World Neurosurg
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The occurrence of isolated fourth ventricle and injury to the Guillain-Mollaret triangle in the setting of posterior fossa ependymoma represents a new association. In this case report, we discuss the clinical, theoretical, and therapeutic aspects of this problem. We describe a lateral transcerebellar trajectory and shunt valve configuration for safe fourth ventricle shunting in a patient with prior posterior fossa surgery. ⋯ Development of an isolated fourth ventricle and injury to the Guillain-Mollaret triangle in the setting of fourth ventricular ependymoma is a newly encountered complication. Choice of treatment modality and timing of intervention should be carefully considered on a case-by-case basis. The data presented in this report may assist in the selection of surgical treatment for isolated fourth ventricle.
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Comparative Study
Comparison of Endovascular Embolization and Surgery in the Treatment of Spinal Intradural Dorsal Arteriovenous Fistulas.
We compared the outcomes of endovascular embolization and surgery and investigated the factors affecting the clinical outcomes of spinal intradural dorsal arteriovenous fistulas (SIDAVFs). ⋯ Our results have shown that surgery results in a low recurrence rate and superior clinical outcomes. A multidisciplinary and ordered decision is crucial for the treatment choice to ensure better outcomes, especially for patients with a definite neurologic deficit at diagnosis.
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Traumatic subdural hematomas (tSDHs) have high morbidity and mortality and often require neurosurgical intervention. The risk of venous thromboembolism (VTE) after tSDH ranges from 1%-20%, yet a consensus chemoprophylaxis protocol does not exist. An increased understanding of VTE risk factors following tSDH may inform development of prophylaxis guidelines. ⋯ While overall VTE risk is low following tSDH, elderly patients and those with severe injuries requiring prolonged hospitalizations have increased thrombotic risk. Development of tiered VTE prophylaxis regimens based on early postinjury thrombotic risk profiles warrants future study.
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The evolution of minimally invasive endovascular approaches and training paradigms has reduced open neurovascular case exposure for neurosurgical residents. There are no published estimates of open neurovascular case volumes during residency or Committee on Advanced Subspecialty Training (CAST) accredited fellowships. ⋯ Strong neurovascular training can be obtained through dedication and planning. Completion of a CAST accredited cerebrovascular fellowship will often more than double aneurysm case exposure of trainees.
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Case Reports
Muscle Forehead Flap: a salvage surgery for closure of cutaneous fistula after cranioplasty exposure.
Infection and skin fistula are well-known complications after cranioplasty leading to reconstruction exposure and usually requiring new surgical procedure with poor condition for cutaneous closure. We describe 2 cases using muscle forehead flap (MFF) to treat skin fistula and cranioplasty exposure. ⋯ MFF is a surgical option to treat complex cases of cutaneous fistula secondary to cranioplasty exposure of the anterior cranial fossa.