BACKGROUND: Spinal meningiomas are slow growing benign tumors arising from arachnoid cap cells throughout the spinal meninges. Spontaneous bleeding is extremely uncommon and scarcely reported in literature. CASE PRESENTATION: We present an 81-year-old male patient who presented to the emergency department with a sudden onset of severe thoracolumbar back pain, radiating to both legs with weakness and paresthesia. Thoraco-lumbar spine MRI with gadolinium depicted an L1-L2 intradural spinal tumorous mass with intraspinal hemorrhage. He underwent an urgent laminectomy for tumor resection and hematoma evacuation. Histopathology confirmed the diagnosis of meningioma WHO grade I. CONCLUSION: Spinal meningiomas presenting primarily with hemorrhage are scarcely reported in literature. To our knowledge, two cases have been reported. A high index of suspicious is crucial as a timely surgical intervention significantly influence the degree neurological recovery.

A recent studies have reported the learning curve in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Over the last two decades there has been a growing interest for the treatment of spinal disorders performed through the use of minimally invasive surgical procedures. The studies are based on clinical result such as blood loss, surgical time, or high rate of perioperative complications but none have studied the origin of these results. This study proposes a systematic learning skills method and a different perspective to evaluate the MI-TLIF learning curve.

Endoscopic surgery has become an important tool in spinal surgery, the ergonomic design and the required length of the instruments, as well as the use of video monitors greatly affect our perception and performance. Some experts are resistant to the use of the endoscope in spinal surgery, because of the limitations in the perceptual information and that this can lead us to commit incorrect actions during the surgical procedure. Since the introduction in 1997 by Smith and Foley of a system consisting of progressive tubular dilators (MED) to later place an endoscopic vision system, the technique has become increasingly popular to this day. Based on this, other authors have documented the use of this endoscopic tubular system called Easy-Go reporting good results, so the authors of this article focus on the intraoperative peculiarities, experience, first impressions and the technical note of this system. (EASY-GO)

The aim of this study was to characterize the clinical and genetic features of a 1-year-old female with merosin-deficient congenital muscular dystrophy type 1A (MDC1A). MDC1A is the most common form of congenital muscular dystrophy. MDC1A is caused by mutation of the laminin a-2 gene (LAMA2), localized to chromosome 6q22-23. Clinical presentation, as well as the results of neuroimaging, electrophysiology and molecular genetic tests were used to evaluate a patient with MDC1A. The patient presented with severe hypotonia and proximal weakness at 5.5 months of age, as well as delayed developmental milestones. The serum creatine kinase levels of the patient were elevated at 1620 IU/l. Magnetic resonance imaging (MRI) showed that the white matter in the frontal, parietal, temporal and occipital lobes was abnormal with low signal intensities on T1-weighted images and high signal intensities on T2-weighted images; the rest of study was normal. Sequencing of the 65 exons of the LAMA2 revealed a homozygous nonsense mutation in exon 50: a Ala>L exchange in nucleotide c.1762 that resulted in a stop codon (Ala588Leufs11 stop). Molecular genetic testing is a reliable method for confirming a diagnosis of MDC1A. When a patient presents with severe congenital hypotonia, muscle weakness, high serum creatine kinase (CK) levels and white matter abnormalities, the evaluation may directly proceed to molecular genetic testing of the LAMA2 gene.

Starting from the concept of suicidal risk, this work re-elaborates the main theories on the theme and related theme of mourning, proceeding with a complete examination of the possible differential diagnoses and of the neural correlates involved, up to the most suitable clinical strategies to avoid the event of death.