Neurosurgery
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Comparative Study
Treatment of distal posterior cerebral artery aneurysms: a critical appraisal of the occipital artery-to-posterior cerebral artery bypass.
This is the largest contemporary series of distal posterior cerebral artery (PCA) aneurysms treated by use of endovascular coiling and stenting as well as surgical clipping, clip wrapping, and bypass techniques. We propose a new treatment paradigm. ⋯ Bypass techniques for the treatment of distal PCA aneurysms are associated with a higher rate of complications than once thought. In our new treatment paradigm, bypass is a last resort and reserved for patients in whom balloon-test occlusion fails, who refuse parent-vessel sacrifice, and who cannot undergo primary stenting with coiling or clip wrapping.
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Case Reports
Anaplastic meningioma arising from a radiologically diagnosed arachnoid cyst: case report.
We report the first example of an anaplastic meningioma arising from an intracranial arachnoid cyst and discuss the diagnostic challenges of this case, including the useful role of genetic markers. ⋯ Malignant transformation of meningothelial elements in arachnoid cysts is an exceptionally rare complication that poses considerable diagnostic challenges. Genetic markers may be particularly helpful in such cases.
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We report on vascular compression syndrome of the 12th cranial nerve (hypoglossal), an occurrence not previously reported, and demonstrate, through corresponding objective electrophysiological evidence, that microvascular decompression of the hypoglossal nerve root can cure hemilingual spasm. ⋯ Hemilingual spasm may be caused by vascular contact/compression along cranial nerve XII at the lower brainstem and belong to the same family of cranial nerve hyperactivity disorders as hemifacial spasm.
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The purpose of Clinical Problem Solving articles is to present management challenges to give practicing neurosurgeons insight into how field leaders address these dilemmas. This illustration is accompanied by a brief review of the literature on the topic. ⋯ Both open and endoscopic options remain viable for excision of a colloid cyst. Each has associated potential complications, as illustrated by the current case.
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Recurrent laryngeal nerve palsy (RLNP) occurs as a complication during anterior cervical spine surgery. In 2005 the authors demonstrated the high incidence of asymptomatic RLNP in a right-sided approach. ⋯ The left-sided approach in anterior cervical spine surgery reduces the incidence of postoperative and permanent RLNP significantly. Endotracheal cuff pressure reduction used additionally decreases the rate of RLNP even more. These results indicate that anterior cervical spine surgery should be performed with a left-sided approach and, if possible, with an additional reduction of the endotracheal cuff pressure while the retractors are inserted.