World Neurosurg
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In the last years, few reports have shown the feasibility of the endoscopic endonasal approach (EEA) for craniopharyngiomas in pediatric patients. For these tumors, recent studies have suggested less aggressive surgery, favoring the preservation of the patient's quality of life. ⋯ EEA can be an effective approach for midline craniopharyngiomas in children older than 3 years. It gives a satisfactory exposure of the suprasellar region and an adequate assessment of the brain-tumor interface. Its main limitations are age-related anatomic features of nasal/paranasal sinuses and the risk of cerebrospinal fluid leak.
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Case Reports
Giant Symptomatic Meningocele as a Delayed, Adult Complication of Lipomyelomeningocele.
An expanding cohort of patients with spina bifida live well into adulthood and pose complex management challenges due to unique combinations of adult health issues overlying congenital problems. ⋯ Symptomatic meningocele may present in a long-delayed fashion in adult patients with a history of spina bifida. Surgical treatment may provide symptomatic benefit.
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Subarachnoid hemorrhage resulting from spontaneous perforation of a small intracranial vessel, with resultant pseudoaneurysm formation, has not been widely reported in the literature. ⋯ This case illustrates an unusual sequela of subarachnoid hemorrhage presenting a unique challenge in surgical management.
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The majority of the abnormalities and diseases that affect the craniovertebral junction (CVJ) have already been reported, and therefore it is exceedingly rare to identify new pathology that affects the CVJ. Immunoglobulin G4-related disease (IgG4-RD) is an immune mediated process treated with immunosuppressive medications. To our knowledge, this is the first reported case of IgG4-RD affecting the CVJ. ⋯ To our knowledge, this case describes the first case of IgG4-RD affecting the CVJ, which mimicked a tumor-like process. When IgG4-RD affects the CVJ, stability must be accounted for, especially in the cases of osteolytic destruction. The combination of medical therapy to target the underlying inflammatory process and surgery to provide structural stability was successful.
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This is a case of a man aged 40 years with a past medical history of smoking, hypertension, polycythemia vera, intellectual disability, and schizophrenia who presented with generalized headaches, progressive loss of balance, and visual disturbance for 1 month. ⋯ Coexistence of hemangioblastomas and AVMs are extremely rare, and only 3 cases have been reported previously in the literature.