World Neurosurg
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Subependymal giant cell astrocytoma (SEGA) is a rare, benign neoplasm predominantly associated with tuberous sclerosis complex. Clinical outcomes have largely been conveyed via small- and medium-sized case series. ⋯ Based on our analysis, younger age and occurrence of surgery are significant independent factors associated with better OS. There was no support for radiation.
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Difficulties are associated with the diagnosis and management of patients with coma because of intracranial hypotension. ⋯ The patient represents the first described case, to our knowledge, of intracranial hypotension with coma because of a CSF leak caused by a spinal ventral dural tear. In the setting of failed EBP attempt, our technique may be a treatment option for severe intracranial hypotension.
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Patients with an aneurysmal subarachnoid hemorrhage (aSAH) and World Federation of Neurosurgical Societies (WFNS) grade I on admission are generally considered to have a good clinical outcome. ⋯ Despite their neurologically optimal clinical condition on admission, 1 in 5 patients with WFNS grade I aSAH has an unfavorable clinical outcome or is dead at 6-month follow-up. Additional multivariable analysis in larger patient cohorts is necessary to identify the extent to which preventable complications contribute to unfavorable outcomes in these patients.
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Embolization of the middle meningeal artery (MMA) has recently been proposed as an alternative to surgery for treatment of chronic subdural hematoma (SDH). There is increasing evidence that fragile neovasculature arising from distal branches of the MMA found within the membrane that forms around a chronic SDH is responsible for high recurrence rates due to chronic, repeated rebleeding. Embolization of the MMA could thus potentially eliminate the blood supply to this membrane and prevent further rebleeding. ⋯ In this case series of 6 patients harboring 7 recurrent, chronic SDHs, 6 of the 7 were successfully treated with MMA embolization and able to avoid surgery for reevacuation, suggesting that this minimally invasive technique may represent an effective alternative to surgery.
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Endovascular coiling has emerged as an option for the management of unruptured intracranial aneurysms, which was traditionally treated via surgical clipping. Unlike aneurysms elsewhere, aneurysms of the middle cerebral artery (MCA) have several features that are favorable for surgery. However, endovascular treatment can be difficult for MCA aneurysms, especially if they have incorporated branches. We report the results of coil embolization of incorporated MCA aneurysms. ⋯ Branch-incorporated MCA aneurysms can be treated with coil embolization, with few procedural complications and midterm durability with appropriate techniques and devices.