World Neurosurg
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Anaplastic meningiomas are rare tumors with a poor prognosis, even after complete surgical resection and radiotherapy. There has been limited evidence with respect to the clinical factors and their effects on the course of the disease. Various retrospective studies have not been able to provide clear evidence of standardized treatment, usually presenting contradictory results. The aim of this study was to evaluate the prognostic factors influencing the progression-free survival (PFS) and overall survival (OS) of anaplastic meningiomas, with a particular focus on the roles of the extent of resection and postoperative adjuvant radiotherapy. ⋯ The extent of resection in anaplastic meningiomas is correlated with a better outcome. However, resection alone is not sufficient for the long-term control of anaplastic meningiomas. Adjuvant radiotherapy is an essential component in the adjuvant treatment of anaplastic meningiomas, including for patients undergoing GTR. Further investigations through which to improve adjuvant therapy options are necessary to improve meningioma therapy.
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Stroke is a major factor of morbidity in the patients with Takayasu arteritis (TA). Restenosis is more common with endovascular intervention than after bypass surgery, but vascular anastomosis is difficult due to calcification involving the whole thickness of the arterial wall in the burned-out stage of TA. We report a case of advanced TA in which endovascular treatment of the left subclavian artery improved cerebral blood flow (CBF) over a wide range of perfusion in the posterior and anterior circulation. ⋯ As collateral circulation is common in advanced TA, the ischemic area is large when the remaining proximal large vessels are occluded. Therefore revascularization of the remaining branch of the aorta in advanced TA may protect against a wide range of perfusion.
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Case Reports
Spontaneous subgaleal abscess associated with lung adenocarcinoma: first description of this unusual association.
Primary, spontaneous, or de novo subgaleal abscesses represent extremely rare lesions usually related to patients with risk factors and predisposing conditions for infections. They are associated with high morbidity, and a proper diagnosis can be misleading. To the best of our knowledge, this is the first reported case of a de novo subgaleal abscess not related to previous traumatic head injury and associated with lung adenocarcinoma. ⋯ We strongly suggest a patient global assessment in the event of subgaleal abscess without history of traumatic head injury, to treat eventual associated findings as soon as possible.
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To assess factors that may predict failure to improve at 12 and 24 months after unilateral laminotomy with bilateral decompression (ULBD) for the management of lumbar spinal stenosis. ⋯ ULBD for the management of lumbar spinal stenosis leads to clinically important improvement that is maintained over a 24-month follow-up period. Female sex and tobacco smoking are associated with poorer outcomes.
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Case Reports
Cerebro-spinal fluid fistula in the frontal sinus secondary to obstructive hydrocephalus.
In some rare cases, long-standing hydrocephalus can cause "high-pressure" cerebrospinal fluid fistulas. We report the case of a young overweight woman with rhinorrhea secondary to hydrocephalus with a fistula into the frontal sinus. ⋯ In these cases, the CSF leakage acts as a safety valve, and closure will worsen the patient's condition if the causative lesion has not been treated first. Moreover, identifying the exact location of the fistula can be challenging and will usually require high-resolution bone computed tomography.