Neurosurgery
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Case Reports
Ventriculosternal Shunting for the Management of Hydrocephalus: Case Report of A Novel Technique.
Conventional cerebrospinal fluid diversion such as ventriculoperitoneal or ventriculoatrial shunting for the management of hydrocephalus is one of the commonest neurosurgical procedures. However, in selected patients, surgical options are limited when relative contraindications for these operations exist. A patient who underwent ventriculosternal shunting, a novel procedure, is presented with durable and successful outcomes. ⋯ Ventriculosternal shunting for the management of hydrocephalus is a feasible, safe, and durable surgical treatment option for selected patients when conventional procedures are contraindicated.
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A piezo actuator-driven pulsed water jet (ADPJ) system is a novel surgical instrument that enables dissection of tissue without thermal damage. It can potentially resect intra-axial lesions while preserving neurological function. ⋯ The ADPJ provided a clear surgical field and enabled surgeons to dissect boundaries between lesions and surrounding brain and spinal cord gliotic tissue. The ADPJ system is a feasible option for cavernous malformation surgery, enabling successful tumor removal and preservation of neurological function.
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Spinal epidural abscesses are difficult to diagnose and could have high morbidity and mortality if left untreated. If patients present with acute neurological deficits and evidence of a multilevel ventral spine abscess on neuroimaging, blood cultures should be taken and the abscess emergently evacuated in patients able to tolerate surgical interventions. ⋯ The patient's neurological deficits completely resolved, and he is intact a year after the operation. In selected patients with pan-spinal epidural abscesses associated with acute neurological deficits, a combination of an open approach and a catheter-based procedure in addition to an intraoperative monitoring option to ensure complete evacuation of the abscess and absence of septations in the anterior epidural space is a low-morbidity option in the armamentarium of the surgeon.
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The use of mechanical thrombectomy in the management of acute ischemic stroke is becoming increasingly popular. ⋯ The Solitaire device is safe and effective in achieving successful recanalization after acute ischemic stroke. Important factors to consider include age, NIHSS score, and location.
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Intraosseous dural arteriovenous fistulae (DAVF) are rare, especially those with drainage into the diploic venous system. The clinical presentation depends on the location of the lesion. This is the first report of an intraosseous DAVF associated with acute epidural hematoma. ⋯ Intraosseous DAVF can be treated by surgical resection or endovascular embolization. Curative treatment requires careful inspection of the angiographic architecture and microsurgical anatomy.