World Neurosurg
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When endovascular clot retrievals are performed using a stent retriever and/or an aspiration catheter, identifying the accurate position of a clot is extremely important for a successful immediate recanalization. Herein, we report a new technique called microcatheter withdrawing angiography, which facilitates the identification of the precise position of a clot. The negative shadow appearance of the clot on angiography was referred to as the actual crab claw sign. ⋯ Microcatheter withdrawing angiography can help identify the actual crab claw sign. This technique has a higher success rate and faster recanalization than conventional strategy, particularly in challenging cases of unsuccessful recanalization during the first attempt.
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A 66-year-old woman presented with a 4.5- × 4-cm left posterior parafalcine meningioma and visual loss in her left eye (Video 1). Prior to meningioma embolization, angiography confirmed an incidental high-risk falcotentorial dural arteriovenous fistula (DAVF) with pial tectal arteriovenous malformation (AVM) and flow-related aneurysms of the superior cerebellar artery (SCA) and posterior cerebral artery (PCA). Arterial supply to the AVM/DAVF consisted of branches of the middle meningeal artery, tentorial branches of the internal carotid arteries, and the PCA and SCA. ⋯ Finally, the drainage into the VG and the venous reflux to the PCCV were ligated. Postoperative angiography showed no residual DAVF or AVM and regression of aneurysms. The patient was discharged with no added deficits, and the meningioma was totally resected several months later.
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To compare clinical outcomes and payments between glioma resections with and without functional mapping. ⋯ Intraoperative functional mapping during glioma resection was associated with decreased complications, reoperations, emergency department visits, and shorter lengths of stay. Furthermore, total charges of mapped resections were not significantly different from those of conventional resections. These findings support the usefulness of functional mapping for resection of supratentorial primary malignant gliomas.
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Case Reports
Symptomatic recurrence of cervical spine myelomeningocele in an adult patient - Case report.
Cervical myelomeningocele (MMC) is a very rare neural type defect that is usually discovered and managed in childhood. It is best described as a closed type of spinal dysraphism, where the posterior portion of the cervical thecal sac forms a pouch that bulges out through a narrow posterior spina bifida and contains spinal neural tissue with or without cerebrospinal fluid. ⋯ Cervical MMC is extremely rare in adults, the symptomatic progression of which is most likely because of cord tethering by fibrotic tissue formation over years. Early surgical correction and release of the tethered cord is relatively safe and prevents the evolution of neurological symptoms.