Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsAcute onset of hemiparesis after gamma knife radiosurgery for arteriovenous malformation caused by hyperacute thrombosis of draining vein: a case report.
Complications after gamma knife radiosurgery (GKRS) have been attributed most commonly to radiation-induced damage to the brain. Early occlusion of the draining veins has been postulated as one of the rare causes of complications after GKRS, which often occurs at or beyond 6 months after GKRS. ⋯ Early draining vein occlusion is an important cause of postradiosurgery complications, and it can rarely occur within days.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsPial arteriovenous fistula as a cause of bilateral thalamic hyperintensities--an unusual case report and review of the literature.
Isolated bilateral thalamic congestion due to an arteriovenous malformation (AVM) is a rare entity. Few case reports of dural arteriovenous fistula associated with it have been reported in the literature. The association of pial arteriovenous fistula (pial AVF) with thalamic hyperintensities has never been described before. The pial AVF is a recently recognized lesion in which the multiple pial arterial feeders drain into a single venous channel without a nidus like in conventional AVM. In spite of being congenital in origin, these lesions may have expression in adulthood due to abrupt change in the venous drainage system. Successful management of pial AVF associated with bilateral thalamic hyperintensities is described here with review of the literature. ⋯ Strong suspicion of vascular malformation as a cause of bilateral thalamic hyperintensities helps in early detection. Such lesions like pial AVF presented here require active intervention by surgery or endovascular therapy. GKT is an important adjuvant in lesions refractory to either of them.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsIs it safe to sacrifice the superior hypophyseal artery in aneurysm clipping? A report of two cases.
Clipping of paraclinoid internal carotid artery aneurysms related to the superior hypophyseal artery (SHA) carries risk of occlusion of this artery when originating distal to the neck of the aneurysm. Sometimes it is inevitable to sacrifice the artery to achieve total aneurysm occlusion. Otherwise a residual aneurysm would remain, which may lead to aneurysm regrowth and subsequent rupture. ⋯ Intraoperative ICG angiography may help to estimate collateral blood flow but is not able to predict visual decline. Although final conclusions cannot be drawn from two patients, it seems that in case of multiplicity of superior hypophyseal complex, sacrifice of one even larger branch is safe. However, visual sequelae have to be taken into consideration when a single SHA has to be sacrificed for total aneurysm clipping.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsIschemic complications after pituitary surgery: a report of two cases.
Cerebral ischemic complications after pituitary surgery are not frequently reported. These vascular complications may be related to (1) direct trauma to the vessel wall, (2) compression of the internal carotid artery (ICA) due to pituitary apoplexy, (3) vasospasm secondary to subarachnoid hemorrhage or vasoactive tumor extract, or (4) hypothalamic injury. ⋯ These cases highlight two different mechanisms of infarcts after pituitary surgery. The first case highlights the importance of ICA evaluation before surgery in elderly patients with risk factors, such as chronic smoking, hypertension, and atherosclerotic disease. Even minimal manipulation of the ICA can generate a cascade of thrombembolic events in such patients. The second case highlights the importance of observing the patient of a highly vascular giant pituitary adenoma in the hospital for a longer than usual time. Delayed vasospasm can occur like in aneurysmal subarachnoid hemorrhage and have a good outcome if detected early and managed judiciously.
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J Neurol Surg A Cent Eur Neurosurg · Dec 2013
Case ReportsReversible cortical blindness and internuclear ophthalmoplegia after neurosurgical operation: case report and review of the literature.
The reversible posterior leukoencephalopathy (RPL) syndrome with typical vasogenic edema in the occipital lobe and associated cortical blindness is a rare finding; however, the brainstem variant is even more infrequent. Etiologies discussed include blood pressure dysregulations, renal failure, or immunosuppression. ⋯ We hypothesize that the patient had an RPL, coincidentally in classic-, and brainstem localization, caused by perioperative fluctuations of blood pressure.