World Neurosurg
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Case Reports
Iatrogenic Removal of the Intima in the Middle Cerebral Artery by a Stent Retriever: A Report of Two Cases.
Mechanical thrombectomy improves functional outcomes in patients with acute ischemic stroke. However, stent retrievers have the risk of vascular damage. ⋯ Full deployment of a relatively large-sized stent into a vulnerable vessel may cause vessel dissection after removal of the intima. Appropriate material selection and treatment strategy while considering stroke etiology and the occlusion site are important to prevent vessel damage.
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To determine the amount of screws needed to achieve an adequate skill level for pedicle screw placement (PSP) via the freehand technique in the nondeformed thoracolumbar spine using the cumulative summation test for learning curve (LC-CUSUM) analysis. ⋯ In this study, the learning curve analysis demonstrated that a substantial learning period may be necessary before an adequate level of performance is achieved for freehand PSP in the nondeformed thoracolumbar spine.
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Case Reports
Endoscopic Transnasal Transclival Approach to a Pontine Cavernoma with Associated Developmental Venous Anomaly.
Brainstem cavernous malformations represent around 8%-22% of all intracranial cavernous malformations but exhibit a higher annual incidence of hemorrhage (2%-3%) compared with other cavernous angiomas and tend to be more symptomatic given their proximity to critical nuclei and fiber tracts. Recently, endoscopic endonasal techniques have been used for the removal of ventral skull base lesions, with significant improvement in operative morbidity and mortality compared with open approaches. Here we demonstrate the utility and feasibility of the endoscopic transclival approach for ventrally located pontine cavernomas in carefully selected patients. ⋯ This approach provided direct visualization of the lesion and the associated DVA allowing for a gross total resection without injury to the DVA. The transclival approach may be considered as an alternative to open lateral and dorsolateral neurosurgical approaches for ventral brainstem cavernomas in carefully selected patients.
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Known facts are that a long period of central catheterization or hemodialysis causes central venous occlusion or stenosis and its further development brings about superior vena cava syndrome. Major symptoms of superior vena cava syndrome include venous congestion caused by the occlusion or stenosis of the central vein in the sites of the head, face, neck, and upper extremity. Clinical manifestations of superior vena cava syndrome are less likely to cause intracranial hypertension, and intracranial venous hypertension does not appear to be a clinical symptom of cavernous sinus-dural arteriovenous fistula. ⋯ In our case, the clinical manifestations of superior vena cava syndrome seemed to be cavernous sinus-dural arteriovenous fistula and symptoms disappeared when resolving central vein stenosis. We report a case of superior vena cava syndrome with atypical clinical features.
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Neurologic deterioration is the primary distinctive complication after revascularization surgery in patients with moyamoya disease (MMD). The present study investigated the risk factors for neurologic deterioration after combined direct and indirect revascularization in patients with MMD. ⋯ Preoperative multiple symptom episodes and one-staged bilateral revascularization are risk factors associated with postoperative neurologic deterioration in patients with MMD. Therefore, 2 unilateral revascularization procedures performed successively rather than one-staged bilateral revascularization procedures should be performed in patients with bilateral MMD.