World Neurosurg
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Acquired anomalies of the dural venous sinuses (DVS) have been correlated extensively with the development of dural arteriovenous fistulas (DAVFs). Despite the known similarities of DAVFs' pathogenesis with that of arteriovenous malformations (AVMs), the relationship of venous sinuses anomalies with AVMs scarcely has been studied. We aimed to investigate whether patients with AVM show a greater prevalence of congenital DVS anomalies. We hypothesized that these congenital anomalies trigger AVM development during early childhood just as acquired DVS anomalies trigger DAVFs formation during adulthood. ⋯ Patients with AVM have a greater likelihood of congenital anomalies of any DVS. These anomalies seem to be related also to the AVM location. These findings suggest that congenital anomalies of DVS may be related to the development of AVMs.
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Case Reports
A frontal sinus osteoma accompanied by an intracranial mucocele and local hyperostosis frontalis interna.
Frontal sinus osteoma accompanied by intracranial mucocele and local hyperostosis frontalis interna has never been reported. A 47-year-old woman presented with a 3-month history of intermittent headache. Physical examination revealed no neurologic abnormality. ⋯ Both the osseous mass and cyst capsule were removed totally via a frontal craniotomy, followed by skull base reconstruction. The postoperative course was uneventful. The final pathologic diagnosis was osteoma and mucocele.
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Oncotic aneurysm is a rare condition with a high mortality rate. Because no consensus has been reached regarding therapeutic strategy for ruptured oncotic aneurysm, treatment remains challenging. ⋯ Aneurysmectomy, resection of the parent artery with irregular walls and reconstruction to the distal recipient artery with normal intima should be considered to secure patency of the anastomosis and prevent the recurrence of oncotic aneurysm. Subsequent chemotherapy is essential to prevent carcinomatous meningitis and disease progression.
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The treatment of Tarlov cysts is challenging and difficult. The objective of our study was to describe the security and efficacy of the subcutaneous infusion port for drainage of symptomatic Tarlov cysts. ⋯ A subcutaneous infusion port is a useful treatment option for symptomatic Tarlov cysts. When the patients' symptoms returned and the cysts repressurized, we quickly and simply drained the cysts by using the infusion port.
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The sitting position has lost favor among neurosurgeons partly owing to assumptions of increased complications, such as venous air embolisms and hemodynamic disturbances. Moreover, the surgeon must assume a tiring posture. We describe our protocol for the "praying position" for pineal region surgery; this variant may reduce some of the risks of the sitting position, while providing a more ergonomic surgical position. ⋯ A protocolized praying position that includes proper teamwork management may provide a simple, fast, and safe approach for proper placement of the patient for pineal region surgery.