World Neurosurg
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Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of ventriculitis. ⋯ The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay.
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Intraoperative resection or occlusion control is indispensable in the surgery of vascular anomalies. This can be conducted using local vascular imaging modalities or angiographic techniques. This series was performed to assess whether cerebral arteriovenous malformations (AVMs) and dural arteriovenous fistulae (dAVFs) can be detected in a sufficient quality by intraoperative 3-dimensional (3D) fluoroscopy with intravenous contrast application. ⋯ This technique quickly supplies intraoperative images of adequate quality to locate cerebral AVM and dAVF. However, it does not produce dynamic images. Thus, early draining veins cannot be located unless anatomically identified based on the preoperative DSA. In this case, it can be used for intraoperative obliteration control.
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Observational Study
Cognitive Impairments After Clipping of Ruptured Anterior Circulation Aneurysms.
The cognitive impairments after treatment of ruptured aneurysms have often been underestimated. This study sought to assess their prevalence and analyze various associated factors. ⋯ Cognitive impairments are frequent after treatment of ruptured anterior circulation aneurysms. Impairments in recent memory, remote memory, and phonemic fluency are significantly greater after treatment of ACA-related aneurysms, compared with others, independent of other factors.
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Intracranial aneurysms (IAs) are rare in the pediatric population and are usually considered difficult to treat with traditional microsurgery owing to their complex morphology. Endovascular techniques have become the standard option for treating IAs in adults. More recently, flow diverters, such as the Pipeline embolization device (PED), are being widely adopted for unruptured IAs, with proven safety and efficacy in adults; however, their use in the pediatric population is not well defined. Here we report a pediatric patient with a ruptured posterior cerebral artery (PCA) aneurysm successfully treated with a PED, and provide a review of the literature on the current status of PED use in this subset of patients. ⋯ Even though the PED has not received Food and Drug Administration approval to treat IAs in children, the literature reports favorable outcomes with this application. Thus, the PED may be a feasible option for treating challenging cases occurring more frequently in the pediatric population. Further studies in pediatric populations are needed to determine whether this technology is a viable and durable option for treating aneurysms in children.
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Case Reports
Cerebellopontine Angle Anaplastic Ganglioglioma Masquerading as Vestibular Schwannoma: Unusual Entity.
Anaplastic gangliogliomas at the cerebellopontine angle (CPA) are exceptionally rare with only a few reported cases in published literature. These are composed of atypical ganglion cells and astrocytes accounting for nearly 1% of all central nervous system tumors. The authors report the case of anaplastic ganglioglioma in an adult patient presenting as a CPA mass lesion. The presentation was bizarre, and the diagnosis was possible only after histopathologic examination of the resected mass. ⋯ This unusual appearance of anaplastic ganglioglioma has not been previously described. Neurosurgeons need to keep in mind the possibility of anaplastic gangliogliomas in the differential diagnosis of CPA lesions.