World Neurosurg
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Few studies have examined the impact of teaching status and location on outcomes in subarachnoid hemorrhage (SAH). The objective of the present study was to compare mortality and functional outcomes among urban teaching, urban nonteaching, and rural centers for hospitalizations with SAH. ⋯ Rural and urban nonteaching centers have higher rates of mortality from SAH than urban teaching centers. Further study is necessary to understand drivers of these differences.
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Review Case Reports
Rapid Recurrence and Anaplastic Transformation of a Pilocytic Astrocytoma in an Elderly Patient: A Case Report and Review of the Literature.
Rapid recurrence of a pilocytic astrocytoma with anaplastic transformation is extremely rare. The case of an elderly patient with a cerebellar pilocytic astrocytoma with anaplastic transformation during short-term follow-up is reported. ⋯ It is extremely rare, as in the present case, that a cerebellar PA in an elderly patient recurs rapidly with anaplastic transformation, despite deferred postoperative adjuvant therapy including radiation and chemotherapy. A novel molecular-targeted therapy is needed for anaplastic PA showing aggressive biological behavior.
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The extradural neural axis compartment (EDNAC) is an adipovenous zone located between the meningeal and endosteal layers of the dura and has been minimally investigated. It runs along the neuraxis from the orbits down to the coccyx and contains fat, valveless veins, arteries, and nerves. In the present review, we have outlined the current knowledge regarding the structural and functional significance of the EDNAC. ⋯ Clinicians should be aware of the extent and significance of the EDNAC, which could affect skull base and spine surgery, and have an understanding of the tumor spread pathways and growth patterns. Comparatively little research has focused on the EDNAC since its initial description. Therefore, future investigations are required to provide more information on this underappreciated component of neuraxial anatomy.
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Case Reports
Endoscopic Endonasal Approach for Clival Chordoma with Subarachnoid Invasion: a 2D Step-by-Step Operative Video.
Chordomas are slow-growing, low-grade, locally invasive, and locally aggressive tumors. They peak at 40-60 years of age, with a male preponderance (2:1). ⋯ An endoscopic endonasal transclival approach was performed and gross total removal was achieved (Video 1). The patient had an uneventful recovery with no deficits, and he was then sent to proton beam therapy.