World Neurosurg
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Case Reports
Traumatic (type II) odontoid fracture with transverse atlantal ligament injury: a controversial event.
Traumatic (Type II) odontoid fractures are very common injuries. Nevertheless, their connection with transverse atlantal ligament injury is controversial and poorly defined. The aim of this study is to report a single case of traumatic (type II) odontoid fracture with transverse atlantal ligament injury and to critically analyze the role of ligaments and membranes together with neuroradiological tools in the management of craniovertebral junction-traumatized patients. ⋯ Traumatic (type II) odontoid fracture with transverse atlantal ligament avulsion can be considered an unusual event. It is our opinion that the routine use of MRI for all patients with type II odontoid fracture could be unjustified in clinical practice. Strict clinical surveillance of all patients managed conservatively and the use of MRI in selected cases could be a reasonable management option.
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Mycotic aneurysm rupture has been described as a rare, universally fatal complication of central nervous system Coccidioides immitis meningitis. Recently, however, we reported the successful surgical management of a midbasilar dissecting mycotic aneurysm related to C. immitis meningitis in a 24-year-old pregnant woman with acquired immune deficiency syndrome. ⋯ Our patient represents the only survivor of a C. immitis mycotic aneurysm rupture. In her case, long-term clinical and radiographic stability were achieved through a vigilant multidisciplinary approach.
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Case Reports
Multimodal treatment of hemorrhagic pituitary metastasis as first manifestation of renal cell carcinoma.
Metastatic tumors involving the pituitary gland are very rare, with only few cases reported so far in the literature. ⋯ This is the first report describing multimodality treatment of a patient with pituitary metastasis of unknown origin requiring presurgical embolization before successful tumor removal.
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The purpose of this study is to provide an institutional retrospective review of surgically treated brainstem cavernous malformations. ⋯ Our longitudinal experience has guided us to emphasize minimally invasive approaches during resection of the brainstem cavernous malformations, occasionally at the expense of achieving a complete resection, to improve patient outcomes.
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Rotational vertebral artery occlusion syndrome refers to vertebrobasilar insufficiency as a result of mechanical occlusion or stenosis of the vertebral artery by head rotation. In most cases, symptoms are produced on extension or rotation to one side. No case of bow hunter's syndrome with bilateral presentation at the C4 level has yet been reported. ⋯ Bony obstruction of the vertebral artery on head rotation tends to occur at levels C4 and below, affecting the ipsilateral side. In this rare case, symptomatic bilateral vertebral artery stenosis occurred as a result of bony compression and was symptomatic on head rotation both to the right and to the left. This stenosis was improved with anterior decompression bilaterally, and no further events occurred postoperatively.