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The pineal tumor was once considered as a restricted area for surgery. Such cases are rare, with many different opinions on surgical treatment.This study aimed to review our experience of tumor treatment in the pineal region and explore the optimal treatment strategy.The clinical data of 72 patients with pineal tumors from January 1997 to May 2015 (18 years) were retrospectively analyzed. Preoperative preparation, pathology types, tumor resection rate, surgical approach, and follow-up outcomes were used as the indicators to evaluate the treatment efficacy.The Krause approach was used in 46 cases, the Poppen approach in 10 cases, and the transcallosal-lateral ventricle-choroid fissure approach in 16 cases. The postoperative pathological results were as follows: 24 cases of germinoma, 11 of teratoma, 15 of glioma, 6 of meningioma, 11 of Pineocytoma, 2 of cholesteatoma, 2 of cavernous hemangioma, and 1 of choriocarcinoma. Further, the study included 64 cases of total surgical resections, 8 of subtotal resections, and 2 deaths. The follow-up period was from 7 months to 10 years. Further, 51 (70.8%) patients were followed up. The multivariate regression model showed that the surgical method and the pathological type contributed significantly to predicting outcomes.The type of pathology, extent of excision, and surgical approach had a significant impact on the prognosis of patients. The transcallosal-lateral ventricle-choroid fissure approach for large and medium-sized pineal tumors near the posterior part of the third ventricle had good efficacy.

A series of unsymmetrical NNN′ ruthenium(II) complexes supported by a tridentate bipyridyl imidazoline ligand with variable steric hindrance (2a–c; R1 = tBu, iPr, or Bn) and electronic effect (2d–h; R2 = H, CH3, OCH3, Br, or NO2) were prepared. The molecular structures of ligands 1f and 1g, and Ru complex 2a were further determined by X-ray single-crystal diffraction. The catalytic activity of these eight complexes for α-alkylation of nitriles with alcohols was evaluated, which could be controlled by the substituents on the imidazoline moiety. Ru complex 2h bearing a strong electron-withdrawing group (R2 = NO2) demonstrated the highest catalytic activity, with alkylated nitriles achieved in up to 97% yield.

Introduction Nonprojectile penetrating skull base injuries as a result of falls have rarely been confronted in normal neurosurgery although a few nonmissile injuries have been reported. These kinds of injuries represent a life-threatening emergency. Case presentation We present an unusual case of a 25-year-old male construction worker who suffered an accidental penetrating skull base injury when he fell on a metal rod while he was walking on a 2-meter-high platform. He was clinically stable at presentation. Skull radiograph showed a solid metallic bar, 30 cm long, that penetrated through the right anguli oris eminence and was lodged low in the right occipital bone. Conclusion Penetrating injury to the head is considered a form of severe traumatic brain injury. Although case of penetrating head injuries as a result of fall from heights are very rare, we anticipate the construction works on high-rise buildings are at maximum risk. We advise that removal of this kind of foreign bodies be done in the theater and not outside because of risk of involvement of larger vessels leading to fatal hemorrhage. We further suggest that patients with nonprojectile injuries should undergo a preoperative computed tomography-angiography to rule out any vascular injury.

Introduction: Langerhans cell histiocytosis (LCH) is a rare uni or multisystem disorder associated with extreme production of immunoreactive Langerhans cells. Although this disorder has been reported in all age groups, spinal involvement especially thoracolumbar spine is seldom reported in toddlers. Case presentation: We present a one (1) year, four (4) months female child with a history of recurrent fever, irritability and severe anemia of one (1) month duration. CT-scan and MRI revealed a collapsed twelfth thoracic vertebra (T12) body height greater than 95% with a huge intradural soft tissue mass. T12 cortectomy via posterior thoracolumbar approach was used to decompress the soft tissue part followed by interbody fusion with titanium cage filled with autologous iliac crest bone graft, fixation using plates and screws. Conclusion: We are of the view that surgical decompression of spinal LHC lesions with interbody fusion with titanium cage filled with autologous iliac crest bone graft and fixation using plates and screws is very crucial in relieving neurological deficits. However, the patient will need repeated surgeries as she advances with age in a timely manner to avert any neurological deficit that may occur. Keywords: Langerhans cell histiocytosis (LCH), Letterer-Siwe disease, Hand-Schüller-Christian disease, Eosinophilic granuloma

