World Neurosurg
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This study aimed to investigate the characteristics of A1 aneurysms according to their locations and to compare their imaging appearances so as to identify factors associated with their rupture. ⋯ Most A1 aneurysms showed a directional predilection according to the location of the A1 segment. Additionally, A1 aneurysms with elongated or irregular shapes, high aspect or height-width ratios, and distal locations of the A1 segment showed high risks of rupture. Therefore, a thorough assessment of the characteristics of A1 aneurysms can enhance the selection of proper treatment strategies.
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Stent thrombosis (ST) is a known complication after intracranial stent implantation. The pathophysiology of ST is multifactorial, and standardized treatments for ST remain uncertain. ⋯ In case of refractory ST, high-flow extracranial-to-intracranial bypass proved to be in this case a feasible and effective rescue option.
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Schizencephaly is a rare congenital central nervous system malformation characterized by linear, thickened clefts of the cerebral mantle. Recently, germline mutations in collagen type IV alpha 1 (COL4A1) have been reported to be a genetic cause of schizencephaly as a result of prenatal stroke. Patients with COL4A1 mutation demonstrate a variety of disease phenotypes. However, little is known about the potential complications of patients with COL4A1 mutations before and after neurologic surgery. ⋯ To our knowledge, malignant hyperthermia and cerebral venous thrombosis have not been reported in the literature in patients with COL4A1 mutations after surgery. Schizencephaly arising from COL4A1 mutations might be a disease prone to these adverse effects because this mutation is known to be associated with venous tortuosity, venous vulnerability, and muscle spasms due to basement membrane protein abnormalities. We need to better understand the wide spectrum of clinical phenotypes of COL4A1 mutations and potential complications in order to better manage surgery of patients with schizencephaly.
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Diagnosis of idiopathic normal pressure hydrocephalus is based in clinical data, radiologic variables, and invasive cerebrospinal fluid (CSF) testing, such as the lumbar infusion test. Several neuroimaging findings are inconclusively related to improvement after CSF shunt surgery. CSF tests are invasive and have complications. The aim of this study was to select radiologic variables related to a positive lumbar infusion test so as to avoid this test in patients. ⋯ Owing to high positive predictive values of matched radiological variables, the lumbar infusion test could be avoided in the diagnosis of idiopathic normal pressure hydrocephalus. However, when 1 or 2 of the variables are negative, this invasive test should be performed.
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The present study was performed to investigate the prognostic role of the preoperative neutrophil/lymphocyte ratio (NLR) in elderly patients with high-grade glioma. ⋯ A high NLR was an unfavorable predictor of prognosis for elderly patients with high-grade glioma.