World Neurosurg
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Actinomycosis of the central nervous system is extremely rare. A 73-year-old woman with a history of abdominal actinomycosis presented with sudden-onset headache. Magnetic resonance imaging demonstrated a nodular lesion at the left precentral gyrus. ⋯ High-resolution vessel wall imaging revealed circumferential wall enhancement of the aneurysm and multifocal enhancement of the M3 and M4 segments of both middle cerebral arteries. The patient had received a 4-week course of antibiotics, but follow-up angiography demonstrated no shrinkage or resolution of the aneurysm. Trapping combined with revascularization was successfully performed for refractory mycotic aneurysms.
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A 79-year-old man with coronary artery disease and tremor-predominant Parkinson's disease underwent a gross total resection of a high-grade glioma and exhibited what appeared to be polymorphic ventricular tachycardia lasting 15-20 seconds on postoperative day 1. Further evaluation revealed that the patient did not have ventricular tachycardia, and that his abnormal telemetry signals were instead an artifact of his Parkinson's tremor. This case underscores the importance of considering tremor artifact when evaluating abnormal telemetry and electrocardiogram signals in patients with tremor, and highlights some features that can distinguish tremor artifact from a true arrhythmia.
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Giant pituitary adenomas are considered a surgical challenge. Their invasiveness, irregular growth, and extensions make this surgery critical. Because of this reason, the radical resection rate is low in such pathology. ⋯ He had no hypopituitarism and diabetes insipidus after the surgery. Cerebrospinal fluid leak was not observed. Unfortunately, oculomotor palsy did not improve after surgery (Video 1).
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This case video demonstrates a multidisciplinary approach to resection of a juvenile nasopharyngeal angiofibroma highlighting direct intratumoral onyx embolization. The patient is a 14-year-old boy who presented with a 1-month history of worsening epistaxis and nasal congestion. Preoperative magnetic resonance imaging demonstrated a 4.5 x 3 x 3 cm lobulated mass in the right pterygomaxillary space, sphenoid, and the nasopharynx adjacent to the cavernous carotid. ⋯ The present video demonstrates the technique for safe direct intratumoral onyx embolization and its role in significantly reducing intraoperative blood loss (Video 1). Postoperatively, the patient made an uncomplicated recovery. The patient consented to the procedure.