World Neurosurg
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Malignant craniopharyngioma is a rare clinical entity; most patients with this disease show transformation from an initially benign craniopharyngioma. The rare prevalence of the disease, nonspecific presenting symptoms, and imaging features that overlap with benign craniopharyngiomas make preoperative identification challenging. ⋯ Malignant craniopharyngioma should not be overlooked in patients with a giant sellar mass, especially in young patients who have experienced multiple recurrences of craniopharyngioma and patients who received radiologic therapy.
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Case Reports
Resolution of Trigeminal Neuralgia After Surgical Disconnection of a Foramen Magnum Dural Arteriovenous Fistula.
Trigeminal neuralgia (TN) resulting from dural arteriovenous fistulas (DAVFs) is rare. TN caused by a foramen magnum DAVF has not been reported yet. We report a patient with TN caused by a foramen magnum DAVF treated with surgical disconnection. ⋯ DAVF is a rare cause of TN. Surgical disconnection is an effective treatment method for TN caused by a foramen magnum DAVF.
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Brainstem cavernous malformations are uncommon vascular lesions that require complex surgical approaches. The case described in this video involved a 23-year-old male who presented with repeated, symptomatic episodes of bleeding of pontomedullary cavernous malformation, which was resected. ⋯ Postoperative imaging depicted complete resection of the cavernoma. Six months after surgery, the patient reported complete resolution of his symptoms.
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Two main types of embolic protection devices have been used during carotid artery stenting (CAS): distal protection devices (DPDs) and proximal protection devices (PPDs). We compared the complications, clinical outcomes, and new ischemic lesions on diffusion-weighted magnetic resonance imaging (DWI) studies between patients who had undergone CAS using a DPD or PPD. ⋯ The number of new ischemic lesions per patient and the incidence of ischemic lesions found on DWI were significantly greater in the DPD than in the PPD group. The lack of differences in the periprocedural and 30-day adverse rates between the 2 groups suggests that cerebral microemboli might not be associated with the clinical outcomes. For patients with poor collateral status, DPDs should be used preferentially to avoid the neurologic compromise associated with PPDs.
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Brain metastases are a common occurrence, with literature supporting the treatment of a limited number of brain metastases with stereotactic radiosurgery (SRS), as opposed to whole brain radiotherapy (WBRT). Less well understood is the role of SRS in patients with ≥10 brain metastases. ⋯ Excellent rates of local control can be achieved when treating patients with >10 intracranial metastases either in the up-front or salvage setting. Hippocampal sparing is readily achievable with expected high rates of new metastatic lesions in treated patients.