World Neurosurg
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Giant aneurysmal bone cysts of the spine are rare lesions and, correspondingly, the optimal treatment sequence is unclear if gross total resection cannot be achieved. We present a remarkable clinical image of a giant cervical aneurysmal bone cyst diagnosed in a 12-year-old female, which was refractory to gross total resection due to vertebral artery encasement and involvement of the carotid artery and jugular vein. We then summarize our planned multimodal management.
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Glioblastomas are the most common malignant brain tumor and despite extensive research have a dismal prognosis. This review focuses on the current treatment paradigms of glioblastoma and highlights current advances in surgical approaches, imaging techniques, molecular diagnostics, and translational efforts. Several promising clinical trials in immunotherapy and personalized medicine are discussed and the importance of quality of life in the patients and their caregivers both during active treatment and survivorship is also commented on.
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Case Reports
Minimally Invasive Syringe Brain Port For Deep-seated Lesions: How To Make The System And Surgical Video.
Brain retraction is crucial for adequate exposure during many intracranial procedures. It facilitates the access to the area of interest inside the brain and gives the surgeon the ability to create a corridor to visualize the deeply seated lesions. Retraction-related injury is a well-known complication. ⋯ It can help the neurosurgeons to achieve brain retraction in a safe, simple, and cost-effective technique. We are presenting a video of how to make this system. Also, we are demonstrating an intraoperative application of this system in a case of a 36-year-old male with deep-seated recurrent right frontal glioblastoma multiforme grade IV.
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Antiplatelet agents are typically administered before and after treatment using flow-diverter stents (FDS) to prevent thrombotic complications, but the effects of anticoagulants are unclear. We present a patient with a giant aneurysm treated with an FDS. The thrombus within the aneurysm was dissolved when a direct factor Xa inhibitor was administered to treat lower limb venous thrombosis that occurred secondary to steroid use. ⋯ Administration of a direct factor Xa inhibitor during healing after placing an FDS may cause dissolution of an existing thrombus; therefore factor Xa inhibitors must be used with caution.
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A noninvasive approach for basilar invagination (BI) and moreover, cervical traction to reduce odontoid invagination, has not been thoroughly described in the literature. We report a case of BI with Arnold-Chiari malformation in which preoperative reduction using Gardner well cervical traction was attempted and the patient developed central hypoventilation syndrome. ⋯ Cervical traction followed by posterior fixation is an effective way to manage basilar invagination with Arnold-Chiari malformation and assimilated C1. However, patients should be monitored closely for respiratory dysfunction.