World Neurosurg
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The Pipeline embolization device (PED) is commonly used for the treatment of distal internal carotid artery (ICA) aneurysms, which often require placing the stent across the origin of the precommunicating segment of the anterior cerebral artery (ACA-A1). We sought to characterize the clinical and angiographic consequences of this maneuver. ⋯ The PED can be used to treat aneurysms with deployment from the MCA-M1 to the ICA without resulting in ACA stroke. Ipsilateral A1 segment dominance might be predictive of continued blood flow into the ACA after deployment at this location.
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To determine whether fat infiltration in the multifidus muscle would predict surgical prognosis in patients with degenerative lumbar spinal stenosis (DLSS). ⋯ Fat infiltration in multifidus muscle at L5-S1 could be a potential predictor of functional improvement after surgery in patients with L4-5 single-segment DLSS.
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Atypical (World Health Organization grade II) meningiomas (AMs) have been associated with a substantial risk of recurrence even after complete, gross total resection (GTR). The present study evaluated the clinical and AM tumor histopathological features that might predict for the risk of recurrence and survival within this patient population. ⋯ AM tumors with a high proliferative index showed an increased likelihood of recurrence and short-term survival even after complete GTR. A smaller tumor volume might also have contributed to an increased risk of recurrence for patients with AM. Although other histopathological features were not linked to recurrence or mortality for patients with AM, the biopsy findings can indicate key predictive information, and further molecular analysis might reveal additional prognostic markers.
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Case Reports
Awake Craniotomy and Excision of A Diffuse Low-Grade Glioma in a Multilingual Patient - Neuropsychology and Language.
Diffuse low-grade gliomas are a group of brain tumors that require an individualized and targeted therapeutic approach, such as awake craniotomy for surgical resection and intraoperative monitoring of speech and language functions. ⋯ Awake craniotomy with speech and language monitoring allows a customized approach to the treatment and management of diffuse low-grade gliomas. Neuropsychological assessment and intraoperative findings are discussed in the context of functional reorganization and cortical representations of language.
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The decision to replace deep brain stimulation (DBS) generators in end-stage Parkinson disease (PD) is based on the patients' clinical status and the risks of this surgery. The infection rates of initial DBS implantation surgery and generator replacement surgery are well established. But the risks of DBS generator replacement for the severely disabled end-stage PD patient have not been described. ⋯ DBS generator replacement surgery is low risk, even in patients who have end-stage PD.