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Immune reconstitution inflammatory syndrome is a common manifestation in human immunodeficiency virus (HIV)-positive patients infected with tuberculosis (TB). One of the unusual complications of this condition is the development of psoas abscess. We describe a case of immune reconstitution inflammatory syndrome (IRIS) in a patient with disseminated TB under treatment, HIV-positive with a low CD4 cell count, complicated by bilateral psoas abscess. Our patient presented with fever, abdominal pain, and lymphadenopathy, typical symptoms of TB-IRIS. Diagnosis was confirmed by surgical drainage of the abscess of the right iliac psoas muscle with detection of acid-fast bacteria on Ziehl-Neelsen staining and negative culture of purulent discharge. Treatment with prednisone was started in addition to continuation of antituberculosis therapy and antiretroviral therapy.

Poor outcomes of aneurysmal subarachnoid hemorrhage (aSAH) can be the result of the initial catastrophic event or the many acute or delayed neurological complications. Recent evidence suggests that some molecules play a critical role in both events, through some unknown pathways involved. Understanding the role of these molecules in these events could allow to improve diagnostic accuracy, guide management, and prevent long-term disability in aSAH. Here we present the studies on aSAH biomarkers present in current medical literature, highlighting their roles and main results.

Immune reconstitution inflammatory syndrome is a common manifestation in human immunodeficiency virus (HIV)-positive patients infected with tuberculosis (TB). One of the unusual complications of this condition is the development of psoas abscess. We describe a case of immune reconstitution inflammatory syndrome (IRIS) in a patient with disseminated TB under treatment, HIV-positive with a low CD4 cell count, complicated by bilateral psoas abscess. Our patient presented with fever, abdominal pain, and lymphadenopathy, typical symptoms of TB-IRIS. Diagnosis was confirmed by surgical drainage of the abscess of the right iliac psoas muscle with detection of acid-fast bacteria on Ziehl-Neelsen staining and negative culture of purulent discharge. Treatment with prednisone was started in addition to continuation of antituberculosis therapy and antiretroviral therapy. [ABSTRACT FROM AUTHOR]

Racemose neurocysticercosis (RNC) is a malignant form of Taenia solium infection. It carries high mortality due to widespread intraparenchymal invasion, mass effect, and cyst rupture. Cerebellar RNC is unusual and constitutes a surgical challenge. Scarce applications of ultrasound (US) -guided resection have been reported for RNC of the posterior fossa. We report the case of a 66-year-old woman who presented with ataxia and dysmetria. Her past medical history was relevant for seizures and hydrocephalus secondary to neurocysticercosis. Because of the increasing cyst invasion and threatening mass effect in the posterior fossa, the patient underwent US-guided resection of lesions. Postoperative computed tomography (CT) demonstrated complete excision of cysts, and a 2-year follow-up magnetic resonance imaging (MRI) showed no recurrence. On neurological examination, the patient had persistent ataxia without new-onset neurological deficits. The present case study illustrates the feasibility and cost-effective approach of US-guided resection to provide enhanced operative visualization and achieve complete cyst resection. [ABSTRACT FROM AUTHOR]

Giant fusiform aneurysms of the middle cerebral artery (MCA) are complex and rare vascular lesions with a poor natural history and challenging treatment decision-making. We report the case of a 46-year-old male with a history of chronic hypertension and a transient ischemic attack who presented with left-sided hemiparesis. A cerebral angiotomography revealed an unruptured giant fusiform aneurysm in the M2 segment of the right MCA. After carefully evaluating the procedure's risks and benefits with the patient, he underwent a low-flow bypass surgery. An anastomosis between the superficial temporal artery and the M3 segment was performed with proximal clipping of the M2 segment. The postoperative course was uneventful, with preserved bypass patency. At follow-up, the patient was neurologically intact. This report illustrates the nuances and operative techniques for treating a giant fusiform aneurysm of the M2 segment that accounted for a preserved bypass patency and optimal patient neurological recovery. [ABSTRACT FROM AUTHOR]

