World Neurosurg
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The basal ganglia and thalamus are uncommon locations for infiltrating gliomas. Tumors here are usually managed with biopsy and adjuvant therapy, with relatively poor results. Rarely do patients undergo extensive surgical intervention. It seems reasonable to suggest that successful cytoreduction may help these patients. However, this hypothesis has not been studied because of the general view that it is not possible to remove deep-seated brain tumors with acceptable outcomes. ⋯ We present the results of our attempts to resect large gliomas infiltrating the basal ganglia in 4 patients. Our technique combined a contralateral, transcallosal approach with awake neuromonitoring. Our results suggest it is possible to remove these tumors with reasonable outcomes.
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To evaluate effectiveness and safety of extended laminoplasty for the treatment of ossification of posterior longitudinal ligament (OPLL) involving the C2 segment. ⋯ If decompression indication for cases with OPLL involving the C2 segment was appropriate, extended laminoplasty up to the C2 segment could provide satisfactory neurologic recovery and would not accelerate cervical or segmental malalignment progression.
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Intrasaccular flow disruption has emerged as a useful modality for treatment of wide-necked saccular aneurysm at vessel bifurcations. The Woven EndoBridge (WEB) device is one such device that has been evaluated in several series with excellent safety and good midterm efficacy. Bailout techniques to retrieve or reposition a dislocated WEB device are sparse and associated with significant risks. We describe a case of a dislocated WEB device that was repositioned with a microcatheter alone. ⋯ Caution should be exercised, especially when detaching the WEB device. Microcatheter repositioning by pushing the dislocated device may be attempted, especially if part of the device is within the aneurysm. This is the first description of the described microcatheter repositioning rescue maneuver.
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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.
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Case Reports
Intracranial methotrexate-associated lymphoproliferative disorder in rheumatoid arthritis: A case report.
Methotrexate (MTX) is widely used as an anchor drug for the treatment of rheumatoid arthritis (RA) because of its ability to control pain and inflammation. However, few studies have shown that long-term MTX use can lead to lymphoproliferative disorders (LPDs) in these patients. Here we describe a rare case of intracranial MTX-associated LPD in a patient with RA. ⋯ Intracranial MTX-associated LPD is extremely rare. Here we describe a particular case and review the literature pertaining to intracranial MTX-associated LPD. More attention should be paid to LPD in a patient receiving immunosuppressive treatment for RA.