World Neurosurg
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The number of patients with nonaneurysmal subarachnoid hemorrhage (naSAH) has increased during the last decade. Data regarding infarctions in naSAH are still limited. The aim of this study was to identify the rate of cerebral vasospasm (CVS)-dependent and CVS-independent infarctions and their influence on clinical outcomes. ⋯ CVS-dependent and independent infarctions occur in naSAH and contribute to unfavorable outcomes. Whereas CVS-independent infarctions occur in any subgroup, CVS-dependent infarctions seem to be associated with blood pattern (Fisher 3). Anticoagulative therapy seems to be not only a predictor for worse outcome but also for nonperimesencephalic SAH. Accordingly, the proportion of perimesencephalic and nonperimesencephalic SAH changed during the study period (from 2.2:1 to 1:1.7).
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The circle of Willis (CoW) is the foremost anastomosis and blood distribution center of the brain. Its effectiveness depends on its completion and the size and patency of its vessels. Gender-related and age-related anatomic variations in the CoW may play an important role in the pathogenesis of cerebrovascular diseases. In this study, we analyzed computed tomography angiograms (CTAs) to assess for differences in CoW completion related to gender, age, and indication for CTA. ⋯ The incidence of complete CoW is likely greater in women for all age groups and likely decreases with age in both genders. The most frequently absent vessel is likely the PCOM, either unilaterally or bilaterally. Completion may play a role in ischemic stroke and a subset of patients with hemorrhagic stroke.
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To show that the combined use of intraoperative high-field MRI (iMRI) and electrophysiologic monitoring (IOM) is feasible, safe, and beneficial for patients. ⋯ The combined use of IOM and 1.5T iMRI is feasible and safe. The complementary use of both technologies might result in more radical resections at comparable surgically induced neurologic deficits. If available and indicated, the combined use of IOM and iMRI should be performed on a routine basis.
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Case Reports
Endoscopic endonasal resection of a mixedlesion of gangliocytoma and non-functioning pituitary adenoma.
The coexistence of a gangliocytoma and a pituitary adenoma is a rare event that has been reported in only case reports. The knowledge of its diagnosis and treatment is extremely limited. ⋯ Our finding of the heterogeneous texture in the lesion of gangliocytoma associated with pituitary adenoma may help to uncover the pathogenesis of this rare disorder. This finding also supports the examination of intraoperative frozen sections to aid in diagnosis. We recommend maximized safe resection as a surgical strategy for the coexistent lesion of gangliocytoma and pituitary adenoma.
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Surgical treatment of giant pituitary adenomas is sometimes challenging. We present our surgical series of giant nonfunctioning adenomas to shed light on the limitations of effective and safe tumor resection. ⋯ Irrespective of the surgical approach, massive intracranial extension, an irregular configuration, and marked CS invasion are inherent factors that independently limit effective resection. These high-risk tumors require an individualized therapeutic strategy.