World Neurosurg
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A discrepancy between definitions of morphologic parameters describing cerebral aneurysms across studies leads to conflicting results concerning performances of these factors and threshold values for rupture status prediction. The aim of the study was to evaluate how various definitions of morphologic parameters may influence the prediction of the risk for aneurysm rupture. ⋯ Different definitions of aneurysm parameters affect various rupture risk determination. AR defined as Hmax/Nwidth and aneurysm location with significantly higher rupture risk of anterior communicating artery aneurysms are independent predictors for aneurysm rupture.
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When distinct pituitary hypersecretory manifestations coexist, the differential diagnosis includes plurihormonal or double pituitary adenomas. We describe a rare case of hypercortisolemia and hyperprolactinemia caused by 2 noncontiguous adenomas that required 2 surgeries. ⋯ A complete clinical and biochemical evaluation is necessary in patients with pituitary adenomas. Repeat surgery may be necessary for noncontiguous double adenomas.
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Multiple subpial transection (MST) is a possible surgical treatment for patients with epileptogenic foci located in eloquent cortical areas. Commonly, it is performed in addition to other surgical techniques. In some cases, however, it is performed alone. We report the clinical results of 12 patients who received solely radiating MST with a minimal follow-up of 5 years. ⋯ rMST performed alone gives a favorable outcome in 75% of the patients at a minimum 5-year follow-up with few minor complications. This procedure appears to be effective even with a prolonged follow-up in drug resistant epilepsy with the epileptogenic foci located in eloquent areas.
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Dural arteriovenous fistulas (dAVFs) are rare vascular malformations of uncertain pathophysiology. If associated with cortical venous reflux, they present a significant risk of hemorrhage. We present a 69-year-old patient who presented with spontaneous right-sided symptomatic chronic subdural hematoma, which was evacuated via burr hole. ⋯ An occipital craniotomy with disconnection of the fistula without isolation of the transverse sinus was performed (Video 1), as published literature demonstrated lower intraoperative risk with disconnection only. The perioperative course was uneventful. Immediate postoperative and follow-up angiography demonstrated complete occlusion of the fistula.