World Neurosurg
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Case Reports
Failure of flow diverter endothelization visualized with optic coherent tomography technology.
We report a case of an intracranial aneurysm of the left posterior inferior cerebellar artery, which was treated with a flow-diverting stent. One year later at follow-up, the patient presented with new symptoms due to mass effect in the posterior fossa and a 3-fold enlargement of the aneurysm. Digital subtraction angiography showed an increase in size of the aneurysm with jet flow into the sac. ⋯ Parent vessel sacrifice was performed by coiling of the left vertebral artery. The patient had a codominant right vertebral artery and tolerated the procedure well. Two years later, follow-up magnetic resonance angiography showed significant decrease of the size of the aneurysm and symptom regression, with a modified Rankin scale of 1 (functionally independent).
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To identify the best protective interventions against shunt infection and, hence, to find an appropriate protocol assumed to be associated with reduction of infection rates. ⋯ Shunt infection is a significant complication that occurs early during the first 2 months after surgery. According to the study findings, an appropriate protocol against shunt infection is assumed to be composed of double-gloving, device and wound irrigation using vancomycin solution, and the use of incision adhesive drapes. Reduced operative time had a beneficial effect against shunt infection, although it was of marginal significance in the current study.
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The Tubridge flow diverter (FD) (MicroPort Medical Co. Ltd., Shanghai, China) is a novel device aimed at reconstructing the parent artery and eliminating the aneurysm. Numerical simulations based on virtual FD deployment allow the assessment of the complex nature of aneurismal flow changes before the actual intervention but are demanding on computational resources. Here, we evaluate an alternative strategy of modeling FD effects for the Tubridge system using a porous medium. The goal of this study is to reduce demands on time and complexity of the simulation procedure for applications in clinical research. ⋯ Using a porous medium approach yields comparable mean values for hemodynamic alterations compared to direct virtual FD simulations. Additionally, the porous medium approach greatly reduced the modeling complexity and computation time.
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Self-shielding gyroscopic radiosurgery (GRS) represents a technical innovation in the field of stereotactic radiosurgery. GRS does not require a radiation vault and is optimized for radiosurgical treatments. Reports on its usage are limited. We describe the first clinical experience of GRS at our institution to assess the application of GRS in the treatment of cranial tumors. Moreover, we perform a dosimetric comparison to robotic radiosurgery (RRS) with vestibular schwannoma (VS) GRS patients. ⋯ This case series provides more evidence on the usage of self-shielding GRS in the management of cranial tumors. Dosimetric comparisons for VS cases revealed mostly equivalent dosimetric characteristics to RRS. Further clinical and physical analyses for GRS are underway.
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To evaluate the reliability and usefulness of cervical flexion/extension magnetic resonance imaging (MRI) as a tool for decision-making regarding treatment of symptomatic cervical spondylosis. ⋯ Flexion/extension MRI studies were useful for assessing patients with cervical degenerative spine disorders regarding the surgical indication, direction of the approach, and use of multilevel instrumentation, especially for patients with early cervical myelopathy.