World Neurosurg
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Polycythemia vera (PV) is a myeloproliferative disorder usually characterized by an increase tendency toward thromboembolic events. Spontaneous hemorrhage/bleeding in PV patients is seldom reported in neurosurgical literature. ⋯ Sporadic reports of hemorrhage within the central nervous system in the setting of PV exist and are attributed to microvascular thrombotic events with hemorrhagic conversion. Though rare, spontaneous central nervous system hemorrhage in the absence of vascular malformation or an inciting event such as trauma can occur in the setting of myeloproliferative disorders like PV.
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To evaluate the risk factors of tumor-related epilepsy (TRE) and the relationship between TRE and functional/survival outcomes in patients with high-grade glioma (HGG). ⋯ In patients with HGG, preoperative epilepsy is significantly associated with tumor involvement of the frontal lobe, whereas postoperative epilepsy is associated with preoperative epilepsy and dominant hemispheric location. Also, patients with HGG with preoperative epilepsy have better PFS and OS.
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The primary treatment for patients with sacral chordoma is en bloc surgical resection with negative margins, which has been shown to reduce local recurrence and tumor-related morbidity. Here we describe the use of intraoperative neuronavigation using preoperative spine magnetic resonance imaging fused to intraoperative computed tomography (CT) to create 3-dimensional tumor reconstructions in the operating room for intraoperative identification of bone and soft-tissue margins for maximal safe tumor resection. ⋯ Magnetic resonance imaging-CT fusion and 3-dimensional reconstruction techniques using an intraoperative CT scanner with image-guided navigation to aid preoperative planning and surgical resection of sacral chordomas are not well represented in the literature. This technique can be used for planning en bloc surgical resections and for more precisely identifying tumor margins intraoperatively.
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Primary intraventricular hemorrhage (PIVH) is a rare condition in adult patients. PIVH occurs frequently in adult hemorrhagic Moyamoya disease (MMD). Idiopathic PIVH is defined as PIVH without cerebrovascular abnormalities. This study is aimed to compare the baseline characteristics and outcomes of acute MMD-related and idiopathic PIVH. ⋯ Compared with patients with acute idiopathic PIVH, patients with acute MMD-related PIVH have younger age, lower blood pressure, and better renal function. Moreover, patients with acute MMD-related PIVH have lower short-term mortality.
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Cerebral arteriovenous malformations (CAVMs) are characterized by altered hemodynamics and associated with angioanatomic changes, such as aneurysms. We encountered a patient with a CAVM-associated dissection of the medial trunk of the posterior inferior cerebellar artery (PICA) instead of an aneurysm. ⋯ This is the first report of a hyperdynamic flow-related dissection of a CAVM-associated feeding vessel. Microsurgical resection of the CAVM allowed for spontaneous resolution of the dissected area by restoration of normal rheodynamics.