World Neurosurg
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Review Case Reports
Giant Cavernous Malformation Mimicking an Infiltrative Intracranial Neoplasm in Children - Case Report and Systematic Review of the Literature.
Giant cavernous malformations (GCMs) are rare and poorly characterized neurovascular lesions in adults or children and often misclassified. In this study, we provide a review of pediatric GCM cases to highlight this rare entity as an important differential diagnosis in preoperative assessment. ⋯ GCMs show variable clinical and radiologic features, representing a diagnostic challenge for treating surgeons. Imaging may show various tumorlike features such as cystic or infiltrative patterns with contrast enhancement. The existence of GCM should be considered preoperatively. Gross total resection should be attempted whenever possible, because it correlates with a good recovery and long-term outcomes. Also, a clear definition criteria of when a cerebral cavernous malformation is termed giant should be established.
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Review Case Reports
Left Distal Transradial Approach for the Treatment of a Sacral Extradural Arteriovenous Fistula: Technical Note and Literature Review.
Sacral extradural arteriovenous fistula (SEAVF) is relatively rare, and its etiology is unknown. They are mostly fed by the lateral sacral artery (LSA). For endovascular treatment, both the stability of the guiding catheter and accessibility of the microcatheter to the fistula, distal to the LSA are required for sufficient embolization of the fistulous point. Cannulation of these vessels requires either crossover at the aortic bifurcation or retrograde cannulation using the transfemoral approach. However, atherosclerotic femoral and tortuous aortoiliac vessels can make the procedure technically difficult. Although the right transradial approach (TRA) can reduce this difficulty by straightening the access route, a potential risk remains for cerebral embolism because it passes the aortic arch. Herein, we present a case of successful embolization of a SEAVF using a left distal TRA. ⋯ Left distal TRA could be a useful, safe, and less invasive option for the embolization of SEAVF, especially for patients with high-risk factors for aortogenic embolism or puncture site complications.
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The management of adult spinal deformity (ASD) relies upon retrospective data, but there have been calls for prospective trials to improve the evidentiary base. This study sought to define the state of the spinal deformity clinical trials and highlight trends to guide future research. ⋯ The number of trials has increased significantly over the past 5 years, with the bulk of trials being funded by academic centers and industry and a notably lack by government agencies. Most trials focused on device or procedural investigation. Despite growing interest in ASD clinical trials, there remain many points for improvement in the current evidentiary base.
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Ankylosing spondylitis (AS) and osteoporosis (OP) are both prevalent illnesses in spine surgery, with OP being a possible consequence of AS. However, the mechanism of AS-induced OP (AS-OP) remains unknown, limiting etiologic research and therapy of the illness. To mine targetable medicine for the prevention and treatment of AS-OP, this study analyzes public data sets using bioinformatics to identify genes and biological pathways relevant to AS-OP. ⋯ Carlumab, bermekimab, rilonacept, rilotumumab, and ficlatuzumab were first identified as the potential drugs for the treatment of AS-OP, proving the value of text mining and pathway analysis in drug discovery.
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Cerebellar arteriovenous malformation (AVM) comprises 10%-15% of intracranial AVMs.1 Rupture often leads to devastating brainstem compression, with mortality reported as high as 67%.2 AVM can be a challenging disease, especially when large in size.3 AVMs can be treated by 1 or a combination of treatment modalities, namely embolization, radiosurgery, or microsurgical resection.4,5 Arterial adhesions to tonsilobulbar and telovelonsilar segments of posterior inferior cerebellar artery (PICA) can be a challenge, increasing bleeding and ischemic risk.6 We present a 2-dimensional video case of a tonsillar AVM. The patient, a previously healthy female in her 20s, presented with a chronic headache. She had no medical history. ⋯ A medial suboccipital telovelar approach was chosen to reduce the working distance and afford a wider corridor to expose the suboccipital surface of the cerebellum.7,8 Complete resection of the AVM was achieved with no additional morbidity. Microsurgery in experienced hands offers the best chance of cure for AVMs. In Video 1, we demonstrate the relationships among the tonsila, biventral lobule, vallecula cerebelli, PICA, and cerebellomedullary fissure as an important anatomic landmark in a safe total resection of a tonsillar AVM.