World Neurosurg
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Surgical indications for patients with pineal cysts are controversial. There are absolute indications such as hydrocephalus or tectal compression; otherwise, it is difficult to decide whether surgery would be beneficial when symptoms are not distinct. ⋯ We suggest that pineal cysts without ventriculomegaly are an indication for surgery when patients present with headache and/or visual disturbances and other causes have been excluded. Resolution of symptoms and quality of life in our cohort may denote a good indication for resection. However, we must admit that there is still no evidence to recommend this technique as a treatment of headache in these patients.
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To present a preliminary experience of perioperative management for patients with spinal tuberculosis (STB) and end-stage renal disease (ESRD) and discuss strategic factors that should be considered. ⋯ Perioperative management of patients with STB and ESRD is a complicated issue, with multiple factors to be considered. Spinal surgery can achieve acceptable outcomes in these patients if meticulous management is performed.
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Spontaneous thrombosis of an intracranial aneurysm is rare but is common in fusiform or large cystic aneurysms, which result in subarachnoid hemorrhage after rupture. This case reports a 47-year-old woman with subarachnoid hemorrhage who developed spontaneous thrombosis of an aneurysm due to rupture of the posterior inferior cerebellar aneurysm. ⋯ This case represents a rare but important complication of ruptured intracranial aneurysm, which can be easily misdiagnosed or ignored. It should be given great attention and considered in patients with subarachnoid hemorrhage who are negative for imaging examinations.
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Extraventricular neurocytoma (EVN) is an exceedingly rare brain tumor. The radiologic and histologic features of EVN are insidious, and only a few reports and clinical cases describe the characteristics of the tumor, which may show different presentations. ⋯ In light of the high variability of imaging presentation, the definitive diagnosis of EVN remains histologic. Although some cases have already been reported in the literature, we believe that the description of our case could be useful to increase the knowledge of this insidious tumor, which has gained recognition only over the past 2 decades and should be included in the differential diagnosis in young patients who present brain tumors.
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Vertebral artery injuries (VAIs) caused by cervical trauma include irregularities with narrowing of the arterial wall, dissection, pseudoaneurysm formation, occlusion, and transection. Although recent guidelines have recommended anticoagulant or antiplatelet therapy to prevent subsequent stroke in patients with traumatic VAIs, regardless of the type of vascular injury, the clinical role of endovascular surgery in the treatment of traumatic VAIs remains to be elucidated. ⋯ The clinical role of endovascular surgery for traumatic VAI has not been previously established; however, a more specific selection of patients according to the VAI type might be necessary. Our data have indicated that preoperative embolization of the occluded VA significantly reduces the risk of postoperative infarction in a specific cohort of patients with traumatic VAI (i.e., patients with post-traumatic VAO who require cervical surgery).