World Neurosurg
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Case Reports
Recrudescence of symptoms of remote ischemic stroke after a cerebral angiogram: Report of a case.
Ischemic stroke recrudescence, or reappearance of previously resolved symptoms of ischemic stroke, may occur after physiologic stress. Although generally thought to be uncommon, this syndrome may account for a significant proportion of stroke mimics. ⋯ Recrudescence of symptoms of a previous stroke may be initiated by subarachnoid hemorrhage and/or a cerebral angiogram. The possibility of ischemic stroke recrudescence should be kept in mind as a possible stroke mimic.
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The rupture rate of unruptured intracranial aneurysms is influenced by certain angioarchitectural and hemodynamic characteristics. Recently the translucent appearance of aneurysms was described as a possible risk factor for aneurysm rupture. In this study, we investigate the intraoperative rupture risk of surgically clipped unruptured translucent aneurysms (TAs). ⋯ The results demonstrate that a lower SR correlates with TA in the MCA bifurcation and the thinner wall of the TA causes intraoperative rupture more likely. These results provide important information on the fragility of TAs and might influence the treatment decisions in unruptured MCA bifurcation aneurysms with lower SRs.
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Optimal surgical management for flexion-distraction cervical spine injuries remains controversial with current guidelines recommending anterior, posterior, and circumferential approaches. Here, we determined the incidence of and examined risk factors for clinical and radiographic failure in patients with 1-segment cervical distraction injuries having undergone anterior surgical fixation. ⋯ This study contributes to the growing body of evidence supporting anterior fixation alone for flexion-distraction injuries. Findings suggest that current measurements of radiographic failure including segmental translation and kyphosis may predict radiographic failure and need for further surgical stabilization in some patients. Future follow-up studies assessing for independent risk factors for anterior approach failure with a validated predictive scoring model should be considered.
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It is sometimes difficult to make a differential diagnosis between brain metastases and hemangioblastomas in the posterior fossa. We assessed whether high b value diffusion-weighted image (DWI) at b = 4000 could differentiate these tumors. ⋯ High b value DWI reflects diffusion more accurately than does regular b value. Our results showed that ADC calculation by high b value (b = 4000) DWI at 3-T magnetic resonance imaging is clinically useful for differentiating hemangioblastomas from brain metastases.
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Watertight reconstruction to separate the intradural compartment from the sinonasal cavities is crucial after endoscopic resection with transnasal craniectomy for nasoethmoidal tumors. A 3-layer reconstruction with the iliotibial tract is a safe and reliable alternative when vascularized flaps are unavailable. ⋯ Use of fibrin glue and intradural irrigation may help the surgeon to stabilize the layers during reconstruction. Three-layer reconstruction with the iliotibial tract is a feasible, highly reproducible, safe, and always available option for reconstruction of anterior skull base defects after endoscopic resection with transnasal craniectomy for nasoethmoidal tumors.