World Neurosurg
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Recent reports have described that endovascular treatment of coil embolization of opththalmic artery (OphA) aneurysms has a relative risk of visual disruption caused by thromboembolic infarction of the central retinal artery (CRA), especially the OphA when it originates within the body of the aneurysm. Patent microthrombus in the OphA might also cause retinal infarction that affects visual acuity. We describe stent-assisted coil embolization of an OphA aneurysm complicated with a severe visual disturbance, although normal flow was scrupulously maintained in the OphA during the procedure. The visual disturbance was recovered by early treatment. ⋯ Despite good anterograde flow in the OphA during aneurysm embolization, the procedural risk of a visual disturbance due to thromboembolic complications of CRA occlusion cannot be avoided. Anterograde flow in the OphA and retinochoroidal blush should be monitored by repeated angiography during coil embolization to prevent vision loss. Should vision be lost, a rapid response including ocular massage and intraarterial fibrinolysis is required for recovery.
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Acinetobacter baumannii meningitis and ventriculitis are difficult issues, because of the low diffusion of antibiotics in the cerebrospinal fluid and bacterial multidrug resistance. The presence of an infected intraventricular hematoma, constituting an equivalent of undrained abscess, may promote biofilm formation and failure of medical treatment. ⋯ This clinical case suggests the usefulness of intraventricular fibrinolysis to lyse the clot and optimize the action of antibiotics.
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The present study was conducted to evaluate the levels of Cdk2, cyclin E, p21, and p27 in growth hormone adenomas (GHPAs) and analyze their association with clinicopathologic features. ⋯ Overexpression of cyclin E/Cdk2 and loss of p27 appears to be associated with a poor prognosis and might play a role in the treatment of GHPAs in the future.
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The management of chronic complete internal carotid artery (ICA) occlusion (COICA) has been challenging. Endovascular procedures have been performed with variable success and risks, depending on the type of occlusion and distal revascularization. We present a novel hybrid procedure to recanalize the ICA when previous endovascular interventions have failed or been deemed too risky. ⋯ A hybrid technique is feasible and should be considered for patients with COICA in whom maximal medical management has failed and who have a high-risk profile for endovascular intervention or in whom previous endovascular attempts have failed.
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We explored the clinical effect of one-stage posterior debridement and bone grafting with internal fixation for the treatment of monosegmental thoracolumbar tuberculosis (TB). ⋯ One-stage posterior debridement and bone grafting with internal fixation might be a better choice for treating patients with monosegment thoracolumbar TB.