Background: Intracranial schwannomas of the accessory nerve are very rare lesions. They are categorised according to their locations into either intrajugular or intracistemal schwannomas although most of them are intrajugular. The intrajugular type constitutes about 2% to 4% of all intracranial schwannomas described in literature. Aim: It’s very unusual for an accessory nerve to mimic glossopharyngeal nerve looking at the anatomical location of the accessory nerve. Although many authors have written on accessory nerve, none have described this unusual presentation. We present a case, management as well as review on the classification and appropriate surgical techniques we could have use to access the tumor in our patient since the choice of a particular surgical approach is based on the nature of tumor, location as well as it extension into other adjacent structures. Case Presentation: We present a case of 52-year-old woman with very unusual accessory nerve schwannoma which mimics the clinical presentation of glossopharyngeal nerve tumor. The main symptom in our case is six (6) months history of deviation of the tongue to right side with dizziness and change of voice. Conclusion: The unusual presentation in our case could be due to massive compression of glossopharyngeal nerve by the growing accessory nerve schwannoma since most lower cranial nerve schwannomas at this location will almost always course compressive symptoms.

Rationale: Neurenteric cysts, are rare benign tumors of the central nervous system that are mostly located in the spinal cord and predominantly seen in male children although adult form of the disorder also occurs. The etiology and treatment of this disorder is still a matter of debate. Our case further throws more light on the pathogenesis and treatment of this disorder. Patient concerns: A 4-year-old boy presented with 5-month history of cervical lordosis and bilateral lower extremity pain that progressed to his abdomen and upper body. The pain was general, recurrent, non-persistent and progressive in nature with no paralysis. The pain was aggravated by trunk stretching and relieved when he assumed opisthotonos position so he preferred sleeping in this position at night. Diagnoses: Magnetic resonance imaging (MRI) revealed a cystic lesion at the thoracolumbar spine with tethering of spinal cord and cervical lordosis. Interventions: He was operated on successfully and the cervical lordosis and pain resolved. Outcomes: The child recovered well with no tumor recurrence and massive improvement of his life. Lessons: The gold standard treatment for this disorder is surgery although the precise surgical approach is still a matter of debate. We are of the view that surgical approach should be individualized and aim at total excision of the cyst.

Cholesteatomas are very rare benign, progressive lesions that have embryologic derivation and usually result in progressive exfoliation and confinement of squamous epithelium behind an intact or preciously infected tympanic membrane. To the best of our understanding no reports demonstrates the extension of cholesteatoma from the temporal bone into the foramen magnum. We therefore present a case of cholesteatoma extending down into the foramen magnum. We report a case of 67- year-old man with a giant cholesteatoma extending into the foramen magnum without substantial destruction of the mastoid and petrous temporal bones. The patient’s major symptoms were recurrent tinnitus in the left ear and dizziness with unilateral conductive hearing loss. A working diagnosis of cholesteatomas was made combining the symptoms and magnetic resonance imaging findings. He was then successfully operated on with very minimal postoperative complications. Cholesteatomas originating from the mastoid bone often linger with the patients for many years in a subclinical state and progress into a massive size before causing symptoms. Patients with unilateral conductive hearing loss who are otherwise asymptomatic and have a normal tympanic membrane should be suspected with a progressive cholesteatoma. Cholesteatoma should be one of the working diagnosis when an elderly patient present with unilateral conductive hearing loss that is associated with tinnitus and dizziness.

