World Neurosurg
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Case Reports
A cerebral aneurysm arising from a variant posterior communicating artery lying lateral to the oculomotor nerve.
In most cases, the posterior communicating artery (PCoA) lies medial to the oculomotor nerve. In this report, a rare case of a ruptured cerebral aneurysm arising from a variant PCoA lying lateral to the oculomotor nerve is described. ⋯ Recognizing this anatomic variant is helpful in minimizing the potential complications in microsurgical management around the PCoA and oculomotor nerve. Lateral localization of the P1-2 junction might affect this rare anatomic variant.
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Cerebral venous thrombosis (CVT) is a rare entity with a potentially fatal outcome. Patients who do not respond to standard medical therapy alone may benefit from endovascular treatment options. We evaluate the angiographic and clinical results of mechanical thrombectomy in patients with severe CVT. ⋯ Transvenous mechanical thrombectomy is feasible, safe, and effective, leading to a high degree of successful recanalization rate of occluded dural sinus. It may be a salvage treatment for selected patients with severe CVT refractory to standard medical treatment.
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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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Proximal anterior cerebral artery (A1) aneurysms are difficult to clip because of their frequent proximity to perforators, location behind the parent artery, or adherence to surrounding structures. ⋯ A1 aneurysms are rare but have their own complex characteristics and are difficult to treat. Meticulous analysis of the relevant angiographs is needed for their diagnosis. An important consideration in surgery is the preservation of perforators and prevention of rupture. Wide opening of the sylvian fissure and temporary control of the parent artery can facilitate dissection of the A1 aneurysms dome. Multiple intraoperative monitoring methods, such as microvascular Doppler ultrasonography and somatosensory and motor evoked potential monitoring, can reduce the relevant complications of surgery.
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Case Reports
Biopsy and ablation of an H3K27 glioma using the skull-mounted Smartframe® device: a technical case report.
Clearpoint Smartframe is a magnetic resonance imaging-compatible stereotactic system often used to perform magnetic resonance imaging-guided biopsies. The system is typically mounted on the scalp through screws that pierce the skin and penetrate the outer table of the cranium. However, the frame can also be configured to be mounted directly onto the skull. ⋯ We describe a case in which the skull mount Clearpoint Smartframe was used to biopsy and ablate a midline H3K27 glioma.