World Neurosurg
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Neuroendoscopy is increasingly being used in the management of intraventricular brain tumors. The role of endoscopy in diagnostic biopsy is well established. Expansion of these techniques may allow for definitive resection of intraventricular tumors. We report the feasibility and outcomes of endoscopic resection of select intraventricular tumors in children. ⋯ Neuroendoscopic gross-total resection of solid intraventricular tumors is a safe and efficacious procedure in carefully selected pediatric patients.
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Sellar/suprasellar cystic lesions can cause compression of the optic pathways and result in a decline in vision. There have been reports of optic pathways being fenestrated by intracranial aneurysms. This is the first report of a sellar/suprasellar arachnoid cyst causing fenestration of an optic nerve. ⋯ Sellar/suprasellar arachnoid cysts likely form when a communication exists between the suprasellar arachnoid space and the sella turcica. We believe that our patient's cyst grew slowly enough to allow normal functioning of the optic nerve as it was being penetrated. Though visual symptoms may be gradual and not present until after the optic nerve has been penetrated, these symptoms and signs may still improve with removal of the cyst. Prognosis for visual improvement is difficult to predict with cases of compressive sellar/suprasellar cystic masses. Improvement in the vision examination after surgical resection is possible even when the optic nerve has been penetrated.
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Surgical access to the third ventricle is challenging, given the depth of the operative field and close proximity of vital neural structures that must be traversed. For anterior third ventricular lesions, approach options include anterior transcallosal or transcortical, subfrontal, frontotemporal, or endonasal. The subcallosal approach, a translamina terminalis approach, is unique in that the surgical corridor is just below the corpus callosum, minimizes retraction and preserves corpus callosum integrity. Case examples are provided, and an anatomical study delineating the dimensions of the surgical corridor is performed. ⋯ The anterior subcallosal approach is a safe approach for lesions of the third ventricle that avoids splitting the corpus callosum and resecting unnecessary brain and minimizes brain retraction. This corridor is superior to the traditional subfrontal approach in terms of working space and compares favorably to the anterior transcallosal approach without disrupting the corpus callosum.
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Sox17 has emerged as an important factor in vascular remodeling because of the potential linkage with Wnt/β-catenin, Notch, and the inflammatory pathway. Brain arteriovenous malformation (BAVM), as an angiogenic and inflammatory disorder, might possess an aberrant regulation of the Sox17 associated pathway. We sought to investigate the expression of the Sox17 associated pathway in BAVMs. ⋯ The Sox17 associated pathway was activated in the BAVM nidus. Our results indicate that arterial identity is gained in thick-walled veins; this might reflect the process of arterialization of the veins as a result of hemodynamic stress. In addition, high expression of the Sox17 associated pathway in medium and small arteries indicates that BAVM vessels are intrinsically active.