Atlantoaxial dislocation is a disorder that is characterized with loss of stability of the atlas and axis (C1-C2) with consequential loss of usual articulation. Although this condition is very common, no one has reported a case as young as our patients. We present a 7-month infant with bilateral paralysis of the lower limbs for four (4) months with no history of trauma. Computer tomographic (CT-scan) imaging revealed alantoaxial dislocation with severe cervical spinal cord compression. The odontoid process is displaced outwardly with no bone destruction. Doppler echocardiogram done revealed patent foramen ovale. Thorough physical examination as well as radiological evaluation revealed no feather malformations. Electrophysio - logical studies reveal normal compound muscle action potentials (CMAP) and sensory nerve action potentials (SNAPs) in all the limbs. Electromyography (EMG) also revealed normal nerves in the limbs and the trunk. We attained a stable fusion and anatomical reduction using a posterior titanium wire and an iliac bone graft harvested from his mother. This is the youngest patient reported in literature. Infantile alantoaxial dislocation should be managed at early stage to prevent long-term neurologic disorders.

Chiari type I malformation with cervicothoracic syringomyelia although very common in clinical practice usually in children can progress slowly and mimic muscular dystrophies in adulthood. We present a rare adult case of Chiari type I malformation with cervicothoracic syringomyelia subterfuge as Flail arm syndrome. A 44- year-old man was diagnosed with congenital type I Chiari malformation with cervicothoracic syringomyelia about 21 years ago without surgery. His health status deteriorated over the years until 21 days prior to presentation when he had severe pain in the right knee. In his upper limbs, he had bilateral corresponding severe weakness of 0/5 proximal strength and 0/5 strength in his distal muscles. Magnetic resonance imaging (MRI) revealed an enlargement of the spinal cord from C1-C4 level with a mass that appeared hypo-dense on T1 and hyperdense on T2. Syringomyelia is a potentially serious neurologic condition that can mimic other neuromuscular disorders. Early detection and diagnosis with MRI is crucial to avoid irreversible neurological complications. We suggest that whether asymptomatic or symptomatic, decompressive surgery should be carried out to allow for free flow of cerebrospinal fluid thereby improving the quality of life for the patient.

In order to evaluate the effects of meiotic stage on survival of vitrified goat oocytes, the Cryoloop method was used to cryopreserve goat immature germinal vesicle (GV) and meiosis II (MII) oocytes following in vitro maturation (IVM). The oocytes collected from local slaughter house were divided into two parts. In the first part, the immature cumulus oocyte complexes (COCs) were further divided into three groups: (1) untreated (control), (2) exposed to the vitrification and dilution solutions but without being plunged into liquid nitrogen (toxicity), or (3) vitrified by the Cryoloop method (vitrification). In the second part, the MII oocytes produced by IVM of immature COCs were also divided into three groups as the above immature COCs. Oocytes survival was assessed by morphological appearance, nuclear maturation, and developmental capability following parthenogenetic activation (PA). The experiment was repeated three times. Our data indicated the rates of oocytes with normal appearance and developmental capability in the toxicity or vitrification group were decreased as compared to the control oocytes. In the toxicity group, the rate of GV oocytes with normal morphology was 76.25% ± 3.37% and significantly less than that of MII oocytes (92.18% ± 1.94%, P 0.05). Additionally, the percentage of GV oocytes developing to blastocyst was significantly less than that of MII oocytes in the toxicity group (13.84% ± 2.81% vs 29.78% ± 4.17%, P 0.05). In conclusion, although vitrification can greatly damage the structure and development capability of goat oocytes, the Cryoloop method can result in acceptable levels of survival and development of goat oocytes. Additionally, compared to immature GV goat oocytes, mature MII oocytes may be more tolerant to the vitrification process.

