- Rapid development of a de novo vertebral artery dissecting aneurysm after contralateral vertebral artery occlusion: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: De novo VADA may develop rapidly after contralateral VA occlusion, likely due to altered hemodynamic stress. Thus, careful vascular surveillance is essential. When parent artery occlusion is not feasible, reconstructive endovascular strategies such as SAC may provide an effective flow-preserving treatment option. https://thejns.org/doi/10.3171/CASE26231.
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- Minimally invasive lumbar spine surgery combining extreme lateral internal fusion, percutaneous pedicle screw fixation, and full endoscopic laminectomy for lumbar isthmic spondylolisthesis with spinal stenosis: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: The combined XLIF with PPS and FEL technique may represent a minimally invasive and effective treatment for patients with SS due to LIS. https://thejns.org/doi/10.3171/CASE251027.
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- Stent-assisted coil embolization for a graft-related aneurysm following high-flow bypass: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: GA can occur as a late complication after HFB, underscoring the importance of long-term follow-up and medical management. Endovascular treatment may represent a less invasive treatment option in selected cases. https://thejns.org/doi/10.3171/CASE26249.
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- Endoscope-assisted release for pancraniosynostosis with delayed single-suture refusion managed with endoscopic re-release in the same patient: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: Endoscopic release for multisuture craniosynostosis was effective in improving cranial asymmetry and decreasing ICP. Close clinical follow-up with laser scans helped identify worsening cranial asymmetries that indicated a refusion. Endoscopic re-release can be considered an option for refusion in infants with good results. ICP remained within normal limits after endoscopic release. https://thejns.org/doi/10.3171/CASE25990.
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- Biomechanical characterization of thyroid-stimulating hormone-secreting pituitary adenoma using in vivo MR elastography and in vitro nanoindentation: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: MRE is a reliable and clinically valuable tool for preoperative evaluation of tumor consistency in rare TSHomas. The strong concordance between MRE findings, intraoperative texture, and in vitro mechanical measurements underscores the potential of MRE to guide surgical planning, reduce operative complexity, and improve clinical outcomes, especially in uncommon and challenging cases. https://thejns.org/doi/10.3171/CASE25402.
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- Occipital transtentorial approach selected based on venous anatomy for a vermian cavernous malformation: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: In superior vermian lesions, patient-specific venous drainage patterns may be decisive in approach selection. https://thejns.org/doi/10.3171/CASE25996.
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- Technical nuances for microsurgical reduction of lateral spinal cord herniation: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: Lateral SCH must be recognized as a distinct pathological entity requiring individualized surgical planning. Strategies should focus on preventing reherniation and mitigating tethering forces rather than attempting conventional dural repair. Coexisting spinal deformity may meaningfully influence cord dynamics and should be incorporated into both pathophysiological understanding and operative decision-making. The complexity of managing such cases underscores the need for technical discussions within the neurosurgical community. https://thejns.org/doi/10.3171/CASE26188.
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- C1-2 CSF tap in a 6-month-old infant: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: A literature review identified no prior reports of a C1-2 CSF tap performed in an infant. Herein, the authors describe the successful performance of a C1-2 CSF tap in a 6-month-old infant for diagnostic evaluation of suspected meningitis, highlighting the technical considerations, safety measures, and clinical implications of this rarely reported approach in infancy. C1-2 puncture is a safe and feasible alternative for CSF sampling in infants when lumbar access is contraindicated or unsuccessful. https://thejns.org/doi/10.3171/CASE26185.
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- Clinical experience with a rare brainstem tumor: ganglioglioma. Illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: Tumors of the fourth ventricle, especially fibroelastic gangliogliomas, represent a complex surgical challenge due to their eloquent location and adhesions. Complete resection requires the use of microscopy and an ultrasonic aspirator. Treatment should be individualized, prioritizing maximum and safe resection, with close follow-up, while radiotherapy remains controversial and of limited indication. https://thejns.org/doi/10.3171/CASE25776.
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- When one becomes many: a pediatric case of extensive multilevel spinal extradural arachnoid cysts challenging diagnostic paradigms. Illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: This case underscores the need to consider SEACs in pediatric progressive myelopathy, even with atypical symptoms. Histopathological confirmation is critical to exclude mimics and guide management. Rapidly progressive decline necessitates timely surgery when cord compression is evident. Successful surgical outcomes set a precedent for complex SEACs. The rarity of multilevel SEACs raises questions about underlying connective tissue or genetic predispositions. This report advances the literature on multifocal SEACs and refines diagnostic and management approaches. https://thejns.org/doi/10.3171/CASE25312.
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- Unexpected [18F]-fluciclovine hyperuptake in radiation necrosis after proton therapy: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: This rare case highlights an important diagnostic pitfall in which [18F]-fluciclovine PET demonstrates markedly elevated TBR despite only moderate SUV in RN. Discordant findings between SUV and TBR should be interpreted cautiously, as they may not always indicate active tumor. Careful integration of clinical course, longitudinal imaging findings, and treatment history is important for appropriate clinical decision-making. https://thejns.org/doi/10.3171/CASE26222.
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- Symptomatic cervical lipomyelomeningocele in an adult: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: Symptomatic cervical LMMC in adults is exceedingly rare. While asymptomatic cases may be managed conservatively with regular surveillance, excision of the lipoma with cord untethering remains the treatment of choice in symptomatic patients. The use of IONM provides an important safeguard during resection, minimizing neurological morbidity. https://thejns.org/doi/10.3171/CASE25771.
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- Interdural spinal cyst following lumbar puncture: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: Interdural spinal cysts can form as a rare complication of lumbar puncture, causing persistent spinal pain. Such cysts should be considered in patients with unexplained, posture-dependent pain after lumbar puncture, as their dynamic nature may elude standard imaging. Suturing both dural layers to obliterate the cyst and repair the defect of the inner dural layer can effectively resolve the symptoms. https://thejns.org/doi/10.3171/CASE2652.
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- Aplastic or twig-like middle cerebral artery with the RNF213 variant: illustrative cases. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: The presence of the RNF213 p.R4810K variant in all 3 patients supports a relationship between twig-like MCA and the RNF213 variant. These findings suggest that Ap/T-MCA may represent the RNF213-related vasculopathy spectrum, and the occurrence in two sisters indicates a hereditary predisposition. https://thejns.org/doi/10.3171/CASE26186.
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- Isolated contralateral radiculopathy in thoracic spinal dural arteriovenous fistula without myelopathy: illustrative case. [Journal Article]J Neurosurg Case Lessons. 2026 May 25; 11(21).JN
- CONCLUSIONS: This case illustrates that SDAVF is capable of presenting as isolated radicular pain, and symptoms may occur contralateral to the shunt origin. SDAVF should be considered in the differential diagnosis of refractory truncal radiculopathy, even in the absence of spinal cord edema. Early diagnosis and intervention promote symptomatic recovery and prevent progression to irreversible myelopathy. https://thejns.org/doi/10.3171/CASE26163.
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