World Neurosurg
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Review Case Reports
Cushing's Syndrome Caused By Ectopic ACTH-secreting Pituitary Adenomas: Case Report and Literature Review.
Ectopic adrenocorticotropic hormone-secreting pituitary adenomas (EAPAs) are rare adenomas causing Cushing syndrome, which are located in ectopic locations outside the sella turcica. No more than 100 cases of this entity have been reported. Because of its rarity and nonspecific clinical and biochemical features, EAPA is often misdiagnosed, leading to surgical failure and delayed treatment. In the article, the cases of 3 patients with suprasellar EAPAs treated at our institution are reported and a review of the literature is presented. ⋯ Although EAPA is an extremely rare entity, it should be considered as a differential diagnosis of Cushing disease. Because of its similar clinical and biochemical behavior to intrasellar pituitary adrenocorticotropic hormone adenoma in Cushing disease, careful examination of the potential occurrence of EAPA on preoperative radiologic imaging is of considerable significance to avoid unnecessary surgery and achieve improved outcomes. Surgical resection EAPA remains the first choice of treatment, and the optimal surgical approach ought to be determined according to the adenoma features, the general condition of the patient, and the surgeon's experience.
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Review Case Reports
Corpus callosotomy for refractory epilepsy in Aicardi syndrome: a case report and focused review of the literature.
Aicardi syndrome is a severe neurodevelopmental disorder that occurs primarily in females and is characterized by seizures, agenesis of the corpus callosum, and chorioretinal lacunae, which occur together in the majority of affected individuals. Seizures begin in infancy and tend to progress in intensity and are often refractory to standard multimodal medication treatments. ⋯ For the subset of children who present with partial, rather than complete, agenesis of the corpus callosum, corpus callosotomy should be considered as a treatment option to reduce seizure burden.
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In parallel with the progress in neurosurgery, improvements in residents' training strategies have been reported. Increasing focus has been placed on residents' participation in research. Previous studies analyzed neurosurgery residents' contributions to research activities, time dedicated to research, and outcomes. However, few studies investigating these aspects outside the United States are present in the literature. ⋯ By describing the current status of Italian residents' participation in research, we provide additional insight into factors supporting research involvement and existing barriers. Strategies for improvement at national and departmental levels are suggested. We encourage further investigations in other countries, to provide useful information in a worldwide framework.
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Atypical and anaplastic meningiomas (AAMs) are rare and comprise approximately 5% of all meningiomas. Extracranial metastases in meningioma patients occur in 0.1% of all cases, but these lesions are difficult to treat and may be a poor prognostic factor. ⋯ Metastasis development from AAM is a rare but serious event. Because scalp invasion is a strongly associated predictive factor for development of systemic metastasis in patients with AAM, it is necessary to consider strategies to prevent and to be vigilant of the development of scalp invasion.
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Superficial temporal artery (STA)-to-middle cerebral artery bypass is frequently performed for moyamoya disease. We discuss an unusual case in a moyamoya patient complicated by the development of dural and pial arteriovenous fistulae (AVF). Both AVF then spontaneously resolved 2 years after surgery. ⋯ AVF as a complication of revascularization surgery is rare. Here, we discuss the possible pathophysiologic mechanisms that we theorize may have contributed and current treatment options and indications. We also review the literature surrounding this phenomenon.