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Article ; Online: Endoscopic endonasal approach for resection of odontoid process, decompression of the cervicomedullary junction spinal cord, and resection of pannus.

Fernandes Cabral, David T / Fernández-de Thomas, Ricardo J / Alattar, Ali / Paul, David A / Wang, Eric W / Gardner, Paul A

Neurosurgical focus: Video

2024 Volume 10, Issue 2, Page(s) V2

Abstract: Odontoid pannus is an abnormal collection of degenerative or inflammatory tissue on the C1-dens joint that can result in severe spinal cord compression myelopathy. Treatment options vary depending on severity and etiology. In cases of severe cord ... ...

Abstract	Odontoid pannus is an abnormal collection of degenerative or inflammatory tissue on the C1-dens joint that can result in severe spinal cord compression myelopathy. Treatment options vary depending on severity and etiology. In cases of severe cord compression, surgical management could be either through a purely posterior approach or in combination with an anterior decompression via endoscopic endonasal approach (EEA). This case presents a 77-year-old female who underwent posterior cervical fixation for odontoid pannus causing dramatic cervical myelopathy who failed to improve over a 6-month period and required anterior transodontoid pannus resection and decompression via EEA. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23176.
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Journal Article
ISSN	2643-5217
ISSN (online)	2643-5217
DOI	10.3171/2024.1.FOCVID23176
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Article: Tension pneumoventricle in a patient with a ventriculoperitoneal shunt and an ethmoidal meningoencephalocele.

De Jesus, Orlando / Fernández-de Thomas, Ricardo J / Feliciano, Caleb

Surgical neurology international

2022 Volume 13, Page(s) 202

Abstract: Background: Tension pneumoventricle is a rare, life-threatening complication. It has been rarely described in patients with ventriculoperitoneal (VP) shunts.: Case description: A 28-year-old male patient with a VP shunt became progressively lethargic ...

Abstract	Background: Tension pneumoventricle is a rare, life-threatening complication. It has been rarely described in patients with ventriculoperitoneal (VP) shunts. Case description: A 28-year-old male patient with a VP shunt became progressively lethargic after falling from his wheelchair. Skull X-rays and head CT scan showed abundant air inside the ventricles. He was taken to the operating room, and the shunt was revised without improvement. Two days later, a frontal external ventricular drain was placed to remove the air. In the investigation toward the etiology of the pneumoventricle, a review of previous head CT scans and brain MRIs showed that the patient had a small left frontonasal meningoencephalocele extending into the ethmoid, which had been unnoticed. He underwent repair of the defect with adequate sealing of the frontal skull base. Conclusion: In a shunted patient with moderate or severe symptoms from a tension pneumoventricle, external ventricular drainage is required to remove the air as the shunt is inadequate.
Language	English
Publishing date	2022-05-13
Publishing country	United States
Document type	Case Reports
ISSN	2229-5097
ISSN	2229-5097
DOI	10.25259/SNI_64_2022
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Article: Bone Fragment Granuloma Mimicking a Brain Tumor Following Placement of an Intracranial Pressure Monitoring System.

De Jesus, Orlando / Fernández-de Thomas, Ricardo J

Cureus

2021 Volume 13, Issue 6, Page(s) e15394

Abstract: The placement of intracranial pressure (ICP) monitoring system requires drilling an orifice in the skull. Bone fragments can accidentally be inserted into the brain parenchyma while introducing the ICP monitoring system during the procedure. An ... ...

Abstract	The placement of intracranial pressure (ICP) monitoring system requires drilling an orifice in the skull. Bone fragments can accidentally be inserted into the brain parenchyma while introducing the ICP monitoring system during the procedure. An intracranial granuloma can be subsequently formed if a non-specific reaction is induced and maintained by the inserted bone fragment in the brain parenchyma. These intracranial granulomas may eventually be confused with brain masses on follow-up imaging studies. We present the case of a 65-year-old male who underwent cranial surgery secondary to a severe traumatic brain injury (TBI). An intracranial bolt was initially placed contralaterally to measure the ICP. Eleven years later, a granuloma from a retained bone fragment secondary to the intracranial bolt placement was suspected. The clinical course, radiological investigations, and differential diagnosis are presented.
Language	English
Publishing date	2021-06-02
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.15394
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Article ; Online: Gamma Knife radiosurgery for a recurrent craniocervical junction solitary fibrous tumour.

