Cervical laminoplasty is a well-established surgical approach for managing various cervical spine pathologies, including cervical spondylotic myelopathy, spinal canal stenosis, and ossification of the posterior longitudinal ligament. Among the available laminoplasty techniques, the use of Hydroxyapatite spacers secured with screws is common for maintaining the expanded interlaminar space. However, one potential complication is screw back-out, which, although recognized, has rarely been documented in the literature. We present a rare case of delayed screw migration culminating in skin perforation in a 76-year-old woman who underwent cervical laminoplasty for cervical spondylotic myelopathy. During the index procedure, Hydroxyapatite spacers were placed and secured with screws into the lamina. Seven years postoperatively, gradual subcutaneous migration of the screw from the lamina of the fourth cervical vertebra was observed, ultimately resulting in complete skin penetration 9 years after the initial surgery. The patient underwent surgical removal of the protruding screw along with surrounding granulation tissue. The surgical site was thoroughly irrigated with copious saline, and the wound was closed primarily with sutures. Postoperative recovery was uneventful. Stitches were removed on day 11 after confirming complete wound healing. This case underscores an exceptionally rare but clinically significant late complication of cervical laminoplasty with Hydroxyapatite spacers -complete screw extrusion through the skin. To our knowledge, this is the first documented case of its kind. The prolonged asymptomatic nature of screw migration in this patient highlights the importance of long-term surveillance following laminoplasty, even in the absence of clinical symptoms, to detect hardware-related complications at an early stage.

Solitary plasmacytoma is a hematologic malignancy in which about 50% of cases progress to multiple myeloma within 10 years. Local radiation therapy is effective for solitary plasmacytoma treatment, but there are cases of spinal cord paralysis due to osteolytic pathological fractures in the spine. Here, we report a 63-year-old male with spinal cord injury caused by pathologic fracture progression after radiotherapy. A 63-year-old male presented with neck pain and left hemiplegia. Imaging studies revealed a pathological fracture of the C5 vertebral body, and biopsy confirmed the diagnosis of solitary plasmacytoma. Radiation therapy temporarily improved symptoms, but progressive quadriplegia developed 2 months later. Cervical spinal cord compression due to an additional vertebral bone fracture was confirmed. Aggressive lesionectomy and fixation using simultaneous anterior and posterior combined approaches were performed. Postoperatively, paralysis completely recovered. No local recurrence or transition to multiple myeloma was observed even after 7 years of follow-up at age 70. Surgical treatment may be effective for spinal cord injury associated with pathologic fracture progression after radiotherapy for solitary plasmacytoma.

Flow diverters have revolutionized the treatment of large and giant cerebral aneurysms. However, aneurysms with branch vessels originating from the aneurysm sac remain challenging for flow diverter monotherapy. We present five cases demonstrating favorable outcomes following combined treatment with overlapping flow diverter with coiling. The study cohort included five female patients with a mean age of 72.8 years. The mean aneurysm diameter was 8.1 mm. Triple antithrombotic therapy (dual antiplatelet therapy plus short-term anticoagulation) was administered to prevent ischemic complications due to posterior communicating artery occlusion in the perioperative period. Complete or near-complete occlusion (O'Kelly-Marotta grade C or D) was achieved in all cases. Follow-up angiography (mean follow-up time: 17.2 months) revealed preserved patency of the posterior communicating artery in four of five cases. In one case, the posterior communicating artery arising from the aneurysm was occluded at its origin but was supplied retrograde from the posterior circulation. Follow-up digital subtraction angiography of most cases showed caliber changes, with the posterior communicating artery diameter reducing and the P1 segment of the posterior cerebral artery increasing. No ischemic or hemorrhagic complications occurred perioperatively or during follow-up. Overlapping flow diverter with coiling combined with low-dose and short-term triple antithrombotic therapy might be a safe and effective treatment for fetal-type posterior communicating artery aneurysms, offering a viable alternative for complex aneurysms. Further studies with long-term follow-up data from a larger patient cohort are required to validate the efficacy and safety demonstrated in this case series.

