Jose Miguel Soto

SICH (spontaneous intracerebral hemorrhage) is a major cause of death and disability. Traditional surgical evacuation, while beneficial, risks damaging healthy tissue. Minimally invasive surgery (MIS) offers a promising alternative. This study explores the feasibility and safety of diffusion tensor imaging (DTI)-guided, trans-sulcal MIS with BrainPath/Myriad NICO Corporation (Indianapolis, IN, USA) for sICH evacuation. DTI/tractography (DTT) visualizes critical pathways like the corticospinal tract (CST), aiding surgical planning and potentially predicting motor function recovery post-surgery. Our objectives include i) assessing the feasibility and safety of DTT-guided, trans-sulcal MIS with BrainPath/Myriad for sICH evacuation. ii) Evaluating DTT's utility in surgical planning and its potential role in predicting motor function recovery. Three sICH patients underwent pre-operative DTT with CST involvement graded A (direct injury) to E (displacement). Based on DTT, surgical trajectories using three trans-sulcal approaches were planned to avoid the CST. MIS with BrainPath/Myriad was performed aiming for <15 mL residual hematoma. Post-operative DTT and motor function follow-up (≥3 months) were conducted. Three patients completed pre- and post-operative DTT scans. All were middle-aged males with sympathomimetic abuse history. Two had Type A CST involvement, and one had Type D. Both Type A patients recovered well but showed no significant motor improvement. The Type D patient showed motor improvement. All patients completed the three-month follow-up. Our limited data suggests that DTI-guided, trans-sulcal MIS with BrainPath/Myriad for sICH evacuation is feasible and safe. DTT seems valuable for surgical planning and potentially predicts motor function recovery. Further studies with more patients are needed to confirm these findings.

Background: The lag screw is a common technique and device used in orthopedic surgery for compressing simple fractures. Here, a lag screw was used to treat a traumatic L5-S1 fracture in a 53-year-old patient with ankylosing spondylitis (AS) resulting in 15 mm of anterior subluxation. Case Description: A 53-year-old patient with AS resulting in 15 mm of anterior subluxation was successfully managed with a lag screw instrumented fusion. Conclusion: A lag screw successfully stabilized a traumatic L5-S1 lumbar spinal fracture in a patient with AS.

The 2021 World Health Organization Classification of Tumors of the Central Nervous System reflected advances in understanding of the roles of oncohistones in gliomagenesis with the introduction of the H3.3-G34R/V mutant glioma to the already recognized H3-K27M altered glioma, which represent the diagnoses of pediatric-type diffuse hemispheric glioma and diffuse midline glioma, respectively. Despite advances in research regarding these disease entities, the prognosis remains poor. While many studies and clinical trials focus on H3-K27M-altered-glioma patients, those with H3.3-G34R/V mutant gliomas represent a particularly understudied population. Thus, we sought to review the current knowledge regarding the molecular mechanisms underpinning the gliomagenesis of H3.3-G34R/V mutant gliomas and the diagnosis, treatment, long-term outcomes, and possible future therapeutics.

Background: Pseudomeningoceles (PMs) are infrequent complications of spine surgery resulting from incidental durotomy and subsequent extravasation of cerebrospinal fluid. Giant PMs (GPMs), defined as ≥8 cm in major diameter, are rarely reported in the literature and present a challenge due to a lack of clear guidelines for surgical management. Case Description: Here, the authors discuss the successful surgical management of a 25.3 cm lumbar GPM that became calcified 3 years following an initial T10-S2 laminectomy with instrumented fusion performed at an outside-hospital. Conclusion: This report focuses on the successful 3-year delayed surgical intervention for the management of an ossified GPM.

Incidental durotomies are well-known complications of spine surgery. They are often identified and repaired intraoperatively, with a preference for primary rather than secondary repair. We present the case of a middle-aged male with worsening radicular pain six months after spinal surgery complicated by a durotomy defect. His pain was worse with coughing or standing. Magnetic resonance imaging identified an L3-L5 extradural fluid collection in the lumbar spinal canal and an empty sac sign. Computed tomography lumbar myelogram identified clumping of the cauda equina nerve roots at L2-L3 and an empty sac sign at L4-L5 and L5-S1, concerning adhesions and arachnoiditis. The patient's unusual worsening of symptoms and a history of a durotomy defect with secondary repair led to suspicion of an alternative cause. Surgical exploration identified the left L5 nerve root herniated through the durotomy defect. Reduction of the nerve root herniation with primary repair of the durotomy was performed, and the patient experienced immediate relief that was stable at his one-month follow-up. This case features an unusual presentation of a delayed herniated nerve root through a prior durotomy defect with entrapment. We highlight the importance of a high degree of caution in cases of increased radicular pain following spinal surgery with a known durotomy, particularly when symptoms do not support the clinical presentation of arachnoiditis. Additionally, primary repair of durotomies should be undertaken whenever possible to avoid this potential complication.