World Neurosurg
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Case Reports
The Art of Mimicry: Anterior Clinoid Dural-Based Cavernous Hemangioma Mistaken for a Meningioma.
Cavernous hemangiomas account for 5%-13% of central nervous system vascular lesions. They are usually found intra-axially but rarely involve extra-axial structures, most commonly the middle cranial fossa. A cavernous hemangioma manifesting as a clinoid meningioma is extremely rare. ⋯ Anterior clinoid dural-based cavernous hemangiomas are extremely rare. Although preoperative diagnosis is difficult using imaging, this etiology should be considered for any dural-based middle fossa lesion, owing to the tendency for these lesions to bleed heavily during resection in some instances.
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Radiologic differentiation between a low-grade and high-grade lesion is crucial when deciding extent of resection and prognostication. Occasionally, imaging features can be confusing between the 2 lesions. We report a case that presented such a radiologic dilemma. The lesion appeared benign and extra-axial on routine magnetic resonance imaging sequences. However, subtle clinical and imaging clues pointed to a high-grade lesion. ⋯ Apart from reporting a rare variant of glioblastoma in an unusual location, this case highlights atypical imaging in a glioblastoma. Brainstem edema may be a subtle indicator of the infiltrative nature of a tumor. Magnetic resonance spectroscopy may be a useful adjunct in such circumstances.
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The effect of patient age on the likelihood of recurrence of ruptured aneurysms after endovascular coil embolization is not well understood. Our aim was to compare the incidence of aneurysmal recurrence after coiling between young and old patients. ⋯ Our results suggest that elderly age may confer a reduced risk of aneurysmal recurrence after endovascular coiling, providing further evidence that coiling should be considered a first-line therapy in elderly patients with a ruptured aneurysm.
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Randomized Controlled Trial Comparative Study
Posterior cervical transfacet fusion with facetal spacer for the treatment of single-level cervical radiculopathy: a randomized controlled prospective study.
Single-level cervical radiculopathy may be treated conservatively with cervical tractions. Posterior cervical transfacet fusion with a facetal spacer is a viable option. The aim of the present study is to compare posterior cervical transfacet fusion with conservative physical treatment in single-level cervical radiculopathy. ⋯ posterior cervical transfacet fusion is a safe and effective procedure to treat single-level cervical radiculopathy.
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Unruptured intracranial aneurysms (UIAs) have become an issue of greater significance as their detection rates have increased over the years. We present the overall experience of microsurgical clipping of unruptured aneurysms by a single surgeon over a period of more than 16 years. ⋯ Surgical clipping is effective and can provide a good long-term outcome. The most commendable consequence that it provides is a better long-term occlusion rate. The experience of the individual surgeon is important for a superior and enduring overall outcome. An increase in the rate of coiling in recent years has affected the outcome rate after surgery that calls for further evaluation.