De Jesus, Orlando / Carballo Cuello, Cesar M / Fernández-de Thomas, Ricardo J / Pastrana, Emil A

BMJ case reports

2022 Volume 15, Issue 9

Abstract: Spinal solitary fibrous tumour (SFT) is an uncommon tumour with few cases reported in the literature. It rarely originates at the craniocervical junction. To our knowledge, only eight cases of spinal SFT located at the craniocervical junction have been ... ...

Abstract	Spinal solitary fibrous tumour (SFT) is an uncommon tumour with few cases reported in the literature. It rarely originates at the craniocervical junction. To our knowledge, only eight cases of spinal SFT located at the craniocervical junction have been reported in the literature. We presented a patient with a craniocervical junction SFT and discussed its clinical presentation, radiological features, pathology, management and outcome. This was the first patient reported in the literature with a recurrent craniocervical junction SFT treated with Gamma Knife radiosurgery. The treatment reduced the tumour volume by more than 85% within 12 months.
MeSH term(s)	Humans ; Radiography ; Radiosurgery ; Solitary Fibrous Tumors/diagnostic imaging ; Solitary Fibrous Tumors/radiotherapy ; Solitary Fibrous Tumors/surgery
Language	English
Publishing date	2022-09-16
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2022-250566
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Article: Secondary Acrocyanosis in a Paraplegic Patient With Spinal Cord Injury.

Ruiz-Rodríguez, Juan F / Fernández-de Thomas, Ricardo J / De Jesus, Orlando

Cureus

2022 Volume 14, Issue 9, Page(s) e29420

Abstract: Secondary acrocyanosis after spinal cord injury is extremely rare. We describe a case with secondary acrocyanosis in a complete T12 paraplegic patient. A 41-year-old man with complete T12 paraplegia after a gunshot wound to the thoracic spine 20 years ... ...

Abstract	Secondary acrocyanosis after spinal cord injury is extremely rare. We describe a case with secondary acrocyanosis in a complete T12 paraplegic patient. A 41-year-old man with complete T12 paraplegia after a gunshot wound to the thoracic spine 20 years prior presented with a four-month history of bilateral foot bluish discoloration precipitated when he sat with his legs down, improving rapidly after a few minutes of leg elevation. Changes in the skin color of the lower extremities were evaluated in the seated position for two hours. The skin color became darker, progressing to a bluish discoloration through the entire length of the legs. After two hours, the feet and most of the legs appeared deep purple. The color of the legs returned to their baseline three minutes later after the patient was placed supine in the bed. The diagnosis of secondary acrocyanosis due to the T12 spinal cord injury was established based on the physical examination and ancillary tests showing no peripheral ischemia. Other causes of secondary acrocyanosis were excluded during the work-up. This report presents the first case of a paraplegic patient with spinal cord injury presenting secondary acrocyanosis.
Language	English
Publishing date	2022-09-21
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.29420
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Article ; Online: Neurosurgery Morbidity and Mortality: A Prospective Surgical and Medical Analysis.

De Jesus, Orlando / Sandoval-Consuegra, José I / De Jesús-Espinosa, Aixa / Fernández-de Thomas, Ricardo J / Carballo-Cuello, César M

Puerto Rico health sciences journal

2023 Volume 42, Issue 1, Page(s) 29–34

Abstract: Objective: The analysis of morbidity and mortality is fundamental for improving the quality of patient care. The objective of this study was to evaluate the combined medical and surgical morbidity and mortality of neurosurgical patients.: Methods: We ...

