World Neurosurg
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Case Reports
Pediatric giant craniopharyngioma, surgical field soak in diluted nimodipine solution reduces cerebral vasospasm.
Craniopharyngioma is a slow-growing benign tumor, accounting for 5.6%-13% of primary intracranial tumors in children. The present patient showed a huge cyst, and computed tomography scan of the brain revealed a 9.2- × 8.7- × 7.0-cm giant cystic lesion with calcification located in the suprasellar cistern. ⋯ The surgical field was soaked in diluted nimodipine solution for 12 minutes, including the exposed nerve and blood vessel, especially the optic nerve and middle cerebral artery, which led to vasospasm recovery. At 3-month follow-up, there was slight subdural hygroma; contrast magnetic resonance imaging scan did not reveal any residual tumor or recurrence.
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Subdural hematomas (SDHs) are a common and dangerous condition, with potential for a rapid rise in incidence given the aging U.S. population, but the magnitude of this increase is unknown. Our objective was to characterize the number of SDHs and practicing neurosurgeons from 2003-2016 and project these numbers to 2040. ⋯ SDH is expected to increase significantly from 2020-2040, with the majority of this increase being concentrated in elderly patients. While the number of neurosurgeons will also increase, the ability of current neurosurgical resources to properly handle this expected increase in SDH will need to be addressed on a national scale.
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Review Case Reports
Spinal Pleomorphic Xanthoastrocytoma: Case report and literature review.
Pleomorphic xanthoastrocytoma (PXA) is an uncommon central nervous system neoplasm with an overall favorable survival prognosis. Metastatic spread of PXA to the spinal cord and the cauda equina is rare and may have a different clinicopathologic course. Treatment and prognostic outcomes, in this context, are not well defined. We discuss a case of a 30-year-old patient with known cerebral PXA presenting with metastatic spinal anaplastic PXA and present a literature analysis of treatment outcomes.
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Carotid artery stenting (CAS) is an established procedure for the treatment of atherosclerotic disease affecting the extracranial internal carotid artery. Recent population-based studies have suggested that long-term survival after CAS may be limited, thereby questioning its efficacy in a real-world scenario. ⋯ Unlike population-based studies, our results indicate acceptable long-term survival after CAS in adequately selected patients.
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Although carotid artery stenting (CAS) has been widely acknowledged as an effective alternative option for patients at high risk of carotid endarterectomy, embolic stroke is a major complication of CAS. Several reports have emphasized that distal protection filter alone is associated with a high risk of embolic complications of CAS with vulnerable plaque. Thus, relatively complicated protection systems have recently been recommended to prevent distal embolic complications. However, those protection systems require many steps, which, themselves, can also cause complications. The FilterWire EZ embolic protection device (EPD) for use in CAS was approved for national health insurance coverage in Japan in 2010. Since then, we have been using it as an EPD in all CAS procedures, even those with vulnerable plaque. ⋯ The FilterWire EZ as an EPD for CAS is quite safe, even for vulnerable carotid stenosis.