World Neurosurg
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Case Reports
Thrombosed Middle Meningeal Artery Aneurysms Mimicking Aneurysmal Bone Cysts in a Patient with Fibrous Dysplasia.
The aneurysmal bone cyst (ABC) is a rare osteolytic lesion that is often associated with osseous disease such as fibrous dysplasia (FD). ⋯ This is the first case report to show that ABC-like lesions in patients with FD could be thrombosed MMA aneurysms. It is thus possible that some lesions previously diagnosed as ABCs were thrombosed MMA aneurysms or included a thrombosed MMA aneurysm. It is therefore important to rule out the presence of a MMA aneurysm when we encounter what appears to be an ABC in the presence of FD.
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Intracranial epidermoid cysts are benign, congenital, keratinizing, squamous epithelial-lined cysts filled with keratin. They are uncommon and often pose a surgical challenge owing to the adherence to surrounding structures. They are typically found at the cerebellopontine angle or in the parasellar region, where they are associated with abnormal development of the Rathke pouch; involvement of the pituitary stalk is rare. ⋯ Although 3 other cases of epidermoid cysts involving the pituitary stalk were identified, our patient's tumor was unique in that it was confined to the stalk. Our patient's case highlights a surgical approach to parasellar epidermoid cysts and the possible complications associated therewith.
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There has been no effective method to predict ischemic intolerance to temporary internal carotid artery (ICA) occlusion during carotid artery reconstruction. Pencil beam presaturation (BeamSAT) pulse suppresses the flow signal of the target vessel in magnetic resonance angiography (MRA). Applying this method, we constructed ICA-selective MRA images. The aim of this study was to identify patients at risk for ischemic intolerance by ICA-selective MRA. ⋯ These findings support the importance of Acom flow as a collateral route. ICA-selective MRA enables prediction of ischemic intolerance to temporary ICA occlusion during carotid endarterectomy or carotid artery stenting. This method provides valuable information regarding probability of an ischemic complication.
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Klotho, a single-pass transmembrane protein associated with premature aging, acts as a tumor suppressor gene by inhibiting insulin/insulin-like growth factor-1 and fibroblast growth factor pathways. Downregulated Klotho expression is reported in melanoma, mesothelioma, bladder, breast, gastric, cervix, lung, and kidney cancers and is associated with a poor prognosis. Klotho expression and Klotho promoter hypermethylation are predictive factors for patient prognosis. ⋯ Epigenetic regulation in GBM appears to be complicated. Specific CpG islands affect genes or micro RNAs that interact to control Klotho expression. The diverse effects of these islands may be due to unique factors of GBM.
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Minimally invasive resection of brain metastases aims to maximize resection while minimizing brain trauma. ⋯ Minimally invasive resection of brain metastasis is safe and effective, and in selected cases confers advantages compared with standard techniques.