World Neurosurg
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Unruptured brain arteriovenous malformations (AVMs) represent a complex disease in young healthy adults. Most often AVMs are clinically silent but also can display a neurologic syndrome due to hypoperfusion/hypometabolism in perilesional brain tissue called steal phenomenon. ⋯ In clinical practice, irritative symptoms in patients with unruptured AVMs could lead to erroneous evaluations. In case of fluctuating clinical syndromes, like our case, establishing that symptoms are related to a steal phenomenon is usually difficult.
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Woven Endobridge (WEB) embolization is an approved technique for endovascular treatment of wide-necked and bifurcation aneurysms. However, the WEB has not yet been routinely used for internal carotid artery (ICA) sidewall aneurysms. In this multicenter study, we evaluate the safety and efficacy of WEB for treatment of these aneurysms. ⋯ The WEB device can be used for treatment of ICA sidewall aneurysms with a high level of procedural safety and a high degree of technical success.
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When distinct pituitary hypersecretory manifestations coexist, the differential diagnosis includes plurihormonal or double pituitary adenomas. We describe a rare case of hypercortisolemia and hyperprolactinemia caused by 2 noncontiguous adenomas that required 2 surgeries. ⋯ A complete clinical and biochemical evaluation is necessary in patients with pituitary adenomas. Repeat surgery may be necessary for noncontiguous double adenomas.
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Dural arteriovenous fistulas (dAVFs) are rare vascular malformations of uncertain pathophysiology. If associated with cortical venous reflux, they present a significant risk of hemorrhage. We present a 69-year-old patient who presented with spontaneous right-sided symptomatic chronic subdural hematoma, which was evacuated via burr hole. ⋯ An occipital craniotomy with disconnection of the fistula without isolation of the transverse sinus was performed (Video 1), as published literature demonstrated lower intraoperative risk with disconnection only. The perioperative course was uneventful. Immediate postoperative and follow-up angiography demonstrated complete occlusion of the fistula.