World Neurosurg
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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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Spinal arachnoid webs are a rare anatomic entity manifesting as neuropathic back pain, compressive myelopathy, radiculopathy, and hydrocephalus. Typical treatments include hemilaminectomy or full laminectomy with durotomy and microsurgical resection, which can result in secondary scarring and recurrent blockage of cerebrospinal fluid (CSF) flow perpetuating the cycle. ⋯ This minimally invasive approach seems useful in achieving restoration of spinal fluid flow at the thoracic region when the underlying blockage results from an arachnoid web and leads to quantifiable clinical improvement.
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Ossification of the ligamentum flavum (OLF) is a relatively common disease in East Asia. Although surgical decompression using a posterior approach is commonly used to treat OLF, there are several different treatment strategies. The purpose of this study is to clarify the technically important points for the treatment of OLF using full-endoscopic spine surgery (FESS). ⋯ Posterior decompression using FESS can be used to treat patients with lumbar OLF. Unilateral round-type OLF with ipsilateral radiculopathy can be treated using a 4.1-mm working channel endoscope. Bilateral-type OLF with cauda equina symptoms should be treated using a 6.4-mm working channel endoscope.
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Case Reports
Two cases of posterior cerebral artery P2 occlusion with motor weakness improved by acute mechanical thrombectomy.
Clinical evidence to support the use of mechanical thrombectomy (MT) for posterior cerebral artery P2 segment occlusion (P2O) has not been established, and hemiplegia due to P2O improved by MT to our knowledge has not yet been reported. We report 2 cases of P2O with hemiplegia improved by MT. ⋯ P2O may cause severe motor deficit. In such cases, MT may contribute to safely improving patients' deficits.
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Case Reports
Posterior Reversible Encephalopathy Syndrome after Transsphenoidal Resection of Pituitary Macroadenoma.
Posterior reversible encephalopathy syndrome is manifested by a reversible neurologic deficit such as vision loss, encephalopathy, and a posterior location, typically the occipital lobes. It is commonly thought to be related to acute, severe hypertension. ⋯ To our knowledge, this is only the second case of posterior reversible encephalopathy syndrome following transsphenoidal surgery to be reported in the neurosurgical or ophthalmic English language literature.