Neurosurgery
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: Neurosurgeons encounter a number of pigmented tumors of the central nervous system in a variety of locations, including primary central nervous system melanoma, blue nevus of the spinal cord, and melanotic schwannoma. When examined through the lens of embryology, pigmented lesions share a unifying connection: They occur in structures that are neural crest cell derivatives. Here, we review the important progress made in the embryology of neural crest cells, present 3 cases of pigmented tumors of the nervous system, and discuss these clinical entities in the context of the development of melanoblasts. Pigmented lesions of the nervous system arise along neural crest cell migration routes and from neural crest-derived precursors. Awareness of the evolutionary clues of vertebrate pigmentation by the neurosurgical and neuro-oncological community at large is valuable for identifying pathogenic or therapeutic targets and for designing future research on nervous system pigmented lesions. When encountering such a lesion, clinicians should be aware of the embryological basis to direct additional evaluation, including genetic testing, and to work with the scientific community in better understanding these lesions and their relationship to neural crest developmental biology. ⋯ DRG, dorsal root gangliaEMT, epithelium-to-mesenchyme transitionNC, neural crestNCM, neurocutaneous melanosisSCP, Schwann cell precursor.
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Multicenter Study
Surgical Clipping of Very Small Unruptured Intracranial Aneurysms: A Multicenter International Study.
Treatment of very small unruptured intracranial aneurysms (VSUIAs, defined as ≤3 mm) can be indicated in selected circumstances. The feasibility and outcomes of endovascular therapy for VSUIAs have been recently published; however, the efficacy and complication rate of surgical clipping has not been reported in any large series to date. ⋯ VSUIA clipping is highly effective and is associated with a low morbidity rate. For VSUIAs selected for treatment, our data support surgical clipping as the modality of choice.
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Multicenter Study Clinical Trial Observational Study
Clinical and Anatomical Follow-up in Patients With Aneurysms Treated With the WEB Device: 1-Year Follow-up Report in the Cumulated Population of 2 Prospective, Multicenter Series (WEBCAST and French Observatory).
Flow disruption with WEB is an innovative endovascular approach for wide-neck bifurcation aneurysms. Initial series have shown a low complication rate with good efficacy. ⋯ The analysis in this large cumulated population of studies confirms favorable safety and efficacy of WEB treatment.
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Review Case Reports
A Mobile Schwannoma of the Cervical Spinal Cord: A Case Report and Review of the Literature.
Mobile schwannomas have been reported in the lumbar spine and occasionally in the thoracic spine. However, to the best of our knowledge, this is the first known report of a cervical mobile schwannoma. Mobile schwannomas require careful preoperative and intraoperative evaluation of their localization because tumor mobility may result in surgery at the wrong level. ⋯ We observed an extremely rare case of a mobile schwannoma of the cervical spine. Unusually dilated subarachnoid space adjacent to the tumor can be a diagnostic sign of tumor mobility, regardless of vertebral level. Repeated MRI studies are useful to preoperatively confirm tumor mobility. Intraoperative ultrasonography is valuable for the real-time localization of such mobile tumors to avoid potentially performing surgery at the wrong vertebral level.