World Neurosurg
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Case Reports
Inflammatory Reaction Secondary to Immune Checkpoint Inhibitor Therapy Mimicking a Post-Operative Brain Abscess.
Immune checkpoint inhibitors have revolutionized the treatment of many cancers, including melanoma, non-small cell lung cancer, and renal cell carcinoma. These therapeutics increase the activity of T cells against neoplastic cells, although the immune response generated also has the potential to target normal cells, resulting in immune related adverse events (irAEs). Most irAEs occur outside of the nervous system, but cases of limbic encephalitis, hypophysitis, optic neuritis, and pseudoprogression have been reported. ⋯ This is the first report of an acute surgical-site irAE after stereotactic radiosurgery and craniotomy in a patient receiving nivolumab and ipilimumab. These immune-mediated responses can be treated with corticosteroids and close observation.
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Provided certain anatomic considerations, stent-assisted coiling of basilar apex aneurysms can be performed using a single stent placed in a horizontal T-configuration across the aneurysm neck prior to coil deployment, although this has predominantly been described using older-generation stents. The development of the Low-profile Visualized Intraluminal Support (LVIS Jr) device has provided greater versatility than previous stents, including use in smaller vessels, the ability to be resheathed, and improved flow diversion properties. ⋯ Use of the LVIS Jr device allows greater versatility in horizontal T-configuration stent-assisted coil embolization, when compared with other available intracranial stents. This provides another tool to treat basilar apex aneurysms with improved coil occlusion and a theoretically decreased risk of thromboembolic events.
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Foraminal cervical nerve root compression can be caused by lateral disk herniation or osteophyte formation of the vertebrae. Improved diagnosis and evaluation can be achieved using different imaging techniques: radiographs, computed tomography (CT), and magnetic resonance imaging. We retrospectively evaluated the potential influence of a virtual reality (VR) visualization technique on surgery planning and evaluation of postoperative results in patients with monosegmental, unilateral osseous cervical neuroforaminal stenosis. ⋯ Reconstruction of pre- and postoperative 2D-CT images of the cervical spine into 3D images, and the spatial and anatomical reconstructions in VR models, can be helpful in planning surgical approaches and treatment strategies for patients with cervical foraminal stenoses, and for evaluation of their postoperative results.