World Neurosurg
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Pineal apoplexy (either hemorrhagic or ischemic) may complicate the course of a tumor at this site. This event usually is characterized by an acute clinical onset and requires emergency surgical management whereas the regression of the lesion is a much rarer outcome. ⋯ Vanishing tumors of the pineal region may occur in different circumstances, resulting from absence of any medical and surgical action to minor manipulation of the tumor to obtain a biopsy. This variety may reflect different underlying mechanisms, leading to hemorrhagic or ischemic change of the tumor and its subsequent regression, although radiological imaging may fail to document hemorrhage or ischemia.
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In reverse bypass that used a naturally formed "bonnet" superficial temporal artery, intraoperative volume flow measurement quantifies flow augmentation after revascularization, confirms flow preservation, and identifies inadvertent vessel compromise. ⋯ Modification of the intraoperative stroke risk and prediction of the long-term patency after reverse bypass can be achieved by meticulous intraoperative blood flow evaluation.
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Despite advances in skull base surgery, achieving effective surgical management of jugular foramen schwannomas (JFSs) that avoids postoperative cranial nerve (CN) deficits remains a challenge. Subtotal resection followed by radiosurgery (rather than radical resection) is increasingly being viewed as a better treatment strategy. Here, an institutional database was retrospectively analyzed for outcomes after surgical treatment of JFSs to evaluate the optimal strategy for managing JFSs. ⋯ Our results suggest that conservative resection of JFSs via a familiar intracranial approach plus radiosurgery may be an effective surgical alternative for improving functional outcome with adequate oncologic control.
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Case Reports
Ruptured Intracranial Dermoid: Is surgery indispensible. 11 Year follow up of a rare entity.
Dermoid cysts are rare intracranial lesions that can occasionally rupture into intraventricular and subarachnoid spaces and can present with a myriad of symptoms. The surgical intervention in such cases is demanding, because the disseminated contents are spread widely in intraventricular and subarachnoid space. ⋯ Surgical intervention may not be essential in all patients with ruptured intracranial dermoids. In a few selected patients who do not manifest increased intracranial pressure and show no change in the size of the lesion on sequential radiologic follow-up, conservative management may be attempted, especially when the ruptured intracranial dermoid is located at eloquent areas and with wide dissemination of contents.
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Comparative Study
The difficulties and risks of Y-stent-assisted coiling: a comparison of first and second stenting procedures.
Y-stent-assisted coiling (YSAC) requires multiple device accesses for double stenting. The purpose of this study was to test the hypothesis that second stenting procedures are riskier than first stenting procedures. ⋯ In YSAC, second stenting procedures seem riskier than first stenting procedures, particularly when SDs occur. A proper device or delivery method may reduce the risks.