World Neurosurg
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Stroke is a leading cause of mortality and disability worldwide. Research activity in Latin American countries might be the key to solving, or at least improving, the understanding of stroke-related issues in the region. Our aim was to describe and analyze the research output on stroke in Latin America. ⋯ Despite the continuous increase in research output from Latin American countries, more effort is needed to strengthen the research capacity by developing networks and collaborative research projects, ideally among the Latin American countries themselves.
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Patients with cancer often present with brain metastases in the setting of controlled extracranial disease, for which they receive stereotactic radiosurgery (SRS) and surgical resection. The role of systemic therapy after SRS is unclear. Brain metastasis indicates active cancer dissemination, and microscopic systemic disease may be present despite absence of gross disease as assessed by conventional imaging modalities. ⋯ Only a minority of patients with brain metastases and controlled extracranial disease receive adjuvant systemic therapy after SRS, but those that do have a reduced risk of brain relapse. Post-SRS systemic therapy may act prophylactically to reduce the risk of intracranial cancer recurrence.
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Case Reports
A staged therapy for internal carotid artery dissection caused by vascular Eagle syndrome.
Eagle syndrome with stroke onset is a rare condition. Carotid stenting of dissected arteries and/or surgical resection of the elongated styloid process are frequently performed; however, there are no definitive criteria for selecting these treatments. ⋯ Stenting in the acute phase prevented the recurrence of stroke, and styloid process resection in the chronic phase cured vascular Eagle syndrome. This staged therapy could be beneficial in the treatment of vascular Eagle syndrome.
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Case Reports
Internal Carotid Artery Bleed: A Rare Complication Of Invasive Sphenoidal Aspergillosis.
Invasive sinonasal aspergillosis is rarely seen in immunocompetent individuals. It may involve adjacent intracranial and intraorbital structures causing high morbidity and mortality. ⋯ This case emphasizes the need for early diagnosis of invasive fungal sinusitis to prevent intracranial complications and fatal outcome. When the diagnosis is made, aggressive treatment with surgical débridement and adjuvant antifungal therapy is required. Internal carotid artery involvement is a rare but life-threatening complication of invasive fungal sinusitis.
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Lesions located at the petrous apex, cavernous sinus, clivus, medial aspect of the jugular foramen, or condylar regions are still difficult to fully expose using the operating microscope. Although approaches to this region through the middle cranial fossa have been previously described, these approaches afford only limited visualization. We have confirmed a transcranial infratemporal fossa combined microsurgical and endoscopic access to the petrous apex, clivus, medial aspect of the jugular foramen, and occipital condyle. We have presented the results of a micro-anatomical cadaver dissection study and its clinical application. ⋯ After microscopic exposure of the middle fossa rhomboid, neuronavigational endoscopic assistance facilitated visualization of the ventral cavernous region, petrous apex, retropharyngeal space, and middle and inferior clivus down to the medial aspect of the jugular bulb and condyle regions. Additional maxillary nerve-mandibular nerve vidian corridor visualization provides a lateral transsphenoidal approach to upper clivus lesions.