Neurosurgery Case Review : Questions and Answers

462 Pages·2009·15.26 MB·English

by  Remi Nader

Neurosurgery Case Review
Questions and Answers
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Neurosurgery Case Review
Questions and Answers
Remi Nader, MD, CM, FRCS(C), FACS
Chief, Division of Neurosurgery
Greenwood Lefl ore Hospital
Greenwood, Mississippi
Clinical Assistant Professor
Department of Neurosurgery
University of Mississippi
Jackson, Mississippi
Abdulrahman J. Sabbagh, MD, FRCS(C)
Director, Neurosurgery Residency Program
Department of Neurosurgery
Neuroscience Center
King Fahd Medical City–Ministry of Health
Riyadh, Saudi Arabia
Thieme
New York • Stuttgart
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Library of Congress Cataloging-in-Publication Data
Neurosurgery case review : questions and answers / edited by Remi Nader, Abdulrahman J. Sabbagh.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60406-052-2 (alk. paper)
1. Nervous system—Surgery—Examinations, questions, etc. I. Nader, Remi. II. Sabbagh, Abdulrahman J.
[DNLM: 1. Nervous System Diseases—surgery—Examination Questions. 2. Neurosurgical Procedures—methods—Examination
Questions. WL 18.2 C338 2009]
RD593.C38 2009
617.4'80076—dc22 2009014543
Copyright © 2010 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any
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However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical
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All chapters in this book are based on actual cases encountered by the primary or senior authors during the scope of their
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Printed in China
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ISBN 978-1-60406-052-2
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Dedication
This book is dedicated to . . .
My lovely wife, Candis, who endured me the past few years during the labor on this project!
My parents, Eleonore and Joseph, and grandmother, Honeine, to whom I owe my life, discipline, and education.
Our pets, Minou and Bibite, who have kept me company and cheered me up during this endeavor.
Remi Nader
To my heroes, my parents, Jafar and Wafa, who selfl essly dedicated their lives to their family and country, taught me
tolerance and persistence, and told me “never stop before you reach the stars.”
To my better half and best friend, my wife, Alaa, without whose true love, altruistic devotion, and unrelenting support I
would never have achieved what I have.
To my children, Leen, Jafar, and Omar, and my siblings, Heba, Ahmad, and Mostafa, for making it all worthwhile.
Abdulrahman J. Sabbagh
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Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Section I Intracranial Pathology
Brain Tumors
Phacomatosis
Case 1 Vestibular Schwannoma in Neurofi bromatosis Type 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Burak Sade and Joung H. Lee
Case 2 Subependymal Giant Cell Astrocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Remi Nader
Case 3 Sturge–Weber Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Remi Nader
Case 4 Von Hippel–Lindau Disease—Hemangioblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Ramez Malak and Robert Moumdjian
Meningioma
Case 5 Parasagittal Meningioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Remi Nader
Case 6 Olfactory Groove Meningioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Stephen J. Hentschel and Lissa Marie Ogieglo
Case 7 Sphenoid Wing Meningioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Remi Nader
Case 8 Hemangiopericytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Burak Sade and Joung H. Lee
Case 9 Clinoidal Meningioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Burak Sade and Joung H. Lee
Case 10 Velum Interpositum Meningioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Michel W. Bojanowski and Denis Klironomos
Pituitary Tumors
Case 11 Pituitary Apoplexy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Michel W. Bojanowski and Denis Klironomos
Case 12 Pituitary Adenoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Remi Nader and Marc-Elie Nader
Case 13 Craniopharyngioma: Endoscopic Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Daniel M. Prevedello, Amin B. Kassam, Paul Gardner, Arlan H. Mintz, Carl H. Snyderman, and
Ricardo L. Carrau
Gliomas
Case 14 High-grade Glioma: Surgical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Ramez Malak and Robert Moumdjian
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Case 15 High-grade Glioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Remi Nader and Abdulrahman J. Sabbagh
Case 16 Eloquent Cortex Low-grade Glioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
John Winestone and Allen K. Sills Jr.
Malignant Intracranial Neoplasms
Case 17 Single Brain Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Joseph A. Shehadi and Brian Seaman
Case 18 Multiple Brain Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Ramez Malak and Robert Moumdjian
Case 19 Meningeal Carcinomatosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Ramez Malak and Robert Moumdjian
Case 20 Primary Central Nervous System Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
John Winestone and Allen K. Sills Jr.
Case 21 Posterior Fossa Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Julius July and Eka Julianta Wahjoepramono
Other Intracranial Tumors
Case 22 Fibrous Dysplasia of the Skull . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Burak Sade and Joung H. Lee
Case 23 Orbital Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Michel Lacroix
Case 24 Multiple Ring-enhancing Cerebral Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Kevin Petrecca and Rolando Del Maestro
