World Neurosurg
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Review Case Reports
Denosumab Treatment for a Residual Giant Cell Tumor of the Clivus: A Case Report and Review of the Literature.
Giant cell tumors (GCTs) are a locally aggressive primary bone neoplasm of osteoclast-like cells. These lesions largely occur in the epiphyses of long bones, but there have been rare reports of occurrence in the pelvis, spine, or skull. Of those located in the skull, involvement of the clivus has been rarely reported. ⋯ Denosumab has demonstrated anti-GCT efficacy. In combination with proton therapy, it has the potential to spare a young, vulnerable population from adverse long-term effects of traditional adjuvant radiation therapy. To our knowledge, this is the first report of the use of denosumab in the treatment of GCT of the clivus in the United States.
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Comparative Study Observational Study
Results of Early and Late Surgical Decompression and Stabilization for Acute Traumatic Cervical Spinal Cord Injury in Patients with Concomitant Chest Injuries.
The benefits of early surgical decompression and stabilisation (within 24 hours of injury) for patients with acute traumatic spinal cord injury (SCI) is unclear. The study objective was to investigate the effects of early (<24 hours of injury) versus late (>24 hours of injury) decompressive and stabilisation surgery for traumatic cervical SCI in patients with concomitant chest injuries. ⋯ For patients with acute traumatic cervical SCI and concomitant chest trauma, early surgical decompression and stabilisation was associated with reduced ICU stay and a lower complication rate. Neurological recovery was more likely in younger patients and those with an incomplete SCI.
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The arcuate foramen is an anatomic variant that is thought to arise from ossification of the posterior atlanto-occipital membrane. Owing to potential entrapment of the vertebral artery segment that traverses the foramen, vertebrobasilar ischemia may occur, and the person may experience vertigo, headache, or neck pain. ⋯ It is important to review the current literature on the arcuate foramen to further understand its morphology and clinical relevance.
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Patients with large vestibular schwannomas (VSs) will require surgical treatment owing to the potential consequences of long tract and cranial nerve compression. We assessed the long-term clinical and radiologic outcomes of patients harboring large VSs treated with a facial nerve (FN)-sparing technique. ⋯ Functional nerve-sparing resection provides satisfactory FN preservation. The low probability of long-term regrowth of small remnants is an argument for a W&reS protocol. GKS is a legitimate option for salvage treatment.
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Case Reports
Dural and Pial Arteriovenous Fistulas Connected to the Same Drainer in the Middle Cranial Fossa: A Case Report.
Dural arteriovenous fistulas (AVFs) in the middle cranial fossa are rare. Pial AVFs are similarly rare but differ from dural AVFs in that they derive their arterial supply from pial or cortical arterial vessels and do not lie within the intradural region. We report an extremely rare case of dural and pial AVF connected to the same drainer in the middle cranial fossa. ⋯ We report an extremely rare case of dural and pial AVF connected to the same drainer in the middle cranial fossa. To our knowledge, this is the first such case report described in the literature.