We present the case of a 58-year-old male with a 3-day history of sudden onset headache, loss of consciousness, and uncontrolled vomiting. The patient had 3/5 quadriparesis and a Glasgow coma scale (GCS) score of 8, which merited neurocritical intensive care. Brain imaging suggested the presence of two lesions: (i) a fusiform aneurysm of 12 × 7 mm in an accessory A2 artery of the anterior cerebral artery and (ii) an unruptured saccular aneurysm of 3.3 × 2.8 mm in the distal segment of the basilar artery. He was deemed a candidate for microsurgical management. Postoperatively, he had 4/5 quadriparesis, paresis of the right oculomotor nerve, and a GCS score of 13. A 3-month follow-up showed a significant improvement in neurological function with a score of 2 on the modified Rankin scale. The presented case illustrates the relevance of a nuanced acquaintance to operate in diseased anatomical variants and complex pathologies of narrow corridors. [ABSTRACT FROM AUTHOR]

Minimally invasive craniotomies are the subject of increasing attention over the last two decades in neurosurgery, following the current trend of attempting to increase patient safety by providing surgeries with less tissue disruption, blood loss, and decreased operative time. However, a significant information overlap exists among the various keyhole approaches regarding their indications and differences with more invasive techniques. Therefore, the present study aims to comprehensively review, illustrate, and describe the potential benefits and disadvantages of minimally invasive techniques to access the anterior and middle fossa, including the mini-pterional, mini orbito-zygomatic, supraorbital, lateral supraorbital, and extended lateral supraorbital approaches while comparing them to classic, more invasive approaches. [ABSTRACT FROM AUTHOR]

Background: The unmet neurosurgical need has remained patent in developing countries, including Peru. However, continuous efforts to overcome the lack of affordable care have been achieved, being neurosurgical missions one of the main strategies. We chronicle the humanitarian labor of organizations from high-income countries during their visit to Peru, the contributions to local trainees' education, and the treatment of underserved patients. Furthermore, we discuss the embedded challenges from these missions and the future perspective on long-term partnerships and sustainability. Methods: This is a narrative review. We searched the literature in PubMed and Google Scholar about neurosurgical missions conducted in Peru. Results: Since 1962, twelve organizations from high-income countries have delivered humanitarian help in Peru by training local neurosurgeons, treating low-income patients, and providing surgical instrumentation. Out of the three main regions of Peru, cities on the coast and highlands have hosted most of these missions, with no reported outreach in the amazon area. About 75% of the organizations are headquartered in the United States, followed by Canada, Luxembourg, and Spain. In addition, 50% of the organizations have an active partnership. The predominant focus of these missions has been pediatrics, neuro-oncology, and spine surgery. Conclusion: Neurosurgical missions have represented a strategy to close the disparity in education and treatment in Peru. However, additional efforts must be conducted to improve long-term partnership and sustainability, such as adopting standardized indicators for progress tracking, incorporating remote technologies for continuous training and communication, and expanding partnerships in less attended areas. [ABSTRACT FROM AUTHOR]

Background: Giant cell tumor of bone (GCTB) rarely originates in the skull, particularly in the occipital bone. Although benign, it can severely destroy the surrounding tissue and undergo an unpredictable clinical course. We report the successful resection of a GCTB invading the occipital bone in a Hispanic adult woman and present a comprehensive review of the literature on this rare pathology by focusing on the occipital area. Case Description: A 40-year-old Hispanic woman presented with a 3-month history of neck pain and a bulging lesion on the retromastoid area. Brain magnetic resonance imaging (MRI) revealed an extradural, expansive, and contrast-enhancing lesion in the right occipital bone with multiple thin septa and evidence of bleeding. The patient underwent an uneventful gross total resection (GTR) of the lesion. The histopathological examination findings included numerous scattered osteoclast-type giant multinucleated cells. At a 10-month follow-up, the patient has not developed any neurological deficits, impairment of life functioning, or signs of recurrence in MRI. Conclusion: GCTB rarely originates in the skull, being the occipital bone the most infrequent site of presentation. When feasible, total surgical resection effectively reduces the risk of recurrence. Nonetheless, radiation and adjuvant therapies have been employed when GTR could not be achieved. A close follow-up with a brain MRI is advised to control recurrence. [ABSTRACT FROM AUTHOR]