World Neurosurg
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Case Reports
Fracture and Embolization of Distal Guide Catheter During Neuroendovascular Intervention.
Embolic strokes mainly result from cardiac or vascular origins, but there are instances when they can arise from iatrogenic foreign bodies. Catheter coatings or retained microcatheters are mainly implicated in foreign body embolism following neuroendovascular intervention. However, there are no known descriptions for free-floating and/or dislodged microcatheter fragments in the literature. ⋯ Knowledge of several salvage techniques is essential in preventing major cerebrovascular complications. It is imperative that a multilevel approach should be taken when treating foreign body embolism.
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Tumors extending into the optic canal can cause progressive visual impairment because of optic nerve compression. Prompt surgical resection is often necessary. When the tumor is located medially in the optic canal, endoscopic transnasal surgery provides a safer, less invasive alternative to a transcranial approach. ⋯ Endoscopic transnasal surgery is a valuable option for aggressive lesions in the optic canal. Although the efficacy of radiotherapy for solitary fibrous tumor remains controversial, it should be considered when the tumor shows progressive features.
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Because of a lack of markers for predicting prognosis and an underlying mechanism, patients with primary brainstem hemorrhage (PBH) are currently treated with multiple strategies, but most of them have poor outcomes in a comparison with patients with supratentorial intracranial hemorrhage. Recently, it has been reported that the neutrophil-to-lymphocyte ratio (NLR) represents a novel composite inflammatory marker to predict the prognosis of patients with intracranial hemorrhage, a majority of whom have supratentorial hemorrhage. In this report, we aim to assess the potential predictive value of NLR in patients with PBH. In addition, other available laboratory parameters, including platelet-to-lymphocyte ratio (PLR), and admission blood glucose level (ABG), will be also investigated as markers for prognosis in patients with PBH. ⋯ NLR, PLR, and ABG can be used to independently predict 90-day functional outcome in patients after PBH. When combined, they have better predictive power in identifying PBH patients with a poor prognosis. To our knowledge, this study is the first to reveal the associations between NLR, PLR, and hyperglycemia and the functional outcomes of patient with PBH. In associating with previously studies on hemorrhage site, our results provide a good opportunity to elucidate the underlying mechanisms of PBH.
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Case Reports
Surgically Treated de Novo Cervicomedullary Arachnoid Cyst in Symptomatic Adult Patient.
Arachnoid cysts are a relatively common finding in adult patients, especially with the advent of advanced imaging techniques. The overall incidence ranges from 1%-2%, and the majority are clinically silent. Arachnoid cysts are postulated to arise by congenital anomalies or trauma. De novo formation of arachnoid cysts has been reported but is exceptionally rare and mostly found in the pediatric population after head trauma. There have only been 2 reported cases of symptomatic de novo arachnoid cyst formation in adult patients to date, both with histories of head trauma. ⋯ This case represents the first incidence of a pathology-proven, nontraumatic de novo arachnoid cyst.
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Although ruptured vertebral artery dissecting aneurysms (VADAs) are often associated with ocular symptoms, such as abducent nerve palsy and Terson syndrome (TS), their frequency and risk factors in comparison with those associated with ruptured aneurysms in other locations have not been reported. ⋯ Eye movement disturbance and TS occurs more frequently in patients with ruptured VADA than with aneurysms in other locations. Early evaluation by an ophthalmologist is recommended in these patients.