World Neurosurg
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Review Case Reports
Endovascular Management of a Ruptured Basilar Perforator Artery Aneurysm Associated with a Pontine Arteriovenous Malformation: Case Report and Review of the Literature.
Arteriovenous malformation (AVM)-associated aneurysms are common, reported in 15% of cases. Regarding the ruptured posterior fossa AVMs, associated aneurysms are present in 48% of cases and are the cause of the bleed in 37%. We present a 75-year-old female who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm arising from a flow-related basilar perforator artery feeder of an anterior pontine AVM. We report the successful treatment of the aneurysm with coil embolization. ⋯ Basilar trunk perforator aneurysms are rare lesions, particularly in the setting of brainstem AVMs. We report successful endovascular treatment of a flow-related ruptured basilar perforator aneurysm associated with an anterior pontine AVM. To the best of our knowledge, this is the second report addressing this scenario. We hope that the information presented here serves to guide future surgical decision making and management.
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Review Historical Article
Review of Treatment of Gunshot Wounds to Head in Late 19th Century.
During the late 19th century, the seeds of modern neurosurgery were planted to bloom into what it is now known. Wars such as the American Civil War and Crimean War drove the need to find better ways of preventing mortality from gunshot wounds to the head. However, the mortality rate from all major surgical procedures to the head, neck, and face remained staggering. Herein, we describe the surgical treatments for head and neck injuries in order to improve our understanding of neurosurgical procedures performed during the late 19th century. ⋯ Because of improved understanding of infectious processes and technologic advances in surgical equipment, the late 19th century was a major milestone in creating modern day neurosurgery. The methodology behind today's treatments is no different from that of the late 19th century.
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Case Reports
Disconnection Surgery for Intractable Epilepsy with a Structural Abnormality in the Medial Posterior Cortex.
The lesionectomy is a general surgical procedure for treating focal epilepsy resulting from a structural abnormality, but a favorable outcome cannot be achieved in some patients, especially patients whose symptomatogenic zone is located in remote regions. Herein we propose the surgical disconnection of the seizure propagation pathway, which consists of short and long associating fibers linking the epileptogenic zone to the remote symptomatogenic zone, as an effective method of achieving favorable seizure outcomes in patients with posterior cortex epilepsy. ⋯ The current study suggested that assuming the presence of association fibers was an important factor for achieving a favorable outcome in the surgical treatment of posterior cortex epilepsy. Though further study is required, disconnection surgery is recommended as a treatment option for cases in which the epileptogenic zone is located in an eloquent area.
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Glioblastoma is the most common primary malignant brain tumor, with more than10,000 new cases each year in the United States. Significant basic science and clinical research has been devoted to understanding this disease, yet median survival with standard of care treatment remains approximately 15 months. ⋯ These advances have generated both prognostic information as well as a multitude of treatment targets that are just now coming into clinical practice. This article aims to provide a comprehensive update on the recent use of genetic profiling to identify the molecular pathways altered in glioblastoma and to describe ongoing clinical trials to exploit these pathways for treatment.
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Retention of nonabsorbable hemostatic materials (RNHMs), that is, retained surgical sponge, gauzoma, gossypiboma, muslinoma, or textiloma, is a rarely seen surgical complication after spinal surgery that may remain asymptomatic for many years and may represent a diagnostic difficulty with associated medicolegal implications. ⋯ RNHMs is an overreported entity in underdeveloped or developing countries, including Turkey and Morocco, with progression occurring over years. RNHMs should be considered in the differential diagnosis of any patient who presents with back pain, spinal cord, or nerve roots symptomatology after spinal surgery.