World Neurosurg
-
To assess the impact of tumor extension into the occipital condyle (OC) in lower clival chordoma management and the need for occipito-cervical fusion (OCF). ⋯ In the absence of mobility-related neck pain, patients with lower clival chordoma and intact OC ≥ 60%, intact apical ligament, and intact tectorial membrane, may not require OCF.
-
To identify high-risk patients for delayed postoperative hyponatremia (DPH) early, we constructed a simple and effective scoring system. ⋯ This scoring system for predicting DPH has an area under the receiver operating characteristic curve of 0.856 (95% CI, 0.787-0.925), indicating moderate to good predictive value for DPH in our cohort, but further prospective external validation is needed.
-
Complex intracranial aneurysms (CIAs) comprise a subset of lesions with defiant vascular architecture, difficult access, and prior treatment. Surgical management of CIAs is often challenging and demands an assessment on a case-by-case basis. The generational evolution of bypass surgery has offered a long-standing potential for effective cerebral revascularization. Herein, we aim to illustrate a single-center experience treating CIAs. ⋯ CIAs represent a spectrum of defiant vascular lesions with a poor natural history. Bypass surgery offers the potential for definitive treatment. Our case series illustrated the predominant role of cerebral revascularization of CIAs with a critical case-by-case approach to provide optimal outcomes in a limited-resource setting.
-
Case Reports
Retrosigmoid Craniectomy for Clip Ligation of Flow-Diverted Posterior Inferior Cerebellar Artery Aneurysm.
Flow diversion (FD) has revolutionized the treatment of cerebral aneurysms. Since the introduction of the Pipeline Embolization Device, there has been a significant shift in the management of cerebral aneurysms, with increasing emphasis being placed on use of endoluminal reconstruction as a means of long-term, durable treatment of aneurysms. Increasingly, FD stents are being used as primary treatment for aneurysms, including those that present with subarachnoid hemorrhage.1 Improper use of FD stents, however, may create havoc, as access to the aneurysm sac is blocked with the placement of these devices. ⋯ Although deconstructive techniques can be used for treatment of failed aneurysm occlusion with flow diversion, where possible, surgical clipping can result in the simplest, most durable solution. Herein we present (Video 1) a case of a patient with a posterior inferior cerebellar artery aneurysm treated previously with FD using a single pipeline embolization device without aneurysm occlusion over 1 year of follow-up who was treated with retrosigmoid craniotomy and clipping of aneurysm. Nuances of the approach selection, clipping of the aneurysm, and preservation of the stent are discussed.
-
Vertebral artery (VA) injury poses a significant risk in cervical spine surgery, necessitating accurate preoperative assessment. This study aims to introduce and validate a novel approach that combines the Fast field echo that resembles a computed tomography using restricted echo spacing (FRACTURE) sequence with Time of Flight (TOF) Magnetic Resonance Angiography (MRA) for comprehensive evaluation of VA courses in the cervical spine. ⋯ The integration of the FRACTURE sequence and TOF MRA presents a promising methodology for the precise evaluation of VA courses in the cervical spine. This approach improves preoperative planning for cervical spine surgery with detailed anatomy and is a valuable alternative to conventional methods without contrast agents.