World Neurosurg
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Tuberculum sellae meningiomas (TSM) arise from the dura mater of tuberculum sellae, limbus sphenoidale, and chiasmatic sulcus and cause asymmetric visual disturbances. In this study, we analyzed the laterality of the origin of TSM and discussed its clinical implications on immediate and long-term visual outcomes. ⋯ Most TSMs that originated from the dura of one lateral end portion of the tuberculum sellae correlated with asymmetric visual symptoms and poor visual outcomes. This microsurgical feature should be considered in the planning of optimal surgical strategy to achieve favorable outcomes.
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Computed tomography/magnetic resonance imaging (CT/MRI) fusion is used increasingly in the surgical treatment of cranial pathology. The merging of these complementary modalities provides excellent visualization of the bony anatomy and clear delineation of the soft tissues, including neurovascular structures. To our knowledge, the application of CT/MRI fusion for the surgical management of spinal pathology has not been reported previously. ⋯ This case highlights both the feasibility and the advantages of applying CT/MRI fusion technology to the surgical treatment of spinal pathology.
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Flow measurement by microvascular ultrasonic flow probe is an established procedure in intracranial vascular surgery. This study tested the application of this procedure in spinal dural arteriovenous fistula (SDAVF) treatment. ⋯ With the limits of our small series, multistage intraoperative quantitative flow measurement is a feasible, safe, and reliable adjunct in the surgical treatment of SDAVFs. The procedure provides data helpful in guiding the surgical strategy or clarifying ICG-VA data when necessary.
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We analyzed the characteristics of patients with World Health Organization (WHO) Grade II meningioma to identify factors that may influence recurrence. ⋯ Younger patients with a lower proliferation rate and gross total resection are less likely to undergo a reintervention for WHO Grade II meningioma recurrence. Observation rather than systematic adjuvant radiotherapy may be preferred. If possible, a redo surgery may be considered in case of relapse or tumor residual progression, because radiotherapy may not decrease the surgical recurrence-free survival after complete or incomplete resection.
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VACTERL association is characterized by a group of congenital malformations that tend to occur together. Rarely, concurrent cerebrovascular abnormalities have been reported. In this article, we present the first reported case of moyamoya disease in a patient with VACTERL association. ⋯ Our report adds moyamoya disease to the spectrum of rare diseases that may occur in the context of VACTERL association. Further studies may reveal whether a common pathophysiology exists between the 2 conditions. Our patient's congenital heart disease and the association between renovascular and cardiac disease with moyamoya may suggest a systemic vasculopathy. Moyamoya should be considered in children with VACTERL association who present with neurologic deficits or seizures.