World Neurosurg
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Posterior circulation stroke resulting from atlantoaxial dislocation (AAD), although uncommon, is a well-described entity. The normally coursed V3 segment of the vertebral artery (VA) is likely to be stretched because of C1-C2 dislocation and further compromised by the C1-C2 translational mobility. The persistent first intersegmental artery (PFIA), an anomalous variant does not course through the C1 transverse foramen, but rather crosses the posterior C1-C2 joints and is unlikely to be affected by the C1-C2 dislocation. Therefore, a patient with AAD and anomalous VA presenting with stroke should be evaluated for other etiologies of VA compromise. ⋯ One should be aware of such an etiology of arterial compromise in cases of AAD with coexistent anomalous VA. An underlying LB or large osteophytes resulting from instability may be the offending cause, and needs to be dealt with, as fusion alone may not benefit the patient.
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Case Reports
Bilateral Squamosal Suture Craniosynostosis Presenting with Abducens Nerve Palsy and Severe Papilledema.
Patients with single-suture or minor suture craniosynostosis are typically asymptomatic at early presentation; intervention is aimed at reducing the risk of elevated intracranial pressure and associated developmental sequelae. Patients may be symptomatic in cases of major multisuture syndromic synostoses or delayed diagnosis. Clinical presentation in this context may include headaches, papilledema, cognitive delay, or behavioral issues. Cranial nerve palsies are atypical symptoms of intracranial hypertension in this patient population. ⋯ Cranial nerve palsies may be presenting symptoms of intracranial hypertension in patients with craniosynostosis. Multidisciplinary evaluation and treatment is paramount for appropriate management.
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Case Reports
The use of a novel heads-up display (HUD) to view intra-operative X-rays during a one level cervical arthroplasty.
In a standard surgical operating room, advanced imaging is projected on a separate monitor screen away from the surgical field of view. This setup requires surgeons to repeatedly shift their attention between the operative field and a screen. Such movement may result in a disruption of focus that can extend surgical time, cause physical strain, and lead to surgical errors. A potential solution to this inefficiency in the surgical workflow is to use a heads-up display (HUD) to mirror what is being displayed. A HUD projects preoperative or intraoperative imaging over the surgical field, allowing surgeons to visualize both as they perform surgery. ⋯ Following surgery, the patient experienced resolution of his preoperative right arm and hand paresthesia and regained full strength. This case describes the novel use of the Moverio BT-35E Smart Glasses (Epson Inc, Suwa, Japan) HUD during a spine procedure.
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Case Reports
Nasal Packing Causing Occlusion of Contralateral ICA during Control of Pseudoaneurysm Bleed.
Carotid pseudoaneurysm is a rare complication of pituitary surgery and can present with epistaxis. Nasal packing is considered first-line treatment for the control of carotid bleeding. We describe a case of complete occlusion of the contralateral cavernous carotid artery because of nasal packing placed to control hemorrhage from a cavernous carotid pseudoaneurysm. ⋯ To our knowledge, this is the only report that describes complete occlusion of the contralateral cavernous carotid artery because of extrinsic compression of the lateral sphenoid wall, in the setting of a symptomatic pseudoaneurysm.