World Neurosurg
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Case Reports
Diverticular enlargement of the foramen of Luschka and hydrocephalus in a child with Noonan syndrome.
We present an unusual association between Noonan syndrome and tetraventricular hydrocephalus, caused by fourth ventricle outlet obstruction, in a 5-year-old boy. Magnetic resonance imaging showed a diverticular enlargement of the left foramen of Luschka, with compression of the facial nerve that resolved following treatment of hydrocephalus by endoscopic third ventriculostomy.
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A 47-year-old male patient presented at our neurosurgery unit with neurogenic claudication symptoms. The patient had a history of low back pain and lower extremity pain for 2 years. ⋯ The patient was treated conservatively, and after weight loss in 13 months (body mass index of 29) he had full recovery of neurologic symptoms. A follow-up magnetic resonance image obtained 14 months after showed complete resolution of spinal epidural lipomatosis.
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Contrary to expectations, some patients with poor-grade subarachnoid hemorrhage (SAH) show favorable outcomes. However, the factors predictive of good prognosis are unclear. The purposes of this study were to identify factors related to poor-grade SAH and to analyze preoperative prognostic factors. ⋯ Poor outcomes correlated with older age, brain-destructive hemorrhage, and EI ≥0.3. The EI reflects both hydrocephalus and the patient's frailty. Radiographic signs of poor-grade SAH were not correlated with poor outcome, suggesting that early decompressive surgery may improve outcome.
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Distal outflow occlusion and extracranial-intracranial bypass represent a possible option for the surgical management of complex middle cerebral artery (MCA) aneurysm. A limitation of the distal clipping strategy combined to bypass is related to the difficulties in predicting intraoperatively the good blood flow supply to the brain territory distal to the aneurysm and the extent and speed of aneurysmal thrombosis. ⋯ We present the first report of a synergistic intraoperative utilization of ICG-VA and CEUS in studying parenchymal perfusion and aneurysm flow in complex neurovascular procedures.
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The clinical application of endoscopic techniques for lumbar lateral recess stenosis (LRS) is still challenging. This study aimed to describe a transforaminal endoscopic decompression (TED) technique for LRS and to demonstrate its clinical results. ⋯ TED with the patient under local anesthesia can be effective for the treatment of LRS, especially for the elderly or patients at a high risk for general anesthesia.