World Neurosurg
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Gamma-Knife radiosurgery can be the treatment of choice for small cerebral arteriovenous malformations (AVMs) in eloquent brain areas or, in association with endovascular treatment, for large and complex AVMs. Among the possible delayed complications occurring after radiosurgery of AVMs, de novo formation of a cavernoma has only recently been described. The authors report a unique case of communicating hydrocephalus with highly proteinaceous cerebrospinal fluid due to a cavernoma-like lesion of an obliterated cerebral AVM treated by embolization and radiosurgery. ⋯ In previous neurosurgical literature, the association of a caveroma-like lesion in an obliterated AVM and communicating hydrocephalus with highly proteinaceous cerebrospinal fluid has not yet been discussed. We believe that only the surgical resection of both the obliterated AVM and the cavernoma-like lesion can lead to complete clinical recovery of the hydrocephalus.
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Quality Improvement (QI) is essential for improving health care delivery and is now a required component of neurosurgery residency. However, neither a formal curriculum nor implementation strategies have been established by the Accreditation Council for Graduate Medical Education. ⋯ A formal didactic curriculum and practical application of QI methodologies adds value to resident training. Further, it has the potential to positively impact practice. Consideration should be given to adopting a formal QI curriculum by other neurosurgery departments and perhaps standardization on national level.
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This study examined the use of noninstrumented posterolateral lumbar fusion with bone morphogenetic protein (BMP) and compared its effectiveness with that of instrumented fusion for the treatment of lumbar spinal stenosis (LSS) with spondylolisthesis in elderly patients. ⋯ Noninstrumented posterolateral lumbar fusion with rhBMP-2 in elderly patients with LSS and spondylolisthesis is a viable alternative to instrumented fusion based on clinical outcomes measured in this study.
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Intracranial arachnoid cysts are a common incidental finding. Most of these remain asymptomatic with surgical intervention being reserved for those cysts causing symptoms from mass effect or hydrocephalus. It is not properly understood why cysts enlarge nor is it possible to predict in which cysts this will occur. The aim of this study is to review the natural history of incidental arachnoid cysts. ⋯ Asymptomatic arachnoid cysts have a low rate of cyst enlargement on follow-up imaging, which supports not routinely imaging these patients. However, serial imaging and surgery may still be indicated in asymptomatic patients at risk of obstructive hydrocephalus which, in this series, was only seen in the pediatric population. A better understanding of the natural history of intracranial arachnoid cysts allows for more efficient follow-up planning.
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The parieto-occipital artery (PoA) is the terminal posterior cerebral artery branch, which typically runs in the parieto-occipital sulcus. Previous studies have highlighted variation in the PoA origin and branching pattern and their clinical implications. Nevertheless, PoA anastomoses have not been systematically investigated. The present study aimed to assess whether putative variation in PoA origin and its branching as well as anastomotic pattern is associated with differences in demographic/anthropometric variables. ⋯ Although the PoA invariably supplies the precuneus and almost always the cuneus, its direct contribution to the former seems inferior to PAc. Nevertheless, the PoA frequently shows putative collateral supply networks to the precuneus and cuneus via anastomoses with the PAc and calcarine artery, respectively. The distance between PoA origin and OP varies with an individual's height; the frequency of intrahemispheric PoA anastomoses varies with its site of origin.