World Neurosurg
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Acute complex C2 vertebral body fracture specifically does not involve the odontoid process or C2 pars interarticularis. External stabilization can be effective but may prolong healing and increase morbidity. Many traditional surgical techniques can achieve internal stabilization at the expense of normal cervical motion. We describe direct surgical C2 pedicle screw fixation as an option for managing acute complex C2 vertebral body fracture. ⋯ Direct pedicle screw fixation of acute complex C2 vertebral body fracture appeared to be safe and effective in our 3 patients. It may provide a more-efficient and less-morbid treatment than halo brace or cervical collar immobilization in some patients.
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In meningioma, correlation of brain invasion with prognosis and clinical variables remains controversial. ⋯ Brain invasion and its patterns are correlated to gender. In contrast to the current WHO classification, invasion was associated with recurrence only after gross total resection and not independent of further histopathologic criteria of atypia.
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The anterior temporal artery (ATA) is an appealing donor artery for intracranial-intracranial bypass procedures. However, its identification may be difficult. Current literature lacks useful landmarks to help identify the ATA at the surface of the sylvian fissure. The objective of this study was to define the topographic anatomy of the cortical segment of the ATA relative to constant landmarks exposed during the pterional approach. ⋯ This article provides topographic evidence for efficient identification of the ATA in the parasylvian space. The key relationship and landmarks identified in this study may increase efficiency and safety when harvesting the ATA for intracranial-intracranial bypass.
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A 20-year-old woman presented with a rare intracranial inflammatory myofibroblastic tumor (IMT) manifesting as headache and insomnia. Magnetic resonance imaging showed a tumorous lesion with heterogeneous enhancement at the right temporal lobe, as well as perifocal edema with midline shift. The tumor was totally resected with the margin free. Pathologic examination showed IMT with myofibroblastic cells admixed with collagen fibers. Sarcomatous change in morphology was observed in tumor recurrence within 7 months. ⋯ Surgical resection and whole brain radiation are recommended in patients with IMT.
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The pipeline embolization device (PED) is a flow-diverting stent that provides an additional treatment modality in the management of intracranial aneurysms. An aneurysm treated with a flow diverter is expected to involute over time, contrary to the immediate obliteration expected by surgical clipping or coiling. Yet, which aneurysms will respond to PED therapy and the time frame to expect full obliteration remain unclear. ⋯ The rate of PED aneurysm obliteration increases with longer follow-up; however, the time frame for observing a persistently filling aneurysm before additional treatment is considered remains unknown. Some aneurysms may never close even after discontinuation of dual antiplatelet therapy. Ophthalmic artery aneurysms have been noted to fail treatment with PED based on the anatomic relationship of the aneurysm to the ophthalmic artery. This case provokes us to consider factors that may affect the latency to aneurysm obliteration, including aneurysm size, aneurysm morphology, patient gender, failure of previous aneurysm treatment, and duration of time from initial endovascular treatment.