Case 25 Paraganglioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Nazer H. Qureshi and Ossama Al-Mefty
Case 26 Colloid Cyst of the Third Ventricle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Remi Nader
Vascular Neurosurgery
Arteriovenous Malformations
Case 27 Dural Arteriovenous Fistula . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Nancy McLaughlin and Michel W. Bojanowski
Case 28 Cerebral Arteriovenous Malformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Pascal M. Jabbour and Erol Veznedaroglu
Case 29 Cavernous Angioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Julius July and Eka Julianta Wahjoepramono
Intracranial Aneurysms
Case 30 Subarachnoid Hemorrhage and Vasospasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Qasim Al-Hinai, Claude-Edouard Chatillon, David Sinclair, and Dennis J. Sirhan
Case 31 Unruptured Anterior Communicating Artery Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Yasser I. Orz
Case 32 Posterior Communicating Artery Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Pascal M. Jabbour and Erol Veznedaroglu
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Case 33 Familial Cerebral Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Hossam Al-Jehani and Richard Leblanc
Case 34 Blister Carotid Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Nancy McLaughlin and Michel W. Bojanowski
Case 35 Concomitant Arteriovenous Malformation and Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Julius July and Eka Julianta Wahjoepramono
Case 36 Middle Cerebral Artery Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Julius July and Eka Julianta Wahjoepramono
Intracerebral Hemorrhage
Case 37 Hypertensive Putaminal Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Remi Nader
Case 38 Intraventricular Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Hosam Al-Jehani, Dennis J. Sirhan, and Abdulrahman J. Sabbagh
Case 39 Cerebellar Hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Julius July and Eka Julianta Wahjoepramono
Ischemic Cerebral Disease
Case 40 Moyamoya Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Abdulrahman J. Sabbagh, Jean-Pierre Farmer, Jie Ma, Ahmad I. Lary, and José Luis Montes
Extracranial Vascular Disease
Case 41 Amaurosis Fugax with Carotid Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Glenn C. Hunter and Alwin Camancho
Case 42 In Tandem Extracranial and Intracranial Carotid Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Glenn C. Hunter
Case 43 Vertebral Artery Stenosis with Ischemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Glenn C. Hunter and Rudiger Von Ritschl
Case 44 High-grade Carotid Stenosis and Intracranial Aneurysm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Glenn C. Hunter and Remi Nader
Cranial Trauma
Closed Head Injuries
Case 45 Chronic Subdural Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Remi Nader
Case 46 Mild Head Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Judith Marcoux and Abdulrazag Ajlan
Case 47 Epidural Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Abdulrazag Ajlan and Judith Marcoux
Case 48 Traumatic Acute Subdural Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Abdulrazag Ajlan and Judith Marcoux
Intensive Care Management
Case 49 New Trends in Neurotrauma Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Judith Marcoux and Abdulrazag Ajlan
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Case 50 Intracranial Pressure Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Abdulrazag Ajlan and Judith Marcoux
Other Cranial Trauma
Case 51 Gunshot Wound to the Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Remi Nader
Case 52 Other Penetrating Intracranial Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Domenic P. Esposito
Pediatric and Developmental Disorders
Hydrocephalus
Case 53 Aqueductal Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Jeff rey Atkinson
Case 54 Cerebrospinal Fluid Shunt Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Jeff rey Atkinson
Case 55 Slit Ventricle Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Jeff rey Atkinson
Case 56 Mega-hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Maqsood Ahmad and Abdulrahman J. Sabbagh
Pediatric Brain Tumors
Case 57 Cerebellar Medulloblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Ali Raja, Ian F. Pollack, and Nazer H. Qureshi
Case 58 Brainstem Glioma 1: Pons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Abdulrahman J. Sabbagh, Ayman Abdullah Albanyan, Mahmoud A. Al Yamany, Reem Bunyan,
Ahmed T. Abdelmoity, and Lahbib B. Soualmi
Case 59 Brainstem Glioma 2: Medulla Oblongata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Jean-Pierre Farmer, Abdulrahman J. Sabbagh, and Ahmad Al-Jishi
Case 60 Pineal Region Tumor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Claude-Edouard Chatillon, José Luis Montes, and Jean-Pierre Farmer
Case 61 Endoscopic Treatment of Hydrocephalus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Jeff rey Atkinson
Case 62 Neurofi bromatosis Type 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Jean-Pierre Farmer and Abdulrahman J. Sabbagh
Case 63 Epidermoid of the Sella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Abdulrahman J. Sabbagh and Jean-Pierre Farmer
Case 64 Frontal Abscess with Sinus Involvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Ramez Malak and Robert Moumdjian
Case 65 Hypothalamic Hamartoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Abdulrahman J. Sabbagh, Sandeep Mittal, Fahad Eid Alotaibi, and José Luis Montes
Pediatric Neurovascular Disease
Case 66 Vein of Galen Malformation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Samer K. Elbabaa and Sten Solander
77005500000088FFMM..iinndddd xx 88//1122//0099 1122::1177::0088 PPMM