World Neurosurg
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Cervical spondylotic myelopathy (CSM) severity and presence of symptoms are often difficult to predict based simply on clinical imaging alone. Similarly, improved machine learning techniques provide new tools with immense clinical potential. ⋯ Machine learning provides a promising method for prediction, diagnosis, and even prognosis in patients with CSM.
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Subependymomas are rare in the spinal cord. They are typically expansile, intramedullary spinal cord masses, eccentrically located with minimal gadolinium enhancement. ⋯ This is the first case, to our knowledge, where imaging revealed a mass appearing to be completely extramedullary with a primary exophytic component. Therefore, subependymomas should remain on the differential for masses in the spinal cord that appear extramedullary and exophytic.
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Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular spinal malformations. According to the reported data, surgery seems to result in better occlusion rates than endovascular treatment. However, the post-treatment evolution of neurological symptoms stratified by the treatment remains unknown. The main objective of the present study was to compare the clinical outcomes for patients according to the treatment method. ⋯ Surgery can be proposed as first-line treatment of SDAVFs after multidisciplinary discussion between neurosurgeons and neuroradiologists. The development of late recurrence negatively affects the neurological outcome of patients.
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The authors present a 3-dimensional surgical video of a half-and-half, transcavernous approach for microsurgical clipping of a giant basilar tip aneurysm that recurred twice after endovascular treatment. The case refers to a 60-year-old man who presented with subarachnoid hemorrhage, was treated with coiling, and had a good clinical and radiographic outcome. At 3 months, he was found to have recurrent filling at the neck of the aneurysm and was treated again endovascularly with stent coiling. ⋯ The transcavernous approach is then performed, followed by a posterior clinoidectomy and division of the posterior communicating artery. After multiple failed clipping attempts, the aneurysm was trapped and opened to remove some of the coils from the neck. This accommodated permanent clipping with preservation of all major vessels and complete obliteration of the aneurysm neck.
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To study the prevalence of OTX1 and OTX2 gene expression in 60 medulloblastoma specimen samples and to establish correlations between gene expression and clinical and histopathological aspects. ⋯ The relative expression of OTX1 and OTX2 was dependent on patient age, tumor location, and histological variant. In addition, OTX2 expression might be a predictive factor for leptomeningeal metastases of medulloblastoma. The OTX pathway should be consider as an important venue for medulloblastomas development.