World Neurosurg
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Pilocytic astrocytoma is a benign glial tumor typically presenting in children. It is rare for adults to present with pilocytic astrocytoma and even less likely to manifest with multiple foci of lesions especially in nonoptic or hypothalamic locations. ⋯ To our knowledge, we believe this is the first reported case with multifocal infratentorial pilocytic astrocytoma on presentation in an adult patient in the absence of a prior history of associated risk factors such as neurofibromatosis 1 or chemoradiotherapeutic intervention.
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Case Reports
Rapid development of an aneurysm at the anastomotic site of an STA-MCA bypass: Case report and literature review.
Direct extracranial to intracranial (EC-IC) bypass is a valuable treatment option for symptomatic occlusive cerebrovascular disease and complex intracranial aneurysms. Aneurysm formation at or near the anastomotic site is a rarely reported phenomenon, and the pathophysiology and appropriate management of such de novo aneurysms are not clear. ⋯ Pseudoaneurysm formation at the site of an EC-IC bypass is a rare phenomenon that should be recognized and treated to prevent further growth and rupture.
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Various methods such as laminectomy, laminoplasty, and/or laminotomy can be used to remove intraspinal lesions. However, laminoplasty has generally been known to be able to prevent postoperative instability and deformity and avoid local scarring at operative site. We have described a new laminoplasty technique that can preserve the interspinous ligament during thoracolumbar intraspinal surgery. ⋯ Ligament-saving laminoplasty can provide an appropriate surgical view and allow for anatomical reconstruction of the spinal posterior element after excision of spinal cord tumors. This procedure might offer an alternative to classic techniques for selected patients to preserve spinal biomechanical function.
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We describe the Hook technique enabling coil embolization in unfavorable M1 bifurcation aneurysms and analyze the morphologic variations in M1 bifurcation to evaluate how often such aneurysms can be seen. ⋯ The Hook technique enabled stent-assisted coiling of M1 bifurcation aneurysm with extension along the asymmetric hypoplastic M2 division and also securing the M2 branch.
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The Spinal Instability Neoplastic Score (SINS) is widely used to assess mechanical instability in metastatic spine disease. We sought to identify a cutoff within the "potentially unstable" category, above which lesions were more likely than not to be stabilized. ⋯ For vertebrae affected by metastatic disease, the decision to stabilize remains dependent on both the radiographic lesion properties and the patient's clinical picture. However, our results suggest that lesions with a SINS of ≤9 might not require stabilization.