World Neurosurg
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The sinking skin flap syndrome, also known as the syndrome of the trephined or the trephination syndrome, occurs in patients who have undergone a decompressive craniectomy. As opposed to this, persistent brain herniation also occurs in patients after a decompressive craniectomy and a cerebrospinal fluid (CSF) drainage procedure is one of the therapies used to reduce it. A continuous lumbar CSF drainage procedure can upset the pressure dynamics of the atmosphere versus intracranial pressures to a point of fatal clinical deterioration and hence needs to be closely monitored. ⋯ Timely intervention eventually led to a favorable outcome and avoidance of a catastrophy.
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Chordomas are slow-growing but locally invasive tumors. The standard of care consists of surgical resection and radiotherapy (RT) when complete resection is not possible. The reported data has reached equivocal results regarding the effect of adding RT to increase patient survival. We investigated the effect of adjuvant RT on patient survival. ⋯ Using data from a large national cancer registry, we found that the available evidence is not enough to suggest that the addition of RT offers a survival benefit for patients with sacral and spinal chordoma after GTR. Given the non-negligible complications associated with RT, the balance of benefits and risks must be considered during preoperative tailoring of the treatment decisions.
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Severe factor V deficiency is an extremely rare coagulation disorder. Patients with factor V activity <5% usually become symptomatic in early childhood. ⋯ We conclude that in this rare bleeding disorder, intracranial surgery was successfully managed because of a thoroughly planned perioperative therapeutic strategy. However, if there is time prior to surgery, a full checkup of the bleeding disorder is advisable.
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Intraspinal dermoid tumors are usually rare benign growths that occur as a result of defects during neural tube formation. They make up less than 1% of tumors in the spine and are associated with spinal dysraphisms or sinus tracts. Although rare, malignant transformation into squamous cell carcinoma has been previously reported. Malignant transformation into adenocarcinoma, however, represents a novel phenotypic differentiation pattern that is hitherto undescribed. ⋯ Dermoid tumors, also known as benign cystic teratoma or mature teratoma, are usually benign congenital tumors comprising epithelial cells that arise from displaced embryonic ectoderm and mesoderm during neural tube formation. Although extremely rare, malignant transformation into squamous cell carcinoma has been reported. This case represents the first report of an intraspinal dermoid tumor transforming into adenocarcinoma. A comprehensive histopathologic analysis is key to identifying the lesion and guiding postsurgical management.
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Fenestrated mini-clips have been reported as useful for treating dog ear-shaped remnant aneurysms, the small aneurysms to which the efferent artery adheres or is impeded by the surrounding neurovascular structure in the restricted operative corridor, because of the smaller clip head. Here, the alternative utility of fenestrated mini-clip was reported by mentioning the narrower clip blade. ⋯ In selected cases, application of a narrower bladed fenestrated mini-clip in the restricted space may be useful to preserve tightly adhering branch arteries, as well as efferent arteries.