Neurosurgery
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Case Reports
Bilateral ethmoidal dural arteriovenous fistulae: a previously unreported entity: case report.
Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. Reported hemorrhage rates have ranged from 62 to 91%, and an aggressive clinical course is more likely than a benign clinical course. We describe the first case of a patient with bilateral ethmoidal dural AVFs. ⋯ Anterior ethmoidal dural AVFs may occur bilaterally. Given their complex angiographic appearance, their presence bilaterally may not be readily apparent on preoperative angiography. Intraoperative angiography is crucial to identify a contralateral fistula and to verify that ligation has been curative.
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This is the second report of a Citrobacter-associated brain abscess in an adult and the first report of its association with an intradural tumor. Excluding those associated with trauma, neurosurgical procedures, and proximity to the skull base, only seven other cases of abscesses associated with intracranial tumors have been published. Five of seven tumor-associated abscesses with a microbiological diagnosis involved gram-negative bacteria, a finding that may indicate a predilection of these microorganisms for intracranial tumors. ⋯ The characteristic endothelial invasiveness of Citrobacter and related gram-negative bacteria may predispose to the formation of abscesses in association with intracranial tumors.
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Comparative Study
Anterolateral approach to the V2 segment of the vertebral artery.
We describe our surgical technique of exposure and control of the second segment of the vertebral artery (VA V2 segment). Our basic principle is that working in the VA vicinity is more confident under visual control. ⋯ Exposure and control of the VA V2 segment is safe if anatomy and variations are perfectly known, and if a rigorous step-by-step surgical technique is followed.
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Basilar artery occlusion is a clinical event with an exceedingly high mortality rate. Improved survival is closely associated with successful recanalization of the occluded basilar artery. Bilateral vertebral artery occlusion (BVAO) is a unique disease entity that effectively denies any direct access to the basilar artery for endovascular rescue therapy. We report a case of successful intra-arterial basilar artery thrombolysis in a patient with BVAO. ⋯ Knowledge of potential collateral pathways is important when direct access to the main intracranial vessels is not available. Basilar artery thrombolysis through collateral vessels is clinically effective when a direct approach to the artery is not feasible.
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Comparative Study Clinical Trial
Endoscopic surgery for intraventricular brain tumors in patients without hydrocephalus.
Endoscopy usually is avoided in patients without hydrocephalus because of presumed difficulties with ventricular cannulation and intraventricular navigation. The feasibility of endoscopic tumor management in patients without hydrocephalus was assessed on the basis of achieving the surgical objective and assessing procedure-related morbidity. ⋯ Endoscopic biopsy or resection of intraventricular brain tumors in patients without hydrocephalus is feasible. The described procedure uniformly satisfied the intended surgical goal. The absence of ventriculomegaly in patients with an intraventricular brain tumor should not serve as a contraindication to endoscopic tumor biopsy or resection.