World Neurosurg
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Despite a wide range of surgical procedures, an unresolved debate remains regarding which attempt is optimal for the treatment of colloid cysts in the third ventricle. In this article, we present a new combination of stereotactic and endoscopic techniques. ⋯ The techniques we describe for removal of colloid cysts are safe and effective, even for recurrent cases, and they provide 100% total resection, favorable cognitive outcomes, low risk of recurrence, and low risk of morbidity. The disadvantages of this method are a longer time for surgery and the need for more complex instrumentation compared with conventional endoscopic resection.
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Case Reports
Vasa vasorum and the growing of thrombosed giant aneurysm of the vertebral artery: a case report.
Giant aneurysms arising from the vertebral artery (VA) are often associated with thrombosis and present as mass lesions with slow progression of symptoms and signs. A consensus is still to be established on the underlying growth mechanisms and surgical management of thrombosed giant aneurysms of the VA. ⋯ Another report described the case of a 58-year-old woman harboring a partially thrombosed giant aneurysm of the VA. At the time of resection, a marked development of vasa vasorum on the occluded VA and the neck of the aneurysm was noted. We highlight the need to comprehend vasa vasorum as potential sources for aneurysmal growth.
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There is a relative paucity of long-term follow-up of treatment of brainstem cavernous angiomas. This has led to uncertainty and a lack of consensus regarding optimum therapy, especially radiosurgery. ⋯ Long-term follow-up of patients treated with radiosurgery is important.
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The prognosis of arteriovenous malformations (AVMs) after treatment has been predicted largely by 2 grading scales: the Spetzler-Martin and Pollock-Flickinger. Although there are studies that examine the rate of hemorrhage with the Spetzler-Martin scale, there have not been studies examining hemorrhage in which the Pollock-Flickinger score was used. The annual hemorrhage rate after radiosurgery of Pollock-Flickinger AVM scores >2 is analyzed. ⋯ The annual hemorrhage rate in AVMs with scores >2 treated with radiosurgery was comparable with baseline rupture rates reported for untreated AVMs. With further stratification by hemorrhagic versus nonhemorrhagic presentation, the subsequent annual hemorrhage rates are similar to their respective natural histories. Considering the mortality rate from hemorrhage at 40.08% (95% CI, 35.54%-44.62%), the consequences of radiosurgical treatment of large AVMs is significantly worse than the reported 10%-30% fatality rate from hemorrhage of an untreated AVM. Additionally, the overall mortality rate was 6.24% however the percentage of mortalities from hemorrhage was 97.62%.
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Atypical teratoid/rhabdoid tumors (AT/RTs) are highly malignant neoplasms that rarely occur in adults. Due to the complex histology of AT/RTs, the differential diagnosis of these tumors is quite challenging and increasingly relies on demonstration of characteristic SMARCB1/INI1 inactivation in tumor cells. ⋯ Pathologic diagnoses in the modern era increasingly integrate molecular data for confirmation as well as prognostication. We present a rare case of a tectal AT/RT in an adult patient and report several novel mutations previously unrecognized in this tumor subtype, in addition to canonical SMARCB1/INI1 loss. Further investigation of these novel variants may improve understanding of the pathogenesis underlying AT/RTs.