World Neurosurg
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Spinal dural arteriovenous fistula (DAVF) occurs at any spinal level; however, a sacral location of fistula is extremely rare, and the clinical characteristics of sacral DAVF have not been well described. This study aimed to document the clinical features of sacral DAVF and review the existing literature. ⋯ Sacral DAVFs are extremely rare and are easily missed by spinal angiography. Clinicians should be aware of the possibility of the occurrence of sacral DAVFs, and spinal angiography for the complete assessment of spinal vasculature should be carried out.
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Management of adolescent idiopathic scoliosis (AIS) in neurosurgery residency training may have a significant impact on resident experience, even though few trainees are likely to pursue careers in the field of AIS. The impact of this exposure on resident knowledge in adult spinal disease management is the subject of our retrospective analysis. ⋯ Treatment of AIS by surgeons with specialized training can be effective and safe. Resident exposure to these patients enhances their understanding of spinal biomechanics and deformity correction, which is applicable to treating AIS and adult spinal deformity.
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Locked-in syndrome (LIS) is a rare neurologic disorder characterized as quadriplegia with anarthria. The diagnosis of LIS is challenging and requires a high index of suspicion. The syndrome is typically caused by an infratentorial lesion to the ventral pons, regardless of etiology. LIS secondary to supratentorial injury is extremely rare, and to our knowledge, this is the first reported case. ⋯ This is a unique case of incomplete LIS after supratentorial injury. Initial ICU care and early rehabilitation likely played a major role in the full recovery of this patient. The influence of etiology and site of injury on outcome prognosis is also suggested. Although severe diffuse brain injury may occur in the face of an unremarkable computed tomography (CT) scan, the emerging role of magnetic resonance imaging in optimally evaluating traumatic brain injury with discordant clinical and CT information is highlighted and is useful in cases of LIS where prognosis prediction is important.
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The internal carotid artery is normally positioned posterolateral to the external carotid artery at the carotid bifurcation. An anatomic variation with the internal carotid artery positioned medial to the external carotid artery, the so-called twisted carotid bifurcation (TCB), is sometimes encountered in patients undergoing carotid endarterectomy (CEA). Little is known about the TCB or the implications for CEA. ⋯ CEA for TCB can be safely performed by extension of the normal procedure, but with more meticulous preoperative assessment and gentle maneuvers. The reason for the right-side dominance is still unknown. Further investigation is needed of this anatomic entity.
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Chronic subdural hematoma is a frequently clinical common problem encountered in neurosurgery practice. Nevertheless, ossified chronic subdural hematoma is extremely rare, especially in children. ⋯ Because of its infrequency and variable clinical manifestation, ossified chronic subdural hematoma should be considered and included in the differential diagnosis when we encounter an intracranial placeholder.