World Neurosurg
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Case Reports
Rosette forming glioneuronal tumor in the optico-chiasmatic region-a novel entity in a new location.
Rosette-forming glioneuronal tumour [RGNT] is a relatively rare entity first identified as a separate entity in 2002. We are reporting the second case of RGNT in the opticochiasmatic region. ⋯ Although initial reports were predominantly in the fourth ventricle, many recent reports have identified the possibility of its occurrence outside fourth ventricle in pineal gland, spinal cord, septum pellucidum, lateral ventricle, and suprasellar region. To date, only 1 case of RGNT involving the opticochiasmatic region has been reported in a patient with neurofibromatosis type 1. Genetic analysis of this rare tumor identified 3 hotspots involving somatic mutations of FGFR-1 and PIK3CA and a germline mutation involving PTPN11, which can be targets for therapeutic intervention in cases where complete resection is not possible. To the best of our knowledge, we report the first case of RGNT involving the opticochiasmatic region without any syndromic association. Other cases of RGNT with syndromic associations provide us with insight into possible therapeutic interventions.
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Subclavian steal phenomenon can cause retrograde flow through the ipsilateral vertebral artery as a result of atherosclerosis of the subclavian artery. Clinically this can present as intermittent vertebrobasilar ischemia or claudication of the affected extremity, but rarely it poses a serious risk of neurologic morbidity or mortality. Aneurysm formation at the vertebrobasilar junction is rare but may occur as a sequela of increased flow through 1 vertebral artery, as occurs in subclavian steal syndrome. Here, we present a rare case of subarachnoid hemorrhage from a vertebrobasilar junction aneurysm related to subclavian steal syndrome.
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To investigate the clinical characteristics, treatment, and outcomes of chronic subdural hematomas (CSDH) in young patients. ⋯ Headache is the most common symptom, and AC/V-P shunts are risk factors of CSDH in young patients. AC/V-P shunt-associated CSDH is associated with younger morbidity. Head trauma is a risk factor for AC/V-P shunt-associated CSDH, but is not significance in patients without AC/V-P shunts. Catheter drainage through a burr hole may be the first-choice surgical procedure in treatment of CSDH in young patients, including AC/V-P shunt-associated CSDH.
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Hemifacial spasm (HFS) is generally caused by the root exit zone of the facial nerve compressed by an overlying arterial loop. HFS can also be caused by various types of tumor, aneurysm, or arteriovenous malformation. We retrospectively analyzed patients to evaluate possible differences in the demographic and clinical features between primary and secondary HFS. ⋯ In cases of secondary HFS, facial nerves of most patients were compressed by blood vessels, so microvascular decompression after tumor resection plays an important role. We should examine the entire nerve root for possible vascular compression.
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Colloid cysts (CC) have been associated with neurocognitive function (NCF) decline, both preoperatively and after resection. Factors such as local pressure on the fornix and hydrocephalus are thought to contribute to preoperative NCF decline. The potential cause of postoperative decline is thought to be forniceal injury during surgery. In the current series, we describe NCF outcomes amongst patients with CC, both nonoperated and operated. ⋯ Patients with CC should undergo routine NCF testing with a standardized protocol, whether they are operated or followed. Surgery has a positive impact on NCF; however, it remains to be determined if the improvement is solely secondary to treatment of hydrocephalus, or to a reduction of local pressure on the fornices. It remains to be determined whether the surgical technique, that is, endoscopic, interhemispheric, or transcortical, has an impact on NCF outcome.