World Neurosurg
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Optimal management of complex anterior circulation aneurysms is an enigmatic challenge because of frequent involvement of major vessel bifurcation, choroidal vessels, and lenticulostriate/thalamostriate perforators. Cerebral ischemia associated with prolonged clipping time is a major concern pertinent to their surgical management, especially in patients with poor cross-flow. To circumvent this hurdle, single/double-barrel low-flow superficial temporal artery (STA) to middle cerebral artery (M3/M4-MCA) can be performed, which can maintain distal cerebral perfusion while facilitating safe clip reconstruction of complex MCA and supraclinoidal internal carotid artery (ICA) aneurysms involving ICA bifurcation or supraclinoidal ICA aneurysms with poor cross-circulation-insurance bypass, as well as supplement/alter blood flow after MCA aneurysm trapping-flow-alteration bypass. ⋯ This series highlights the surgical strategy and safety for successfully managing complex MCA and ICA aneurysms using low-flow STA-MCA revascularization procedures.
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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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With the advent of extensive endoscopic approaches for pituitary tumors, there has also been an increase in surgery for larger and more complex tumors. Intraoperative manipulation during endoscopic resection of sellar tumors poses potential risk in postoperative visual function in this tumor population. This study proposes a method of accurate intraoperative monitoring of visual evoked potentials (VEPs) and its role in predicting visual function outcomes. ⋯ Changes in VEP amplitude during endoscopic sellar tumor resection correlate with postoperative visual function. Intraoperative VEP monitoring can serve an important role in preventing postoperative visual field loss.
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To evaluate safety and effectiveness of the application of piezosurgery in en bloc laminectomy for the treatment of multilevel thoracic ossification of ligamentum flavum (MTOLF). ⋯ The application of piezosurgery in en bloc laminectomy is a safe and effective method in the treatment of MTOLF, and it was advantageous for reducing both operation time and intraoperative blood loss compared with the high-speed drill.
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Clear cell sarcoma (CCS) is a rare malignant soft tissue tumor with poor prognosis owing to metastasis and insensitive response to chemotherapy and radiotherapy. ⋯ To the best of our knowledge, this is the first case of primary central nervous system CCS. Primary CCS may involve the skull and should be one of the differential diagnoses for intra-extracranial communicating tumors. Further research on biological characteristics and molecular targeted therapy of CCS are needed to improve its poor prognosis.