World Neurosurg
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The A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) trial has received fierce criticism, including considerable selection bias, poor generalizability, questionable clinical practices (only 15.8% underwent surgical resection, the gold standard for arteriovenous malformation [AVM] treatment), and short follow-up (33 months) for a disease process that carries a life-long risk. In this study, we sought to present our own experience treating unruptured brain AVMs to provide supporting evidence of the ARUBA trial criticism. ⋯ The criticism of the ARUBA trial is warranted, as our study found that treatment of unruptured brain AVMs has an acceptable safety profile when approached in a multidisciplinary manner at an experienced institution, using surgical resection as the primary treatment modality when applicable.
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Posterior percutaneous endoscopic cervical foraminotomy and diskectomy has remarkably evolved with successful results. Although percutaneous endoscopic cervical diskectomy (PECD) has gained popularity, the risk of surgical failure may be a major obstacle to performing PECD. We analyzed unsuccessful cases requiring reoperation. The objective of this article was to find common causes of surgical failure and elucidate the limitations of the conventional PECD technique. ⋯ Surgeons should be aware of the specific complications for the PECD approach.
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A duplicated middle cerebral artery (dMCA) is a rare anatomical variant that can be associated with aneurysm formation and rupture. The dMCA arises from the terminal portion of the internal carotid artery, with the caudal trunk supplying the temporal lobe and the cranial trunk supplying the frontal lobe and the lenticulostriate perforators. Previous reported cases were all treated with open surgical clipping with or without cerebral revascularization to reconstruct the dMCA. ⋯ We have demonstrated the unique anatomical relationship among the dMCA, internal carotid artery, and the anterior choroidal artery. Understanding and preserving the dMCA anatomy is essential in such cases to prevent ischemic complications. This was achieved endovascularly by balloon remodeling and coil embolization of the aneurysm in this location.
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Glioblastoma multiforme (GBM) is usually characterized by diffuse, infiltrative growth and local tumor progression. Extensive leptomeningeal metastases are rarely observed. It is unclear which GBMs are prone to this specific growth pattern and progression, and standardized salvage treatment protocols are unavailable. ⋯ High-risk genetic profiles for GBMs prone to develop extensive leptomeningeal metastases need to be identified. Guidelines on preemptive, complete neuraxis imaging in certain patients with GBM as well as treatment guidelines need to be developed.
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Intracranial aneurysm (IA) is the leading cause of subarachnoid hemorrhage. The pathomechanisms of IA are poorly understood but can be related to arterial tortuosity resulting from underlying systemic factors leading to arterial wall weakening. We aimed to analyze the tortuosity of the intracranial artery in a cohort with IA, hypothesizing that the tortuosity of intracranial arteries differs depending on the characteristics of the IA. ⋯ The BA tortuosity was higher in patients with large IAs, which may represent an imaging biomarker of aneurysm growth.