World Neurosurg
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We describe treatment with Onyx embolization in a series of cases of tentorial dural arteriovenous fistula (DAVF) with pial arterial supply. The aim of this study was to analyze the cause of intraoperative hemorrhage and to explore therapeutic strategies. ⋯ Pial arterial supply may be a risk factor for intraoperative hemorrhage during transarterial embolization of DAVF through dural feeders. Identification of pial feeders and early superselective occlusion of such feeders are important for safe management.
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Complex skull base approaches are often used to treat lesions within the middle incisural space; yet the well-known retrosigmoid route may provide an effective avenue to this difficult-to-reach region. The purpose of this study was to quantify the exposure advantages on the middle incisural space provided by cutting of the tentorium cerebelli via a standard suboccipital retrosigmoid approach (i.e., via the cerebellopontine cistern route). Also, 2 illustrative cases are presented. ⋯ Tentorial incision may be useful to extend the rostral exposure of the middle incisural space via a simple retrosigmoid approach, avoiding the need for more complex skull base routes.
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Focal hand dystonia in musicians, also known as musician's dystonia, is a task-specific movement disorder characterized by unwanted involuntary muscle contractions occurring only when playing a musical instrument. ⋯ The findings in these 2 cases indicate the utility of bilateral stereotactic Vo thalamotomy in the treatment of medically intractable musician's dystonia affecting both hands.
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Pituitary apoplexy is an acute clinical syndrome caused by pituitary gland hemorrhage or infarction. Rarely, this clinical syndrome is associated with cerebral infarction secondary to compression of an internal carotid artery. We report an unusual case of pituitary apoplexy associated with a cerebral infarct with a large ischemic penumbra. ⋯ Cerebral perfusion imaging is a useful diagnostic tool for identifying the subset of pituitary apoplexy patients that may benefit from emergent surgical intervention.