World Neurosurg
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Hirayama disease (HD) is a rare disease traditionally treated with nonsurgical procedures. Surgical treatment, which is performed by decompression and/or fusion of the cervical spine, is generally considered for rapidly progressive or advanced cases, and the choice of surgical technique is debatable. We describe the first severe case of HD that was successfully treated by posterior lateral mass screw fixation without decompression or fusion. ⋯ Nondecompression and nonfusion surgery was successful and achieved satisfactory results in this case; therefore, it serves as a promising candidate for the surgical treatment of HD.
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Case Reports
MCA-to-MCA Bypass with Interposition Graft for Ruptured Mycotic Middle Cerebral Artery Aneurysm.
Mycotic aneurysm, also referred to as infected aneurysm, is a rare entity that may result from the bacterial infection or infective endocarditis.1-3 The treatment options include conservative medication and endovascular or direct microsurgical intervention.1,4,5 However, the optimal strategy remains unknown and cerebral revascularization may be required in some rare cases.6 In this surgical video, we demonstrate a distal middle cerebral artery (MCA) mycotic aneurysm that we treated by intracranial-intracranial bypass with an interpositional graft. Our patient is a 53-year-old male who presented with a 6-day history of severe headache. He was subsequently admitted to our institution. ⋯ A 4-month follow-up angiogram showed a patent STA and excellent left distal MCA blood flow (Video 1). The favorable outcome of this case revealed that MCA-to-MCA bypass with interpositional graft is a safe, effective method for the unclippable cerebral aneurysm. As other authors have asserted, a full dose of long-term antibiotic therapy remains essential following intervention.7 Meanwhile, dextran has proved to be a viable alternative for anticoagulation during perioperative management of bypass surgery.8,9.
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To investigate the clinical characteristics of delayed remission (DR) of growth hormone (GH)-secreting pituitary adenoma after transsphenoidal adenectomy and inform follow-up treatments. ⋯ For certain groups of patients likely to achieve DR, additional treatments should not be performed early after surgery. Prolonged follow-up and close observation could help determine the therapeutic effect of surgery and guide postoperative treatments.
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Patients with hydrocephalus secondary to third ventricular colloid cysts can require bilateral external ventricular drain (EVD) placement while awaiting surgery. However, some patients could develop auto-fenestration of the septum pellucidum (AFSP) and only require 1 EVD. We evaluated our experience with bedside iohexol ventriculography and staged EVD placement for patients with obstructive hydrocephalus. ⋯ A subset of patients with obstruction at the foramina of Monro can develop AFSP. Iohexol ventriculography after unilateral EVD placement allows clinicians to assess for the presence of AFSP and identify patients who can be treated with a single EVD before surgery.
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Case Reports
Apoplectic Silent Crooke's Cell Adenoma with Adjacent Pseudoaneurysms: Causation or Bystander?
Crooke cell adenomas (CCAs) are rare and potentially aggressive pituitary tumors that often invade the cavernous sinuses. Although clinical presentations of pituitary tumors may include the development of accompanying intracranial aneurysms, there are no documented cases of coexistent intracranial aneurysms and CCAs to date. Herein we describe an apoplectic silent CCA that presented with adjacent cavernous internal carotid artery (ICA) aneurysms. ⋯ CCAs are a poorly characterized and rare pituitary tumor type. In this case, an apoplectic silent CCA invaded the left cavernous sinus and presented with pseudoaneurysms along its involvement of the ICA. Accordingly, the authors speculated that the invasive qualities of this silent corticotroph adenoma may have directly contributed to the development of these aneurysms.