World Neurosurg
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Case Reports
Interhemispheric Transcallosal Approach for Resection of Choroidal Arteriovenous Malformation: Operative Video.
Choroidal arteriovenous malformations (AVMs) are rare vascular entities located deep within the brain and in close relationship with vital paraventricular structures.1,2 Recruitment of feeders from the anterior and posterior choroidal arteries is typical in these lesions.3 We present the case of a 38-year-old woman who presented initially to an outside hospital with an intracranial hemorrhage 17 months prior. Initial computed tomography scan showed a large intraventricular hemorrhage and a right thalamic hemorrhage. She was diagnosed with a cerebral AVM and underwent treatment with placement of an external ventricular drain followed by partial embolization of a feeder with Onyx liquid embolic system (ev3, Irvine, California, USA). ⋯ Drainage was noted into an arterialized vein that coursed anteriorly and inferiorly prior to joining the internal cerebral vein and ultimately draining into the vein of Galen. After reviewing the management options, decision was made to proceed with microsurgical resection via an interhemispheric transcallosal approach (Video 1). The patient tolerated the procedure well and was discharged home on postoperative day 4 with no evidence of residual AVM on DSA and no neurologic deficit noted at last follow-up.
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Infratentorial multinodular lesions resembling multinodular and vacuolating neuronal tumor of the cerebrum (MVNT) have been indicated in literature with 2 different names reflecting alternative perspectives: multinodular and vacuolating posterior fossa lesions of unknown significance (MV-PLUS), suggesting that these lesions may belong to a new entity, and MVNT of the brain, assuming that they actually correspond to infratentorial MVNT. Because of the limited number of cases reported and the absence of histopathologic data, it is unclear which denomination should be used. ⋯ Infratentorial lesions show nodules with cystic or cyst-like signal intensity on MRI, a feature infrequently reported in supratentorial MVNT, and may involve the cortex. No variations were noted during a prolonged follow-up supporting the benign behavior of these lesions.
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Indirect bypass surgery is used to improve the hemodynamic status of pediatric patients with moyamoya disease (MMD). Symptomatic cerebral infarction during the early postoperative period may be the most frustrating complication. This study was conducted to investigate the factors associated with early postoperative symptomatic cerebral infarction. ⋯ Postoperative symptomatic infarctions can occur despite a unified surgical method and formulaic perioperative management protocol. Patient-centered factors, such as young age, genetic background of MTHFR, and certain medical conditions, including hyperthyroidism, renovascular hypertension, and hemolytic uremic syndrome, as well as management-related factors, including 2 craniotomies and low immediate postoperative hemoglobin level, could be risk factors for early postoperative symptomatic cerebral infarction.
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Ventriculostomy-related infection with multidrug-negative strains are challenging to treat. We report the use of new antibiotics in such a case. ⋯ We observed than even in the case of mild meningeal inflammation, ceftaroline penetration in CSF, although moderate, enabled efficient bacterial clearance and clinical efficacy, in adjunction to correct ventriculoperitoneal shunt management.
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The present study evaluated the early death and factors associated with early mortality in patients with glioma. ⋯ The early deaths rates, including 1 and 3 months after tumor resection in patients with glioma, have decreased slightly during the previous 40 years. The risk factors for early mortality included advanced age, male sex, tumor located in the lateral ventricle, cerebellum, or brainstem, receipt of biopsy only, no chemotherapy or radiotherapy, and specific histopathological types.