World Neurosurg
-
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.
-
Case Reports
Intra-arterial dantrolene for refractory cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage.
Dantrolene has a safe side-effect profile and a mechanism of action that makes it attractive as an option for treatment of cerebral vasospasm. The authors report 2 cases of refractory cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhage that were successfully treated with intra-arterial (IA) dantrolene. ⋯ This evidence suggests IA dantrolene as a safe and effective novel alternative for the treatment of cerebral vasospasm.
-
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.
-
Case Reports
Cervical Kyphotic Deformity Worsening After Extensor Cervical Muscle Paralysis from Botox Injection: Case Report.
Botulinum toxin (Botox) has long been used therapeutically to treat a variety of diseases, including migraine headaches, cervical spine dystonia, and chronic cervical spine pain, among many others. Although quite useful, Botox has been reported to cause adverse events, some of which may lead to devastating morbidity. ⋯ This case illustrates a potential danger of using Botox in the neck of an elderly patient who may have pre-existing cervical spine instability, underlying cervical musculature weakness, and pre-existing cervical kyphosis. It demonstrates the need to evaluate patients who are predisposed to developing cervical kyphotic deformities before offering them Botox treatment.
-
Recent advancements in understanding the molecular basis of gliomas and new concepts of neuronal plasticity have shown the importance of maximal resection in gliomas to improve progression-free overall survival. Awake craniotomies with intraoperative cortical and subcortical mapping have helped to achieve this aim while allowing us to preserve executive function including language. Language mapping becomes a daunting task in individuals who are bilingual because of the complexity of varied cortical representation of different languages. ⋯ Advancements in anesthesia and neuromonitoring have further allowed for long awake periods, permitting complex language tasks to be tested intraoperatively. The results obtained from this case study have allowed us to further plan for awake surgeries for patients with bilingualism. With understanding bilingual representation of languages, we hope to achieve maximal resection with minimal postoperative deficits.