A 5-year-old girl presented with an 8 × 10-cm dumbbell-shaped mass in her left occipitoparietal region (figure 1). A preoperative CT angiogram demonstrated a large subcutaneous mass with abundant blood vessels (figure 2A). MRI revealed a giant extracranial–intracranial space-occupying lesion (figure 2, B–D). After endovascular embolization, we resected the tumor (figure 2E). The postoperative pathologic diagnosis was primitive neuroectodermal tumor (figure 2F). Primitive neuroectodermal tumor extension to the brain is rare; imaging is not pathognomonic and requires confirmation by pathology. Early intervention is preferable.

A 46-year-old man presented with a 4-year history of headache and visual field defect. Physical examination revealed a large patch of pigmented skin with alopecia areata measuring 10 × 12 cm in the right occipitotemporal region (figure 1A). Imaging showed a large intracranial space-occupying mass (figure 1, B–D). Pitch-black, chocolate-like substance was found during the surgery (figure 2A). The wound was repaired using split-skin graft (figure 2B). Pathologic examination confirmed the diagnosis of pigmented nevus. Giant pigmented nevus is a congenital melanocytic lesion originating from the neural crest.1 Intracranial spread is extremely rare2 and may represent a malignant transformation.

Background context Paraspinal neurogenic tumors in the thoracic region are not a rare clinical entity in neurosurgical practice. They usually consist of intrathoracic and intraspinal parts, namely dumb-bell type. However, in some rare cases, they might display a bidirectional extraspinal growing pattern, compromising three components with intraspinal, intrathoracic, and subcutaneous parts, thus appearing to be shamrock-like. Despite its benign nature, the removal of this type of tumor could be challenging for both neurosurgeons and thoracic surgeons, especially when the tumor has grown to an enormous size. Purpose We present a case of a giant paraspinal shamrock-shaped schwannoma in the T9–T12 level resected completely by one-stage combined surgery of hemilaminectomy and posterolateral thoracotomy performed by an interdisciplinary team of neurosurgeons and thoracic surgeons. Study design/setting Operating room of a large tertiary medical center where expertise and equipment of neurosurgery, thoracic surgery, and neuroanesthesia are readily available. Methods Under generalized anesthesia, the patient was intubated with a double-lumen endotracheal tube to allow one-lung ventilation during the thoracotomy, and he was then placed in the left lateral position. Because of the giant subcutaneous mass, the normal hemilaminectomy could not be carried out like it usually would be. Thus, we did slight modification to the standard hemilaminectomy; first, by elevation of a skin flap to allow in situ excision of the subcutaneous portion of the tumor, then followed by a standard unilateral laminectomy to remove the intraspinal portion, done by neurosurgeons, and finally, posterolateral thoracotomy to remove the intrathoracic part, performed by a thoracic team. Results The postoperative magnetic resonance imaging scan showed complete removal of the tumor, and the patient experienced an improvement in lower extremity muscle weakness with no new neurological deficits. Conclusions This is the first case to demonstrate the removal of giant paraspinal shamrock-shaped schwannoma in the thoracic level. The combined approach of modified hemilaminectomy and posterolateral thoracotomy was proven to be appropriate in managing such cases, making this procedure a potential addition to present methods.

The progresses and theoretical methodology of computer modeling of cathodic protection using the boundary element method (BEM) are outlined. To test the effectiveness and accuracy of BEM numerical modeling of cathodic protection for offshore structures, a miniature model offshore jacket with a sacrificial anode was built and put in a test pool full of seawater. Cathodic protection potentials on different positions were measured and compared with the values obtained from computer modeling. The results show good agreement between measured value and numerical simulated value. The factors that led to discrepancy in the two groups of data were discussed.

This report presents a fully thrombosed giant aneurysm of the posterior inferior cerebellar artery (PICA) mimicking an intracranial tumour in a 9-year-old paediatric patient. Surgical clipping and aneurysmectomy were performed. Postoperative imaging studies confirmed the removal of the lesion and the patient was discharged with no neurological deficits. Our case shows that giant thrombosed aneurysms involving the PICA could be potentially misdiagnosed as neoplasms in children and great care must be exercised when managing such cases.