World Neurosurg
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Review Case Reports
Unilateral Symptomatic Hypertrophic Olivary Degeneration Secondary to Midline Brainstem Cavernous Angioma: A Case Report and Review of the Literature.
Hypertrophic olivary degeneration (HOD) is a rare phenomenon in the dento-rubro-olivary pathway caused by lesion or disruption of the fibers of the Guillain-Mollaret triangle. Hemorrhage of pontine and midbrain cavernous angiomas can rarely lead to HOD portending neurologic deterioration and possible concomitant life-threatening complications; for this reason, it may define a poignant consideration in planning intervention. ⋯ The literature regarding imaging recommendations for stable cavernous angioma in the midbrain-pontine junction is reviewed. The implication of HOD for patient outcome is discussed and a comment is made on how the development of HOD may affect management of the cavernous angioma.
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Multicenter Study Comparative Study
Unruptured versus Ruptured AVMs: Outcome analysis from a multicentric consecutive series of 545 surgically treated cases.
Recent literature strongly challenged indications to perform preventive surgery in unruptured arteriovenous malformation (AVM) claiming that invasive AVM treatment is associated with a significant risk of complications and thus conservative management may be a preferable alternative in many patients. On the other hand, the recent improvement of surgical instrumentation and treatment strategies (both surgical and interventional) yielded better outcomes than those achieved only a decade ago. Therefore, even among specialists, a wide variety of opinions, concerning the treatment of unruptured AVM, can be found. ⋯ In unruptured low-risk AVMs (Spetzler-Martin grades 1-3), over time, the risk of surgery-associated neurologic deficits becomes lower than that linked to spontaneous hemorrhage, with a crossover point at 6.5 years. Because the average bleeding age is less than 45 years, preventive surgery can be advocated to safeguard the patient and overcome the risks associated with the natural history of AVMs.
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Multicenter Study Comparative Study
Is there an indication of intraoperative MRI in subtotal resection of glioblastoma? - A multicenter retrospective comparative analysis.
Surgery in patients with highly eloquent glioblastoma (GB) remains challenging. The aim of this study was to evaluate influence of use of intraoperative magnetic resonance imaging (iMRI) on extent of resection (EOR), clinical outcome, and survival in patients with preoperatively intended subtotal resection of GB. ⋯ Maximum safe resection is an important prognostic factor for patients with eloquent GBs. iMRI seems to be a relevant tool to achieve this goal.
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Total removal of craniopharyngiomas is burdened by high morbidity. In cases of a cystic or mixed craniopharyngioma, when the symptoms are caused by the cystic component of the tumor, a less invasive surgical approach aiming at cyst drainage may be recommended. Here, we report our experience with intraventricular neuroendoscopy, describe our clear-cut surgical technique, and analyze results in the context of literature data. ⋯ We describe a neuroendoscopic treatment of cystic craniopharyngiomas that, without adjuvant radiotherapy, is safe and effective and ensures long-term recurrence-free survival.
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Review Case Reports
Small cell glioblastoma of the sella turcica region: a case report and review of the literature.
Glioblastomas in the sellar region are very rare; in most cases, the tumor originates from the optic nerve or optic chiasm. Only 4 cases of sellar glioblastoma with a nonoptic origin have been reported. We present such a case with detailed clinical, imaging, and histopathologic information. We also review similar published cases. ⋯ This is the first report of a small cell glioblastoma in the sella turcica region. Glioblastomas in the sellar region with no clear evidence of an optic origin should be viewed as an independent disease entity. The typical characteristics of this tumor indicate it should be considered a rare subtype of glioblastoma. Further accumulation of experience is needed to better differentiate these cases and to offer optimal treatment.