Neurosurgery
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Study of the corticosubcortical functional anatomy of reading and picture naming. ⋯ We propose the existence of a dual visual language route in the left dominant hemisphere. The first pathway seems to run basally, from the occipital lobe to the posterobasal temporal cortex, mediated by the left inferior longitudinal fascicle, subserving visual recognition. The second pathway might run superiorly and more medially, from the occipital pole directly to the frontal areas, and could be underlain by the inferior fronto-occipital fascicle, involved in naming (semantic processing). Such a model might have both fundamental and clinical implications for the selection of the tasks during awake mapping as well as for postsurgical rehabilitation.
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The incidence of radiation-induced complications is increasingly part of the informed consent process for patients undergoing neuroendovascular procedures. Data guiding these discussions in the era of modern radiation-minimizing equipment is lacking. ⋯ Radiation exposures exceeding 2 Gy are common in interventional neuroradiology despite modern radiation-minimizing technology. The incidence of side effects approaches 40%, although the majority is self-limiting. Gaps in current models of brain tumor formation after exposure to radiation preclude accurately quantifying the risk of future CNS tumor formation.
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To manage arachnoid cysts, incorporation with the normal circulation is the single most important determinant of success. Although the postoperative cerebrospinal fluid leakage rate is 3.9% for all cases of transsphenoidal surgery, it is 21.4% for intrasellar arachnoid cysts. ⋯ Endoscopic fenestration of an intrasellar arachnoid cyst is a safe and simple procedure without serious complications.
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Cavernous malformations (CMs) in deep locations account for 9% to 35% of brain malformations and are surgically challenging. ⋯ Symptomatic deep CMs can be resected with acceptable morbidity and outcomes. Good preoperative modified Rankin Score and single hemorrhage are predictors of good long-term outcome.
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Thromboembolic events are the most common complication after coiling of unruptured intracranial aneurysms (UIAs). However, it remains unclear whether these clinically silent ischemic lesions (CSILs) have any clinical significance. ⋯ Exhaustive neuropsychological evaluation of UIA patients who underwent coil embolization demonstrated recovery or improvements from baseline cognitive function after 4 weeks, although some patients still showed cognitive deficits at 4 weeks after the procedure. However, we found no statistically significant relationship between the presence and number of CSILs on DWI and cognitive changes after the procedure.