World Neurosurg
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Ankylosing spondylitis (AS) is a systemic enthesopathy. In its presence, spinal fractures are often unstable. Acknowledging the preinjury level of kyphosis is key in the management of cervical fractures, and placement into a hard collar has been shown to result in life-threatening spinal cord complications. ⋯ We described the first case in the literature of a posttraumatic C5 palsy after application of a hard collar in AS. This report and literature review should act to underscore the importance of respecting a preexisting rigid kyphotic deformity in cervical fractures but also to stimulate further thoughts and investigations into what may contribute to a posttraumatic C5 palsy.
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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.
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Cerebral aneurysm growth is significantly associated with aneurysm rupture, but risk factors for aneurysm growth are not well characterized. It is believed that altered intracranial hemodynamics may contribute to the pathophysiology of aneurysm growth, but these mechanisms are not fully understood. ⋯ The subset of unruptured cerebral aneurysms that demonstrate growth over time has a significantly higher mean PV-LWSS than stable aneurysms, as measured by quantitative magnetic resonance angiography. This information at the time of diagnosis may help predict future aneurysm growth, stratify rupture risk, and identify those aneurysms that should undergo prophylactic treatment.
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Sacral fractures are a challenge regarding treatment and classification. Surgical techniques using spinal navigation systems can improve treatment, especially if used in collaboration among different specialists. ⋯ Navigation systems in instrumented spinopelvic and sacropelvic reconstruction provide greater safety, reducing learning times and malpositioning. Multidisciplinary management allows us to achieve optimal results, especially when the sacral fracture is combined with spinal and pelvic lesions. The use of navigation systems could represent an important advancement.
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Case Reports
Dysembryoplastic Neuroepithelial Tumor with an Enlarging Heterogeneously Enhancing Organizing Hematoma.
This report portrays an unusual presentation of a dysembryoplastic neuroepithelial tumor characterized by a chronic, enlarging, heterogeneously enhancing organizing hematoma. Differential diagnoses included the malignant transformation of a low-grade glioma, radiation necrosis, and radiation-induced cavernoma. A dysembryoplastic neuroepithelial tumor may have atypical characteristics and behavior, so continued follow-up with serial imaging is recommended.