World Neurosurg
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Fusiform aneurysms are challenging lesions to manage given their poorly understood natural history and lack of a distinct neck. Historically, they have been treated surgically but endovascular management has recently evolved as a viable alternative. In this case, we describe a novel flow diversion technique for treatment of a fusiform anterior cerebral artery (ACA) aneurysm by jailing the compromised parent vessel obtaining endovascular aneurysm trapping. ⋯ This case illustrates the efficacy of the Pipeline Embolization Device for treatment of a fusiform anterior circulation aneurysm via remodeling the circle of Willis.
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Supratentorial cavernous malformations (CMs) can be epileptogenic lesions. However, little is known about clinical comorbidities, medication use, and radiologic features that predict a first seizure presentation without associated CM hemorrhage. ⋯ These prospective data provide possible clues to radiologic factors, clinical comorbidities, and medication influences on seizure presentation in patients with CM. Further multicenter studies would be helpful to determine if disease-modifying agents in addition to epileptic medications or surgery might be helpful.
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To describe a new method for cranial reconstruction after posterior fossa craniectomy in the surgical treatment of Chiari 1 malformation through a technical note and presentation of 3 illustrative cases. ⋯ 3D virtual surgical planning provides feasible tools for the planning of posterior fossa decompression and intraoperative fabrication of accurate patient-specific suboccipital cranioplasty.
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The foundation of spine surgery centers on the proper identification, decompression, and stabilization of bony and neural elements. We describe easily reproducible and reliable methods for optimal decompression and release of neural structures to alleviate symptoms and improve patients' quality of life. ⋯ After properly identifying the anatomic structures, each of these techniques provides a consistent, reproducible, and efficient means to decompress the spine under various circumstances. These techniques provide surgical trainees with a framework for approaching surgical decompression.
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To characterize the intratumoral immune microenvironment and evaluate its clinical implications in patients with primary axial osteosarcoma. ⋯ Our results suggested that the immune microenvironment is of clinically relevant significance in patients with axial osteosarcoma. Specifically, we identified both PD-L1+ TILs and CD8+ TILs as independent favorable prognostic markers.