World Neurosurg
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Gamma-Knife radiosurgery can be the treatment of choice for small cerebral arteriovenous malformations (AVMs) in eloquent brain areas or, in association with endovascular treatment, for large and complex AVMs. Among the possible delayed complications occurring after radiosurgery of AVMs, de novo formation of a cavernoma has only recently been described. The authors report a unique case of communicating hydrocephalus with highly proteinaceous cerebrospinal fluid due to a cavernoma-like lesion of an obliterated cerebral AVM treated by embolization and radiosurgery. ⋯ In previous neurosurgical literature, the association of a caveroma-like lesion in an obliterated AVM and communicating hydrocephalus with highly proteinaceous cerebrospinal fluid has not yet been discussed. We believe that only the surgical resection of both the obliterated AVM and the cavernoma-like lesion can lead to complete clinical recovery of the hydrocephalus.
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Advancements in microscopy and more recently in neuroendoscopy have revolutionized the field of neurosurgery. Handheld neurosurgical instruments are integral components of these procedures. However, these instruments have many limitations, such as poor ergonomics, constrained maneuverability, and limited degrees of freedom. A need for developing better instruments is commonly felt by neurosurgeons. Also, the focus of modern neurosurgical training is shifting toward simulation models. The baseline data of surgical instruments play a vital role in the development of virtual and physical simulators. A primary factor impeding development of novel instruments and simulators is lack of a comprehensive surgical instrument database. The aim of this study was to develop and validate a virtual repository of microscopic and neuroendoscopic instruments. ⋯ The virtual database is an efficient starting aid to foster research collaborations related to neurosurgical instruments and surgical simulation platforms.
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Electrical bicycles (E-bikes) allow people of all ages to ride at high speeds but have an inherent risk of traumatic brain injury (TBI). Their sales have increased tremendously in recent years. ⋯ E-bikers had a significantly greater risk of moderate to severe TBI compared with bicyclists. Helmet use was associated with decreased odds of severe TBI in bicyclists and a tendency toward a more favorable outcome for E-bikers.
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Stiff neck or nuchal rigidity is a significant clinical sign of neurologic disease. It is commonly associated with meningitis, subarachnoid hemorrhage, and posterior fossa tumors. It may also occur as a result of tonsillar impaction following pressure in the infratentorial compartment from an expanding posterior fossa mass. It is, however, not commonly known to be associated with uncal herniation. ⋯ In the presence of stiff neck or nuchal rigidity in a patient with clinical signs of uncal herniation from a temporal arachnoid cyst, this unusual association could possibly be owing to the effect of increased pressure in the posterior fossa from massive shift of brain tissue posteriorly following a rapid rise in middle cranial fossa pressure consequent on an acute enlargement of the cyst. A false impression of acute meningeal irritation in such a situation could be quite misleading, resulting in late diagnosis and subsequently a delay in timely intervention.
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Ventricular shunts are most commonly placed via a frontal or parietal approach. However, there is a paucity of data comparing complication and revision rates associated with these approaches in the idiopathic normal pressure hydrocephalus (iNPH) population. ⋯ These results suggest that the type of approach for shunting may not have a significant impact on complication and revision rates in patients with iNPH, and either approach is a reasonable first-line option.