World Neurosurg
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Case Reports
AN EPIDERMOID CYST EXTENDING ALONG TRIGEMINAL NERVE PATHWAY WITH UNUSUAL IMGAGING FINDINGS.
Epidermoid cysts (ECs) are benign extraaxial tumors. They frequently occur at the cerebellopontine angle and parasellar regions. However, they rarely occur in the Meckel's cave. ⋯ Preoperative suspicion was trigeminal schwannoma with unusual radiologic features. Finally, the pathologic diagnosis was epidermoid cyst. Therefore to establish a proper preoperative diagnosis, one should be aware that ECs can occur in Meckel's cave and with unusual radiologic features, as occurred in the case described earlier.
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Shunt overdrainage is a potential complication in pediatric hydrocephalus. The addition of adjustable gravitational units to previous shunt systems has been proposed as effective management for this problem. These devices have been traditionally implanted over the occipital bone. We propose chest implantation as an easier, safer, and more stable alternative in the pediatric population, especially in those cases with parieto-occipital shunts. ⋯ In our experience, chest implantation for adjustable gravitational devices was a suitable shunt modification in pediatric patients suffering from overdrainage.
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Case Reports
Microsurgical Treatment of a Complex Cognard V Tentorial Dural Fistula with Superior Cerebellar Artery Supply.
This case video demonstrates a microsurgical technique for the clipping and obliteration of a Cognard V tentorial dural fistula (Video 1). The patient was a 49-year-old male who presented with progressive upper and lower extremity weakness over 12 months, with associated cervical spinal cord edema. The patient was initially misdiagnosed with transverse myelitis; however, abnormal flow voids on magnetic resonance imaging led to a cerebral angiogram being performed. ⋯ In addition, this case is unique in providing a surgical visualization of the meningeal superior cerebellar artery feeder contributing to this fistula, namely the artery of Wollschlaeger & Wollschlaeger. Postoperatively, the patient demonstrated significant improvement in upper and lower extremity strength, indicative of a successful recovery. The patient was discharged to rehabilitation, with continued motor improvement.
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Miyazaki syndrome is overshunting-associated myelopathy, which is a rare complication of ventriculoperitoneal shunt. We present the first case of Miyazaki syndrome caused by cystoperitoneal (CP) shunt for an arachnoid cyst (AC) in this report. ⋯ When patients with a history of any kind of shunt surgery develop myelopathy, Miyazaki syndrome should be suspected and, for early diagnosis, cervical and/or contrast-enhanced magnetic resonance imaging should be performed.
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Perioperative craniotomy practices depend mainly on neurosurgeon preferences. To investigate the variations in these preferences, we surveyed neurosurgeons in Poland regarding different aspects of their practices. ⋯ Perioperative craniotomy practices among Polish neurosurgeons show a significant heterogeneity. Economic factors can explain some choices, but others trace to a conservative mindset. Further studies are needed to identify which factors are most relevant and to identify approaches to a standardized method of care.