Neurosurgery
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This report describes the first case of symptomatic de novo arteriovenous malformation (AVM) appearing ectopically after total resection of other AVMs. We discuss the growth phenomenon and the nature of AVMs. ⋯ Our findings suggest that patients who undergo complete resection of AVMs may sustain other de novo AVMs some years later. The growth of an AVM seems to be related to the patient's age at onset and the duration of the posttreatment period. We emphasize the importance of long-term follow-up in patients with cerebral AVMs treated during childhood.
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Hydrocephalus requiring shunt placement is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). Previous investigations suggest that fenestration of the lamina terminalis during microsurgery for aSAH may be associated with a reduced rate of shunt-dependent hydrocephalus. We report a retrospective analysis correlating fenestration of the lamina terminalis with decreased shunt-dependent hydrocephalus after aSAH. ⋯ Fenestration of the lamina terminalis appears to be associated with a decreased incidence of shunt-dependent hydrocephalus of more than 80% after aSAH. This straightforward microsurgical maneuver should be performed whenever possible during aneurysm surgery.
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To determine whether cranial magnetic resonance imaging (MRI) is associated with deep brain stimulation (DBS) lead displacement or program interference. ⋯ MRI was not associated with significant DBS electrode movement or changes in clinical responses. Other IPG models and components and MRI scanners should be evaluated, to develop specific guidelines for MRI among individuals with implanted DBS systems.
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To describe techniques and materials used in sellar repair after an endoscopic endonasal transsphenoidal approach. ⋯ Reconstruction of the sella was considered necessary in only one-third of the patients who underwent operations via an endoscopic transsphenoidal procedure. Some minor expedients can be useful for the reconstruction, and the ideal material for the repair should be chosen.
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We sought to assess the value of adjusting shunt valve opening pressure, complications, and outcomes with the use of an adjustable shunt valve in the treatment of patients with normal-pressure hydrocephalus (NPH). ⋯ Noninvasive, particularly consecutive, minor or single larger adjustments to the valve opening pressure can further improve outcome in patients with NPH who undergo shunting.