World Neurosurg
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The endoscopic technique is in many cases the technique of choice for the removal of pituitary adenomas. Extended endoscopic approaches make it possible to remove lesions with suprasellar and parasellar extension and fibrous consistency. We identify some characteristics that might point to the adoption of an expanded approach in the preoperative phase. ⋯ The ability to predict the consistency of pituitary adenomas allows the surgeon to design a surgical procedure tailored to the patient. This approach has advantages concerning the extent of resection and allows a radical strategy with a single surgical procedure to be pursued.
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Referring to the anterior inferior cerebellar artery (AICA) traversing a cerebellopontine angle tumor during retrosigmoid vestibular schwannoma (VS) removal as a challenging AICA (c-AICA), we describe incidence, anatomic characteristics, mechanism of development of c-AICA, and surgical techniques used to remove VS while preserving the AICA. ⋯ c-AICAs occur more often than expected. The anatomy of the SAA is related to the development and characteristics of c-AICAs. Although preserving a c-AICA is challenging and necessitates a complex dissecting technique, understanding of anatomic characteristics and appropriate surgical management of c-AICAs enable VS removal while preserving the AICA.
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Case Reports
Transient Episode of Alice in Wonderland Syndrome after Ventriculoatrial Shunt Revision.
Visual misperceptions as a result of neurosurgical disorders are well documented. Alice in Wonderland syndrome (AWS) typically is reported in neurologic and psychiatric disorders. We present a patient who developed symptoms of AWS postoperatively. ⋯ Visual disturbances caused by lesions along the optic radiations are common findings for neurosurgery patients, although AWS after surgical intervention has not been reported previously.
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The present study was conducted to evaluate the levels of Cdk2, cyclin E, p21, and p27 in growth hormone adenomas (GHPAs) and analyze their association with clinicopathologic features. ⋯ Overexpression of cyclin E/Cdk2 and loss of p27 appears to be associated with a poor prognosis and might play a role in the treatment of GHPAs in the future.
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Recent reports have described that endovascular treatment of coil embolization of opththalmic artery (OphA) aneurysms has a relative risk of visual disruption caused by thromboembolic infarction of the central retinal artery (CRA), especially the OphA when it originates within the body of the aneurysm. Patent microthrombus in the OphA might also cause retinal infarction that affects visual acuity. We describe stent-assisted coil embolization of an OphA aneurysm complicated with a severe visual disturbance, although normal flow was scrupulously maintained in the OphA during the procedure. The visual disturbance was recovered by early treatment. ⋯ Despite good anterograde flow in the OphA during aneurysm embolization, the procedural risk of a visual disturbance due to thromboembolic complications of CRA occlusion cannot be avoided. Anterograde flow in the OphA and retinochoroidal blush should be monitored by repeated angiography during coil embolization to prevent vision loss. Should vision be lost, a rapid response including ocular massage and intraarterial fibrinolysis is required for recovery.