World Neurosurg
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Observational Study
Risk Factors for Mild Cognitive Impairment in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Endovascular Coiling.
To assess the potential early risk factors of mild cognitive impairment after aneurysmal subarachnoid hemorrhage. ⋯ The location of the aneurysm, delayed cerebral ischemia, and hydrocephalus were independently associated with the occurrence of mild cognitive impairment after aneurysmal subarachnoid hemorrhage and can contribute to improved identification of patients at high risk for mild cognitive impairment.
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Intraoperative aneurysm rupture (IOAR) is a common complication during intracranial aneurysm (IA) surgery. In light of the paradigm shift regarding IA selected for clipping in the post-International Subarachnoid Aneurysm Trial (ISAT) era, we aimed to evaluate the risk factors and effects of IOAR in an institutional series of clipped ruptured IA (RIA) and unruptured IA (UIA). ⋯ IOAR was independently predicted by the ruptured status, location, and size of IA and by initial severity of aneurysmal bleeding and pretreatment rebleeding. The influence of IOAR differed between RIA and UIA cases.
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To describe our experiences with microsurgical treatment of unruptured anterior choroidal artery (AchA) aneurysms, and to evaluate the incidence of and risk factors for procedure-related complications. ⋯ When microsurgical treatment of unruptured AchA aneurysms was performed, the procedure-related complication rate was 4.5%. Patients with AchA aneurysms with a smaller MiC angle and smaller DC angle may be at a higher risk of procedure-related complications when undergoing microsurgical treatment.
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Case Reports
Giant Pediatric Rhabdoid Meningioma Associated with a Germline BAP1 Pathogenic Variation: A Rare Clinical Case.
Rhabdoid meningiomas are rare World Health Organization grade 3 tumors that tend to follow an aggressive course, with an increased likelihood for local recurrence, remote metastasis, and cerebrospinal fluid dissemination. Genetic testing has found certain genes associated with reduced time to tumor recurrence. BAP1 (BRCA1-associated protein 1) is a tumor suppressor gene that is associated with multiple tumors, including rhabdoid meningiomas. ⋯ Rhabdoid meningiomas are unlikely to be found in children and have a high rate of local recurrence. Gross total resection has to be balanced with risk of postoperative deficit. Genetic testing of this rare entity should be performed to identify any hereditary germline mutations.
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Case Reports
Transblepharo-preseptal modified orbitozygomatic craniotomy for treatment of a ruptured aneurysm.
Various supraorbital approaches to the anterior cranial fossa using a transciliary or supraciliary incision have been described. An orbitotomy is a valuable addition to the standard supraorbital keyhole approach offering an extended angle of exposure with minimal frontal lobe retraction. The transpalpebral approach is common in oculoplastic surgery and offers excellent cosmetic outcomes using the natural crease of the superior eyelid. ⋯ Considering the location and morphology of the aneurysm, as well as the patient's eyelid anatomy, clip ligation via a transblepharo-preseptal modified orbitozygomatic craniotomy was recommended. Aneurysm clipping was uneventful, and postoperative imaging showed complete occlusion. The patient was discharged neurologically intact.