomas, two spinal dural arteriovenous fistulas, one fifth ventricle, one arachnoid cyst, one cavernoma, and one epidural lymphoma. Four cases were performed in the