World Neurosurg
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A 3-month-old first of dizygotic male twins, born at 34 + 5 weeks gestational age, presented with a 4-week history of increasing head circumference and vomiting. He had a tense anterior fontanelle and a head circumference above the 97th percentile. Magnetic resonance imaging showed large bilateral subdural collection with hemosiderin deposits suggestive of hemorrhage. ⋯ Benign enlargement of subarachnoid space has an assumed autosomal/multifactorial inheritance and predisposes to subdural hemorrhage. Ultimately, no safeguarding issues were raised. Both twins continued to be neurologically stable at 2-year follow-up with head circumferences between the 98th and 99th percentiles.
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Dural arteriovenous fistulas draining into an isolated sinus often require a multimodal treatment, with transarterial and transvenous approaches.1-6 However, there is no consensus about the injection technique. Some authors suggest filling the sinus with coils in order to have a compact cast without unnecessary migration of the embolic material. We present a case of a patient with left temporal hemorrhage caused by a dural arteriovenous fistula on the isolated left transverse sinus. In this operative video we demonstrate how the arterial flow control during treatment allows us to obtain a compact cast of the embolic material inside the isolated sinus without coils (Video 1).
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Vestibular schwannoma is the third most common benign intracranial tumor that can occur sporadically or be associated with neurofibromatosis type 2 (neurofibromatosis type 2 vestibular schwannoma [NF2-VS]). The aim of this study is to provide a comprehensive bioinformatic analysis of methylated-differentially expressed genes (MDEGs) in NF2-VS. ⋯ Analysis of MDEGs may enrich the understanding of the molecular mechanisms of NF2-VS pathogenesis and lay the groundwork for potential biomarkers and therapeutic targets for NF2-VS.
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Intramedullary tumors of the spinal cord account for 2%-4% of all central nervous system tumors. Surgical resection with intraoperative neuromonitoring, although challenging, remains the mainstay of treatment with the goal to prevent neurologic decline. We present a case of an unusual anaplastic glioma of the thoracic spinal cord in a 42-year-old male that spanned 7 vertebral levels and could not be definitively characterized using the 2021 World Health Organization Classification of Central Nervous System Tumors.
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Vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm is challenging owing to its variable anatomy and interference of lower cranial nerves. A recurrent ruptured VA-PICA aneurysm was successfully treated by occipital (OA)-PICA bypass with aneurysm trapping (Video 1). Informed consent was obtained from the patient. ⋯ Occlusion of the aneurysm was achieved by placing permanent clips on the VA proximal and distal to the aneurysm and the PICA next to the aneurysm sac without occluding the perforator. The postoperative course was uneventful with bypass patency. We believe this case demonstrates the surgical tenet of OA-PICA bypass for VA-PICA aneurysm.