Neurosurgery
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Surgical planning for deep brain stimulation implantation procedures requires T1-weighted imaging (T1WI) for stereotactic navigation. Because the subthalamic nucleus, the main target for deep brain stimulation, and other midbrain nuclei cannot be visualized on the stereotactic guidance T1WI, additional T2-weighted imaging (T2WI) is generally obtained and registered to the T1WI for surgical targeting. ⋯ The scan parameters of 3-dimensional spoiled gradient recalled acquisition in steady state are chosen in a way that T1WI can be obtained from conventional magnitude reconstruction and images with improved contrast between midbrain nuclei and surrounding tissues can be produced from the same data by performing susceptibility-weighted imaging reconstruction on a chosen region of interest. In addition, our preliminary experience suggests that the resulting contrast between the midbrain nuclei is superior to the current state-of-the-art fast spin echo T2WI in depicting the subthalamic nucleus as distinct from the substantia nigra pars reticulata and clear depiction of the nucleus ventrointermedius externus of thalamus.
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Our patient's symptomatology, history, physical examination, diagnosis, management, and functional outcome 1 year after surgical repair is presented and discussed in light of the current literature on lipofibrohamartomas. ⋯ At 18 months postoperatively, the patient had excellent left hand function. On the basis of our experience with this patient, we believe that intraoperative nerve action potentials and the availability of usable proximal and distal nerve fascicles (which may be discernible on diagnostic imaging) are key factors in deciding whether a lipofibrohamartoma needs to be repaired or decompressed/biopsied. As illustrated by our case, we believe that resection and graft repair may be the best treatment option for some of these patients, and perhaps more so for pediatric patients.
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Intraventricular hemorrhage (IVH) is a serious complication of intracerebral hemorrhage (ICH). We hypothesized that antiplatelet medication use and platelet activity would be associated with more IVH. ⋯ Reduced platelet activity was related to more IVH as a complication of ICH. The relationship of platelet activity to IVH deserves further study.
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Hemangiomas of the brachial plexus are very rare, and there has not been a collection of multiple cases published in the literature to date. Extraneural brachial plexus hemangiomas typically present with similar signs and symptoms as nerve sheath tumors, including pain, paresthesia, and occasionally weakness, in addition to nonspecific imaging findings, making their diagnosis difficult. Exploratory surgery can lead to significant bleeding and nerve injury when a hemangioma or an associated aneurysm is encountered intraoperatively. We present 5 cases of extraneural hemangiomas causing brachial plexopathy, including pre-, intra-, and postoperative decision making, with an emphasis on diagnostic and management issues as well as outcomes. ⋯ Extraneural hemangiomas of the brachial plexus are very rare, but a high index of suspicion and appropriate preoperative evaluation, including angiography with the option for embolization, can result in decreased intraoperative hemorrhage and better patient outcomes.
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Bypass surgery for brain aneurysms is evolving from extracranial-intracranial (EC-IC) to intracranial-intracranial (IC-IC) bypasses that reanastomose parent arteries, revascularize efferent branches with in situ donor arteries or reimplantation, and reconstruct bifurcated anatomy with grafts that are entirely intracranial. We compared results with these newer IC-IC bypasses to conventional EC-IC bypasses. ⋯ IC-IC bypasses compare favorably to EC-IC bypasses in terms of aneurysm obliteration rates, bypass patency rates, and neurological outcomes. IC-IC bypasses can be more technically challenging to perform, but they do not require harvest of extracranial donor arteries, spare patients a neck incision, shorten interposition grafts, are protected inside the cranium, use caliber-matched donor and recipient arteries, and are not associated with ischemic complications during temporary arterial occlusions. IC-IC bypass can replace conventional EC-IC bypass with more anatomic reconstructions for selected aneurysms involving the middle cerebral artery, posteroinferior cerebellar artery, anterior cerebral artery, and basilar apex.