World Neurosurg
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Dural presentation of a cavernous hemangioma is a rare occurrence. Classically an intraparenchymal lesion with varying symptomatology including mostly headaches, seizures, and neurologic deficits depending on its location, a few cases have been reported along the convexity of the brain, even less eroding the calvaria, with none occasioning abnormal movements as the initial presentation. This is a case of a 67-year-old male who presented to the clinic for atypical progressive choreiform movements of the right side of his body and a soft subgaleal mass. ⋯ A craniotomy was performed on January 29, 2018, during which the tumor was resected along with the invaded dura mater and calvaria. Pathology report was positive for cavernous hemangioma, an unexpected diagnosis based on the tumor's characteristics. Following the surgery, the patient recovered completely without residual symptoms, suggesting a compressive mass effect causing the atypical movement disorders.
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Dysfunction of endothelial cells (ECs) constitutes a critical factor in the formation of intracranial aneurysms (IAs). However, little is known about the response of ECs to hemodynamic insults and its contribution to IA formation. ⋯ The potential mechanism, that IAs are always localizing in the bifurcation apices, may be that the endothelium injury of vessel wall can be induced by different hemodynamic conditions. Hemodynamic changes in artery bifurcation may initiate the formation of IAs.
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The optimal approach of blood blister-like aneurysms (BBAs) is debated. Wrapping has been reported to be an effective strategy, but artificial materials were often used. In addition, perforator protection was difficult using this technique. In this case, we report a ruptured BBA of the left internal carotid artery (ICA) treated with a clip-reinforced wrapping technique using a Y-shaped autologous temporalis fascia to protect the posterior communicating artery (PComA). The outcome was favorable. ⋯ Clip-reinforced wrapping technique using a Y-shaped temporalis fascia may be an effective method for treating BBAs located opposite the PComA origin. Long-term follow-up and large sample-size studies, however, are necessary to validate this approach.
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The atrium is the most common location for masses in the lateral ventricle. However, access to this area is limited owing to its deep location and adjacent eloquent neurovascular structures, such as the choroidal arteries, perisylvian white matter (WM) tracts, and optic radiations. We investigated the feasibility and safety of an endoscopic approach to the atrium via the anterior middle temporal gyrus (MTG). ⋯ Our findings have confirmed the feasibility of an anterior endoscopic approach to the atrium through the anterior MTG, with preservation of the functional integrity of the eloquent cortex and WM tracts.
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Cerebral revascularization is used in the treatment of treat complex aneurysms and acute and chronic cerebral occlusive disease. While STA-MCA remains the workhorse of extracranial-intracranial bypass, several approaches for the same have been developed during the past half century. ⋯ While technically challenging and unfamiliar, maxillary-intracranial bypass offers the advantages of higher flow, good caliber matching, shorter graft length, calvarial protection of the interposition graft, and versatility for revascularizing multiple intracranial targets, including the intracranial internal carotid, proximal and middle cerebral, posterior cerebral, and superior cerebellar arteries. We discuss and review the evolution of, operative approaches for, and clinical applications of maxillary artery to intracranial bypass.