World Neurosurg
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A cardiac myxoma (CM) is the most common primary tumor of the heart. This case report highlights that for metastatic CMs, even after a successful total resection, there is a small but real risk of recurrence that can manifest as late as 10 years after initial tumor resection. ⋯ Our case report demonstrates the metastatic nature of CMs to the central nervous system, even after successful gross total resection and no local relapsing mass in subsequent ultrasonographic follow-ups. A comprehensive evaluation on clinical and imagological grounds is mandatory to rule out the presence of myxomatous metastatic disease. Awareness and recognition of the potential neurologic manifestations of a metastatic CM will prevent unnecessary diagnostic workup and treatments.
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Pseudoaneurysms (PAs) of the extracranial vertebral artery (VA) are rare lesions, representing less than 1% of all aneurysms. Although these lesions may resolve spontaneously, they present a high rupture rate, so early preventive treatment is advised. ⋯ The use of flow diverters seems to be a safe and effective therapeutic option for the treatment of PAs of the extracranial VAs.
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Moyamoya syndrome (MMS), distinguished from definite moyamoya disease (MMD), is characterized by moyamoya vasculopathy thought to develop secondary to underlying conditions (e.g., hyperthyroidism). Recent studies have shown that a proportion of East Asian (EAS) patients with MMS possess the p.R4810K variant of RNF213 (rs112735431), the foremost susceptibility variant among EAS patients with MMD. We evaluated the association between hyperthyroidism-associated MMS (hMMS) and sequence variants in RNF213. ⋯ Rare and low-frequency missense variants in RNF213 confer susceptibility to both MMD and hMMS. This finding indicates that susceptibility variants in RNF213 may require additional clinical factors with an effect equivalent to hyperthyroidism in order to develop moyamoya vasculopathy.
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Spinal epidermoid cysts are very rare tumors, especially in the thoracic spine; they represent 0.8% of all spinal epidermoids. In adult cases, they are often associated with surgical procedures such as lumbar puncture. We report a rare case of spinal epidermoid cyst in the thoracic spine of an elderly patient who had never undergone lumber puncture, thoracic spinal surgery, or trauma. ⋯ Epidermoid cysts must be considered among spinal tumors in elderly patients. Early detection by diffusion-weighted imaging and complete resection may lead to good neurological outcome.
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Cranial dural arteriovenous fistulas (dAVFs) are abnormal connections between arteries supplying the dura mater and the cranial venous system. These present with various signs and symptoms. Progressive ocular manifestations are quite rare and may be confused with carotid cavernous fistulas (CCF). ⋯ Ocular manifestations of cerebrovascular origin are not necessarily associated with CCF or cavernous sinus dAVF. Other vascular malformations such as dAVFs should be considered specifically when accompanied by venous stenosis distal to the site of the fistula.