World Neurosurg
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Multicenter Study
The Use of Flow Diverter in Ruptured, Dissecting Intracranial Aneurysms of the Posterior Circulation.
Acute dissecting aneurysms of the posterior circulation are a rare cause of subarachnoid hemorrhage. Established endovascular treatment options include parent artery occlusion and stent-assisted coiling, but appear to be associated with an increased risk of ischemic stroke. Vessel reconstruction with flow diverters is an alternative treatment option; however, its safety and efficacy in the acute stage remains unclear. ⋯ Flow diverters might be a feasible, alternative treatment option for acutely ruptured dissecting posterior circulation aneurysms and may effectively prevent rebleeding. Larger cohort studies are required to validate these results.
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Patients with bitemporal lobe epilepsy are generally not considered for surgical resection. Fortunately, responsive neurostimulation provides another avenue for the management of this challenging disease process. In conjunction with our epileptologist, we consider responsive neurostimulation for patients who have clinical features of temporal lobe epilepsy without clear localization on imaging and stereoelectroencephalography. ⋯ Robotically implanted responsive neurostimulation is a safe and effective treatment for bitemporal epilepsy and can possibly lead to valuable diagnostic information to guide future surgical management in patients who previously were not considered candidates for resective or ablative surgery.
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Herpes zoster ophthalmicus (HZO) is caused by reactivation of the herpes simplex virus in the trigeminal nerve. HZO-initiated cerebral vasculopathy is well characterized; however, there are no documented cases that report the efficacy of surgical revascularization for improving cerebral hemodynamics following progressive HZO-induced vasculopathy. We present a case in which quantitative anatomic and hemodynamic imaging were performed longitudinally before and after surgical revascularization in a patient with HZO and vasculopathic changes. ⋯ HZO can lead to progressive, symptomatic intracranial stenoses. This report suggests that surgical revascularization techniques can improve cerebral hemodynamics and symptomatology in patients with aggressive disease when medical management is unsuccessful; similar procedures could be considered in managing HZO patients with advanced or progressive vasculopathy.
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Case Reports
Rapid-Onset Thoracic Myelopathy due to an Epidural Sarcoid-Like Lesion in a Pediatric Patient.
Isolated intraspinal neurosarcoidosis is a rare clinical entity, with most reports describing intramedullary involvement in adults. ⋯ Although less likely than neoplasia, rheumatologic processes such as inflammatory granulomatous disease warrant consideration in similar cases.
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Several strategies have been proposed for developing and spreading surgical specialties in Sub-Saharan East Africa. Regarding neurosurgery, improvements are coming from the cooperation between Western and African institutes by means of the World Federation of Neurological Surgeons and independent organizations but, far from big cities and more equipped hospitals, shortcomings in the delivery of services persist. ⋯ The model proposed should be considered a preliminary and immersive survey to evaluate the eligibility of a decentralized East African hospital to interface with neurosurgical activities, through the support of experienced local institutes and Western organizations. Host hospitals would also have the chance to enhance clinical services currently lacking and to train its personnel at low cost. The program may represent a rewarding personal and professional opportunity for young trained neurosurgeons, which also addresses the contemporary shortage of local specialists.