World Neurosurg
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Review Historical Article
Syrinx in Spinal Cord in Mummified Individual from West Thebes (Egypt).
We analyzed a total of 36 partial or complete mummies containing neural structures from Sharuna and Qarara (Middle Egypt) and Dra Abu-el Naga, West Thebes (Upper Egypt). Individual TT16 13.3-B06-Ind07 corresponded to a partial mummy from T2 to T11. At distal levels, it showed a structure compatible with the lower spinal cord (SC). ⋯ Field radiograph confirmed a structure compatible with the SC with a syrinx that shows a maximum diameter of 3.2 mm measured by digital caliper. Bearing in mind the normal shrinking mechanism at work in mummification, a pathologic condition such as syringomyelia during the individual's life is a distinct possibility. After a thorough review of the literature, this would be the earliest report of syringomyelia.
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Review Case Reports
Bow Hunter's syndrome: surgical vertebral artery decompression guided by dynamic intraoperative angiography.
Bow hunter's syndrome is a symptomatic vertebrobasilar insufficiency resulting from a rotational stenosis or occlusion of a dominant vertebral artery (VA). The VA is dynamically compressed by cervical osteoarthritis (discovertebral structure or osteophytes) during head rotation or neck extension. Diagnosis is based on dynamic computed tomography angiography and confirmed with dynamic catheter angiography. Surgery tends to be the best treatment option in most cases. Dynamic intraoperative assessment of VA decompression seems to improve surgical results but remains poorly evaluated in the literature. ⋯ Surgical decompression guided by dynamic intraoperative catheter angiography leads to selective VA release and allows real-time assessment of the efficacy of the decompression. This multidisciplinary treatment involving neurosurgical and neuroradiologic teams is a simple and effective treatment. Dynamic intraoperative catheter angiography is an essential guide to perform selective decompression of the VA, and implementation of an intra-arterial remodeling balloon can improve the safety of surgery making this method valuable compared with other intraoperative assessment techniques, such as Doppler ultrasound and indocyanine green fluorescent videography.
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Multicenter Study
Long-Term Outcomes After Carotid Endarterectomy: The Experience of an Average-Volume Surgeon.
Long-term outcome data for patients undergoing carotid endarterectomy (CEA) are lacking. As most of the published literature on CEA outcomes has been from high-volume providers, we wanted to investigate the outcomes of an average-volume cerebrovascular neurosurgeon. ⋯ In the hands of an average-volume cerebrovascular neurosurgeon, CEA can provide durable protection from recurrent stroke in the ipsilateral carotid distribution that extends beyond 15 years. Thus, this procedure should be considered the gold standard against which other revascularization modalities should be evaluated.
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Review Case Reports
Brainstem Congestion due to Dural Arteriovenous Fistula at the Craniocervical Junction: case report and review of the literature1.
Dural arteriovenous fistulas (DAVFs) at the craniocervical junction are rare. Clinical manifestations range from acute or chronic myelopathy to subarachnoid hemorrhage to brainstem dysfunction. We encountered 4 cases of DAVFs at the craniocervical junction with progressive brainstem dysfunction and investigated the typical magnetic resonance imaging (MRI) features using T2-weighting imaging, susceptibility-weighted imaging, diffusion-weighted imaging, and contrast-enhanced imaging. Literature review revealed 10 case reports of DAVFs at the craniocervical junction manifesting with brainstem dysfunction. ⋯ Susceptibility-weighted imaging, diffusion-weighted imaging, or contrast-enhanced scanning should be used during MRI examination of patients with progressive brainstem dysfunction to differentiate DAVFs at the craniocervical junction from other diseases, such as glioma or infection. Prompt diagnosis using MRI is of great significance in producing good functional outcomes of the patients.
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Review
The Introduction of Innovations in Neurovascular Care: Patient Selection and Randomized Allocation.
Most neurovascular innovations have been introduced by using case series followed by observational studies. A better approach would be a pragmatic randomized trial. Two important aspects of trial design, patient selection and randomized allocation, remain poorly understood. We discuss the role trial methodology can play in the protection of patients being offered innovative treatments.