World Neurosurg
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Direct carotid-cavernous sinus fistulas (CCFs) are high-flow arteriovenous shunts that are typically the result of a severe head injury. The endovascular treatment of these lesions includes the use of detachable balloons, coils, liquid embolic agents, and covered stents. To minimize the chance of treatment failure and subsequent complications, endoluminal reconstruction using a flow-diverting stent may be added to the treatment construct. ⋯ We believe that endovascular coil or balloon occlusion of the fistula from either a transvenous or transarterial approach followed by flow diversion may be an appropriate treatment for direct CCFs. This addition of a flow diverter may facilitate endothelialization of the injury to the internal carotid artery.
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In endovascular embolization of intracranial aneurysms, a tortuous cervical internal carotid artery can limit guiding catheter access to a sufficiently high position. Although intermediate distal access catheters can go beyond the tortuous segment of internal carotid arteries, they may increase the risk of procedure-related complications, require significantly complex technical procedures, and limit the use of adjunctive techniques. Using simple neck extension alone, we successfully improved guiding catheter access in 2 patients. ⋯ The simple neck extension technique successfully improved accessibility of the guiding catheter. As the need for safe and highly skilled intervention increases, our technique may be useful because it can reduce procedure-related complications and allow balloon-assisted techniques.
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Neuronavigation has become a common means of placing pedicle screws in vertebral arthrodesis, because it reduces the incidence of complications related to poor screw positioning. ⋯ When coupled with fpCT, the ROSA Spine robot is a reliable, accurate means of performing lumbar pedicle screwing.
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Case Reports
Image-Guidance to Aid Pedicle Screw Fixation of a Lumbar Fracture-Dislocation Injury in a Toddler.
Pedicle screw fixation of the lumbar spine in children age <2 years is particularly challenging, as successful cannulation of the small pedicle dimensions requires a high level of precision and there are no implants specifically designed for the infant spine. Image-guided navigation is commonly used in adult spinal surgery and may be particularly helpful for the placement of spinal screws in areas where the bony anatomy is small and/or anatomically complex, as in the upper cervical area. ⋯ Image-guided placement of pedicle screws may be a useful aid in achieving accurate and safe fixation in the small dimensions of the infant spine.
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Meningiomas are the most common primary intracranial tumor, but the lack of prospective randomized trials has led to different guidelines for their treatment. We proposed a classification of meningiomas that considers surgical removal, histology, and cytogenetic profile, based on a literature review of these 3 criteria. The classification can be used to guide adjuvant treatment and follow-up. ⋯ The proposed meningioma classification was based on our experience and retrospective evidence collated from the literature and supported by recommendations. The application of the classification criteria yielded an algorithm for treatment and follow-up of patients with meningioma.