World Neurosurg
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Although the clinical course of spontaneous intracranial hypotension (SIH) is generally benign, in unusual cases it can result in deterioration of consciousness. The exact mechanisms involved have not always been described in previously reported cases. ⋯ SIH should be recognized as a possible cause of coma as a result of deep cerebral vein stagnation due to severe brain sagging. A change in the vein of Galen/straight sinus angle may be an anatomic marker associated with functional venous stenosis.
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This study aims to evaluate the safety and effects of using argatroban, immediately after mechanical thrombectomy (MT) with large artery occlusion. ⋯ This study showed the safety and usefulness of argatroban immediately after MT, indicating that using argatroban after MT could prevent reocclusion of target artery without increasing bleeding complications.
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Case Reports
Hydrocephalus with Ventricular Papillary Structure Induced by Aggressive Intracranial Dural Arteriovenous Fistulas.
A 76-year-old man presented with progressive dementia, gait disturbance, and urinary incontinence for 1 year. Computed tomography scan revealed nonobstructive hydrocephalus, but abnormal papillary structures at the ventricular wall were noted. Before cerebrospinal fluid (CSF) diversion surgery for hydrocephalus, we performed magnetic resonance angiography and magnetic resonance venography, which revealed multiple engorged vessels over the ventricular wall and bilateral hemispheres. ⋯ DAVFs with CVH might be a factor contributing to acquired hydrocephalus. DAVFs should be considered when patients with hydrocephalus exhibit abnormal papillary structures at the ventricular wall. Performing CSF diversion surgery for hydrocephalus before downgrading or curing such aggressive DAVFs may lead to major complications.
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The use of the recent concept of sellar barrier revealed that a specific group of patients were difficult to categorize. For this reason, we propose to add a new subtype: the mixed sellar barrier. The aim of this work was to define the new mixed barrier subtype and analyze this in a series of operated patients. ⋯ The new mixed sellar barrier subtype was precisely defined and illustrated. The correlation between MRI and intraoperative findings for this new subtype has been demonstrated in this study. A prospective study with a larger series of patients is required for validation.
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We evaluated the technical feasibility and potential advantages of transcranial insertion of an atlas screw for atlantoaxial fixation. ⋯ Transcranial insertion of atlas screw can be used as a salvage procedure when the conventional method of screw insertion is not possible because of technical difficulties.