World Neurosurg
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Vasospasm and resultant clinical deterioration caused by delayed cerebral ischemia (CD-CDI) are a considerable source of morbidity after aneurysmal subarachnoid hemorrhage (SAH). Although they are a relatively common cause of spontaneous SAH, AVM rupture and ensuing vasospasm are rarely reported. ⋯ Even in cases of SAH from AVMs, angiographic vasospasm after AVM rupture is relatively rare. We thus do not recommend empiric delayed angiography to assess for vasospasm in these patients. Nevertheless, it does remain a rare possibility and should be considered in those with CD-DCI.
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Review Case Reports
Evolution and future of skull base surgery: the paradigm of skull base meningiomas.
Skull base meningiomas represent the paradigm for the evolution of skull base surgery within the past 50 years into a distinct neurosurgical subspecialty. ⋯ A large contemporary series of skull base meningiomas is presented. In addition, the evolution of surgical approaches to skull base meningiomas is reviewed, together with the current issues regarding radiation therapy, management of cavernous sinus tumor, oncologic management of atypical and malignant subtypes, molecular genetics, and future therapeutic options.
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To report a case of cervical radiculopathy caused by an anomalous vertebral artery (VA) and illustrate the efficacy of microvascular decompression by the anterolateral approach. ⋯ Cervical root compression by an aberrant or anomalous extracranial VA is a rare cause of radiculopathy. The best management of such lesions is the anterolateral approach with bony and direct microvascular decompression.
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Endoscopic third ventriculostomy (ETV) is being used increasingly in adults as an alternative to cerebrospinal fluid (CSF) shunting. We analyze patient, radiographic, and operative factors associated with CSF diversion surgery-free outcomes after ETV. ⋯ ETV is a safe and effective procedure in adult patients. Perioperative factors, intraoperative image guidance, and steroid treatment may lower ETV failure rates.
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We are in an aging population and many elderly people are prone to falling and suffering an acute traumatic subdural hematoma (aSDH). Yet, the operative treatment of patients older than 65 years of age for aSDH remains controversial, and very limited data exists with regard to expected outcome in this elderly patient group. ⋯ Craniotomy for patients older than 65 years of age remains controversial, and our case series seems to support the notion that surgical treatment is associated with significant postoperative morbidity, mortality, and adverse outcome. However, selected patients benefit from an intervention, with a good outcome in 41% of patients.