Background: Juvenile xanthogranuloma (JXG) is a proliferative disorder of non-Langerhans histiocytes. The lesions typically occur in children as solitary cutaneous lesions, but are only rarely found in adults in their late twenties to thirties. Approximately 5–10% of JXG are extracutaneous in location, with spinal JXG being only rarely encountered. Here, we described a 28-year-old male with an extradural spinal JXG resulting in severe C6– T1 spinal cord compression and a progressive quadriparesis that warranted a decompressive laminectomy/C6–T2 fusion. Case Description: A 28-year-old male presented with a progressive quadriparesis of 12 months’ duration that rapidly worsened over the last 3 months. When the MRI revealed severe cord epidural C6–T1 cord compression, the patient successfully underwent a C6–T1 laminectomy for gross total tumor excision followed by a C6–T2 instrumented fusion. The histopathology confirmed the diagnosis of a spinal JXG. Conclusion: Spinal JXGs in adults are only rarely encountered and should be treated with gross total tumor excision with/without fusion to achieve the best long-term outcomes.
Background: Cervical spinal cord injury (SCI) is a life-threatening condition. Prompt surgical intervention is needed to avoid hemodynamic and respiratory catastrophe. In Indonesia, however, spine surgery is more common in tertiary hospitals and thus might prolong the time gap to surgery due to referral waiting time. Case Description: We performed an emergency surgery for a patient with complete SCI due to unstable cervical fracture. The patient was in spinal shock and experienced respiratory arrest after radiological workup. Stability was achieved in the ICU and patient was directly sent to operating theater. Anterior-posterior approach was chosen to decompress and stabilize the cervical spine. The patient was discharged on postoperative day 17 and was seen well at 1-month follow-up. Conclusion: The capability to perform spine procedures should not be exclusive to tertiary hospitals in Indonesia. Satisfying results can be achieved with the presence of capable neurosurgeons or orthopedic surgeons and anesthesiologists in lower-level hospitals.
Brain traumatic injury (BTI) is one of the causes of death and disability worldwide that affects people regardless of sex, age, income and social status, race, or nationality. In patients with brain traumatic injury, one of the problems that occurs is Diffuse Axonal Injury (DAI) that can produce a direct clinical effect, leading to coma and death. Adrenocorticotropin analogues (ACTH) is one of neuroprotective therapy in brain injury. The aim of this study was to analyze the effect of ACTH analogue on the clinical output (Glasgow Outcome Score/GOS and Bartle Index) in patients with DAI at hospital discharge, 3 months and 6 months post-treatment. This study revealed that ACTH analogue administration resulted in higher GOS and Barthel Index scores than that in control. Further study will required with other variables, such as cognitive and motor examination, and some biomarkers can also be examined serially.Brain traumatic injury (BTI) is one of the causes of death and disability worldwide that affects people regardless of sex, age, income and social status, race, or nationality. In patients with brain traumatic injury, one of the problems that occurs is Diffuse Axonal Injury (DAI) that can produce a direct clinical effect, leading to coma and death. Adrenocorticotropin analogues (ACTH) is one of neuroprotective therapy in brain injury. The aim of this study was to analyze the effect of ACTH analogue on the clinical output (Glasgow Outcome Score/GOS and Bartle Index) in patients with DAI at hospital discharge, 3 months and 6 months post-treatment. This study revealed that ACTH analogue administration resulted in higher GOS and Barthel Index scores than that in control. Further study will required with other variables, such as cognitive and motor examination, and some biomarkers can also be examined serially.
Introduction: Foramen magnum meningiomas (FMMs) arise from meningothelial cells of arachnoid layer in the craniospinal junction. FMMs are rare and comprise only 1.8 to 3.2% of all meningiomas. Patients with FMMs generally have vague symptoms and are often misdiagnosed. Surgical management of FMMs poses a challenge because foramen magnum is a highly complex territory of the skull base and contains many important and vital structures. Up until this date, the surgical approaches for FMMs that arise anterolaterally remain varied. We aimed to present a case of anterolateral FMM that was successfully managed through posterior suboccipital midline approach. Case presentation: A 49-year-old female presented with chief complaint of tetra paresis for the past 4 months. Initially, she was experiencing tingling and numbness on her right neck radiating to her right hand. Her symptoms were worsened, radiating to all of her four extremities along with progressive motor weakness that made her unable to walk. Whole spine MRI was performed and anterior meningioma extending to the right side at the level of foramen magnum was found. The posterior suboccipital midline approach with C1 laminectomy and C2 partial superior laminectomy was performed. The patient made a good recovery immediately after the surgery and there was no recurrence of her symptoms during 4 months follow-up. Conclusion: Surgical approaches for FMM remain varied according to several studies. However, the surgical strategy should be patient-tailored to achieve the maximal resection and prevent morbidity. As for our case, posterior suboccipital midline approach is safe and feasible surgical procedure to treat anterolateral FMM.
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