World Neurosurg
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To assess the dynamic change of the dural sac size in patients with lumbar spinal stenosis (LSS) from supine to standing position and their correlation with clinical symptoms. ⋯ Dural sac size on MRI was reduced significantly from supine to standing position. Standing MRI and the changes of DCSA significantly correlated with claudication distance and VAS score of leg pain in patients with LSS. Therefore, standing MRI provides more radiologic information correlating with clinical symptoms in patients with LSS than supine MRI.
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Bypass graft stenosis following extracranial-intracranial bypass surgery carries significant risks for morbidity and mortality. In case of graft failure, treatment options include surgical revision and endovascular intervention. Whereas endovascular intervention following coronary artery bypass is well established, the role of endovascular therapy in cerebral bypass conduits is rarely reported. We present a case of extracranial-intracranial bypass graft stenosis in the early postoperative period that was successfully treated by endovascular angioplasty and stenting. ⋯ Endovascular intervention is a feasible treatment option in management of graft stenosis after cerebral revascularization surgery. Our case adds evidence to the safety and role of endovascular intervention in early cerebral bypass conduit failure. In addition, endovascular stenting can be considered as a salvage option for cases that are refractory to angioplasty.
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Case Reports
A Multimodal Approach for the Treatment of a Hemorrhaged Mesencephalic Arteriovenous Malformation.
Brainstem arteriovenous malformations (AVMs) are complex and life-threatening lesions. In our video (Video 1), we illustrate resection of a posterior midbrain hemorrhaged AVM (Spetzler-Martin grade III, Lawton-Young grade III, Supplementary Spetzler-Martin grade 6) in a 55-year-old woman presenting with ventricular hemorrhage and coma. Multimodal therapy with endovascular embolization of an associated prenidal aneurysm of the right posteromedial choroidal artery, followed by microsurgical resection via supracerebellar-infratentorial approach, is demonstrated. ⋯ At the 4-year follow-up, the patient had a modified Rankin Scale score of 3. AVMs in eloquent brain regions require a carefully tailored, multimodal diagnostic and therapeutic approach to limit procedure-related complications and obtain acceptable outcomes. Herein, we illustrate such a situation and discuss some key points for success.
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To investigate the ultrasonographic characteristics in hourglasslike constriction of peripheral nerve in the upper extremity and to evaluate the value of ultrasonography in the diagnosis. ⋯ Ultrasonography could be used as a routine noninvasive examination for hourglasslike constriction of upper limb nerves. Ultrasonography suggests that resection of the lesion rather than neurolysis should be considered in the treatment of complete constriction. For patients with clinical symptoms, ultrasonography showed local nerve enlargement but no constriction; clinicians should be prompted to explore carefully during operation to avoid missing nerve hourglasslike constriction.