World Neurosurg
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Patients with Klippel-Feil syndrome may present with neurologic complaints such as neck pain, radiculopathy and gait instability. Here we describe surgical management of a patient with congenital fusion of the occipital-cervical region and also block circumferential fusion of dens to T3 with spinal cord compression. This report is the first of its kind with such extensive fusion. ⋯ This is the first reported case of Klippel-Feil syndrome with fusion of all cervical vertebrae down to T3. We recommend surgery for advanced cases of myelopathy or radiculopathy due to stenosis and spinal instability.
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The subthalamic nucleus (STN) is an important target during deep brain stimulation (DBS). Accurate lead placement is integral to achieving satisfactory clinical outcomes; however, the STN remains a structure whose visualization is highly variable with borders often difficult to define. We aimed to develop an objective method of evaluating the visibility of the STN on preoperative magnetic resonance imaging (MRI) to standardize future comparative assessments between imaging protocols and patient-specific parameters. ⋯ Our proposed statistical model allows for standardized examination of the visibility of the STN border for DBS and has potential for both clinical and academic applications.
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Case Reports
PSEUDOANEURYSM RESULTING IN REBLEEDING AFTER EVACUATION OF SPONTANEOUS INTRACEREBRAL HAEMORRHAGE - A CASE REPORT.
Spontaneous intracerebral hemorrhage (ICH) is a devastating cerebrovascular disease with high morbidity and mortality. Branching pattern of the lenticulostriate arteries from the middle cerebral artery makes them susceptible to formation of microaneurysms, which have been implicated in hypertensive ICH. Recurrence of hematoma due to delayed development of pseudoaneurysm after initial surgical evacuation is uncommon. ⋯ The rates of rebleeding have ranged from 10%-40% in various studies and have been directly correlated with mortality. Since follow-up with angiograms are not a usual practice in spontaneous ICH management, such as pseudoaneurysmal rebleeds could go undiagnosed. This case report reinforces the need for a thorough angiographic evaluation in the event of a deviation from expected clinical course, rebleeding not in concordance with intraoperative findings and significantly delayed hematoma recurrence.
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Brainstem tumors represent formidable lesions for neurosurgical intervention. They should be approached with a thorough understanding of the anatomy and clear sense of surgical goals. A 14-year-old previously healthy girl presented with 2 weeks of nausea, headaches, diplopia, and gait instability. ⋯ Near total resection was obtained without any new neurologic deficit. Final pathology was consistent with pilocytic astrocytoma, World Health Organization grade I. The video demonstrates the surgical approach in addition to techniques for brainstem tumor resection (Video 1).