World Neurosurg
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Pediatric hydrocephalus is a health burden for East African countries, with an estimated incidence of 6000 new cases per year. The objective of this study is to describe the epidemiology and surgical outcomes of patients treated for pediatric hydrocephalus in the single neurosurgical center of Zanzibar. ⋯ It seems that hydrocephalus in Zanzibar has similar causes, progression, and complication rates to previous reports from other African hospitals. Further studies of postinfectious hydrocephalus need to be conducted because recent findings suggest that it is a potentially preventable cause of the disease.
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Endoscopic surgery for lumbar stenosis is gaining acceptance because of the minimal muscle damage, short recovery times, reduced blood loss, and good clinical results. We report a novel technique of decompressing contralateral traversing and exiting nerve roots through a single interlaminar window, avoiding separate incision for foraminal decompression with minimal damage to facet joints and comparing morphometric changes after decompression. ⋯ Biportal endoscopic decompression of the lateral recess and cranial foramen through a single interlaminar window can be performed using a contralateral approach. In view of the good clinical and radiologic outcomes of patients, with notable improvements in morphometric measurements at stenosed segments, this surgical technique is worthy of further evaluation and application.
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Vascular pineal malformations are rare and technically demanding lesions. Because the locations of these lesions, endovascular techniques and radiosurgery have been increasingly used in the recent decades to accomplish safe occlusion. Nevertheless, microsurgical treatment may be required sometimes. ⋯ The pineal region is an infrequent but challenging location for vascular lesions. A careful and stepwise operative strategy for the different types of vascular lesion is paramount to accomplish an effective and safe microsurgical treatment when other alternatives fail or are not available.
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Case Reports
Unusual Clinical Sequelae of Kawasaki Disease-Symptomatic Extracranial Internal Carotid Stenosis in Young Adult.
Kawasaki disease (KD) is an acute systemic vasculitis that primarily affects the coronary artery, but it does not commonly affect the carotid artery. Cerebral infarction (CI) with internal carotid artery stenosis (ICS) in patients with KD has not been reported until now. We report a patient with CI as a remote-phase complication of KD. ⋯ KD in childhood may cause symptomatic ICS as a sequela of a remote phase.
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Case Reports
Craniotomy for a Large and Aggressive De Novo Cavernous Malformation Resection in the Basal Ganglia Region.
Cerebral cavernous malformations (CCMs) are present in up to 0.5% of the general population. Although CCMs have been considered congenital lesions, numerous reports have observed de novo formations in patients with the familial form of CCM and in patients after cranial radiotherapy. Outside of these circumstances, there is scant evidence as to the potential etiologies of CCM. ⋯ Given the patient's medical history and imaging findings, we propose that de novo CCMs can arise directly from angiogenic proliferation, secondary to BCL-2 overexpression from underlying causes. We hypothesize that inappropriate secretion of estrogen could have set off a genetic cascade with attendant endothelial proliferation. Thus, female hormones may play an important role in influencing the biological behavior of CCMs. The relationship between estrogen and CCM needs further investigation.