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  • From the data here midline crossing tumor p and

    2018-10-22

    From the data here, midline-crossing tumor (p=0.0208) and voltage gated potassium channel floor invasion (p=0.0196) are significantly related to the presence of cN2c and pN2c. This is consistent with other studies. All pN2c patients were histopathologic and had clinically advanced tumor stage (≥T3), which shows statistically significant (p=0.0235) correlation to N2c by univariate analysis, although not by multivariate analysis. This result is similar to those reported previously. For clinical practice, our study further reinforces the predictive value of midline-crossing tumor, mouth floor invasion tumor, and advanced tumor stage (≥T3). Therefore, prophylactic contralateral neck dissection is highly recommended for these patients. The other part of our study focused on contralateral neck relapse after treatment. Because contralateral neck dissection remains controversial, the patients were grouped according to neck dissection performance. Among the 26 contralateral neck relapse patients, only one came from the primary contralateral neck dissection group. Eighteen were from the ipsilateral neck dissection group and seven came from the non-neck dissection group. For patients who had undergone contralateral neck dissection with either prophylactic or curative intent, poorly differentiated tumors were statistically significant having contralateral neck relapse. For those patients who had undergone ipsilateral neck dissection, mouth floor invasion (p=0.0025) and tumor differentiation (p=0.0228) showed statistical significance for contralateral neck relapse.
    Conclusions
    Introduction Posterior circulation aneurysms arising from the posterior inferior cerebellar artery (PICA) are uncommon, accounting for 0.5–3% of all intracranial aneurysms. The most frequent clinical presentation of PICA aneurysms is subarachnoid hemorrhage (SAH), as described in a published series. In addition, patients with a PICA aneurysm may present with low cranial nerve deficits, other signs of mass lesions, ischemic symptoms, and incidental findings during evaluation of an unrelated disease. Conventional therapies include direct clipping, clipping/wrapping, trapping with or without a bypass procedure, or endovascular embolism. We report a patient with a ruptured PICA aneurysm who showed signs and symptoms suggestive of cervical myeloradiculopathy. He was successfully treated with endovascular therapy. We also emphasize the importance of including PICA aneurysm in the differential diagnosis of cervical myeloradiculopathy.
    Case report Magnetic resonance imaging (MRI) of the cervical spine showed a herniated intervertebral disc (HIVD) with moderate stenosis at C5/6 and C6/7 (Fig. 1) and a small area of hyperintensity in the cord on T2-weighted MRI was also noted at C4/5 (Fig. 1). Neck collar fixation and a rehabilitation program were advised. Six months later, he was admitted to our hospital because painful numbness in his neck and both arms had worsened. The neck pain was associated with mild headache, shoulder pain, dizziness, and an unsteady gait. A mild spastic gait was also noted. The repeated cervical spinal MRI revealed similar findings (Fig. 2). Due to neurological deterioration, anterior cervical discectomy with fusion at C6/7 and an artificial disc replacement at C5/6 were carried out. The patient was sent to the intensive care unit for postoperative observation and was returned to the ward 2 days later. The symptoms of bilateral arm pain improved, but neck pain and dizziness did not disappear. He suddenly developed profuse vomiting and complained of a severe stinging sensation in the neck and headache on the afternoon of the same day. Loss of consciousness followed. The patient was immediately intubated, and computed tomography (CT) of the brain showed diffuse SAH within both sylvian fissures, the basal cisterns, and along the falx cerebelli. A ruptured aneurysm was strongly suspected, and a three-dimensional CT angiography revealed the presence of a ruptured aneurysm arising from the left vertebral artery (VA)-PICA, complicated with diffuse basal cisternal and cerebral SAH and sequential hemoventricle (Fig. 3). Additionally, a conventional four-vessel cerebral angiography was performed, which revealed one fusiform aneurysm, about 4×6mm in size with a tiny daughter sac, originating from the left PICA orifice (Fig. 4). Focal stenosis of the left VA was also noted, and VA dissection was suspected. Our radiologist carefully performed coil embolization (Fig. 5), followed by implantation of an external ventricular drain to relieve early hydrocephalus. The patient gradually regained consciousness and was returned to the ordinary ward 9 days later. He was discharged 3 months later as there was no evidence of recurrent or residual aneurysm in the magnetic resonance angiography (MRA) study (Fig. 6), and his symptoms had also been ameliorated.