World Neurosurg
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Case Reports
Thoracic Intradural Extramedullary Ependymoma with anaplastic transformation: A case report and discussion.
Intradural extramedullary spinal ependymomas arising from outside the region of the conus medullaris are rare clinical entities, and anaplastic transformation of these lesions is even more exceptional. ⋯ We advocate that primary spinal ependymomas should be within the differential of intradural extramedullary lesions arising outside the region of the conus medullaris.
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Spinal arteriovenous fistulas (AVFs) are a rare entity that can have devastating neurologic outcomes. Currently, these lesions are treated via open microsurgical resection or transarterial embolization with good success. However, some patients cannot be treated with a minimally invasive endovascular technique secondary to difficulty catheterizing their vascular anatomy. Our aim is to present a case of balloon-assisted Onyx embolization of a spinal AVF. ⋯ We present a challenging case in which normal embolization microcatheters were unable to navigate difficult anatomy, but we were able to gain access and obliterate the fistula by using a balloon catheter.
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The preventable shunt revision rate (PSRR) was recently introduced in pediatric hydrocephalus as a quality metric for shunt surgery. We evaluated the PSRR in an adult hydrocephalus population. ⋯ The 90-day PSRR can be applied to an adult population and serve as a quality metric.
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Case Reports
Hybrid surgical rescue of failed stent retrieval with acute middle cerebral artery occlusion.
Failure of stent retrieval and periprocedural embolization of plaque are rare complications of carotid artery stenting, which need emergency surgical treatment. In Video 1, we demonstrate failed stent retrieval with acute middle cerebral artery occlusion that was treated with carotid endarterectomy and stent-assisted thrombectomy in a hybrid operating room. A 65-year-old man underwent carotid artery stenting for symptomatic left internal carotid artery stenosis with severe calcification. ⋯ After carotid endarterectomy, the stent-assisted thrombectomy was performed. Postoperative digital subtraction angiography confirmed the recanalization of the middle cerebral artery. The patient's neurologic function dramatically improved after hybrid treatment.