Neurosurgery
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Case Reports
A von Hippel-Lindau disease-associated microcystic adenoma of the ethmoid sinus: case report.
We present a unique case of an anterior cranial base von Hippel-Lindau disease (VHL)-associated microcystic neoplasm. To determine the lesion's relationship with VHL and its appropriate management, we discuss its salient clinical, pathological, and molecular features. ⋯ Because primary VHL-associated microcystic tumors in the anterior cranial base have not been described previously, the natural history of these tumors remains unclear. Based on the benign features of these lesions, they can be managed conservatively with close observation and surgical intervention reserved for those that produce symptoms.
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We describe an unusual presentation of a ruptured aneurysm of the posterior communicating artery with an acute intracranial hematoma between the dural layers associated with an acute spinal epidural hematoma descending to L1. ⋯ Ruptured aneurysm of the posterior communicating artery may cause cranial acute interdural hematoma with a typical subarachnoid hemorrhage clinical presentation, and it rarely can extend to spinal epidural space.
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Neuromodulation strategies have been proposed to treat a variety of neurological disorders, including medication-resistant epilepsy. Electrical stimulation of both central and peripheral nervous systems has emerged as a possible alternative for patients who are not deemed to be good candidates for resective procedures. ⋯ In addition to electrical stimulation, novel therapeutic methods that may open new horizons in the management of epilepsy include transcranial magnetic stimulation, focal drug delivery, cellular transplantation, and gene therapy. We review the current strategies and future applications of neuromodulation in epilepsy.
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Aneurysmal subarachnoid hemorrhage is a serious condition with a high morbidity and mortality rate despite advances in neurocritical care. Intraparenchymal monitors providing continuous bedside physiological data have been introduced into the care of the neurocritically ill and are the focus of clinical research. We review the available technology for bedside brain monitoring and the knowledge that has been gathered and its clinical utility by organizing it into 3 main areas: detecting vasospasm early, establishing end points to resuscitation in the management of cerebral vasospasm, and developing insights into the pathophysiology of the disease. Finally, we discuss its implications for the field and future directions.
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Clip application for temporary occlusion is not always practical or feasible. Adenosine is an alternative that provides brief periods of flow arrest that can be used to advantage in aneurysm surgery, but little has been published on its utility for this indication. ⋯ Adenosine appears to allow safe flow arrest during intracranial aneurysm surgery. This can enhance the feasibility and safety of clipping in select circumstances.