World Neurosurg
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Comparative Study
The Need For Grass Root Innovation In Developing Countries: A Case For Stationary Binder Clips In Scalp Hemostasis.
The primary training in any surgical practice starts with tissue handling and effective hemostasis. Neurosurgical procedures start with an incision in the scalp and require summative use of mechanical hemostats and bipolar coagulation to achieve hemostasis. Though Raney clips are the most popular and effective in maintaining hemostasis, their high cost and nonreusability become deterrents for routine use in resource-stricken environments. ⋯ Stationery binder clips are a cost-effective, ready-to-use alternative for standard Raney clips.
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Review Case Reports
Intracranial DAVF as a reversible cause of dementia: case series and literature review.
Intracranial dural arteriovenous fistulas (DAVFs) can manifest with a reversible form of dementia and parkinsonism that may be related to medullary venous hypertension and impaired cortical venous drainage. We report a consecutive case series of patients with DAVFs who presented with cognitive decline and report angioarchitecture and outcomes of treatment. ⋯ Cognitive decline is a rare but reversible manifestation of DAVFs that have impaired venous drainage of the transmedullary veins and associated medullary venous hypertension.
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Review Case Reports
Multiple Intracranial Aneurysms from Coccidioidal Meningitis: A Case Report Featuring Aneurysm Formation and Spontaneous Thrombosis with Literature Review.
Coccidioidal meningitis can progress to vasculitis with aneurysm formation. Although aneurysmogenesis is rare, it carries exceptionally high mortality. Except in one instance, prior case reports have documented universally fatal consequences. ⋯ Coccidioidal aneurysms carry a high mortality. The mainstay of therapy remains lifelong triazole antifungal therapy with the addition of liposomal amphotericin in cases of treatment failure. Steroid use is controversial but should be considered whenever there is vascular involvement. Although watchful waiting is reasonable in light of the possibility of spontaneous thrombosis with medical management, dynamic changes in aneurysm size or configuration should prompt timely endovascular or operative interventions.
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Review Case Reports
Management of Choroid plexus tumors in infants and young children up to 4 years of age: An institutional experience.
Choroid plexus tumors (CPTs) are rare tumors characterized by papillary and intraventricular growth. The young age of presentation of such tumors, especially in infants, and the lack of consensus on adjuvant therapy in case of atypical choroid plexus papilloma (aCPP) and choroid plexus carcinoma (CPC) create dilemma for the management of such tumors. We discuss the presentation, management, complications, and outcome in 15 patients (children 4 years of age and younger) and review pertinent literature. ⋯ CPTs are challenging tumors in infants and very young children because of the potential for massive blood loss. CPP is associated with lesser blood loss and favorable outcome compared with aCPP and CPC. Massive blood loss in CPC and aCPP can be life threatening as has been shown in our series. CPC has a rapid proliferation potential as shown in one of our cases. Attempts at decreasing vascularization of such tumors should be made by various methods, including preoperative embolization and neoadjuvant chemotherapy; however, a consensus on this is lacking.
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Review Case Reports
Recurrent secondary trigeminal neuralgia caused by an obliterated tentorial dural arteriovenous fistula cured with surgical resection: A case report and literature review.
Trigeminal neuralgia (TN) caused by a tentorial dural arteriovenous fistula (TDAVF) is quite rare. To date, only 10 cases and 2 small case series have been reported in this regard, and most were treated with either embolization or surgery. Here, we report a unique case of a TDAVF presented as TN, which was embolized with Onyx first and resected later. ⋯ Even complete obliteration of fistula could cause the recurrence of neuralgia, and resection of embolized dilated veins might be effective for the treatment of TN in such recurrent cases.