Object Superior cluneal nerve (SCN) entrapment neuropathy is a poorly understood clinical entity that can produce low-back pain. The authors report a less-invasive surgical treatment for SCN entrapment neuropathy that can be performed with local anesthesia. Methods From November 2010 through November 2011, the authors performed surgery in 34 patients (age range 18–83 years; mean 64 years) with SCN entrapment neuropathy. The entrapment was unilateral in 13 patients and bilateral in 21. The mean postoperative follow-up period was 10 months (range 6–18 months). After the site was blocked with local anesthesia, the thoracolumbar fascia of the orifice was dissected with microscissors in a distal-to-rostral direction along the SCN to release the entrapped nerve. Results were evaluated according to Japanese Orthopaedic Association (JOA) and Roland-Morris Disability Questionnaire (RMDQ) scores. Results In all 34 patients, the SCN penetrated the orifice of the thoracolumbar fascia and could be released by dissection of the fascia. There were no intraoperative surgery-related complications. For all patients, surgery was effective; JOA and RMDQ scores indicated significant improvement (p < 0.05). Conclusions For patients with low-back pain, SCN entrapment neuropathy must be considered as a causative factor. Treatment by less-invasive surgery, with local anesthesia, yielded excellent clinical outcomes.

A 2-year-old female presented with a rare case of recurrent giant cell tumor affecting the frontal bone. She had already undergone partial removal twice at the ages of 14 and 18 months. The tumor was located in the frontal bone, expanding to the ethmoid and orbital bones, and invading the frontal base dura mater. The tumor was totally removed including the surrounding bone and frontal base dura mater. No local recurrence and metastasis were observed at 18 months after the last operation. Most giant cell tumors occur in the epiphyses of long bones and are rare in the cranio-facial bone. These tumors usually affect young adults and few pediatric cases are reported.

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Dural arteriovenous fistula in a case of dementia with bithalamic MR lesions T2-weighted MRI of the brain revealed bithalamic hyperintense lesions (figure, A) in a 73-year-old man with a 5-month history of dementia. Although the tentative diagnosis was metabolic encephalopathy or glial tumors, we finally suspected dural arteriovenous fistula (AVF) 1 based on bithalamic vasodilatation on enhanced MRI. Cerebral angiography demonstrated a dural AVF with retrograde flow through the vein of Galen (figure, B). After transarterial embolization, dementia improved accompanied by disappearance of bithalamic abnormal intensities (figure, C). Hypertension of the vein of Galen resulting from a dural AVF should be considered in dementia cases with characteristic bithalamic lesions. 2A. Matsumura, MD, M. Oda, MD, T. Hozuki, MD, T. Imai, MD, PhD, and S. Shimohama, MD, PhD, Sapporo, Japan Disclosure: The authors report no disclosures.