World Neurosurg
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Complications arising from cerebral venous occlusion/sacrifice during neurosurgical procedures have received comparatively less attention in the neurosurgical literature. Consequently, cerebral venous complications are not given due recognition, even though most practicing neurosurgeons would agree that they are not uncommon. We present a review of complications arising from venous sacrifice/occlusion during neurosurgery and discuss strategies described in the literature to prevent such occurrences. ⋯ The unpredictable response of the brain to venous injury causes catastrophic complications in a few patients. To avoid these complications, meticulous venous preservation should be a goal in all neurosurgical procedures. Increased recognition of cerebral venous complications over the last 2 decades has resulted in the increasing recognition among neurosurgeons that venous preservation is an essential tenet of neurosurgery.
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Case Reports
False Localization of a Ruptured Intracranial Dermoid Secondary to Subarachnoid Spread of Cyst Contents.
A 34-year-old right-handed female presented to the emergency department with a worsening headache, neck stiffness, intermittent abnormal sensation, and right arm weakness. Shortly after arrival, she had a generalized tonic-clonic seizure. A noncontrast head computed tomography scan revealed a right-sided, low-attenuating, lobulated mass ipsilateral to her arm symptoms. ⋯ During mass resection, sebum was visible throughout the subarachnoid space. The patient had an uneventful recovery from surgery and has been seizure free since the resection with steady improvement of symptoms. This case highlights the importance of avoiding cyst rupture of dermoid cysts.
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Surgical treatment of vertebral artery (VA) and VA-proximal posterior inferior cerebellar artery (PICA) aneurysms poses a special challenge to the operating surgeon because of the complex anatomy of the neck and the location of the aneurysm. We report our surgical results of unruptured VA and VA-PICA aneurysms operated on through the transcondylar fossa approach. ⋯ Although the incidence of rupture of asymptomatic unruptured VA and VA-PICA aneurysms is low, they should be considered for surgical treatment because they carry higher early mortality and morbidity after rupture. The transcondylar fossa approach provides adequate exposure of the aneurysm without permanent lower cranial nerve morbidity.
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We have described the use of 3-dimensional (3D) virtual planning and 3D printed patient-specific osteotomy templates in the surgical correction of a complex spinal deformity. Pedicle subtraction osteotomies (PSOs) for the correction of severe spinal deformities are technically demanding procedures with a risk of major complications. In particular, operations of the severely deformed spine call for new, more precise, methods of surgical planning. The new 3D technology could result in new possibilities for the surgical planning of spinal deformities. ⋯ In addition to direct translation of the planned PSO for surgery, the 3D planning also facilitated a detailed preoperative evaluation, greater insight into the case-specific anatomy, and accurate planning of the required correction.
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Case Reports
Malignant Peripheral Nerve Sheath Tumor Arising in Schwannomatosis with Multiple Lung Metastases.
Malignant peripheral nerve sheath tumor (MPNST) is a kind of rare neurogenic malignancy, which usually arises from nerve fibers in any tissue and organ that have nerve fiber distributions, especially the trunk and extremities, but it is extremely rare in spinal canal. ⋯ Many cases of MPNST usually developed from neurofibromatosis type 1. However, the incidence of MPNST arising from schwannomatosis was extremely rare. More significantly, using genetic testing on her, we found a splice site mutation (c.1118+1G>A) that occurred between exons 8 and 9 of the SMARCB1 gene, which was first found in this MPNST patient and could lay the foundation for further study of its pathogenesis.