World Neurosurg
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The goal of the treatment of direct carotid cavernous fistula (CCF) is to occlude the arteriovenous shunt and to preserve the patency of the concerned internal carotid artery. However, for the ipsilateral posttraumatic fragile cerebrum, coil embolization plus parent artery occlusion for the high-flow direct CCF is better for the prevention of hyperperfusion syndrome and intracranial hemorrhage. We experienced such a case and managed it successfully. ⋯ Coil embolization of the aneurysm and parent artery occlusion for the posttraumatic direct CCF was a good option to manage the abducens nerve palsy and to prevent postoperative hyperperfusion.
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Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that often affects the craniovertebral junction. RA is associated with atlantoaxial instability and basilar invagination; the detailed presentations vary. Surgical treatment of atlantoaxial instability and basilar invagination caused by RA is challenging due to anatomic complexity and poor bone quality. The prevailing procedure is posterior occipitocervical fixation after transoral decompression or posterior decompression followed by occipitocervical fixation. However, these surgical modalities inevitably severely limit neck motion and cause dysesthesia of the C2 dermatome. ⋯ This method effectively reduces BI and allows AAI fixation without significantly compromising neck motion or causing C2 dermatome dysesthesia.