World Neurosurg
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Intraspinal degenerative cysts in the cervical region are rare disorders that may cause myelopathy or radiculopathy. Most of the intraspinal degenerative cysts reported are extradural cysts. This case report includes the neuroimaging, intraoperative, pathologic, and postoperative findings obtained in a patient with a degenerative intradural cyst at the craniovertebral (CV) junction. ⋯ In this case report, we demonstrated the clinical, imaging, intraoperative, and pathologic features of a degenerative intraspinal cyst at the CV junction that was intradural in location. Compression of the spinal cord resulted in a gradually progressive myelopathy that showed remarkable improvement immediately after decompression by cystectomy.
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To identify predictors of short-term mortality and complications after anterior odontoid screw fixation. ⋯ Functional dependence and preoperative systemic inflammatory response syndrome predict mortality following odontoid screw placement. Although age often is considered a limiting factor in pursuing surgical intervention in patients with odontoid fracture, age did not independently increase odds of either complications or perioperative mortality in this analysis. Further studies are needed to explore these findings.
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Provided certain anatomic considerations, stent-assisted coiling of basilar apex aneurysms can be performed using a single stent placed in a horizontal T-configuration across the aneurysm neck prior to coil deployment, although this has predominantly been described using older-generation stents. The development of the Low-profile Visualized Intraluminal Support (LVIS Jr) device has provided greater versatility than previous stents, including use in smaller vessels, the ability to be resheathed, and improved flow diversion properties. ⋯ Use of the LVIS Jr device allows greater versatility in horizontal T-configuration stent-assisted coil embolization, when compared with other available intracranial stents. This provides another tool to treat basilar apex aneurysms with improved coil occlusion and a theoretically decreased risk of thromboembolic events.
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The treatment of hypothalamus-invading craniopharyngiomas, based on pediatric experience, is subtotal resection (STR) with radiotherapy. This strategy sometimes leads to uncontrollable tumor progression. In adults, with the use of endoscopic endonasal surgery (EES), does removing the hypothalamic part of the tumor-whenever possible-compromise the outcome of the patients? ⋯ EES GTR of grade 2 craniopharyngiomas does not cause major hypothalamic worsening, in contrast with children operated by cranial approaches. The surgeon's experience is key in deciding when to stop the dissection. Offering GTR whenever possible aims at avoiding tumor progression and radiotherapy.
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Case Reports
Malignant Glioma developed on a patient under Deep Brain Stimulation patient: pitfalls in management. Case report.
Glioblastoma (GBM) is the most common aggressive malignant primary brain tumor, rarely concurrent in patients who require deep brain stimulation (DBS) implants. Despite the high incidence of these circumstances alone, the coexistence of both in a patient has been seldom reported. In this paper, we report a case of a patient suffering from a movement disorder treated with DBS who developed a GBM. ⋯ We advise the use of magnetic resonance imaging-safe devices; otherwise, we recommend keeping the system and proceeding with computed tomography imaging for diagnostic and management if necessary. The true relationship between chronic DBS stimulation and GBM is to be clarified.