World Neurosurg
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Metastatic glioblastoma to the vertebral spine is rarely encountered. The decision to intervene surgically must consider the poor prognosis in these patients. ⋯ She initially underwent vertebroplasty with symptomatic improvement, but the progression of disease precluded further surgical interventions, and the patient was referred for chemotherapy and radiotherapy. The case illustrates that the choice of treatment modality varies throughout the time course of the disease-patients with spinal instability or few solitary metastases may benefit from intervention, but as the disease burden increases, palliative radiotherapy and chemotherapy may offer greater benefit.
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Posterior inferior cerebellar artery (PICA) aneurysms are usually complex to treat because of their deep location, frequent entanglement with the lower cranial nerves, the presence of perforating arteries to the brainstem, and their often dissecting or fusiform morphology.1 These aneurysms can require revascularization of the PICA.2 The length and size of the occipital artery (OA) make it an excellent donor.3,4 Video 1 shows the technical nuances of an OA-PICA bypass for the treatment of a ruptured fusiform aneurysm of the left PICA. The patient is a 34-year-old male presenting with an abrupt headache and confusion (Hunt and Hess grade III and World Federation Neurology Surgeons grade II). Computed tomography of the brain revealed hydrocephalus and subarachnoid hemorrhage (Fisher IV) and digital subtraction angiography revealed a fusiform aneurysm on the tonsillomedullary segment of the left PICA. ⋯ The patient remained neurologically intact, and imaging showed good flow through the bypass and no evidence of stroke. OA-PICA bypass is a useful strategy to treat ruptured fusiform PICA aneurysms since it avoids sacrificing the PICA and the use of dual-antiplatelet therapy. This video is one of the few videos published on OA-PICA bypass.6,7 It explains the technical aspects, open and endovascular alternatives, and rationale for this procedure.
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Recently many different endoscopic techniques have been used in spontaneous intracerebral hemorrhage evacuation. However, most of these techniques require expensive special equipment or a well-coordinated assistant. We present a simple and effective binding technique for endoscopic hemorrhage evacuation, which is especially useful during emergency treatment and suitable for use in less-developed areas. ⋯ The binding technique is a modification that allows a single surgeon to achieve easy and accurate hemostasis in endoscopic surgery of intracerebral hematomas. This technique is easy to learn and suitable for emergency surgery, especially in less developed areas.
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Case Reports
Occipital interhemispheric transtentorial approach for a pineal region meningioma with pseudobulbar palsy.
Meningiomas represent 8%-10% of all pineal region (PR) tumors. When they arise from the falx, tentorium, or tentorial incisura, they are not always considered a true PR tumor, as they do not originate from it but instead only grow toward the region. The true meningioma of PR must be originated from the arachnoid envelope of the pineal gland or from the 2 leaflets of the velum interpositum. ⋯ Careful management of the deep veins is mandatory during the resection of PR meningiomas. The venous system improvement after the surgery may be associated with the dramatic recovery seen in this unique case. The patient consented to publication of her images.
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We sought to elucidate the long-term surgical outcomes and incidence of recurrence and reoperation of endoscopic endonasal cyst fenestration for Rathke cleft cyst (RCC). ⋯ Patients with a symptomatic RCC can be effectively treated with endoscopic endonasal cyst fenestration. Reversal of the presenting symptoms resulted, including headache, visual dysfunction, and pituitary hormone dysfunction, in the majority of patients. In our series, appropriate reconstruction of the sellar floor reduced the risk of postoperative cerebrospinal fluid leakage without impacting cyst regrowth. This simple technique appears to effectively disrupt cyst progression in most cases, even after a relatively long-term follow-up period.