World Neurosurg
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For more than 2 decades, dural spinal cysts have been broadly classified as extradural and intradural. ⋯ We suggest a revised classification of spinal dural cysts. This case highlights that, during surgery for spinal meningeal cysts, surgeons should bear in mind the possibility of an interdural cyst. This may help avoid inadvertent tears in the deep layers of such cysts, thus maintaining dural patency.
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We summarized 63 cases of anterior cerebral artery (ACA) anomaly with an infraoptic course reported in the literature including abstracts written in English. All cases were reported individually, with a maximum of 3 cases. This report describes our findings in another case and opinions regarding the terminology. ⋯ Use of the terminology "infraoptic course of the ACA" versus "carotid-ACA anastomosis" was discussed. Based on the literature reports, at least one third of the cases have a normal-positioned ACA rather than the infraoptic ACA. Also, based on embryogenesis, it is thought that the infraoptic ACA is not a misplaced A1 segment, but rather persistence of an embryologic vessel. Therefore, based on the literature and embryology, we prefer the term "carotid-ACA anastomosis" rather than "infraoptic ACA." However, as a morphologic and positional description, the term "infraoptic ACA" has value. To the best of our knowledge, the present case of a carotid-ACA anastomosis associated with a paraclinoid aneurysm and ophthalmic artery originating from the middle meningeal artery is the first to appear in the literature.
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Comparative Study
The difficulties and risks of Y-stent-assisted coiling: a comparison of first and second stenting procedures.
Y-stent-assisted coiling (YSAC) requires multiple device accesses for double stenting. The purpose of this study was to test the hypothesis that second stenting procedures are riskier than first stenting procedures. ⋯ In YSAC, second stenting procedures seem riskier than first stenting procedures, particularly when SDs occur. A proper device or delivery method may reduce the risks.
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Biomechanical studies demonstrate that cortical bone trajectory pedicle screws (CBTPS) have greater pullout strength than traditional pedicle screws with a lateral-medial trajectory. CBTPS start on the pars and angulate in a mediolateral-caudocranial direction. To our knowledge, no large series exists evaluating the perioperative outcomes and safety of CBTPS. ⋯ As CBTPS becomes increasingly popular among spine surgeons performing lumbar fusion, this report provides an important evaluation of technique safety and acceptable perioperative outcomes.
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Intraventricular meningiomas (IVMs) are rare tumors compared with intracranial meningiomas. Optimal surgical management of IVMs is controversial. The objective of this article was to review the outcomes and complications of meningiomas treated with various surgical approaches. ⋯ Based on a literature review and our experience, surgical approaches for patients with IVM vary according to size, location, and laterality of the meningioma. In addition, the growth pattern of the tumor (transependymal extension), vascular supply of the tumor, and brain function (particularly visual function) can affect surgical treatment and should be identified preoperatively.