World Neurosurg
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Central nervous system dermoid cysts are rare lesions derived from ectopic epithelial cells. They are slow-growing benign tumors but may cause significant morbidity through compression of neurologic and vascular structures and, rarely, rupture into the subarachnoid space. ⋯ The dermoid cyst is a rare entity, the rupture of which is exceptional and often spontaneous. It is manifested by a polymorphic and nonspecific clinical picture requiring the use of imaging. This is based on CT and especially MRI, which make it possible to positively diagnose the nature of the cyst and the rupture, specify the extent of the dissemination of the lipid content in the subarachnoid spaces, and detect possible complications such as hydrocephalus. It also makes it possible to carry out a precise topographic assessment to plan the therapeutic conduct and guide a possible surgical intervention.
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Recent three-dimensional constructive interference in steady state (3D-CISS) studies have shown that the involved arteries decrease not only their own luminal caliber but also outer diameter in moyamoya disease (MMD). This study was aimed to clarify how the outer diameter of the involved arteries serially change during disease progression in MMD using qunatitaive 3D-CISS imaging. ⋯ Using quantitative 3D-CISS imaging, this study clearly shows that the involved arteries serially decrease in their own outer diameter in parallel with luminal stenosis during spontaneous disease progression in early stages of MMD (stage 1-3). This phenomenon has not been reported previously and may result from the pathognomic mechanisms underlying the development of MMD.
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In presurgical planning for intracranial meningiomas, the relationship between tumors and adjacent vasculature must be identified. The purpose of this study was to evaluate the usefulness of 3-dimensional digital subtraction angiography (3D-DSA) with dual-volume visualization (DVV). ⋯ 3D-DSA with DVV may be useful for preoperative planning by allowing the surgeon to identify the relationship between a tumor and peritumoral vasculature before meningioma surgery. Young neurosurgeons with little experience may benefit most from this technique.
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Cervical total disk replacement (TDR) has emerged as a motion-preserving alternative to anterior cervical diskectomy fusion (ACDF). Biomechanical studies have demonstrated that the TDR preserves motion at the diseased segment and minimizes motion and stress at adjacent segments compared with fusion. There has been growing interest in performing a TDR adjacent to a cervical fusion. The purpose of this study was to investigate the kinematics of a TDR after sequentially fusing adjacent segments. ⋯ Biomechanically performing a cervical TDR adjacent to a long-segment fusion did not subject the implant to significantly greater motion than when the TDR was instrumented alone.
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Case Reports
The "SHI" Internal Maxillary Bypass for 1 Giant Fusiform MCA bifurcation 2 Aneurysm: 2-Dimensional Operative Video.
Although the extracranial-to-intracranial bypass has been widely used for 5 decades, the substantive modification in this technique has rarely presented except for the internal maxillary artery (IMaxA) bypass. Recently, the IMaxA bypass has been redefined as the new "workhorse" for high-flow arterial reconstruction and replaced the cervical artery bypass as the results of sparing second incision, short graft harvesting, and well-matched caliber between donor and recipient. This video demonstrates a 37-year-old female who presented with a 1-month history of severe headache. ⋯ The free end of the RAG was then brought to the sylvian fissure and anastomosed to the M2 in an end-to-side manner. The proximal part of M1 after the bypass takeoff was then occluded with a permanent aneurysm clip (Aesculap Instruments Corp., Tuttlingen, Germany). Complete elimination of the aneurysm with a patent graft artery was observed postoperatively, and the patient was discharged with intact neurologic function (modified Rankin Scale score 0).