Neurosurgery
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Flow disruption with the WEB technique has been developed to treat large-neck bifurcation aneurysms. ⋯ CO, complete occlusionNR, neck remnantRA, residual aneurysm.
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Following gamma knife (GK) therapy for intracranial arteriovenous malformations (AVMs), obliteration of the nidus occurs over several years. During this period, complications like rebleeding have been attributed to early draining vein occlusion. ⋯ Shielding of the draining vein is a potent new strategy in minimizing PRI and hemorrhage as well as clinical deterioration following GK therapy for intracranial AVMs.
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Magnetic resonance angiography (MRA) is helpful for preoperatively evaluating the degree of carotid stenosis, although it is not always useful for assessing surgical accessibility to the distal internal carotid artery (ICA) due to the lack of osteological information. ⋯ The C1-H line measured on 3-D MRA is a simple and useful indicator of the distal point of the accessible ICA during CEA, especially in patients with renal dysfunction and allergies to contrast medium.
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Intracranial aneurysms (IAs) are rare in the general pediatric population and account for <2% of all cerebral aneurysms. Only 7 children with sickle hemoglobinopathy and IAs have been reported, the majority of which were discovered after rupture. ⋯ Children with SCD are at risk for developing multiple intracranial aneurysms, and a high index of suspicion must be maintained during the interpretation of routine magnetic resonance imaging or angiography of the brain.
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Our clinical understanding of os odontoideum (OO) remains incomplete. Congenital and traumatic causes have been proposed and advocated. Clinical presentations range from asymptomatic to axial pain to myelopathy or vertebral-basilar ischemia. A consensus for surgical management exists for those found to have an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression. ⋯ Our data reveal that surgical treatment for OO using the indications and techniques delineated is associated with high satisfaction rates, improved functional scores, and high fusion rates with low complication rates.