Abstract	Objective: The analysis of morbidity and mortality is fundamental for improving the quality of patient care. The objective of this study was to evaluate the combined medical and surgical morbidity and mortality of neurosurgical patients. Methods: We performed a daily prospective compilation of morbidities and mortalities during a consecutive 4-month period in all the patients who were 18 years of age or older and had been admitted to the neurosurgery service at the Puerto Rico Medical Center. For each patient, any surgical or medical complication, adverse event, or death within 30 days was included. The patients' comorbidities were analyzed for their influence on mortality. Results: Fifty-seven percent of the patients presented at least 1 complication. The most frequent complications were hypertensive episodes, mechanical ventilation for more than 48 hours, sodium disturbances, and bronchopneumonia. Twenty-one patients died, for an overall 30-day mortality of 8.2%. Mechanical ventilation for more than 48 hours, sodium disturbances, bronchopneumonia, unplanned intubation, acute kidney injury, blood transfusion, shock, urinary tract infection, cardiac arrest, arrhythmia, bacteremia, ventriculitis, sepsis, elevated intracranial pressure, vasospasm, stroke, and hydrocephalus were significant factors for mortality. None of the analyzed patients' comorbidities were significant for mortality or longer length of stay. The type of surgical procedure did not influence the length of stay. Conclusion: The mortality and morbidity analysis provided valuable neurosurgical information that may influence future treatment management and corrective recommendations. Indication and judgment errors were significantly associated with mortality. In our study, the patients' comorbidities were not significant for mortality or increased length of stay.
MeSH term(s)	Patient Care ; Prospective Studies ; Neurosurgical Procedures/adverse effects ; Neurosurgical Procedures/mortality ; Postoperative Complications/mortality ; Hospital Mortality ; Comorbidity ; Morbidity ; Puerto Rico/epidemiology
Language	English
Publishing date	2023-03-06
Publishing country	Puerto Rico
Document type	Journal Article
ZDB-ID	639137-0
ISSN	2373-6011 ; 0738-0658
ISSN (online)	2373-6011
ISSN	0738-0658
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Article ; Online: Rare sacral extradural grade II ependymoma: a comprehensive review of literature.

Fernández-de Thomas, Ricardo J / Amaral-Nieves, Natalie / De Jesus, Orlando / Pastrana, Emil A

BMJ case reports

2021 Volume 14, Issue 11

Abstract: Sacral spinal cord ependymoma is an uncommon pathology. Most of the reported cases are consistent with a myxopapillary ependymoma histopathologic subtype. Non-myxopapillary ependymomas rarely occur in the sacral region. Most lesions are intradural; ... ...

Abstract	Sacral spinal cord ependymoma is an uncommon pathology. Most of the reported cases are consistent with a myxopapillary ependymoma histopathologic subtype. Non-myxopapillary ependymomas rarely occur in the sacral region. Most lesions are intradural; however, rare extradural cases can occur. We present the case of a 46-year-old female patient diagnosed with a grade II sacral extradural ependymoma, emphasising the importance of an interdepartmental case approach for diagnosis and management. Even though grade II ependymomas are considered low grade, the potential for recurrence and metastatic disease has been reported. There are no treatment guidelines for these rare tumours besides gross total resection.
MeSH term(s)	Ependymoma/diagnostic imaging ; Ependymoma/surgery ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; Sacrococcygeal Region ; Sacrum/diagnostic imaging ; Spinal Cord Neoplasms/diagnostic imaging ; Spinal Cord Neoplasms/surgery
Language	English
Publishing date	2021-11-09
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-246540
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Article ; Online: Intraoperative ultrasound evidence of accidental simultaneous cannulation of the common carotid artery and internal jugular vein: illustrative case.

Mittal, Aditya M / Nowicki, Kamil W / Fernández-de Thomas, Ricardo J / Mayor, Jessica / McEnaney, Ryan M / Gerszten, Peter C

Journal of neurosurgery. Case lessons

2022 Volume 4, Issue 10

Abstract: Background: Establishing central venous access is important to provide fluid resuscitation or medications intravenously to patients.: Observations: Although accidental cannulation of the internal carotid artery has been reported in the literature, to ...

Abstract	Background: Establishing central venous access is important to provide fluid resuscitation or medications intravenously to patients. Observations: Although accidental cannulation of the internal carotid artery has been reported in the literature, to our knowledge this report is the first documented intraoperative ultrasound video demonstrating accidental and simultaneous common carotid artery and internal jugular cannulation during central line placement in the internal jugular vein. Lessons: Ultrasound use minimizes accidental carotid cannulation during central line placement in the internal jugular vein. Carotid artery puncture can be managed by external application of pressure or surgical reexploration.
Language	English
Publishing date	2022-09-05
Publishing country	United States
Document type	Journal Article
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE22286
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Article: Prognosis and Outcome of Cervical Primary Extraosseous Intradural Extramedullary Ewing Sarcoma: A Systematic Review.

Carballo Cuello, César M / De Jesus, Orlando / de Jesús Espinosa, Aixa / Fernández-de Thomas, Ricardo J / Murray, Gisela / Pastrana, Emil A

Cureus

2022 Volume 14, Issue 7, Page(s) e26665

Abstract: Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high malignancy, occurring in a few patients with ES. The occurrence of this tumor in the intradural extramedullary spinal region is infrequent. This systematic ... ...

