World Neurosurg
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Case Reports
Two Cases of Large Filar Cyst Associated with Terminal Lipoma: Relationship with Retained Medullary Cord.
A small, incidental filar cyst associated with terminal lipoma is thought to be caused by failure of secondary neurulation; however, the precise embryologic background is not fully understood. Retained medullary cord (RMC) also originates from late arrest of secondary neurulation. The central feature of RMC histopathology is a central canal-like ependyma-lined lumen with surrounding neuroglial core. ⋯ The present findings support the idea raised by Pang et al that entities such as filar cyst, terminal lipomas, and RMC can all be considered consequences of a continuum of regression failure occurring during late secondary neurulation.
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Vascular reconstruction is required to treat infectious intracranial aneurysms (IIAs) on arteries supplying the eloquent area. However, extracranial-intracranial bypass is sometimes impossible because IIAs are frequently located distally on arteries and the length of a donor artery is limited. We report a rare case of an unruptured Gemella morbillorum IIA, which was successfully treated by intracranial-intracranial (IC-IC) bypass using a Y-shaped superficial temporal artery (STA) interposition graft. ⋯ This case suggests that end-to-side IC-IC bypass using a Y-shaped STA graft can be a good option for surgical treatment of IIAs, which are located in eloquent areas.
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Surgery appears to yield better results in adult spinal deformity treatment when fixed minimum clinically important difference values are used to define success. Our objective was to analyze utilities and improvement provided by surgical versus nonsurgical treatment at 2 years using Oswestry Disability Index with treatment-specific minimum clinically important difference values. ⋯ Our results suggest that surgical treatment has less disease burden and less chance of deterioration, but equal chances for improvement at 2 years of follow-up. As it appears to be a better modality in the absence of complications, future efforts need be directed to decreasing the complication rates.
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In cardiac intervention, the transradial approach (TRA) is increasingly used as the first-line approach owing to numerous advantages over the transfemoral approach. Neurointerventional TRA, especially in intracranial interventions, is predominantly restricted to an alternative approach, as transradial carotid cannulation using a conventional transfemoral system can be technically challenging for patients with unfavorable acute takeoff of the target common carotid artery. This study evaluated the feasibility and safety of first-line TRA with a radial-specific neurointerventional guiding sheath for a large series of consecutive intracranial anterior circulation aneurysm embolizations. ⋯ A transradial 0.088-inch triaxial or quadraxial system provided sufficient stability and kink resistance for intracranial aneurysm embolization. This method is feasible, highly successful, and safe for intracranial anterior circulation aneurysm embolization.