World Neurosurg
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During carotid endarterectomy (CEA), carotid cross-clamping is performed to allow for artery incision and plaque removal. A small subgroup of patients can tolerate carotid occlusion for only a few seconds, if at all, without presenting neurologic deficit. These patients are described as having ''cross-clamp intolerance.'' The purpose of this study was to demonstrate the safety of locoregional anesthesia in identifying patients with cross-clamp intolerance and factors associated with this condition. ⋯ Locoregional anesthesia is a safe method for identifying patients with cross-clamp intolerance. Patients with cross-clamp intolerance present contralateral stenosis that is greater on average than patients who readily tolerate carotid artery occlusion.
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Gangliogliomas (GG) are benign, primary neoplasms most commonly noted in young adults. Intraventricular location is rare. We report a case of a multicentric intraventricular GG posing diagnostic and therapeutic challenges and in addition provide a detailed literature review of intraventricular GG. ⋯ Intraventricular GG are rare tumors. Complete surgical excision achieves excellent results. The role of adjuvant therapy is controversial.
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Review Case Reports
Orbitofrontal cholesterol granuloma: Four case reports and a systematic review of the English literature.
Primary orbitofrontal cholesterol granuloma (OFCG) is rare. We present 4 cases of OFCG and a systematic literature review to examine patient characteristics, presentation, treatment, and outcome. ⋯ Thorough removal of the lesion with curettage of the boney cavity is recommended for OFCG. Recurrence following complete removal of OFCG is rare.
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Treatment for lumbar disc disease and spinal stenosis is the most common reason patients seek neurosurgical consultation in rural sub-Saharan Africa. Yet the misperception remains that lacking access to magnetic resonance imaging/computed tomography and a "spine surgeon," neither a definitive diagnosis can be made nor corrective treatment instituted. To combat such therapeutic nihilism, the author has supervised the on-site training of general surgeons in rural Kenya for the past 15 years with the intent of making spine surgery available for patients in outlying provincial areas. ⋯ Assuming experienced spine surgeons are willing to involve themselves in such hands-on training, the results of this study affirm that general surgeons can diagnose efficiently and then treat safely such degenerative spine conditions-thereby addressing this most prevalent of disease processes that has huge socioeconomic implications for rural sub-Saharan Africans.
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Case Reports Comparative Study
Delayed Hemorrhage Following Treatment of Brain Arteriovenous Malformations (AVMs).
The risk of delayed hemorrhage occurring greater than 2 years after treatment in brain arteriovenous malformations (AVMs) rarely is reported. In this study, we compare the risk of delayed hemorrhage across different treatment modalities. ⋯ This study is the first to compare the risk of delayed hemorrhage across different treatment modalities. Surgical resection is associated with the lowest risk for delayed hemorrhage compared with other treatment modalities. Patients with partially embolized AVMs should seek timely definitive treatment to decrease the risk of delayed hemorrhage.