World Neurosurg
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One disadvantage of carotid artery stenting (CAS) is a high incidence of distal embolism (DE) during or after the procedure. Patients with unstable plaque are considered at high risk for DE and plaque protrusion (PP) after stent placement, which can cause postprocedural ischemic complications. This study was conducted to compare the rate and size of PP between the CASPER stent, a new-generation double-layer micromesh stent, and conventional stents as assessed by optical frequency domain imaging (OFDI), and also to evaluate the efficacy of CAS with the CASPER stent in cases with unstable plaque. ⋯ On OFDI evaluation after CAS, the degree of PP was significantly smaller in the CASPER stent group compared with the conventional stent group. This result provides new insight into the use of CAS to treat carotid artery stenosis with unstable plaque.
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Case Reports
"On the spot": the use of 4D-CTA to differentiate a true "spot sign" from a distal intracranial aneurysm.
Spontaneous intracerebral hemorrhage may arise from underlying abnormalities, including aneurysms. Computed tomography angiography (CTA) is widely used for the detection of possible underlying causes, which is important because it may have immediate therapeutic consequences. In addition, CTA is used to detect the so-called spot sign, indicating active hemorrhage, which carries a worse prognosis. However, CTA is a snapshot in time. Four-dimensional (4D) CTA is a dynamic type of imaging and has emerged as a valuable imaging technique for different neurovascular disorders. ⋯ Our case findings show how 4D-CTA can discern active bleeding from aneurysmal hemorrhage in cases with hemorrhagic stroke. This finding proves the additional value of this relatively new technique, because the detected underlying disorders have different therapeutic consequences in the acute setting.
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Ecchordosis physaliphora (EP) is a benign notochordal remnant that is usually asymptomatic. We report a case of a symptomatic large EP mimicking an epidermoid cyst. ⋯ EP in the prepontine cistern should be considered in the differential diagnosis of epidermoid cyst.
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Intracranial schwannomas most commonly arise from the vestibulocochlear nerve and less frequently from trigeminal, facial, and hypoglossal nerves. Intracranial schwannomas unrelated to cranial nerves are very rare; only approximately 50 cases have been reported in the literature. Tentorial schwannoma (TS) is even rarer, with only 13 cases reported to date. We present a rare case of giant TS. ⋯ TSs are extremely rare. Knowledge of radiologic and morphologic features can be helpful in making a preoperative diagnosis. The dural tail sign, which is considered a characteristic feature of meningioma, is commonly seen in TS as well, and thus TS should always be considered in the differential diagnosis of lesions arising from the tentorium.