Syringopleural Shunt Insertion Using a Minimally Invasive Approach: Technical Note, Case Series, and Review of the Literature

Objective Syringomyelia is a rare neurosurgical condition that could benefit from insertion of a syringopleural shunt in selected symptomatic cases. Treatment of syringomyelia through minimally invasive intervention is an attractive alternative to open approach. The objective of this report is to demonstrate the technical aspect, assess the feasibility, outcomes, and complications of syringopleural shunt insertion through minimally invasive surgical (MIS) approach. Methods Single-center retrospective chart review was done on patients with syringomyelia who underwent insertion of syringopleural shunts using the Metrx QuadrantTM retractor system from January 1, 2008 to April 1, 2020. A technical report of the steps of the surgical intervention is also described. Results Ten procedures were performed on 9 patients with a mean follow-up of 7.2 years. The etiologies of syringomyelia included post-traumatic, Chiari malformation, idiopathic, and diastematomyelia. All patients underwent correction of underlying etiologies prior to insertion of syringopleural shunts. Six patients (67%) had sustained neurological improvement, and 3 (33%) had halted progression of myelopathy. One patient was admitted for urgent removal of newly inserted syringopleural shunt due to immediate postoperative neurological decline and subsequently returned to their neurological baseline. The remaining eight patients were discharged on the same day of surgery. Conclusion Minimally invasive techniques have not been widely utilized in the treatment of syringomyelia. Our case series presents a novel, minimally invasive technique for the insertion of a syringopleural shunt, with reduced hospital stay and durable outcomes. Further, our series demonstrates that this technique is feasible and safe in appropriately selected patients

Cerebellar Medulloblastoma in Middle-to-Late Adulthood

Medulloblastoma is a malignant brain tumor that is typically seen in children. It is classified as an embryonal tumor, classically located within the posterior fossa. When it involves the fourth ventricle, the patient commonly presents with signs and symptoms of raised intracranial pressure secondary to obstructive hydrocephalus. It is exceedingly rare for Medulloblastoma to occur in middle and late adulthood. In this paper, we present a case of a 51-year-old man who presented with a posterior fossa mass that was diagnosed later as Medulloblastoma

Aneurysmal bone cyst of the spine: Report of four cases and review of the literature

Purpose: We report four cases of spinal Aneurysmal bone cyst (ABC) that were managed surgically at King Fahad Specialist Hospital in Dammam, Saudi Arabia. This report aims to describe the clinical features and the need for surgical excision preceded by embolization in spinal ABC. Method: A retrospective review of the OR list and tumor board records between 2013 and 2016 yielded a total of 4 cases of spinal ABC who were surgically treated at KFSH-D. Their clinical presentations, radiological and pathological features are reviewed along with the surgical intervention utilized and its outcome. Results: Total of 4 cases were identified, all of them were female (100%). The age ranged from 13 to 25 years old (mean age = 17.75). Two cases (50%) were located in the thoracic spine, one (25%) cervical and one (25%) in the lumbar spine. Back pain, unsteady gait, and progressive limb weakness were the most common presenting symptoms. All the cases underwent embolization followed by surgical excision and fixation with a variable degree of improvement postoperatively. Conclusion: Spinal ABC is a benign tumor that can present with a wide variety of non-specific symptoms. Pre-operative embolization can be helpful to reduce bleeding during surgery. Surgical decompression can lead to significant improvement even in case of severe neurological deficit. Radiation therapy can be used as an adjunct treatment in selected cases