Acta neurochirurgica
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Acta neurochirurgica · Sep 2019
Management of perineural (Tarlov) cysts: a population-based cohort study and algorithm for the selection of surgical candidates.
Perineural cysts, also known as Tarlov cysts, are cerebrospinal fluid-filled growths that develop at the intersection of a dorsal root ganglion and posterior nerve root. They are typically an asymptomatic and incidental finding during routine spine imaging. For symptomatic perineural cysts, there is little evidence on which treatment is most effective or when it is indicated. The aim of this study was to review our experience from a population-based cohort of patients with symptomatic perineural cysts and to propose an algorithm that could be used in the selection of surgical candidates. ⋯ Microsurgical cyst fenestration seems to be a safe and effective option for symptomatic relief in patients with perineural cysts. Based on the results from our series and those of others, we propose an algorithm for the selection of surgical candidates.
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Acta neurochirurgica · Aug 2019
Biography Historical ArticleSir Hugh Cairns: a pioneering collaborator.
In April 1988, Peter Schurr delivered the twelfth Sir Hugh Cairns Memorial Lecture to the Society of British Neurological Surgeons. In his lecture, The Cairns Tradition, Schurr extolled the personal virtues of Cairns. He encouraged his colleagues to draw inspiration from Cairns' renowned determination, organisation, drive for perfection, compassion, and commitment to the training of those around him. ⋯ Lawrence are well known to many. But, more than thirty years after Peter Schurr's memorial lecture, and following the eightieth anniversary of the department of neurosurgery founded by Cairns in Oxford, it is his work as a pioneering collaborator which defines his legacy today, and which calls us to learn yet another lesson from his remarkable life. In this legacy article, we review the origins of Cairns' collaborative spirit and uncover the achievements he shared with Charles Hallpike, Howard Florey, Derek Denny-Brown, William Ritchie Russell, Ludwig Guttman, and Peter Medawar, among many others.
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Acta neurochirurgica · Aug 2019
The approach angle to the interoptic triangle limits surgical workspace when targeting the contralateral internal carotid artery.
The interoptic triangle (IOT) offers a key access to the contralateral carotid artery's ophthalmic segment (oICA) and its perforating branches (PB), the ophthalmic artery (OA), and the superior hypophyseal artery (SHA). It has been previously reported that the assessment of IOT's size is relevant when attempting approaches to the contralateral oICA. However, previous studies have overseen that, since the oICA is a paramedian structure and a lateralized contralateral approach trajectory is then required, the real access to the oICA is further limited by the approach angle adopted by the surgeon with respect to the IOT's plane. For this reason, we determined the surgical accessibility to the contralateral oICA and its branches though the IOT by characterizing the morphometry of this triangle relative to the optimal contralateral approach angle. ⋯ The exposure of contralateral oICA, OA, SHA, and PB directly correlates to rIOT's surface. Therefore, preoperative assessment of rIOT's surface is helpful when considering contralateral approaches to the oICA. A virtual 3D planning tool greatly facilitates this assessment.
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Acta neurochirurgica · Aug 2019
WEB-only treatment of ruptured and unruptured intracranial aneurysms: a retrospective analysis of 47 aneurysms.
WEB (Woven EndoBridge) device is an intrasaccular flow diverter designed for endovascular treatment of intracranial aneurysms. Recent clinical trials showed good feasibility, safety, and efficacy profiles. In most of the published studies however, aneurysms treated with adjunctive devices other than WEB such as coils or stents were included which might make it difficult to reflect the real potential of this device. The purpose of this single-center study was to present the results of ruptured and unruptured aneurysms treated only with WEB device. ⋯ WEB enables adequate occlusion of ruptured and unruptured intracranial aneurysms mostly without requirement of long-term antiplatelet therapy. The benefit is seen especially by the wide-necked aneurysms, but indications should be extended to include narrow-necked, smaller, and side-wall aneurysms.
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Acta neurochirurgica · Jul 2019
Review Case ReportsIatrogenic pseudoaneurysm rupture of the anterior cerebral artery after placement of an external ventricular drain, treated with clip-wrapping: a case report and review of the literature.
External ventricular drains (EVDs) are often placed emergently for patients with hydrocephalus, which carries a risk of hemorrhage. Rarely, rupture of a pseudoaneurysm originating from an EVD placement precipitates such a hemorrhage. ⋯ Although EVD-associated pseudoaneurysms are rare, they have a high propensity for rupture. Early treatment of these lesions should be considered to prevent neurologic deterioration.