World Neurosurg
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Presentation of clinical cases involving successful anterior stabilization of the C1-C2 segment in patients with invaginated C2 odontoid process and Chiari malformation type I. ⋯ Anterior decompression followed by anterior stabilization of the C1-C2 segment is a novel and promising approach to treating Chiari malformation type I in association with C2 odontoid process invagination.
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Chronic subdural hematoma (cSDH) is a common neurosurgical ailment, particularly in elderly patients. A recent study uncovered an association between liver disease and recurrence in patients with cSDH. Here, we explored that relationship to identify recurrence predictors in at-risk patients. ⋯ Liver disease is significantly associated with the recurrence of cSDH. Although coagulopathy alone does not predict recurrence, patients with coagulopathy and liver disease are at greater risk for recurrence than those with coagulopathy alone. Liver disease effects are reflected in certain hematologic laboratory values.
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Case Reports
Ultrasound-assisted neuronavigation-guided removal of a live worm in cerebral sparganosis.
Cerebral sparganosis is a rare zoonotic infestation that often mimics glioma and metastatic tumors. ⋯ Ultrasonography was helpful in the intraoperative localization of the worm and is recommended when intraoperative magnetic resonance is not readily available.
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Rapid growth in cerebral cavernous malformation is rare. A review of the literature revealed 4 patients with known cerebral cavernous malformations who later developed a high-grade glioma at the same site. All 4 patients were females, ranging in age from 25 to 71 years, with imaging confirming rapid growth in the lesion. ⋯ We conclude that, although rare, rapid expansion of an existing cavernoma should be considered suspicious for the development of other malignant tumors, and propose adding chronic inflammation in the surrounding brain caused by microbleeds and hemosiderin deposition from the cavernoma to the list of possible causes.
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Flow diversion has become a popular treatment option for a variety of cerebral aneurysms. We sought to compare conscious sedation and general anesthesia for flow diverter placement in a matched cohort study. ⋯ Placement of a flow diverter can be safely performed under conscious sedation and is associated with reduced procedure length. The ideal candidate is cooperative, requires an intervention that is not too complex, and has an experienced operator performing the intervention.