World Neurosurg
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Regional neurovascular structures must be avoided during invasive spine hardware placement. During C1 lateral mass screw placement, the C2 nerve root is put in harm's way. Therefore the current anatomic study was performed to identify techniques that might avoid such neural injury. ⋯ On the basis of our cadaveric study, the C2 nerve root can be detethered enough at the level of the posterior lateral mass of C1 to avoid its injury during screw placement into this area.
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Clear cell meningioma (CCM) is a rare histologic subtype of meningioma that is classified as World Health Organization grade II tumor. We conducted the present study to characterize clinical features of intracranial CCM and investigate the prognostic factors associated with surgical recurrence-free survival of the patients. ⋯ The results suggest that intracranial CCM has its own unique clinical features compared with the other 2 types of grade II meningiomas. Patients with subtotally resected tumors, males, or those who did not receive postoperative radiotherapy are at greater risk of recurrence. GTR should be the primary goal in the surgical management of intracranial CCMs. Our data also highlight the value of radiotherapy in intracranial CCM patients.
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A 29-year-old patient experienced a violent headache during bodybuilding exercises. Brain magnetic resonance imaging revealed diffuse meningitis and a 38-mm necrotic pituitary adenoma. Meningoencephalitis was suspected but was ruled out by lumbar puncture. Rapid deterioration of the patient's condition led to coma and oxygen desaturation secondary to intracranial hypertension. Intense treatment for intracranial hypertension included profound sedation with respiratory assistance, osmotherapy, hypothermia, and external ventricular drainage. After 4 weeks in the intensive care unit, the patient fully recovered and was discharged with hormonal supplementation. ⋯ The few reported cases of pituitary apoplexy mimicking bacterial meningoencephalitis may have resulted from blood leakage or necrosis into the subarachnoid space.
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Comparative Study
Identification of a Long Non-Coding RNA-Associated Competing Endogenous RNA Network in Intracranial Aneurysm.
Intracranial aneurysm (IA) is a cerebrovascular disorder characterized by an abnormally bulged artery in the brain and subarachnoid hemorrhage caused by IA rupture with a high ratio of fatality and morbidity. However, the genetic cause of IA remains largely unknown. ⋯ By comparing IAs and their control arteries, we identified differentially expressed lncRNAs, miRNAs, and mRNAs and suggested ceRNA roles in the pathogenesis of IA. These findings may help to characterize the pathogenesis of IA and provide novel therapeutic targets in the future for patients with IA.
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Case Reports
Unique venous drainage of a sphenoid wing dural arteriovenous fistula with ocular symptoms.
Dural arteriovenous fistulas (DAVFs) presenting with ocular symptoms, such as exophthalmos and chemosis, are commonly situated in the cavernous sinus (CS). DAVFs at the sphenoid wing with a drainage route into the superior orbital vein (SOV) should be considered as one of the differential diagnoses of ocular symptoms. ⋯ After embolization, the ocular symptoms resolved, and the patient was discharged without neurologic deficit. Herein, we discuss the developmental mechanism of the unique drainage pattern, including the clinical symptoms and anatomic features of greater sphenoid wing DAVFs.