Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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The occipital interhemispheric transtentorial approach is commonly used for pineal region tumors. However, there are few reports of this approach for lesions in the superior cerebellum. We present a 47-year-old male patient with an incidental cystic lesion in the superior cerebellum, detected on MRI consistent with cerebellar hemangioblastoma. ⋯ We performed surgery using the occipital interhemispheric transtentorial approach to remove the lesion. There were no intraoperative complications and the patient tolerated the procedure well. We describe our approach, supplemented by a short video, and review operative approaches to the superior cerebellum.
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We report our single-center experience using detachable balloons (DB), coils and Willis covered stents (MicroPort, Shanghai, China) to treat post-traumatic direct carotid-cavernous fistulas (DCCFs), focusing on preservation of the internal carotid artery (ICA). We retrospectively reviewed the records of 51 patients who received endovascular treatment (EVT). EVT with DBs was chosen as the first-line therapeutic strategy, and Willis covered stent placement and coiling was the alternative. ⋯ DCCF-related symptoms improved gradually between 1 day and 6 months after treatment. EVT using DB to occlude fistulas and preserve the ICA is the preferential treatment for DCCFs. When standard treatment has failed, coils and/or Willis covered stents can be used as a safe alternative or remedial tool with ICA preservation and reconstruction.
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Thrombosis via Hunterian ligation, with or without high-flow bypass, is the definitive treatment for unclippable giant aneurysms; however, secondary deterioration may occur. We present a 67-year-old woman with an unclippable giant (33mm) carotid ophthalmic aneurysm. ⋯ Subsequent expansion of the thrombosed aneurysm created mass effect with hydrocephalus, leading to marked cognitive and visual decline. Aneurysmal decompression led to improved vision and near-normal neurological function.