World Neurosurg
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Intraoperative microscopic fluorescence angiography using indocyanine green (ICG) provides visual information on real-time blood flow. However, this method cannot be applied for lesions that are not visible under microscopic imaging because excitation light does not reach the targeted vascular structures. Endoscope-integrated ICG video-angiography has recently been advocated to compensate for this limitation. This is the first reported case of a spinal arteriovenous malformation in which endoscope-integrated ICG video-angiography was successfully used. ⋯ A posterior approach with the assistance of an endoscope and endoscope-integrated ICG video-angiography is feasible for spinal vascular diseases located ventrally.
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A 5-month-old boy, the product of a normal, spontaneous, uncomplicated vaginal delivery, presented to a peripheral hospital with a 2-month history of recurrent fever, vomiting, seizures, and progressive lower limb weakness. He was discovered to have hydrocephalus secondary to a posterior fossa lesion. An external ventricular drain was inserted, and he was transferred to our hospital. ⋯ He tolerated the procedure well, and his weakness improved. The antibiotic course was completed, and the external ventricular drain was removed. Follow-up after 2 years showed a normal neurologic examination.
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This report describes the need for a tailored approach for intracranial vascular occlusive disease and introduces the usefulness of the OA as a donor artery for interposition graft. ⋯ When end-to-side anastomosis in single-branch bypass is not appropriate for cerebral revascularization, a tailored double-barrel "insurance bypass" with an OA interposed graft could be a good alternative treatment modality. In addition, an OA interposition graft is a useful option for double-barrel bypass surgery in such cases of intracranial vascular occlusive disease.
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Utility of the Lone Star® Retractor System in Microsurgical Carotid Endarterectomy: Technical Notes.
The retractor system is an important device in carotid endarterectomy (CEA). We applied the Lone Star (LS) Retractor System, which is a self-retaining retractor originally designed for improved visualization in many other surgical fields, in microsurgical CEA. ⋯ The application of the LS retractor system in microsurgical CEA is feasible. An additional merit is that it is single use.
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Temozolomide (TMZ) is now standard adjuvant therapy in combination with radiotherapy for patients with newly diagnosed malignant glioma. Treatment-related myelodysplastic syndrome and acute treatment-related leukemia (t-AML) associated with TMZ chemotherapy for patients with glioma is quite a rare complication. ⋯ In this case study, we continued adjuvant TMZ therapy beyond the recommended 6 cycles. Currently, there is no consensus as to how long the adjuvant TMZ therapy should be continued for the treatment of residual tumor showing no apparent interval change. A new decision-making tool to assess the clinical benefits against the side effects for long-term adjuvant TMZ therapy is needed.