World Neurosurg
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Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid arteries and the cavernous sinus. CCFs often present with double vision, reduced visual acuity, and conjunctivitis. Deteriorating ocular symptoms caused by abnormal fistula drainage can cause permanent blindness, and so urgent interventional treatment is necessary. Transvenous embolization of the fistula is the primary treatment option for most patients with symptomatic CCFs. Orbital approaches are considered to be risky compared with the traditional approach via the inferior petrosal sinus and are thus used as a secondary option. These approaches include embolization via the superior ophthalmic vein, inferior ophthalmic vein, and medial ophthalmic vein and direct transorbital puncture. This study aims to assess the merits and risks of orbital approaches in transvenous embolization of CCFs. ⋯ All orbital approaches for transvenous embolization of CCFs are effective and safe.
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Flow diversion with the Pipeline Embolization Device (PED) currently is adopted for treatment of a variety of intracranial aneurysms. The elevated risk of thromboembolic complications associated with the device necessitates the need for administration of antiplatelet agents. We sought to assess current dual-antiplatelet therapy practices patterns and their associated costs after PED placement. ⋯ Significant heterogeneity in dual-antiplatelet regimens after PED placement and associated costs exists at major academic neurovascular centers. The most commonly used first-line dual-antiplatelet regimen consists of aspirin and clopidogrel. Two major alternate protocols involving ticagrelor and prasugrel are administered to clopidogrel hyporesponders. The optimal dual-antiplatelet regimen for patients with cerebrovascular conditions has not been established, given limited prospective data within the neurointerventional literature.
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Observational Study
Primary hemorrhagic neurovascular diseases (PHNVDs) in Tibetans: a retrospective observational study.
Although there have been many studies on primary hemorrhagic neurovascular diseases (PHNVDs) in different populations, a study focusing on PHNVDs in Tibetan people was lacking. This study aimed to explore the notable characteristics of Tibetan PHNVDs by comparing the 3 most common PHNVDs (aneurysmal subarachnoid hemorrhage, spontaneous intracerebral hemorrhage, and arteriovenous malformation) in our institution between Tibetan and Han patients. ⋯ For Tibetan PHNVDs, a high incidence of BLAs in aneurysmal subarachnoid hemorrhage, a tendency toward brainstem hemorrhage in subtentorial spontaneous intracerebral hemorrhage, and a high rate of infarction and rebleeding in all 3 subtypes were all recognized.
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Review Case Reports
Intra-sellar and supra-sellar schwannoma misdiagnosed as pituitary macroadenoma: A case report and review of the literature.
Intracranial schwannomas usually arise from sensory nerves with a predilection for the trigeminal nerve and the vestibular component of the eighth cranial nerve (VIII). Schwannoma arising in the sella and extending into the suprasellar region is exceedingly rare and easily misdiagnosed as pituitary macroadenoma. Only 26 cases of intrasellar schwannomas have been reported in the literature. ⋯ Although schwannoma in the sellar region is rare, it remains an important differential diagnosis because of different surgical approaches.
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Surgical treatment of trigeminal neuralgia (TN) associated with vertebrobasilar dolichoectasia is challenging. We analyze the treatments for this disease, discussing the advantages and drawbacks, and present our own technique and series. ⋯ TN associated with vertebrobasilar dolichoectasia can be treated surgically with minimal morbidity. BA repositioning has the highest success rate. Our technique of inducing a dural scar to fix the BA in its new position away from the trigeminal nerve is simple, not technically demanding, and highly effective.