Browsing by Author "Anokwute, Miracle"

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    Intradural iatrogenic epidermoid cyst at cauda equina: A case report
    (Medknow Publications, 2020-09-18) Hernandez, Jose Javier Cuellar; Anokwute, Miracle; Martinez, Silvia Judith Hernandez; Olivas, Jose Ramon; Neurological Surgery, School of Medicine
    Background: Spinal epidermoid accounts for <1% of all primary spinal cord tumors. They occur due to the invagination of epidermal elements into the neural tube during the embryonic period. Even more infrequent are spinal epidermoid cysts that occur without attendant spinal dysraphism (e.g., as occurs with the iatrogenic inoculation of epithelial cells in the subarachnoid space following a lumbar puncture). Case Description: A 38-year-old female with a history of epidural spinal blocks at L2-3 for two previous pregnancies presented with low back pain, right lower extremity weakness (4/5 level), hyporeflexia, and tingling/ numbness in the right L3-5 distribution. The lumbar MR demonstrated an intradural extramedullary lesion at the L2-L3 level that compressed the cauda equina/nerve roots. MR findings were compatible with an epidermoid cyst, this was histologically confirmed following a microsurgical L2-3 laminectomy for lesion resection. Pathologically, the lesion demonstrated a keratinized stratified squamous epithelium with keratin content without cutaneous attachments, thus confirming the diagnosis of an epidermoid cyst. Postoperatively, her sensory complains improved and her motor strength fully recovered to the 5/5 level. Conclusion: Patients with spinal epidermoid cysts typically present with underlying spinal dysraphism, but only rarely do iatrogenic cases arise. Here, we presented a patient who developed a spinal lumbar epidermoid cyst in a female patient after undergoing spinal epidural anesthesia during pregnancy. Notably, this was successfully treated a with decompressive laminectomy and microsurgical resection.
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    Supraorbital transciliary keyhole approach for removal of tuberculum sellae meningioma: 3D surgical video
    (Scientific Scholar, 2021-01-05) Cuellar-Hernandez, J. Javier; Olivas-Campos, J. Ramon; Tabera-Tarello, Paulo M.; Anokwute, Miracle; Valadez-Rodriguez, Alan; Neurological Surgery, School of Medicine
    Background: Tuberculum sellae meningiomas have an incidence from 5 to 10% of all intracranial meningiomas[2] and tend to be surgically difficult and challenging tumors given their proximity to important structures such as the internal carotid artery (ICA), anterior cerebral artery (ACA), and optic nerves.[3] Typically, their growth is posteriorly and superiorly oriented, thereby displacing the optic nerves and causing visual dysfunction, which is the primary indication for surgical treatment.[1] The main goals of the treatment are the preservation or restoration of visual abilities and a complete tumor resection.[1] Conventionally, surgical approaches to tuberculum meningiomas involve largely invasive extended bifrontal, interhemispheric, orbitozygomatic, pterional, and subfrontal eyebrow approaches. The supraorbital craniotomy, however, is a minimally invasive transcranial approach that offers a similar surgical corridor to conventional transcranial approaches, using a limited craniotomy and minimal brain retraction that can be used for tumoral and vascular pathologies,[4,5] offering added cosmetic outcomes.[1] We present the case of a patient undergoing a supraorbital transciliary craniotomy with a tuberculum sellae meningioma causing bitemporal hemianopsia. Case description: A 70-year-old female with chronic headaches and progressive vision loss and visual field deficit for about 1 year. On ophthalmological evaluation, she was able to fixate and follow objects with each eye, light perception was only present in the right eye, and the vision in the left eye was 0.2 decimal units. Her visual fields demonstrated severe campimetric deficits. Her extraocular movements were intact and bilateral pupils were equal, round, and reactive to light. MRI of the brain demonstrated tuberculum sellae meningioma with bilateral optic canal invasion, displacing the chiasm, and extending ≥180° around the medial ICA wall and anterior ACA wall. The patient underwent supraorbital transciliary keyhole approach for total resection of the tumor. Postoperatively, visual acuity and visual field were significantly improved. Conclusion: Performing a supraorbital transciliary keyhole craniotomy for tuberculum sellae meningiomas requires an adequate and meticulous preoperative planning to determine the optimal surgical corridor to the lesion. The use of supraorbital craniotomy is safe with good cosmetic results and potentially lower morbidity allowing for adequate exposure, resection, and release of neurovascular structures.