World Neurosurg
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Transthyretin wild-type (ATTRwt) amyloidosis is a systemic process resulting in deposition of misfolded transthyretin protein in several different tissues throughout the body. It is known to be a cause of progressive, life-threatening cardiomyopathy and lumbar spinal stenosis and carpal tunnel syndrome. ⋯ Knowing that extracardiac symptoms may occur first, we propose that sending ligamentum flavum and flexor tenosynovium for pathologic evaluation may be a unique opportunity to screen and treat a population of patients at risk for developing CA and heart failure.
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Proximal junctional failure (PJF) is a major and sometimes devastating problem following adult spinal deformity (ASD) correction surgery. Common consensus still lags on guidelines for preventing and managing these complications. Surgical treatment of scoliosis in the presence of osteogenesis imperfecta (OI) in the pediatric population is well described. The complication rates are unusually higher in this special subset of patients owing to poor quality of bone. There is a paucity of literature focusing on surgical techniques, strategies, and problems involved in the management of ASD associated with OI. ⋯ This is the first report of successful management of PJF following ASD correction in the presence of OI using this technique. Suboptimal hold of implants due to poor bone quality must be at the focus of any surgical planning for these patients. All possible strategies to prevent PJF must be considered when planning the deformity correction in adults with OI.
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Intraorbital and intracerebral cavernous malformation (CM) lesions are considered independent entities. Purely cerebral CMs have variable biology with recent evidence depicting inflammation as an important player and a risk factor for aggressiveness. We describe a case of concomitant left intraaxial and extraaxial CMs, linked by the ipsilateral basal vein, where the extraaxial component has developed an aggressive behavior. ⋯ A case of intraorbital and extracranial cavernomatous mass, connected to a cerebral intraventricular CM through a large basal vein, has presented with an aggressive course. A complete histopathologic and immunohistochemical analysis of the orbital mass has pictured a clear immune-cellular inflammatory reaction adding to the amounting evidence of association between inflammation and site aggressiveness in the setting of CMs.
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Some patients with hydrocephalus and idiopathic intracranial hypertension treated for elevated intracranial pressure (ICP) with a cerebrospinal fluid shunt may continue to experience symptoms or develop new symptoms despite valve adjustments. Use of telemetric ICP measurements may help confirm clinical suspicion of cerebrospinal fluid underdrainage or overdrainage in these patients. However, point in time, duration, and activity during the measurements have never been standardized. We devised a simple, repeatable maneuver for outpatient telemetric ICP recording and evaluated its test-retest reliability. ⋯ We confirmed high test-retest reliability of the standing-supine-sitting paradigm for telemetric ICP measurements in the outpatient setting. High test-retest reliability should be considered as prerequisite for clinical decision making.
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Despite the recent increase of transradial access among neurointerventionalists, there is still a paucity of evidence in the neurosurgical literature. There are 3 newly Food and Drug Administration-approved devices-Woven EndoBridge (WEB), Surpass, and PulseRider-that significantly expand the options available for endovascular treatment of cerebral aneurysms. Our work reports the safety and feasibility of radial artery catheterization for the deployment of these new devices. ⋯ Our experience with 10 patients revealed no limitations during catheterization and deployment of these devices. One patient had to be converted to coil embolization, which was feasible through the same vascular access. None of the patients had vascular complications postoperatively with minimal wrist discomfort.