World Neurosurg
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Review Case Reports
Evolution and future of skull base surgery: the paradigm of skull base meningiomas.
Skull base meningiomas represent the paradigm for the evolution of skull base surgery within the past 50 years into a distinct neurosurgical subspecialty. ⋯ A large contemporary series of skull base meningiomas is presented. In addition, the evolution of surgical approaches to skull base meningiomas is reviewed, together with the current issues regarding radiation therapy, management of cavernous sinus tumor, oncologic management of atypical and malignant subtypes, molecular genetics, and future therapeutic options.
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Review Case Reports
Coexistence of extra-axial cavernous malformation and cerebellar developmental venous anomaly in the cerebellopontine angle.
The coexistence of cavernous malformations (CMs) and developmental venous anomalies (DVAs) in the cerebellopontine angle (CPA) is exceedingly rare. To the authors' knowledge, only one case of CPA CM with concurrence of a neighboring DVA has been reported to date. ⋯ CMs should be considered in the differential diagnosis of any extra-axial hemorrhagic mass, especially with a DVA in the proximity. The coexistence of CM and DVA in CPA, although maybe just a coincidence, suggests the possibility of a new subtype of extra-axial CPA CM secondary to a preexisting DVA. A long-term follow-up is justified in discovering the potential mechanism and biology of such uncommon vascular malformations.
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Review
Monitoring techniques for prevention of procedure-related ischemic damage in aneurysm surgery.
To describe the application of intraoperative monitoring techniques during aneurysm surgery and to discuss the advantages and limitations of these techniques in prevention of postoperative neurologic deficits. ⋯ The choice of monitoring modality should be governed by the vessel and by the vascular territory most at risk during the planned procedure with proper awareness of the potential limits related to each technique. Aneurysm surgery monitoring should help to address issues of continuity and provide a morphologic and functional assessment. Although the use of monitoring devices is still not routine in aneurysm surgery and no standards have been established, combining different monitoring techniques is crucial to optimize aneurysm surgery and avoid or minimize complications.
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Iliac crest autograft remains the gold standard for spinal fusion operations. Given risk of donor site morbidity, many centers utilize allograft. We reviewed published series of C1-2 posterolateral instrumented fusions with allograft and autograft. ⋯ This review is limited by the retrospective data and inconsistent methodology of fusion determination used in most studies. Modern instrumentation and proper surgical techniques result in high rates of successful C1-2 arthrodesis. The use of allograft is a treatment option (Class III evidence) during posterior C1-2 instrumentation and fusion operations. Randomized, controlled trials using standardized radiographic assessments are needed across spinal arthrodesis studies to better determine the prevalence of radiographic fusion and establish technique superiority.
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To review retrospectively experience with stent-assisted coiling of ophthalmic segment internal carotid artery (ICA) aneurysms to report outcome data and identify the rate of associated visual complications. ⋯ Stent-assisted embolization of ophthalmic segment ICA aneurysms is technically achievable and in our series did not appear to result in increased visual complications compared with coil embolization alone or surgical treatment.