RESUMEN
Background: Pituitary neuroendocrine tumors (PitNETs) are a diverse group of benign neoplasms that account for a significant proportion of intracranial tumors (13%). The coexistence of PitNET with other intracranial lesions, such as meningiomas and intracranial aneurysms, has been constantly reported in the literature; yet, the pathophysiological mechanisms remain unknown, and the appropriate management is controversial. This study aims to describe the clinical characteristics, surgical treatment, and outcomes of patients with PitNET with coexisting intracranial lesions in a single healthcare center. Methods: A retrospective analysis was conducted on 12 patients who underwent surgical treatment for PitNET and another intracranial lesion at our single tertiary referral center over 15 years from January 2008 to May 2023. Results: Among these coexisting lesions, aneurysms were the most commonly found (41.67%), followed by meningiomas (33.33%). Surgical intervention for both lesions was performed in a single-stage procedure for most cases (75%), employing transcranial, endoscopic endonasal, and combined approaches. We found low preoperative Karnofsky Performance Scale scores in three patients, with significant differences in functional outcomes. Conclusion: These findings contribute to the limited knowledge about PitNET coexisting with other intracranial lesions and emphasize the importance of patient-tailored, multidisciplinary management in these unusual scenarios.
RESUMEN
Background: Postsurgical spinal infections are a severe complication and a challenge to the neurosurgeon due to their complex management. Revision surgeries and the removal of hardware are usually necessary. Recently, advances in nuclear medicine have made it possible to employ radiotracers to identify infections. The radiolabeled antimicrobial peptide technetium-99m-ubiquicidin (99mTc-UBI) (29-41) has been demonstrated to detect bacterial infections. UBI 29-41 is a peptide sequence with selective binding to the anionic cell membrane of bacteria, which has recently been used to differentiate between infection and inflammation. Here, we describe the clinical utility of 99mTc-UBI 29-41 single-photon emission computed tomography-computed tomography (SPECT-CT) in a patient suspected of a postoperative infection. Case description: A 54-year-old male who presented with conus medullaris syndrome secondary to T12 spondylodiscitis and multiple abscess collections was initially managed with debridement, corpectomy, and minimally invasive lateral instrumentation. The patient developed postsurgical empyema near the surgical site. The image study avoided the need for a second surgery and hardware removal. Conclusion: The use of 99mTc-UBI 29-41 SPECT-CT served as a tool to avoid a second invasive procedure; instead, conservative management with antibiotics was performed with an effective outcome after two weeks. This radiotracer has utility in cases in which infection is suspected, but the location is not entirely clear, and information is needed to guide the therapeutic approach.
RESUMEN
BACKGROUND: Persistent trigeminal artery or persistent primitive trigeminal artery (PTA) is the most common carotid-basilar anastomosis in both cadaveric and live patient studies, followed by persistent hypoglossal and persistent otic arteries. Approximately 0.2% of all angiographies reported this finding. CASE REPORT: We present the case of a 21-year-old male who arrived at the emergency department with tonicâclonic seizures. After performing diagnostic contrast magnetic resonance imaging and digital subtraction angiography, the patient was diagnosed with a right occipital arteriovenous malformations (AVM) fed by the right calcarine artery associated with an ipsilateral PTA. After considering surgical and endovascular treatment options, the patient was selected for watchful waiting. We included a literature review of the PTA, the results of a PubMed search regarding the combined presence of these findings, and a brief discussion providing insight into the implications for treatment. CONCLUSIONS: Although several studies have linked PTA to different vascular pathologies, such as cerebral aneurysms, the association between PTA and AVMs remains scarce. This case, along with the literature review, shows that further research is needed to characterize the relationship between these findings.