World Neurosurg
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Embolic protection devices are commonly used to prevent cerebral embolism during carotid artery stenting (CAS). However, the PercuSurge Guardwire device, a distal balloon protection device, was discontinued in April 2021. We present a case of successful CAS using a new distal balloon protection system. The procedure, referred to as the jailbreak technique, was performed via transradial access. ⋯ The jailbreak technique allows distal balloon protection during transradial CAS. This is a useful treatment option for patients with carotid stenosis.
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Bilateral thalamic gliomas (BTGs) are rare central nervous system tumors, and the outcome is usually dismal. BTG often harbors an EGFR mutation; however, a mutation in H3K27M is rare. We described 5 cases of BTGs harboring concomitant alterations of EGFR and H3K27M and retrospectively analyzed the clinicopathological features and prognosis of this rare entity. ⋯ Concomitant alterations of EGFR and H3K27M might indicate a new subtype of diffuse midline glioma, H3K27M-altered. In addition, EGFR alterations could provide potential molecular therapeutic strategies to improve the dismal prognosis of BTGs. Due to the rarity of these tumors, more cases must be collected to study the pathogenesis, treatment, and clinical outcomes of BTGs with double alteration phenotypes.
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Transcranial removal of the anterior clinoid process (ACP) provides access to the clinoidal segment of the internal carotid artery as well as superolateral decompression of the optic canal. Endoscopic endonasal approaches (EEAs) can access the entire medial and inferior portions of the optic canal, but no data exist to support what proportion of the anterior clinoid could be safely resected via an EEA. ⋯ Using the safe route above the optic canal, removal of 21% of the ACP can be achieved via EEA. Although substantially more of the ACP can be drilled by accessing the optic strut, the benefits of pursuing additional removal must be weighed against the significant risks of drilling in this narrow corridor bordered by the internal carotid artery, the third cranial nerve, and the optic nerve.
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Recurrent symptomatic tethered cord (RTC) is a long-term complication of spinal cord lipomas, responsible for progressive motor deficits, urologic dysfunction, and aggravation of spinal deformities. We retrospectively analyzed all cases of recurrent tethering after spinal cord lipoma surgery, the clinical and radiologic features that led to the diagnosis, the surgical management, and the neuro-orthopedic outcome at the last follow-up. ⋯ When RTC is confirmed, the child should be referred to surgery as soon as possible, because we show that the postoperative clinical outcome improved and surgery did not worsen patients' condition. Follow-up should be as long as possible for these patients.