World Neurosurg
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The Spinal Instability Neoplastic Score (SINS) is widely used to assess mechanical instability in metastatic spine disease. We sought to identify a cutoff within the "potentially unstable" category, above which lesions were more likely than not to be stabilized. ⋯ For vertebrae affected by metastatic disease, the decision to stabilize remains dependent on both the radiographic lesion properties and the patient's clinical picture. However, our results suggest that lesions with a SINS of ≤9 might not require stabilization.
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Papillary glioneuronal tumors (PGNTs) are rare World Health Organization grade I neoplasms that are characterized by a benign course and excellent response to surgical resection. A few reports exist of tumors with more aggressive clinical and histologic features. In this report we detail the case of an unusually aggressive PGNT in a 67-year-old woman. ⋯ PGNTs, while typically benign, can rarely recur after surgery. Molecular testing should be performed on all PGNTs to help possibly identify more aggressive tumors and potentially reveal novel treatment options.
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Medially pointing aneurysms of the ophthalmic segment of the internal carotid artery (oICA) represent a neurosurgical challenge. Conventional ipsilateral approaches require internal carotid artery and optic nerve (ON) mobilization as well as anterior clinoidectomy (AC), all associated with increased surgical risk. Contralateral approaches could provide a better exposure of the superomedial aspect of the oICA, ophthalmic artery, and superior hypophyseal artery, sparing AC and internal carotid artery or ON mobilization. However, the microsurgical anatomy of this approach has not been systematically studied. In the present work, we exhaustibly analyzed the anatomic and morphometric characteristics of contralateral approaches to the oICA and compared them with those from ipsilateral approaches. ⋯ Contralateral approaches may enable successful exposure of the oICA and related vascular structures, reducing the need for AC or ON mobilization. Systematic clinical/surgical studies are needed to further determine the effectiveness and safety of the approach.
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Safe surgical approaches to the anterolateral lumbar spine require a good working knowledge of the anatomy and anatomic variations of this region. As the iliolumbar vein is in the vicinity of both oblique and lateral transpsoas approaches to the lower lumbar spine, the following study was performed to better elucidate its anatomy, variations, and position during such surgical procedures. ⋯ The ILV should be considered during both oblique and lateral transpsoas approaches to the lumbar spine.
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No reports have evaluated collateral circulation using simpler measures involving magnetic resonance imaging. Because an anterior communicating artery (A-com) is important in collateral circulation, we investigated whether the presence of an A-com affected the clinical revascularization outcomes in acute ischemic stroke (AIS) in the anterior circulation. ⋯ The presence of an A-com on preoperative time-of-flight magnetic resonance angiography is a good prognostic factor for revascularization in patients with anterior circulation AIS, confirms collateral circulation, and allows for faster and safer endovascular treatment.