World Neurosurg
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Case Reports
Surgical decompression for optic neuropathy from carotid artery ectasia: case report with technical considerations.
Symptomatic compression of the optic nerve (ON) through its intracranial course or within the orbit may occur at several locations by abnormalities of adjacent soft tissue, bony, or vascular structures. Compressive optic neuropathy secondary to vascular ectasia is a rare phenomenon. ⋯ We present a patient with severe monocular visual loss and significant anatomic displacement of the ON by an ectatic internal carotid artery-ophthalmic artery complex with dramatic and rapid visual improvement after surgical decompression. Complete untethering of the nerve and total cessation of transmitted pulsatility may not be necessary for symptomatic improvement. Optic nerve contact or displacement by the ipsilateral carotid artery is common in asymptomatic patients, therefore ruling out other etiologies of monocular visual loss before surgical decompression is paramount.
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Comparative Study
Comparative proteomic tissue analysis in patients with ossification of the posterior longitudinal ligament.
The ossification of the posterior longitudinal ligament (OPLL) involves the ligament that lines the posterior surface of the spinal vertebral bodies. Hormonal and metabolic factors as well as hereditary factors have been proposed to be involved in pathologic ligamentous OPLL. However, there are currently no definitive serological biomarkers for OPLL that might be used to achieve a more convenient and economic diagnosis. To find an easier and simpler diagnostic method and to identify pathogenic proteins associated with OPLL, we assessed PLL tissues from patients with OPLL for proteomic alterations. ⋯ The information obtained via this proteomic analysis will be very useful in understanding the pathophysiology of OPLL as well as in finding protein candidates to serve as new diagnostic biomarkers of OPLL.
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Strokelike migraine attack after radiation therapy is a recently described clinical entity characterized by transient hemispheric dysfunction manifesting as, but not limited to, visuospatial deficits, confusion, hemisensory deficits, hemiparesis, aphasia, seizures, and, most prominently, headache in patients with a history of remote external beam radiation therapy to the brain. The radiographic hallmark on magnetic resonance imaging is the presence of transient, diffuse, unilateral gadolinium enhancement of the cortex with white matter sparing, usually corresponding to the previous radiation field. ⋯ SMART syndrome should be considered in the differential diagnosis of postsurgical patients with remote history of cranial irradiation and significant, new transient neurologic deficits not explainable by any other mechanism. It is possible that manipulation of the trigeminal ganglion, or the dura of the Meckel cave, contributed to triggering the manifestations of this syndrome in our patient during the immediate postoperative period.
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To present a large series of patients and examine the learning curve of the endonasal endoscopic transplanum, transtuberculum approach for primarily suprasellar or sellar-suprasellar tumors. ⋯ The endonasal endoscopic transtuberculum transplanum approach is a safe and effective minimal access approach to midline pathology in the suprasellar cistern.