Growth of Intramedullary Spinal Cord Dermoid Cyst from a Congenital Thoracic Dermal Sinus Tract after Negative Screening Ultrasound Imaging.

INTRODUCTION: Intramedullary thoracic dermoid cysts are rare lesions that are associated with dermal sinus tracts (DSTs). Current recommendations advocate for imaging-based screening of suspected DSTs shortly after birth to exclude associated inclusion lesions. CASE PRESENTATION: A 6-year-old male child presented with a 2-week history of progressive ataxia, lower limb weakness, and hyperreflexia. He was suspected to have a thoracic DST at birth, though initial screening ultrasound was negative for an inclusion lesion or intradural tract. On representation, MRI demonstrated a 3.9-cm intramedullary thoracic dermoid cyst causing significant spinal cord compression. Intraoperatively, a DST extending intradurally was found. The associated dermoid cyst was removed via intracapsular resection. CONCLUSIONS: Whilst dermoid cysts are presumed to progressively develop from DSTs, to our knowledge, this is the first case in English literature documenting a thoracic spinal cord intramedullary dermoid cyst following a negative screening ultrasound for a suspected DST. We use this case to highlight the false-negative rates associated with postnatal screening and advocate for early neurosurgical referral of suspected DSTs, regardless of imaging findings.

Complications of elective intracranial pressure monitoring in adult hydrocephalus.

Continuous invasive monitoring of intracranial pressure (ICP) can be used in the diagnosis and management of various types of chronic cerebrospinal fluid (CSF) circulation disorders, such as hydrocephalus, shunt dysfunction and idiopathic intracranial hypertension. The risk profile and incidence of adverse events of this surgical procedure in this patient population is not well established. We aimed to investigate and describe the risks of ICP monitoring in adult patients with chronic CSF circulation disorders. We analysed 152 patients undergoing continuous ICP monitoring between 2010 and 2019, mainly for idiopathic normal pressure hydrocephalus. The average duration of ICP monitoring was 17 h 51 min. We observed no major adverse events, such as symptomatic intracranial haemorrhage, intracranial infection, or persistent neurological deficit. Minor complications were seen in 7% of patients and included accidental removal of the ICP probe in 4 patients, inability to remove the probe requiring surgical removal in 2 patients and single generalised seizures in 2 patients. In summary, the risk of serious adverse events and complications from invasive ICP monitoring in chronic CSF circulation disorders in adult patients appears to be low.

Minor Trauma in Ankylosing Spondylitis Causing Combined Cervical Spine Fracture and Esophageal Injury.

BACKGROUND: We illustrate the case of an unstable fracture of the cervical spine in ankylosing spondylitis with associated esophageal injury after minor trauma. CASE DESCRIPTION: A 66-year-old man fell backwards from the first rung of a ladder, sustaining a transverse fracture of the C6 vertebral body and a new diagnosis of ankylosing spondylitis. He was taken for surgical fixation; however, his esophagus was discovered entrapped within the fracture at the time of surgery. Despite the severity of the injury, with surgical reduction, fixation, and esophageal exclusion this patient made a full recovery. CONCLUSION: This case demonstrates the severity of injury after minor trauma in the context of ankylosing spondylitis, the capacity for full recovery in esophageal perforations in spinal trauma, and that clinical suspicion of such injuries allows early diagnosis, treatment, and reduced complications.

Differences in the Pathological Diagnosis and Repeat Craniotomy Rates in Cerebral Tumors Undergoing Biopsy or Resection in an Urban Versus Regional Center.

Primary intracranial tumors occur with an incidence of between 2.5 and 6 per 100,000 individuals. They require specialist expertise for investigation and management including input from radiology, pathology, neurosurgery, and oncology. Therefore, most patients with intracranial neoplasia are investigated and managed in larger hospitals. The geographically dispersed population of Australia has facilitated the development of neurosurgical units in regional areas. However, major metropolitan hospitals are over-represented compared with regional centers in most research cohorts. We therefore sought to investigate the spectrum of intracranial neoplasms undergoing biopsy and surgery at a major regional center in Australia and to compare the demographic and pathological features to similar cohorts treated in major metropolitan hospitals.We searched the pathological databases of both a major regional pathology provider and a major metropolitan pathology practice, which provides surgical pathology services for both a large private and a large public neurosurgical hospital, to identify all cerebral tumors undergoing biopsy or resection over a 14-year period (calendar years 2001 and 2014).In all, 3717 cerebral tumors were identified. Among them, 51% were from an urban private hospital, 33% from an urban public hospital, and 16% from a regional public hospital. Overall, one-third of them were neuroepithelial in origin, a quarter metastatic disease, a fifth meningeal, and one-tenth were pituitary adenomas. The regional center treated a higher proportion of metastatic tumors and less meningeal tumors compared with the urban center. Additionally, patients were less likely to undergo a second operation in the regional center (P < 0.001). The differences give an important insight into the burden of neurosurgical disease in regional Australia, and how it differs from that encountered in large metropolitan centers.