World Neurosurg
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Transient tumor attack is a rare but well-known phenomenon. Described by Ross in 1983, it demonstrated a transient ischemic attack-like picture in patients with intracranial mass lesions. Usually these attacks were recognized at sites anatomically away from the primary lesion that were not explained by primary mass effect of the lesion. The exact pathophysiology of such transient tumor attacks is postulated to be due to either a vascular steal phenomenon or compression of a vessel or localized prothrombotic state. ⋯ We try to shed some light on the pathophysiology of this unusual phenomenon.
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Treatment of complex unruptured middle cerebral artery (MCA) aneurysms that are untreatable with conventional surgical techniques are rare, and direct aneurysmal clipping usually remains the first-line treatment for large and giant saccular MCA aneurysms. Tandem clipping and multiple clipping techniques represent neck reconstruction in direct clipping surgeries that address these aneurysms. ⋯ "Mass reduction" clipping, which changes the shape of the aneurysm and reduces the size of the whole aneurysmal mass, is a useful variation for the treatment of large aneurysms when conventional clipping across the neck is feasible.
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To analyze the plasma cell-free DNA (Cf-DNA) in glioma patients with high throughout sequencing for a novel non-invasive method for the early diagnosis and management of glioma. ⋯ There were some cancer-related somatic mutations in the Cf-DNA of glioma patients, but no identical mutations were found in the paired solid tumors. Therefore, plasma Cf-DNA mutations may not be a suitable marker for the detection of glioma.
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Perforation of a solid visceral organ and subsequent development of a cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunts. ⋯ A series of 22 cases of previously reported intrahepatic pseudocysts and abscesses is presented, and the putative mechanisms that have been put forward to explain the development of these collections are discussed. Review of the literature demonstrates that several techniques have been successfully employed in the management of this complication.
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Historical Article
Great Hospitals in North America: The Medical College of Wisconsin Neurological Surgery.
The Medical College of Wisconsin Department of Neurosurgery delivers subspecialty adult and pediatric neurosurgical care that is patient-centered, evidence-informed, and value-based. Medical College of Wisconsin research advances the science of neurological disease with the goal of a positive translational effect on clinical care. ⋯ The journey to become a neurosurgical center of excellence was accomplished with the leadership and foresight of the men and women who turned their dreams into reality. The establishment and rise of the department as a national force for neurosurgery and spine is an elegant example of the combination of individual leadership and foresight with synergistic institutional support.