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  • ISSN: 2373-9479
    Volume 2, Issue 1
    January/February 2014
    Aleksandra Glavaski-Joksimovic*
    Since their discovery in the 1960s [1,2] mesenchymal stem cells (MSC), also known as mesenchymal stromal stem cells, are the subject of investigation of many research groups. MSC are an attractive cell source for the regenerative therapy because they can be easily procured from several adult tissues, have low or absent tumorigenicity, have ability to migrate to the site of injury, and can be used for the patient-specific therapy to circumvent immune response.
    Joon W. Shim*
    In 2013, clinical and basic science research has rolled the dice further to extend our understanding to hydrocephalus. A group of research team at Boston Children's Hospital and Harvard Medical School, led by neurosurgeon, Joseph Madsen, has published the laboratory investigation results on vascular endothelial growth factor, VEGF, and showed its potential effect on the development of experimental ventriculomegaly in an animal model [1].
    Alp Yurter, Daniel M. Sciubba, Ziya L. Gokaslan, and Paul E. Kaloostian*
    Chordomas are rare, benign tumors that account for 1-4% of bony lesions and most frequently occur in the skull base, mobile spine, and sacrum. Historically, they have been most effectively managed with en bloc surgical resection, as they are resistant to conventional radiotherapy and chemotherapy.
    Short Communication
    Hiroshi Kuroki*
    Abstract: The atlantoaxial complex is more easily destabilized in certain pathological conditions. Significant atlantoaxial instability is a potentially serious progressive condition that, if untreated, may result in local pain, myelopathy, or ultimately death. Surgical intervention is often indicated to realign and stabilize the segment, and to decompress the neural structures if necessary. Various types of procedure to fix the atlantoaxial complex can be found in the literature; posterior wiring procedures, interlaminar clamps, intra-articular screw fixation, transarticular screw fixation, and screw and rod fixation. Each surgical method has advantages and disadvantages. Not only anatomical but biomechanical conditions of the atlantoaxial complex are extremely variable in individual cases. Therefore, for successful treatment, it is important to select the most applicable surgical procedure to fix the atlantoaxial complex as strong as possible under detailed morphological assessment to secure safety of each patient.
    Case Series
    Victoria Ohla, Anand Mahadevan, Scott Floyd, Pedro Ciarlini, Matthew Anderson, and Ekkehard M. Kasper*
    CNS metastases from systemic sarcoma are exceedingly rare and difficult to treat, as the lesions appear late in the course of the disease. The situation is even more complicated by the fact that sarcoma is considered a radioresistant tumor of mesenchymal origin. Adjuvant CyberKnife radiosurgery (CKSRS) as a treatment option has not been described in the management of secondary central nervous system involvement from systemic sarcoma, but can offer good local control and increased progression free survival without interfering with the need of ongoing systemic therapy. We therefore report our experience of 4 lesions in 2 patients treated with CKSRS in this setting.
    Clinical Presentation:
    Case A: While undergoing adjuvant radiation for a pulmonary artery sarcoma, patient A presented with a generalized seizure. A right 2cm fronto-parietal lesion was identified and resection was performed. The patient was subsequently treated electively with CKSRS. Serial MRI demonstrated a significant decrease in size in the treated lesion with no evidence of residual or recurrent disease at 30 months. The patient remains clinically stable since the time of radiosurgery.
    Case B: A 60- year old woman with a history of metastatic chondroblastic osteosarcoma complained of new onset of headaches combined with a right visual field cut and anomia. Two separate lesions were identified on MRI and a open resection was performed on the larger of the lesions. Postoperative CKSRS was performed subsequently to the resection cavity and a second native lesion. Effective local tumor control was seen after treatment. A delayed recurrence of the resected lesion was retreated at 5 months. Repeat CKSRS was required for this lesion and third out-of-field lesion at 5-months after the initial CKSRS. The CNS sites remained well controlled until the patient succumbed due to systemic disease progression 19 months after initial treatment.
    Conclusion: Based on this report and available information in the literature, CyberKnife radiosurgery appears to be a suitable approach for patients with secondary central nervous system involvement from systemic sarcoma.
    Case Report
    Edward E. Kerr, Ripul R. Panchal, and Kee D. Kim*
    Introduction: Spinal pseudomeningocele involving the cervical spine is rare and may be symptomatic or asymptomatic. It can occur spontaneously, after trauma or after a surgical procedure. Typically, treatment involves primary closure of the fistula with or without CSF diversion. However, when pseudomeningocele is refractory to surgical revision additional options are limited.
    Methods: We describe a case of a 50-year-old female presenting with post-operative pseudomeningocele after 16 days from a C1 schwannoma resection. She failed a revision surgery with primary closure reinforced with Duragen® and Duraseal™ application and a lumbar drain placement. Hence, a novel method was attempted by applying extrinsic compression to the upper cervical spine utilizing a polycarbonate elastic face mask (Jobst Incorporated, Prior Lake, MN, USA).
    Results: The elastic face mask with a posterior cervical strap to provide continuous external compression to the surgical wound was worn for 9 weeks. Complete resolution of pseudomeningocele was noted on follow up MRI and the patient remained asymptomatic at 7-month follow up evaluation.
    Conclusions: Extrinsic compression with polycarbonate face mask may be a safe nonsurgical option or may be a useful adjunct to surgical repair for post-operative cervical spinal pseudomeningocele.
    Libby Kosnik Infinger* and Abhay K. Varma
    Herpes simplex virus type 1 and 2 can infect the human nervous system causing meningitis and encephalitis. HSV meningitis tends to be benign, but HSF encephalitis can have a high morbidity and mortality despite treatment. We present a case of HSV meningitis leading to hydrocephalus without evidence of encephalitis. The patient had persistent hydrocephalus requiring long term CSF diversion despite successful treatment of the infection.
    A 57 year old African-American female presented with acute decline in sensorium secondary to hydrocephalus. HSV type 2 was isolated from the CSF by polymerase chain reaction (PCR). There was no evidence of infiltrative lesion in the brain parenchyma on MRI. She was treated with CSF diversion and antiviral therapy. The meningitis was successfully treated, but the patient required ventriculoperitoneal shunt placement due to persistent hydrocephalus. This is the second reported case of post HSV-2 meningitis presenting with acute hydrocephalus, and first reported case of persistent hydrocephalus following HSV-2 meningitis.
    Adult HSV-2 meningitis usually has a benign course. Hydrocephalus is rare sequelae of this condition. The patient in this case was treated for HSV meningitis, and the virus was cleared from the CSF upon repeat PCR testing. Aqueductal stenosis from ependymal inflammation may play a role in the pathophysiology of hydrocephalus. This is the first reported case of persistent hydrocephalus following HSV-2 meningitis that required a permanent CSF diversionary procedure. Viral etiology should be actively sought in a case of spontaneous and unexplained hydrocephalus, even in an adult.
    Review Article
    Isaiah Tubbs, Marios Loukas, and Shane Tubbs R*
    Although considered an excellent anatomist, Carolus Stephanus is unknown to many and moreover, his contributions to the early understanding of neuroanatomy are mostly lost to history. This 16th century French anatomist was partially taught by Sylvius and was the classmate of Vesalius. He was a prolific writer but most of his work and research were overshadowed by Vesalius. His contributions to neuroanatomy included detailed descriptions of the optic chiasm, hippocampus, spinal cord and spinal nerves. The current paper reviews the life and works of this forgotten anatomist and his contributions to neuroanatomy.
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