World Neurosurg
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Cervical pial arteriovenous malformation (AVM) is an extremely rare condition that can present with progressive myelopathy or acute hemorrhage (subarachnoid or intramedullary). The classification process is still a topic of discussion, given the limited number of cases described, as well as correct therapeutic management. Here, we present a case of a young female with anterior cervical pial AVM associated with spinal aneurysm. ⋯ Surgical procedure with perioperative neuromonitoring is an effective way to treat anterior cervical pial AVM associated with spinal aneurysm. A multidisciplinary approach is always suggested.
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Review Case Reports
Multifocal Intracranial Ganglioglioma in a Sexagenarian: A Case Report and Review of the Current Literature.
Gangliogliomas are rare, well-differentiated, low-grade neoplasms that most often occur unifocally in children and most commonly affect the temporal lobe. Gangliogliomas that occur in patients age >40 years tend to have worse prognoses. These tumors generally stain positively for neural and glial cell markers, as well as CD34. Here we report an unprecedented case of multifocal intracranial ganglioglioma in an adult age >40 who had a favorable course, and review the current literature on multifocal intracranial gangliogliomas. ⋯ Multifocal intracranial gangliogliomas are exceedingly rare tumors, especially in adults. These tumors present unique management barriers because as they are multifocal at the time of diagnosis, making resection more technically challenging. In our review, the average age at diagnosis was 19.2 years, and 80% of the cases had at least 1 lesion in the temporal lobe. Two studies opted for resection of intracranial tumors, whereas the remaining studies performed biopsy with conservative management and serial imaging. Biopsy was performed in all cases. We present the first case of an intracranial multifocal ganglioglioma in a patient age >40 years with lesions in the occipital lobe, corpus callosum, and frontal lobe at presentation.
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Randomized Controlled Trial
The effect of dexmedetomidine with different anesthetic dosage on neurocognitive function in the elderly patients after operation based on neural network model.
This paper uses a neural network model to study the protective effect of dexmedetomidine on the anesthesia recovery period and neurocognitive function in elderly patients undergoing radical resection of colorectal cancer. Eighty-eight patients with colorectal cancer who underwent radical surgery in our hospital from January 2015 to June 2017 were randomly divided into groups: study (43 cases) and control (45 cases). The study group was treated with dexmedetomidine for anesthesia. ⋯ The study found that the probability of cognitive dysfunction in the study group was significantly lower than that in the control group, and the degree of cognitive dysfunction in the study group was significantly lower than that in the control group (P < 0.05). Therefore in the operation of elderly patients with colorectal cancer radical surgery, dexmedetomidine is used for anesthesia to protect postoperative cognitive function and reduce the incidence of cognitive dysfunction. Extensive promotion and application in the clinic.
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Intracranial aneurysm (IA) is a debilitating cerebrovascular degeneration. Current clinical diagnosis relies mainly on conventional angiogram except for some peculiar aneurysms. Nonetheless, there is no documentation of aneurysm showing robust intracranial artifact on computed tomography or magnetic resonance imaging. ⋯ Taken together, accidental findings of intracranial metal artifacts on computed tomography and magnetic resonance imaging can be indicative to iron deposition on intracranial aneurysm. Neuroimaging using magnetic field should be performed with caution. Local accumulation of lysed products from erythrocyte might contribute to the occurrence of this enriched iron deposition, but further evidence regarding the pathogenesis of copper deposition should be provided. Surgically, measures should be taken to avoid perioperative complications like vasospasm and delayed cerebral ischemia. Future report of similar cases would be helpful in optimizing the treatment modality for the aneurysm with metallic plaque.
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Skull base tumors arising from the middle cranial fossa and invading of the infratemporal fossa (ITF) and middle cranial fossa are challenging for neurosurgeons, because of complex anatomy and critical neurovascular structure involvement. The first pioneering ITF approaches resulted in invasive procedures and carried a high rate of surgical morbidity. However, the acquisition of deep anatomical knowledge, and the development operative skills and reconstruction techniques allowed surgeons to achieve total or near total resection of many ITF lesions with a low morbidity rate. ⋯ First, a standard extradural middle fossa approach subtemporal approach is performed on a cadaveric specimen, illustrating the anterior extension to the cavernous sinus. Second, the anterior ITF approach is performed for the surgical treatment of a temporal lobe meningioma with extension to the anterior ITF. This technique provides a minimally invasive approach for treating middle fossa lesions with anterior ITF extension.