World Neurosurg
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In situations in which posterior atlanto-occipital fixation might not be possible or might require supplemental fixation, anterior fixation might add stability in obtaining arthrodesis. The present study aimed to provide a radiographic evaluation of the safety and feasibility in the anterior approach. ⋯ The ideal entry angle for anterior atlanto-occipital fixation ranges from 41.0° to 55.0°, with a safe screw length from 30.9 to 31.3 mm. The potential success rate could reach >90%.
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Rupture of the spinal dermoid is rare. There may be intracranial deposition of fat secondary to it. We report a case of an adult male who presented with features of obstructive hydrocephalus secondary to ruptured lumbar dermoid. ⋯ He is asymptomatic for the spinal lesion. Silent rupture of the spinal dermoid causing obstructive hydrocephalus is rare. These patients may remain asymptomatic for the spinal lesion and improves with cerebrospinal fluid diversion.
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Multiple carotid cavernous fistula (CCF) classifications have been proposed. However, they lacked predictive factors for the clinical presentation, natural history, and hemorrhagic risk. Our aim was to externally validate a new classification according to venous drainage (i.e., the Thomas classification [TC]) to assess its relationship with symptoms, endovascular treatment, and outcomes. ⋯ The TC provided useful information regarding the fistula anatomy and venous hemodynamics, which correlated with the clinical symptoms and treatment strategy.
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Case Reports
Idiopathic Pseudoaneurysm of the External Carotid Artery with Delayed Facial Palsy after Covered Stenting.
Idiopathic pseudoaneurysms of the external carotid artery (ECA) between the internal maxillary artery and the facial artery are rare. Endovascular covered stenting is an alternative method for surgically challenging cases; however, movable and flexible vessels may prevent the maintenance of the stent. ⋯ The ECA aneurysm between the internal maxillary artery and facial artery may be more floating and changeable than any other portions of the ECA, and regrowth of the ECA aneurysm may cause delayed complication. In addition, knowledge of the mechanism is necessary to help in the endovascular treatment.
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Diagnostic methods of the epileptogenic area continue to be a challenge in epilepsy surgery research. We hypothesized that temporal lobe epilepsy (TLE) will result in white matter changes that can be detected using diffusion tensor imaging. Measurement of white matter diffusivity will therefore be useful for presurgical assessment. ⋯ Our results suggest that there are alterations in diffusion parameters in white matter tracts both in m-TLE and nl-TLE patients. Diffusion tensor imaging could be a useful presurgical tool to help establish the laterality of TLE, including patients with "normal" MRI. Further studies with a larger number of patients would be necessary to confirm these results.