World Neurosurg
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Review Historical Article
The carotid siphon: a historic radiographic sign, not an anatomic classification.
After the term carotid siphon was introduced by Moniz in 1927 to describe the radiographic appearance of the intracranial internal carotid artery (ICA), the concept gained popularity in decades following in both the anatomic and the medical literature. However, as conflicting definitions persist in the delineation of proximal and distal sites, does the term carotid siphon provide the precision needed for current anatomic and clinical studies? ⋯ Tracing the origin and usage of the term carotid siphon during 6 decades in the medical literature shows continued discrepancy rather than consensus. The term carotid siphon is historically relevant but can now be supplanted by definitive ICA classification systems, which continue to evolve in contemporary medical and anatomic communications.
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The concept of human brain reorganization due to slow-growing lesions, including low-grade glioma, has been gradually and generally accepted. However, few cases have been reported in which the reorganization, especially in the topographic pure primary motor cortex, was observed during brain surgery. We report a case of slow-growing oligodendroglioma located in the pure primary motor cortex, as detected by magnetic resonance imaging that could be resected in part thanks to the brain plasticity. In addition, we describe a pitfall of topographic guidance using somatosensory-evoked potential (SEP) monitoring. ⋯ Pure primary motor cortex could be reorganized by its own lesion. In reorganized brain, topographic central sulcus defined based on SEP findings may be an inappropriate guidance to estimate true functional area. In such a condition, intraoperative direct electrical stimulation under awake craniotomy makes it feasible to resect pure primary motor cortex invaded by tumors.
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Acrodysostosis is a rare syndrome characterized by peripheral dysostosis, nasal hypoplasia, and frequently mental retardation. Only two adult cases of acrodysostosis have been reported to have neurological symptoms. ⋯ Special attention should be given to these patients to detect signs of spinal stenosis, as early decompression can lead to neurological recovery.
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Review
The circular sinus: an anatomic study with neurosurgical and neurointerventional applications.
Skull base surgery requires knowledge of the intracranial venous sinuses, which overall have been well studied. However, the intercavernous sinuses and their contribution to the so-called circular sinus have received scant attention. ⋯ A true "circular sinus" (type II) is present in only a few cases; both intercavernous sinuses disconnected are found in most specimens. No intercavernous sinus was found within the free edge of the diaphragma sella, which is typically depicted. These data are useful for invasive and minimally invasive procedures of the parasellar region.
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Review Case Reports
Occlusion of all aortic arch great vessels: acute revascularization to perform endovascular stroke therapy.
We present a case of a patient with a left-sided stroke and occlusion of all aortic arch great vessels who was treated successfully with endovascular intervention followed by delayed cardiothoracic revascularization. ⋯ We report a rare case of occlusion of all aortic arch great vessels. Combined endovascular intervention and surgical revascularization resulted in an excellent durable outcome.