World Neurosurg
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Quantitative magnetic resonance angiography (qMRA) using noninvasive optimal vessel analysis (NOVA) is a novel noninvasive imaging technique that is being increasingly used to measure blood flow in extracranial and intracranial arteries. By providing important quantitative flow data, NOVA qMRA can facilitate the management of cerebrovascular disease. While the same technology can also be applied to measure flow in intracranial and extracranial veins, NOVA quantitative MRV (qMRV) is only rarely used in neurovascular practice. ⋯ To the best of our knowledge, this is the first report of successful clinical application of NOVA qMRV in adult patients with intracranial arteriovenous malformations or dural arteriovenous fistulas. We propose that NOVA qMRV is a promising technique for noninvasive measurement of intracranial and extracranial venous blood flow and for monitoring treatment effectiveness in patients with intracranial arteriovenous shunt lesions.
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Case Reports
Intracardial catheter migration of a ventriculoperitoneal shunt: Pathophysiology and interdisciplinary management.
Intracardial migration of a ventriculoperitoneal (VP) shunt (ICMVP) is a rare complication that has been described in only single case reports. Here we report the successful interdisciplinary management of an ICMVP and provide a review of the relevant literature. ⋯ The management of an ICMVP is complex and carries a high risk for severe potential complications. Two different pathophysiological mechanisms have been discussed in the literature, including gradual erosion into an adjacent vein and transvenous catheter placement of the initial shunt secondary to subcostal placement of shunt tunneling instruments. The suction effect of the venous system results in gradual pulling of the catheter into the venous system.
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Case Reports
Dural Arteriovenous Fistula of the Vein of Trolard Mimicking a Cavernous Sinus Fistula.
Arteriovenous fistulas (AVFs) involving the cavernous sinus usually become clinically apparent due to eye symptoms. Although rare, the same symptoms can be associated with AVFs located remote from the cavernous sinus when the shunt drains into its tributaries. We report the unusual case of a dural AVF in which such communication was not immediately obvious from the diagnostic angiogram. ⋯ Dural AVFs involving cortical veins may cause atypical symptoms suggesting a cavernous sinus fistula due to remote venous drainage. Understanding venous anatomy helps to correlate vascular pathology and clinical symptoms and thus allows efficient and safe treatment.
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Case Reports
3D Real-Time Image-Guided Navigation Spine Corpectomy with Ultrasonic Bone Cutter: Technical Note.
Surgical interventions for congenital scoliosis are challenging for spine surgeons. The coordination of 3-dimensional (3D), real-time, image-guided navigation with an ultrasonic bone cutter allows surgeons to localize the affected area of the spine accurately and remove the lesion without damaging soft tissue structures. The goal of this technical paper is to report a previously undescribed method of hemivertebrectomy that combines 3D, real-time, image-guided navigation and an ultrasonic bone cutter. We highlight the feasibility and safety of this method in spinal surgery. ⋯ We believe that the combination of 3D, real-time image navigation and an ultrasonic bone cutter improves hemivertebrectomy by increasing accuracy and avoiding dura laceration, major organ damage, or potential vessel damage.
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Accuracy of intraoperative cerebrovascular neuronavigation is difficult to maintain because of the ongoing need for brain shift correction. By including 3-dimensional rotational intraoperative digital subtraction angiography (3D-iDSA), the intraoperative cerebrovascular neuronavigation can be updated and upgraded throughout the microneurosurgical procedure. The aim of this technical note is to demonstrate the feasibility and advantage of updating and upgrading the accuracy of targeted cerebrovascular neuronavigation with an intraoperative 3D-DSA dataset. ⋯ 3D-iDSA vascular segmentations can update und upgrade the intraoperative neurovascular roadmap by thereby enhancing accuracy of cerebrovascular neuronavigation, as well as correcting brain shift. This technique is feasible within the hybrid operation room. Evaluation in larger series is required to support these findings.