World Neurosurg
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Review Case Reports
Targeted stereotactic radiosurgery for AVM downgrading followed by microsurgical resection: a case report and review of the literature.
An unruptured brain arteriovenous malformation (bAVM) is a complex pathological entity with the potential to lead to disabling or fatal intracranial hemorrhage. The treatment approaches for these lesions have included microsurgical resection, endovascular embolization, stereotactic radiosurgery (SRS), and medical management or any combination of these modalities. However, the optimal treatment approach for unruptured bAVMs has not yet been determined. In the present case, we used SRS strategically to downgrade an AVM to allow for improved resectability. ⋯ We have proposed a protocol of using focused SRS to eliminate the portions of the AVM that confer an increased surgical risk. SRS, followed by microsurgical resection, could represent an optimal treatment strategy for high-grade AVMs with difficult surgical anatomy.
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In this video, we present the case of a 61-year-old female who was brought to the emergency department after she had partial complex seizures. Computed tomography and magnetic resonance imaging of the brain revealed a right temporal lobe mass, which was initially thought to be a tumor. The patient was therefore referred to us for further management. ⋯ A strategy was then devised, which consisted of cutting the dome of the aneurysm and clearing the distal two thirds of the clot ("tulip technique") and then completing thrombus resection under temporary occlusion. Once clot removal was completed, the aneurysm was clipped using the "shingle clip cut clip" technique (Video 1). The patient's postoperative course was uneventful, and the patient remained seizure free.
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Multicenter Study
Current training status of neurosurgical residents in South Korea: A Nationwide multicenter survey.
In South Korea, special legislation was introduced in December 2016 to limit residents' training time to a maximum of 80 hours per week. The aim of this study was to survey the current training system and environment of neurosurgical residents and to find ways to improve the quality of neurosurgical training. ⋯ The major reason that neurosurgical residents are dissatisfied with the current training system and environment is the excessive time spent on it. These survey results are expected to be used as the basis for improvement of the residents' training system and work environment in South Korea.
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Pure arterial malformations (PAMs) are rare intracranial vascular anomalies. As recently reported, PAMs have a benign natural history and can be treated conservatively. However, their etiology, natural history, and treatment have not yet been fully elucidated. ⋯ Whether the aneurysmal component of PAMs merits invasive treatment has remained controversial. The findings from our case raises the possibility of evolution for some patients with PAMs and stresses the importance of scheduled follow-up noninvasive imaging studies to rule out progression of these nosological entities, especially PAMs with an "aneurysm-like" component.
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To investigate the occurrence and progression of heterotopic ossification (HO) in patients treated by anterior cervical discectomy with arthroplasty. It was evaluated if HO affects clinical outcome and range of motion (ROM). Risk factors of HO was studied as well. ⋯ HO occurs in three fourths of the patients at 2 years after surgery, but does not necessarily correspond to clinical outcome, nor loss or preservation of ROM. The McAfee-Mehren classification should be combined with ROM evaluation to properly study HO.