World Neurosurg
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Review Case Reports
Spontaneous Spinal Subarachnoid Hemorrhage with Development of an Arachnoid Cyst-A Case Report and Review of the Literature.
Spontaneous spinal subarachnoid hemorrhage (SAH) is extremely rare and occurs in <1% of all cases of SAH. To the best of our knowledge, only 1 case of spontaneous spinal SAH with later development of a symptomatic spinal arachnoid cyst (SAC) has been described in the literature to date. The objective of the present study was to report the challenging clinical management of SAC based on a literature review. ⋯ Treatment of secondary SAC is challenging, and surgery of the SAC with or without placement of a shunt is a possible treatment option.
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To assess outcomes and complications of stereotactic radiosurgery treatment for trigeminal schwannoma (TS). ⋯ GKRS provides effective control for most TS. Increased margin doses are associated with tumor expansion, which was a poor prognostic event associated with progression and clinical decline. Based on these results, combined with analysis of available data from other series of TS treated with GKRS, we believe that margin dose between 13 and 14 Gy offers a high probability of tumor control, yet minimizing risk of adverse radiation effects.
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Although stereotactic radiosurgery (SRS) is an effective modality in the treatment of brainstem metastases (BSM), radiation-induced toxicity remains a critical concern. To better understand how severe or life-threatening toxicity is affected by the location of lesions treated in the brainstem, a review of all available studies reporting SRS treatment for BSM was performed. ⋯ Current data suggest that brainstem substructure location does not predict for toxicity and lesion volume within this cohort with median tumor volumes 0.04-2.8 cc does not predict for toxicity.
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Indirect revascularization is simple and safe, but it is not commonly used in adult moyamoya disease owing to its unreliable effect. This prospective study aimed to evaluate the effectiveness of indirect revascularization in treating adult moyamoya disease after refinement of the surgical technique and perioperative care. ⋯ With refinements of surgical techniques and perioperative care, indirect revascularization is more reliable and can be a viable alternative treatment for adult moyamoya disease. In our cohort, outcomes were satisfactory, with mean 38.6-month follow-up.
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Innovative techniques have revolutionized minimally invasive surgeries, which has significant benefits for the patients. Despite the benefits, these advancements require a longer learning curve for an inexperienced surgeon. ⋯ How to stay out of trouble is explained with these surgeries. These techniques will help young surgeons to become proficient and achieve better outcome.