Neurosurgery
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Case Reports
Twenty-year follow-up of flow reversal and revascularization for a giant serpentine basilar artery aneurysm.
Current microsurgical and endovascular therapies have offered little advancement for the treatment of complex vertebrobasilar aneurysms. The outcome of patients with these rare lesions has remained poor, despite sometimes heroic measures. ⋯ This case demonstrates that good functional outcomes are possible for select complex posterior circulation aneurysms by using flow reversal and revascularization; however, at this time, we are unable to predict for which patients this strategy will be successful.
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Reports of cervical perimedullary arteriovenous shunt (PMAVS) are limited, and treatment strategies have not been established. ⋯ Shunting points of the cervical PMAVS were predominantly located ventral or ventrolateral to the spinal cord and were often fed by the ASA. Even for ventral lesions, posterior exposure assisted with neuromonitoring and endoscopy, and intraoperative angiography provided a view sufficient to understand the relationships between the shunts and the ASA and contributed to good surgical outcomes.
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The role of radiotherapy after surgery for myxopapillary ependymoma (MPE) is unclear. ⋯ Postoperative radiotherapy after resection of MPE was associated with improved PFS and LC.
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Acute intraoperative intraventricular hemorrhage is a feared event in endoscopic neurosurgical procedures. ⋯ The SCIT is a powerful tool that the neuroendoscopist can use for visualization to achieve hemostasis when performing intraventricular endoscopic surgery.
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The maneuver of transmeatal drilling carries the risk of injuring inner ear structures, which may cause immediate or delayed hearing loss. ⋯ Vestibular schwannomas cause significant distortion of the petrous bone anatomy. Detailed preoperative knowledge of the topography is necessary for the preservation of function.