World Neurosurg
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Aneurysms at the origin of a duplicated middle cerebral artery (DMCA) are quite rare. Here, we report a patient with such an aneurysm successfully treated endovascularly using our novel "wrapped-candy" low-profile visualized intraluminal support (LVIS) technique. ⋯ Stent-assisted coiling can be a feasible treatment for an unruptured, usually wide-necked, aneurysm at the origin of a DMCA. The wrapped-candy LVIS technique may be useful in more challenging morphologies such as wide-necked aneurysms that incorporate the branch origin into the aneurysm neck.
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Skull base chordomas will occasionally penetrate the clival dura mater and extend into the prepontine cistern, involving the basilar artery. Few reports have described cases of skull base chordoma accompanying a dissecting aneurysm of the basilar artery, and the treatment strategies have remained largely unknown. ⋯ We have reported a case of a dissecting aneurysm of the basilar artery with clival chordoma. Our findings suggest that chordoma with intradural vascular encasement has the potential to invade the vessel wall. To avoid rupture of those critical vascular structures, treatment strategies that minimize stress on the involved arteries and offer safe and sufficient surgical resection should be considered.
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Case Reports
Sustainable effects of 8-year intermittent spinal cord stimulation in a patient with thalamic post-stroke pain.
Central post-stroke pain (CPSP) is a central neuropathic pain syndrome secondary to a cerebrovascular accident. CPSP treatment usually begins with medication; however, this is associated with inadequate pain relief and adverse effects. Neurostimulation therapies, including spinal cord stimulation (SCS), have been developed for improved pain relief. We report a patient with thalamic pain who underwent 8-year cervical SCS in an intermittent mode. ⋯ Our findings indicate that SCS is safe and efficacious for CPSP, including thalamic stroke pain. Long-term intermittent stimulation can preserve implantable pulse generator battery life and achieve sustained improvement of a patient's pain, movement, and affective mood status.
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Chordomas are rare, locally malignant tumors derived from remnants of the notochord that can manifest anywhere in the spine or base of the skull. Surgical treatment for chordomas of the lumbar spine often fails to achieve successful en bloc resection, which is critical to minimizing recurrence risk. ⋯ This approach offers a promising technological adjunct for the treatment of complex spine tumors requiring precise resection and reconstruction.
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Case Reports
Atlantoaxial dislocation associated with type-1 neurofibromatosis: case report and review of the literature.
Neurofibromatosis type 1 (NF-1) is an autosomal dominant genetic condition in which spinal deformities are commonly involved. However, atlantoaxial dislocation in NF-1 is extremely rare. A review of the English literature has identified only 10 cases in 8 reports. We report a rare case involving NF-1 associated with severe atlantoaxial dislocation. ⋯ Atlantoaxial dislocation is a rare complication in NF-1 patients. Surgical reduction combined with fusion is essential for a good outcome. Spine surgeons should also be knowledgeable about the possibility of significant hemorrhage before surgery.