World Neurosurg
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Observational Study
Post Cranioplasty Quantitative Assessment Of Intracranial Fluid Dynamics And Its Impact On Neurocognition "Cranioplasty Effect -A Pilot Study".
This study was done to evaluate the effects of cranioplasty on cerebrohemodynamics (cerebral blood flow [CBF] and mean transient time [MTT]) and cerebrospinal fluid (CSF) hydrodynamics (flow velocities) by using computed tomography perfusion and cardiac-gated cine phase magnetic resonance imaging (MRI) (phase contrast [PC] MRI), respectively. It also aims to determine the co-relation between changes in CBF, MTT, and CSF flow dynamics with neurocognitive outcome. ⋯ Cranioplasty can remarkably improve cortical perfusion for both the ipsilateral and contralateral hemispheres. Postoperative increased CSF velocities suggest improved rapid turnover of CSF in a circuit and possibly play a role in good neurologic outcome. Our study shows there is improvement in CSF flow at the aqueduct of Sylvius after cranioplasty. We propose that improvement in CSF circulation along with changes in CBF co-relate well with cognitive outcome (Montreal Cognitive Assessment score).
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Case Reports
Primary glioblastoma of the cerebellopontine angle in an adult mimicking an acoustic neuroma.
Gliomas are usually located in the supratentorial region and are extremely rare at the cerebellopontine angle (CPA). Consequently, gliomas in the CPA are easy to misdiagnose preoperatively. ⋯ To our knowledge, this case is the second report of a true primary extraaxial CPA glioblastoma. Therefore glioma should be considered in the differential diagnosis of CPA masses with atypical imaging features, although they are extremely rare.
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Spinal arachnoid cysts (SACs) are uncommon lesions in the spinal canal. They are usually asymptomatic, but can occasionally cause mass effect leading to neurologic symptoms. They can be congenital or secondary to a variety of causes. They can produce a variety of neurologic symptoms including pain, weakness, sensory changes, incontinence, and more. Surgical intervention may be necessary when SACs cause symptomatic mass effect. ⋯ SACs are usually asymptomatic, but rarely cause mass effect and neurologic deficits requiring surgical intervention. Surgical intervention is tailored to the position of the cysts' dorsal or ventral locations. Pain and weakness are the most likely symptoms to improve, whereas sensory symptoms are least likely to improve.
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Subaxial cervical spine injuries may be treated with either nonoperative stabilization or surgical fixation. The subaxial injury classification (SLIC) provides 1 method for suggesting the degree of necessity for surgery. In the current study, we examined if the SLIC score, or other preoperative metrics, can predict failure of nonoperative management. ⋯ Management of subaxial spine injuries is complex. In our cohort, SLIC scoring did not adequately predict odds of failure of nonoperative management. Time to evaluation, however, did. We created a modified SLIC score that significantly predicted failure of nonoperative management.
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Internal carotid artery occlusion (ICAO) causes transient ischemic attack and cerebral infarction. ICAO management remains clinically challenging. We discuss a hybrid treatment combining carotid endarterectomy and endovascular intervention (E-I) for patients with nontaper or nonstump lesions of symptomatic ICAO. ⋯ Recanalization of nontaper or nonstump ICAO with hybrid treatment was more successful than that with E-I, with fewer perioperative complications. The carotid endarterectomy procedure enables easier wire crossing across the occlusion and reduces potential technology-related complications by requiring a shorter lesion and fewer dissections and minimizing the effect of calcification.