Abstract	Primary spinal extraosseous Ewing sarcoma (ES) is a rare mesenchymal tumor characterized by high malignancy, occurring in a few patients with ES. The occurrence of this tumor in the intradural extramedullary spinal region is infrequent. This systematic review examines primary extraosseous intradural extramedullary ES in the cervical region to provide specific outcomes and evaluate the role of adjuvant chemoradiation in overall prognosis. A systematic review was conducted to identify all cervical primary extraosseous intradural extramedullary ES reported in the literature. The search included the databases of PubMed, Google Scholar, Medline, Embase, and Scopus from inception to June 2021. Inclusion criteria include a reported death outcome or a minimum one-year follow-up. Our search retrieved 21 articles that involved the cervical spine, but only 11 cases met the inclusion criteria. Of the nine patients who demonstrated disease progression, six experienced local failure, two had distant craniospinal axis failure, and one had systemic metastases. Five patients died of the disease at a median of 11 months after diagnosis. Our analysis showed a one-, two-, and five-year progression-free survival (PFS) of 36.4%, 36.4%, and 12.1%, respectively. The one-, two-, and five-year overall survival rates were 72.7%, 62.3%, and 46.8%, respectively. Three of the five (60%) patients who died received craniospinal radiotherapy. Of the six patients who survived, two received craniospinal radiotherapy (33%), and one received whole spine radiotherapy (17%). This review showed that patients with cervical primary extraosseous intradural extramedullary ES had poor progression-free survival and overall survival rates. The addition of adjunct craniospinal radiotherapy did not improve the prognosis of these patients.
Language	English
Publishing date	2022-07-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.26665
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Article ; Online: Spine Trauma Secondary to Diving Accidents: A Seven-year Retrospective Study in Puerto Rico.

Carballo-Cuello, César M / De Jesus, Orlando / Fernández-de Thomas, Ricardo J / De Jesús-Espinosa, Aixa / Vigo-Prieto, Juan A

Puerto Rico health sciences journal

2022 Volume 41, Issue 4, Page(s) 222–225

Abstract: Objective: Review the profile of patients with spinal trauma after diving accidents referred to the Puerto Rico Medical Center. This study intended to develop more awareness of the risks of spinal cord injury after diving.: Methods: The patient's ... ...

Abstract	Objective: Review the profile of patients with spinal trauma after diving accidents referred to the Puerto Rico Medical Center. This study intended to develop more awareness of the risks of spinal cord injury after diving. Methods: The patient's records for diving accident cases referred to our center during January 2014 until December 2020 were assessed retrospectively. The cases were evaluated according to sex, age, vertebral level, and neurological deficit. The Puerto Rico Medical Center is the only level 1 trauma center in Puerto Rico; therefore, this study likely included all the cases of diving injury on the island. Results: Sixty five patients with a median age of 29 years were identified consisting primarily of males (94%). The regions affected included the cervical (96%), thoracic (2%), and lumbar (2%) spine. Twenty-seven patients (42%) developed a spinal cord injury secondary to a diving accident. Involvement of the C4, C5, or C6 vertebral level, was significant for the development of a spinal cord injury. Diving accidents occurring at beaches were the most common cause. Conclusion: In Puerto Rico, there is a yearly incidence of 9.3 diving accidents causing spinal trauma; these accidents most frequently affect the C6 vertebra. These diving accidents mainly occur in young individuals, predominantly at beaches. Most of our patients were neurologically intact after their diving accident, although 42% sustained a spinal cord injury. This study provided a better understanding of this traumatic event and determined its most affected levels, accident sites, and population involved.
MeSH term(s)	Male ; Humans ; Adult ; Retrospective Studies ; Diving/adverse effects ; Diving/injuries ; Puerto Rico/epidemiology ; Spinal Cord Injuries/epidemiology ; Spinal Cord Injuries/etiology ; Accidents
Language	English
Publishing date	2022-12-14
Publishing country	Puerto Rico
Document type	Journal Article
ZDB-ID	639137-0
ISSN	2373-6011 ; 0738-0658
ISSN (online)	2373-6011
ISSN	0738-0658
Database	MEDical Literature Analysis and Retrieval System OnLINE

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