World Neurosurg
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The pathophysiology of dural arteriovenous fistulas (dAVF) is not fully understood. Retrograde venous flow can lead to venous congestion and disruption of the blood-brain barrier, resulting in diffuse contrast enhancement. ⋯ This case report highlights how venous congestion is an important differential diagnosis in contrast-enhancing lesions associated with dAVF and how it should be taken in consideration to avoid radiologic misdiagnoses and unnecessary treatment.
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Review Case Reports
Migration of a Ventriculo-peritoneal Shunt into the Pulmonary Vasculature: Case Report, Review of the Literature, and Surgical Pearls.
Ventriculoperitoneal shunts are prone to common complications such as infection or mechanical failure, but more insidious events can easily be missed. Distal shunt migration into the vascular system is a rarely observed phenomenon, and there are no established guidelines for its management. We present a case of a distal catheter migration into the pulmonary vasculature, review existing cases in the literature, and present recommendations for their management. ⋯ Although distal shunt migration into the heart and pulmonary vasculature is rare, early recognition is important and precautions should be taken to avoid potentially significant morbidity or mortality. Live fluoroscopic imaging and the help of specialty services can be of great assistance in safely removing the device. Early recognition of potential vascular injury signs during the subcutaneous tunneling procedure is also important.
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Review Historical Article
Management of subarachnoid hemorrhage in two important Italian political leaders: a paradigm of ethical and technological evolution of neurosurgery during the past half-century.
For a curious and extraordinary coincidence, 5 of the 7 most relevant leaders of the Italian Communist Party (Partito Comunista Italiano, which was established in 1921, has been the biggest Communist Party in Western Countries) suffered a cerebral stroke. Cerebrovascular diseases afflicted also Stalin and Lenin, and a number of Presidents of the United States. ⋯ Retracing their medical incidents, separated by 50 years of history, we show how a fatal medical disease has become neurosurgical and successfully cured thanks to the advances of neurosurgery, neuroradiology, and hospital organization. A neurologic disease that was disgraceful 50 years ago has lost any disquieting and embarrassing significance in the present time to the light of evolution of vascular neurosurgery.
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Review Case Reports
Delayed Presentation of an Extracranial Internal Carotid Artery Pseudoaneurysm and Massive Epistaxis Secondary to a Nasal Foreign Body. Case Report and Review of the Literature.
Epistaxis is a very common medical condition and can often be controlled with conservative measures. Rarely, uncontrolled and life-threatening epistaxis can occur. ⋯ Massive epistaxis is a potentially lethal condition. Although the source uncommonly originates from the internal carotid artery, pseudoaneurysm rupture needs to be considered on the differential diagnosis in selected patients. This case illustrates the need for vigilance for the presence of foreign objects and/or vessel injuries in the setting of acute, massive epistaxis. Additionally, we describe treatment options and review the literature.
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Review Case Reports
Intramedullary recurrence of a thoracic meningioma - Presentation of an unusual case and review of the literature.
Spinal meningiomas are typically extra-axial, slow-growing, benign tumors that arise from the arachnoid cap cells. Intramedullary spinal meningiomas are exceedingly rare with few cases reported in the literature. ⋯ Intramedullary spinal meningiomas, particularly intramedullary low-grade recurrence of a previously extramedullary tumor, are rare phenomena. Although the pathogenic mechanisms are not well understood, intramedullary recurrence as described in this patient may reflect extrinsic factors related to prior surgical resections in addition to histologic progression. When operating on recurrent extramedullary lesions, aggressive arachnoid dissection may predispose patients to unusual patterns of recurrence.