World Neurosurg
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Brain arteriovenous malformations (bAVMs) are uncommon and represent a heterogeneous group of lesions. Although these 2 facts have delayed research on this topic, knowledge about the pathophysiology, diagnosis, and treatment of bAVMs has evolved in recent years. ⋯ The latest investigations have helped in defining some molecular pathways involved in the pathology of bAVM. Although there is still more to learn and discover, describing these pathways will allow the creation of targeted treatments that could improve the prognosis of patients with bAVMs.
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Delayed infection from an implanted device can be challenging to diagnose. Here, we report a case of a 56-year-old male patient with history of congenital hydrocephalus and previous placement of a ventriculoperitoneal (VP) shunt who presented with sepsis without any evidence of shunt infection at follow-up 3 years after his most recent shunt implantation. ⋯ Of note, 2-[18]-fluoro-2-deoxy-D-glucose-positron emission tomography scan revealed hypermetabolism at the distal end of the latest implanted abdominal catheter without any abnormality of migrated cerebral catheters, highlighting the advantageous use of 2-[18]-fluoro-2-deoxy-D-glucose-positron emission tomography to identify the infected catheter when multiple devices are involved. Removal of abdominal catheters confirmed the localized infection, and follow-up was uneventful after shunt replacement.
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The Pipeline Flex Embolization Device with Shield technology (PED-Shield [Medtronic, Dublin, Ireland]) is a third-generation flow diverter. Surface modification of the mesh with phosphorylcholine covalently bound to the metal struts aims to reduce thrombogenicity. In the present study, we report the results from the first U.S. series of patients with intracranial aneurysms treated with the PED-Shield and a comprehensive systematic literature review. ⋯ In our initial periprocedural experience with the PED-Shield for intracranial aneurysm treatment, the device demonstrated an excellent performance and no major complications. Further studies are required to evaluate the long-term follow-up results and the safety of different antiplatelet regimens.
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Radiomics is a powerful tool for automatic extraction of morphological features, but when applied to cerebral aneurysms, it is inferior to established descriptors in classifying rupture status. We sought a strategy to recover neck orientation and parent vessel caliber to enhance Radiomics performance and facilitate its adoption for aneurysm risk stratification. ⋯ Enhanced Radiomics incorporating neck orientation and parent vessel estimate is an efficient operator-independent methodology that offers superior rupture status classification for both sidewall and bifurcation aneurysms and should be considered a strong candidate for larger-scale multicenter and multimodality validation.
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To investigate the efficacy of a lateral mass fusion device combined with a three-dimensional-printed model in treatment of craniovertebral junction abnormalities. ⋯ During 1-year follow-up, neurological function improvement and atlantoaxial joint reduction were satisfactory. The lateral mass fusion device combined with a three-dimensional printed model may be a clinically useful technique.