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Background: Bertolotti's syndrome is characterized by enlargement of the transverse process at the most caudal lumbar vertebra with a pseudoarticulation between the transverse process and sacral ala. Here, we describe the use of intraoperative three-dimensional image-guided navigation in the resection of anomalous transverse processes in two patients with Bertolotti's syndrome. Case Descriptions: Two patients diagnosed with Bertolotti's syndrome who had undergone the above-mentioned procedure were identified. The patients were 17- and 38-years-old, and presented with severe, chronic low back pain that was resistant to conservative treatment. Imaging revealed lumbosacral transitional vertebrae at the level of L5-S1, which was consistent with Bertolotti's syndrome. Injections of the pseudoarticulations resulted in only temporary symptomatic relief. Thus, the patients subsequently underwent O-arm neuronavigational resection of the bony defects. Both patients experienced immediate pain resolution (documented on the postoperative notes) and remained asymptomatic 1 year later. Conclusion: Intraoperative three-dimensional imaging and navigation guidance facilitated the resection of anomalous transverse processes in two patients with Bertolotti's syndrome. Excellent outcomes were achieved in both patients.

Background Corpora amylacea (CA) are accumulations of polyglucosan bodies typically found in astrocytic foot processes, and rarely, can mimic neoplasm. CA accumulation has also been associated with seizure disorders. We report the first case of a histologically confirmed intracranial, intraparenchymal CA lesion mimicking a low-grade glioma and manifesting as a seizure. Case description A 43-year-old man presented after a general tonic-clonic (GTC) seizure. Brain magnetic resonance imaging (MRI) revealed a small lesion in the right mesial temporal lobe with radiologic features of a low-grade glioma. The patient underwent a right pteronial craniotomy for resection of the lesion. Histology demonstrated abundant polyglucosan bodies without neoplastic features. The patient tolerated the procedure well, was free from seizures without antiepileptic drugs at 2-week follow-up, and is undergoing serial surveillance. Conclusion The clinical manifestation of CA as a seizure in the context of an identified brain mass is extraordinarily rare. Nevertheless, CA should be considered in the differential diagnosis for patients with seizures and a radiologically identifiable low-grade lesion. Symptomatic CA lesions Mimicking a low-grade glioma should be surgically pursued with a goal of safe, maximal resection to confirm the diagnosis and to provide the patient with prognosis, which can significantly impact patient quality of life.