World Neurosurg
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Cerebral lipiodol embolization is a rare but known complication of lymphatic embolization for plastic bronchitis. The classic imaging finding on a noncontrast head computed tomography is multiple small areas of hyperdensity within the cerebral hemispheres, which represent lipiodol deposition in the brain. We report a case of lipiodol deposition in the middle cerebral artery following lymphatic embolization, producing an "ultradense" vessel sign on noncontrast computed tomography.
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Adult pilocytic astrocytomas (PAs) are relatively rare central nervous system (CNS) tumors with a favorable prognosis. We sought to investigate existing clinical management strategies and overall survival (OS) as a function of various clinical characteristics in a cohort of adult patients with PA. ⋯ Our data provide large-scale prognostic information from a contemporary cohort of patients with PA, confirming that age, median income, Charlson/Deyo Score, and tumor size have significant effects on OS. Although resection status, tumor size, and location likely bias against EBRT, novel therapeutics are clearly needed in patients with tumors not amenable to resection or radiosurgery.
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Use of telemedicine for neurotrauma when performed by neurosurgeons is an innovative care option for traumatic brain injury patients, particularly in countries with limited neurosurgery expertise resources. In recent years, Albania has developed a robust telemedicine program and teleneurotrauma is the flagship of the program. We aimed to evaluate the outcomes of the first neurotrauma patients managed via telemedicine in Albania. ⋯ Telemedicine for neurotrauma, when structured appropriately and led by neurosurgeons, is a valuable service for the entire country, prevents unnecessary transfers to trauma center, and saves resources, particularly in low- and middle-income countries.
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Case Reports
Successful Use of Covered Stent for Carotid Artery Injury with Active Medial Projecting Extravasation.
Nontraumatic carotid artery injury with active extravasation, or carotid blowout syndrome (CBS), is relatively rare and highly difficult to treat because it is difficult to approach the lesions owing to anatomic factors. It also involves quick progression and a risk of cerebral embolization caused by thrombi and carotid artery occlusion. Recently, covered stents were revealed to be effective for CBS. However, they have several disadvantages, such as their costs, rebleeding complications, or cerebral embolic risks. A firm selection method of CBS types that are appropriate for covered-stent therapy is expected. ⋯ CBS cases having rupture points around the clavicle and having medial projection extravasation should be treated by covered stent placement under tentative hemostasis using manual finger pressure rather than conventional open surgical treatment.
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Adult tethered cord syndrome is a rare neurologic disorder that classically presents with back or leg pain, weakness, and urinary dysfunction. Spinal cord tethering has been associated with acquired Chiari malformations. Whereas the effects of tethered cord release on Chiari malformation symptoms have been described previously, we report an unusual case of acquired tethered cord syndrome following Chiari decompression. ⋯ Our patient exhibited an unusual acquisition of tethered cord syndrome. The tethering of the spinal cord may have been triggered by arachnoid adhesions from initial lumbar surgery 35 years before presentation and subsequently exacerbated by alterations of cerebrospinal fluid dynamics after Chiari decompression. Given the potentially devastating sequelae of tethered cord syndrome, investigation of cerebrospinal fluid flow dynamics may be beneficial before operative intervention in patients with risk factors for a tethered cord who exhibit adult-onset Chiari malformation.