To investigate whether oral contraceptives induce acute ischemic stroke in patients with moyamoya disease. We retrospectively reviewed female patients with moyamoya disease who were taking oral contraceptives during their reproductive years (12-49 years of age) at the time of diagnosis or during follow-up. The patients' detailed clinical history, including the time course of oral contraceptive usage and acute ischemic stroke occurrence, was evaluated. For patients with radiological evidence of acute ischemic stroke, the imaging pattern of stroke was assessed to investigate the underlying mechanisms. Among 589 female patients, 12 patients took oral contraceptives at some point during the period from 2012 to 2023; 5 patients were taking oral contraceptives at the time of diagnosis, and 4 of them were diagnosed with moyamoya disease after acute ischemic stroke. Among the 7 patients who started oral contraceptives during follow-up, 2 patients developed acute ischemic stroke several months after starting oral contraceptives. Notably, none of the hemispheres that developed acute ischemic stroke previously underwent revascularization, and none of the 5 hemispheres with prior revascularization developed acute ischemic stroke. The imaging pattern of acute ischemic stroke in 7 patients suggested the contribution of a thromboembolic mechanism. Oral contraceptives may increase the risk of acute ischemic stroke via thromboembolic mechanisms in patients with moyamoya disease, but its risk might be manageable in hemispheres with prior revascularization and stable disease conditions for years. Active education of patients regarding the possible risk of oral contraceptives and close communication with gynecologists seem necessary to provide the best treatment strategies for female patients with moyamoya disease who require contraception or treatment of menstrual disorders.

Cardioembolic stroke caused by tumor emboli is a rare form of cancer-associated stroke. We report a case of a patient with cardiac metastasis of extraskeletal chondrosarcoma who developed left internal carotid artery occlusion due to embolic stroke. Extraskeletal chondrosarcoma is an extremely rare subtype of soft tissue sarcoma characterized by a tendency for local recurrence and metastasis. Endovascular thrombectomy was performed using a combined technique, achieving complete revascularization. Histopathological analysis of the retrieved cell mass confirmed that the embolic source was the preexisting extraskeletal chondrosarcoma.

Diffuse midline glioma, H3K27-altered, is a rare and aggressive central nervous system tumor that typically affects children, whereas adult cases are uncommon and less well characterized. We report a 43-year-old woman who experienced progressive lightheadedness for 10 months and was diagnosed with orthostatic hypotension on the basis of a positive tilt-table test result. Despite treatment with midodrine, her symptoms worsened, and dysarthria, dysphagia, sensory disturbance, and gait instability later developed. Magnetic resonance imaging confirmed an intra-axial mass in the dorsal medulla oblongata. Partial resection was performed, and histopathological examination with immunohistochemistry confirmed the diagnosis of H3K27-altered diffuse midline glioma. The patient subsequently received adjuvant chemoradiotherapy. Although her motor function improved postoperatively, severe orthostatic hypotension persisted, leading to recurrent syncopal episodes that significantly hindered rehabilitation. The solitary nucleus in the dorsal medulla plays a central role in the baroreflex by relaying sympathetic and parasympathetic signals within the central autonomic network. Disruption of this network by medullary tumors can impair blood pressure regulation, causing orthostatic hypotension. Although orthostatic hypotension has been reported in association with various medullary tumors, gliomas are rarely implicated. To our knowledge, this is the first reported case of medullary diffuse midline glioma presenting with orthostatic hypotension under the current World Health Organization molecular classification. This case highlights the importance of considering brain magnetic resonance imaging in patients with newly developed or severe orthostatic hypotension, particularly when accompanied by neurological symptoms, to enable timely diagnosis and management.

Myxoid glioneuronal tumor is a newly included entity in the 2021 World Health Organization classification of central nervous system tumors, based on both pathological and molecular evidence, characterized by platelet-derived growth factor receptor alpha mutations. A 23-year-old female presented with intermittent visual field abnormalities and dizziness. Magnetic resonance imaging revealed a 2-cm mass occupying both foramens of Monro, leading to non-communicating hydrocephalus. Endoscopic surgery via the transcortical approach achieved gross total resection of the tumor. Postoperatively, she developed cognitive dysfunction involving recent memory disturbance and progressive ventricular dilation, necessitating a ventriculoperitoneal shunt, which led to significant cognitive recovery. Histopathological analysis confirmed myxoid glioneuronal tumor with a platelet-derived growth factor receptor alpha p.K385L mutation. A review of 23 cases, including ours, indicates that surgical resection is the preferred treatment and is generally associated with a favorable prognosis. However, recurrence and meningeal dissemination have been reported in some cases, emphasizing the need for long-term follow-up. Myxoid glioneuronal tumor is frequently located close to critical structures like the fornix, so careful surgical planning is essential to balance maximal resection with functional preservation. Endoscopic techniques offer advantages for deep-seated lesions by minimizing cortical damage while allowing adequate tumor resection. Further studies are needed to establish the optimal treatment strategies and clarify the long-term prognosis of myxoid glioneuronal tumor.