World Neurosurg
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Middle Cerebral Artery Bifurcation Aneurysm (MbifA) is associated with a high risk of rupture and poor overall prognosis in patients once it ruptures. Morphological, geometric, and hemodynamic parameters have been identified as factors contributing to the rupture of intracranial aneurysms. However, there are no studies that combine these 3 types of parameters to specifically target MbifA rupture. ⋯ Height, AR, DNR, EI, UI, NSI, WSS, and NWSS may be correlated with MbifA rupture, but only NWSS was an independent risk factor. A lower NWSS was associated with a higher risk of MbifA rupture. No significant differences were observed in the angle parameters, including the Inflow Angle, between ruptured and unruptured MbifAs. OSI was significantly increased at the dome of the aneurysm but the mean OSI was not found to be associated with MbifA rupture.
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This study aimed to examine the mechanism of occipital condyle fractures (OCFs), their clinical symptoms, computer tomography (CT) scan findings, treatment options, and classification. ⋯ OCFs are predominantly present in cases of high-energy trauma, with high-resolution thin-layer CT scans serving as the preferred diagnostic method. The application of the modified Anderson-Montesano classification, distinguishing between stable and unstable fractures, facilitates the determination of suitable treatment strategies. Stable OCFs can be managed using a rigid neck brace, while unstable OCFs may require Halo-vest frame fixation or surgical intervention.
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Foix-Alajouanine syndrome is a rare cause of spinal dural arteriovenous fistula that can cause irreversible myelopathy and paraplegia if not treated promptly. The complex nature of this pathology often leads to missed or delayed diagnosis regardless of broad workups executed. ⋯ Even with endovascular intervention, our patient was unable to recover neurologically. Including appropriate spinal imaging early in the workup for Foix-Alajouanine syndrome is necessary to halt or treat this disease process.
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Case Reports
Microsurgical Resection of a Pineal Cyst via a Paramedian Supracerebellar Infratentorial Approach.
Pineal cysts are typically detected in around 1.3% to 4.3% of patients during routine magnetic resonance imaging (MRI) scans.1,2 The vast majority of pineal cysts are benign, asymptomatic, and typically do not necessitate surgical intervention. Large pineal cysts are known to cause hydrocephalus with its associated symptoms and thus can require in rare cases surgical resection. Even in the absence of hydrocephalus, selected patients with large pineal cysts causing headaches and visual disturbances can find relief after surgical resection.3,4 The supracerebellar infratentorial (SCIT) approach is widely used and represents an extraparenchymatous approach through a natural corridor to the pineal region.5 Performing this approach in a semisitting position allows for an optimal retraction of the cerebellum by gravity. ⋯ A subsequent MRI revealed enlargement of the pineal cyst, leading to the indication for surgical resection. The surgery was performed mainly under the operating microscope with endoscopic visualization in suitable situations as our small approach restricts bimanual dissection with an endoscope. In our experience, this approach provides a versatile and minimally invasive access to the pineal region, making it optimally suitable for pineal cysts requiring surgical resection.
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Gliomas adjacent to the corticospinal tract (CST) should be carefully resected to preserve motor function while achieving maximal surgical resection. Modern high-field intraoperative magnetic resonance imaging (iMRI) enables precise visualization of the residual tumor and intraoperative tractography. We prospectively evaluated the extent of resection and distance between the tumor resection cavity and CST using 3-T iMRI combined with motor evoked potentials (MEP) in glioma surgery. ⋯ Resection of gliomas adjacent to CST with a navigation system using 3-T iMRI could result in an ultimate EOR >98%. The combination of intraoperative tractography and MEP contributes to maximal removal of motor-eloquent gliomas.