World Neurosurg
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Review Case Reports
Balloon Angioplasty for in-stent restenosis resulting in carotid stent fracture with literature review of stent-in-stent technique as a viable therapeutic option.
Carotid stent fractures are rare, and multiple etiologies have been proposed to explain their occurrence. We describe a patient with an internal carotid artery (ICA) stent who developed in-stent restenosis. We performed balloon angioplasty to address in-stent restenosis, but he developed a carotid stent fracture after the procedure. To our knowledge, balloon angioplasty has not been reported to cause stent fractures. ⋯ Balloon angioplasty to address in-stent restenosis can secondarily cause stent fractures. We provide evidence of successful management of stent fracture with recurrent in-stent stenosis by repeat stent placement via a stent-in-stent technique.
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For many years, the microsurgical transoral approach has been accepted as the gold standard for anterior decompressions of the craniovertebral junction (CVJ). The introduction of the endoscopic endonasal approach (EEA) has gained wide recognition and overwhelming support in recent years, including for diseases of the CVJ. The aim of this study was to critically analyze and discuss all cases of CVJ diseases approached by means of an EEA so far reported in the literature, including our institutional experience consisting of 6 consecutive patients. ⋯ On the basis of the reviewed literature and our personal experience, the reported increased safety of the EEA needs to be reassessed and discussed.
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In the setting of trauma, the cause of intracranial hemorrhage (ICH) is frequently attributed to the physical, traumatic event. Caution should still be directed toward nontraumatic (or spontaneous) causes responsible for the trauma, such as hypertension, cerebral amyloid angiopathy, aneurysms, vascular malformation, and hemorrhagic infarcts. The role for immediate computed tomography angiography remains controversial to evaluate for nontraumatic causes. ⋯ ICH in patients with traumatic brain injury seems to be vastly associated with the traumatic event. Only rare cases have been attributed to aneurysmal rupture. None has been associated with arteriovenous malformation. Nevertheless, clinical vigilance remains reasonable, especially in younger patients and those with hemorrhage within the subarachnoid cisterns or sylvian fissure.
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Several studies have looked for an association between radiologic findings and neurologic outcome after cervical trauma. In the current literature, there is a paucity of evidence proving the prognostic role of soft tissue damage or bony integrity. Our objective is to determine radiologic findings related to neurologic prognosis in patients after incomplete acute traumatic cervical spinal cord injury, regardless of initial neurologic examination results. ⋯ Early MRI has an intrinsic prognostic value. Ligamentous injury and larger edema are strong predicting factors of a bad neurologic outcome at long-term follow-up.
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Review Case Reports
Case Report of a Primary Pituitary Abscess and Systematic Literature Review of Pituitary Abscess with a Focus on Patient Outcomes.
Pituitary abscess is a rare but potentially life-threatening condition with an incidence of 0.2%-1.1% of operative pituitary lesions. Diagnosis can be challenging, because this disorder shares many similarities with other pituitary lesions in terms of signs and symptoms and radiographic findings. Most pituitary abscesses are categorized as secondary, arising from preexisting pituitary lesions or in conjunction with transsphenoidal surgery, sepsis, meningitis, or sinusitis. There have been only a few reports of primary pituitary abscess, which occurs without any of the aforementioned risk factors. ⋯ A PubMed search was performed; all cases of pituitary abscess reported in the literature were screened, and 200 cases including our case were analyzed with a focus on outcomes. The most common presentations were headache, visual disturbance, and endocrine abnormalities. Approximately 66.1% of patients achieved partial or complete recovery of pituitary function; 75.7% with vision deficits recovered visual function. Treatment via a craniotomy had a recurrence rate of 17.2% compared with 9.7% via a transsphenoidal approach. To our knowledge, this is the first systematic review on the topic and the largest series reported.