World Neurosurg
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Transvenous embolization is a not so widely used technique for treatment of arteriovenous malformations.1,2 However, in the reported cases and series in the literature, it is proven to be a safe and efficient method that can lead to total occlusion of the formation in 1 procedure.2-5 The transvenous approach is reserved for small, deeply localized formations with a single draining vein.2-4 In this video, we present a case of a successful single-session transvenous embolization of a ruptured arteriovenous malformation with Onyx. Prior to the injection of the liquid embolic agent, coils were deployed at the proximal part of the draining vein. A balloon was inflated at the arterial part to decrease the pressure inside the nidus, therefore ensuring better penetration of the embolic agent. Control angiogram at the end of the procedure showed total occlusion of the nidus of the arteriovenous malformation.
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Atypical and anaplastic meningiomas (AAMs) are rare and comprise approximately 5% of all meningiomas. Extracranial metastases in meningioma patients occur in 0.1% of all cases, but these lesions are difficult to treat and may be a poor prognostic factor. ⋯ Metastasis development from AAM is a rare but serious event. Because scalp invasion is a strongly associated predictive factor for development of systemic metastasis in patients with AAM, it is necessary to consider strategies to prevent and to be vigilant of the development of scalp invasion.
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Differentiating sellar region meningiomas from pituitary adenomas on standard magnetic resonance imaging (MRI) sequences can be difficult. Arterial spin labeling (ASL) is a noninvasive technique of magnetic resonance perfusion imaging. The range of applications of ASL in neurosurgery has increased, and the information provided can be unique and complementary to other MRI sequences. Here we investigate the utility of ASL MRI in differentiating between sellar region meningiomas and pituitary adenomas. ⋯ ASL MRI is a useful adjunct sequence in differentiating sellar region meningiomas, which exhibit high perfusion, from pituitary adenomas, which exhibit relatively low perfusion.
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Neuroendoscopy offers wide and close surgical views with fine illumination, even in deep surgical sites. Furthermore, transcylinder surgery has the advantage that a tubular retractor can protect critical neurovascular structures in the surgical corridor. These advantages of neuroendoscopy and transcylinder surgery can contribute to safer and less invasive surgical approaches for deep-seated fourth ventricular lesions, for which various critical neurovascular structures exist along the surgical route. ⋯ Our novel approach can be an effective surgical option for fourth ventricular lesions with minimal cerebellar retraction and injury.