World Neurosurg
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Blood blister-like aneurysms (BBAs) are a subgroup of aneurysms located on nonbranching sites of the internal carotid artery (ICA) and characterized by small size, a fragile wall, and a poorly defined broad-based neck. Both direct surgery and endovascular treatment for BBAs are often challenging. Some of the BBAs have been reported to look like true saccular aneurysms, and the misdiagnosis of BBA might result in catastrophic outcomes. The purpose of this study is to clarify the clinical and intraoperative findings of saccular BBAs. ⋯ Saccular BBAs may not merely develop secondarily from typical BBAs, but also form by the surrounding structures-dependent mechanisms when an aneurysm points toward the optic nerve. The findings in this study suggest that saccular-shaped aneurysms at nonbranching sites of the ICA toward the optic nerve should be considered as saccular BBAs.
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Structural magnetic resonance imaging (MRI) and histopathologic tissue sampling are routinely performed as part of the diagnostic workup for patients with glioma. Because of the heterogeneous nature of gliomas, there is a risk of undergrading caused by histopathologic sampling errors. MRI has limitations in identifying tumor grade and type, detecting diffuse invasive growth, and separating recurrences from treatment induced changes. Positron emission tomography (PET) can provide quantitative information of cellular activity and metabolism, and may therefore complement MRI. In this report, we present the first patient with brain glioma examined with simultaneous PET/MRI using the amino acid tracer 18F-fluciclovine (18F-FACBC) for intraoperative image-guided surgery. ⋯ 18F-Fluciclovine uptake was found in parts of the tumor where regional WHO grade, cell proliferation, and cell densities were highest. This finding suggests that PET/MRI with this tracer could be used to improve accuracy in histopathologic tissue sampling and grading, and possibly for guiding treatments targeting the most malignant part of extensive and eloquent gliomas.
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Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, many patients respond poorly to initial MVD. For these patients, redo MVD is commonly done. There has been no research regarding the effectiveness of nerve combing (NC) plus MVD in patients with TN and failed prior MVD. We compared the clinical outcome of NC plus MVD and simple redo MVD in patients with TN and failed prior MVD. ⋯ In patients with TN who failed prior MVD, NC plus MVD significantly improved the success rate of the operation compared with simple redo MVD. We obtained good short-term and long-term surgical outcomes with NC combined with MVD.
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Clinicians may have limited opportunities to perform neurological determination of death (NDD, or brain death) certification during their training. This study aimed to evaluate the level of resident exposure to the brain death exam at a large-volume donor hospital. ⋯ Neurology and neurosurgery residents may be limited in their exposure to the brain death exam during training. High-volume donor hospitals may be able to complete 2 exams for NDD certification in a timely manner without detrimentally influencing organ authorization or family refusal rates.
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Most sellar gangliocytomas are discovered with a concurrent pituitary adenoma, also known as a mixed gangliocytoma-adenoma (MGA). MGAs are rare, with fewer than 100 cases reported in the literature to date and only 1 previously documented surgical series. Because MGAs are radiologically indistinguishable from pituitary adenomas, they are often diagnosed after surgery. Combined with the paucity of clinical outcome data for these tumors, this makes their diagnosis and management challenging. Here we describe the clinical presentation and outcomes of 10 individuals who were diagnosed with a MGA at a single institution. ⋯ MGAs are often associated with a hypersecretory adenoma. Transsphenoidal surgery is well tolerated by most patients, and when performed in combination with adjuvant therapy, a low rate of recurrence and reversal of preoperative endocrinopathy can be expected.