World Neurosurg
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Techniques for endovascular management of carotid-cavernous fistulas (CCFs) have evolved over the years. Current strategies include transarterial or transvenous approaches and direct puncture or exposure of the cavernous sinus. Rarely, complex CCFs may require multiple approaches or procedures. We describe our experience managing CCFs, reporting on outcomes and technical nuances. ⋯ CCFs are complex vascular lesions that require facility with various endovascular and surgical approaches. High-flow, direct-type fistulas may harbor a significant risk of recurrence after transarterial embolization. Partial or unsuccessful embolization may necessitate an open surgical approach to the superior ophthalmic vein or cavernous sinus.
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Case Reports
FAILURE OF SURGERY IN IDIOPATHIC SPINAL CORD HERNIATION - Case Report and Review of the Literature.
Idiopathic spinal cord herniation is a disorder in which the spinal cord herniates through a dural defect. We present a case in which both the standard surgical method and a salvage method failed. ⋯ In this patient there was no single satisfactory surgical treatment of his ventrally herniated spinal cord-partly related to the herniated component of the cord acting as a mass within a narrow canal at the apex of the thoracic kyphosis. We encountered previously unreported complications of the ventral defect widening technique of surgical treatment.
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The anatomico-functional complexity of the ophthalmic segment aneurysms is attributable to the presence of critical neurovascular structures in the surgical field. Surgical clipping of the ophthalmic artery (OpA) aneurysms can result in postoperative visual deficit due to the complexity of the aneurysm, vasospasm, or optic nerve manipulation. In this study, we aimed to characterize the feasibility of an intracanalicular OpA (iOpA) revascularization with 2 donor vessels: an intracranial-intracranial (IC-IC) bypass using the anterior temporal artery (ATA) and an extracranial-intracranial (EC-IC) bypass using the superficial temporal artery (STA). We further discuss their potential role in "unclippable" OpA aneurysms. ⋯ This study confirms the feasibility of iOpA revascularization using IC-IC and EC-IC bypasses. These techniques could potentially be used for prophylactic or therapeutic neuroprotection from retinal ischemic injury while treating complex OpA aneurysms, infiltrative tumors, or intraoperative arterial injuries.
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A paucity of randomized trials have compared prophylactic dose of unfractionated heparin (UFH) versus low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolic events in spinal surgery. Our objective was to determine the most prevalent chemoprophylactic techniques in spine surgery. ⋯ Prophylactic UFH was statistically more common than LMWH in neoplastic spinal surgery, but not in the degenerative/deformity and trauma groups (cohorts). Further trials are warranted.
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Colloid cysts are the most common third ventricular tumor and may present with symptoms related to obstructive hydrocephalus. Although definitive endoscopic or microsurgical resection is the standard of care, patients may receive temporizing ventriculoperitoneal shunts when definitive management is deferred. Subsequent definitive treatment can be challenging because of the ventricular collapse and narrowing of the operative corridor. There is currently no literature evaluating the feasibility of definitive colloid cyst resection in patients with preexisting ventriculoperitoneal shunts. ⋯ Surgical resection of colloid cysts is possible despite a preexisting ventriculoperitoneal shunt. Because the ventricular space may be collapsed postoperatively because of cerebrospinal fluid diversion, a transcortical route (either endoscopic or microscopic) can be complicated by a small operative corridor with reduced visibility. The transcallosal approach was safe and feasible in these cases for providing midline access with adequate visualization for complete resection despite ventricular collapse.