World Neurosurg
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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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The optimal management of dural closure is unclear; therefore, we aimed to survey current common practices among Italian practitioners. ⋯ This study elucidates the areas of consensus and uncertainty on dural closure management among a group of Italian neurosurgeons. It provides reliable and comparable data for the investigation of the departments' daily practice in dural closure. Given the lack of solid evidence, there is a need for further comparative studies of dural repair strategies.
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Dural venous sinus thrombosis is a rare yet major cause of stroke and mortality, especially affecting young women and children. Anticoagulation is the mainstay of therapy; however, nearly 13% of the patients experience poor outcome with anticoagulation alone.1 In addition, nearly one third of the patients with severe presentation have a risk of incomplete recovery with systemic anticoagulation.2 The subgroup of patients who have incomplete recovery or who develop rapid deterioration in spite of anticoagulation can benefit from mechanical thrombectomy with or without intrasinus thrombolysis. Our patient is a 33-year-old lady on oral contraceptive pills who developed extensive dural venous sinus thrombosis after undergoing lumboperitoneal shunt for pseudotumor cerebri (Video 1). ⋯ However, its utility for intracranial use is limited by the stiffness, large (6-French) catheter diameter, and short length (120 cm). After the procedure, the patient achieved rapid clinical improvement and was maintained on systemic oral anticoagulation. In addition to the case presentation, the video article also demonstrates the technical aspects of mechanical venous thrombectomy.
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Diverse adipose lesions can affect peripheral nerves, including an intrinsic disorder known as lipomatosis of nerve (LN). This condition leads to massive nerve enlargement and has often been associated with nerve territory overgrowth. Although LN has been well documented as a peripheral lesion, it is uncertain whether LN can occur or extend intradurally. ⋯ A review of our institutional cases and reported cases did not show any example of LN extending or occurring intradurally. It appears that LN is a benign tumor-like nerve lesion that is without a central location, unlike more well-known tumors such as schwannomas.
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To identify predictors of short-term mortality and complications after anterior odontoid screw fixation. ⋯ Functional dependence and preoperative systemic inflammatory response syndrome predict mortality following odontoid screw placement. Although age often is considered a limiting factor in pursuing surgical intervention in patients with odontoid fracture, age did not independently increase odds of either complications or perioperative mortality in this analysis. Further studies are needed to explore these findings.