World Neurosurg
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Case Reports
Pediatric Moyamoya presenting as a subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm.
The incidence of Moyamoya disease (MMD)-associated intracranial aneurysms ranges from 3% to 14% in adult patients, whereas this complication has rarely been reported in children. ⋯ MMD-associated aneurysms are extremely rare in children, and hemorrhage may be the initial presentation of the disease. Prompt intervention is essential to exclude the ruptured aneurysm that is at risk of rebleeding because of persistent hemodynamic stress.
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Idiopathic hypertrophic pachymeningitis (IHP) is a rare clinical disease characterized by inflammatory fibrosis, which causes diffuse thickening of the dura mater. The inflammatory fibrosis will be locally invasive in nature but will be characterized by a benign histological appearance, known as an inflammatory pseudotumor. We present the case of a patient with an infiltrative lesion involving the right frontal convexity diagnosed as IHP, which had been suspected to be a malignant tumor or high-grade meningioma from the preoperative radiological findings. ⋯ Surgical treatment can be the first treatment option when the lesion is not localized to a critical portion of the brain. Thus, it might be possible to arrive at a definitive diagnosis histologically and determine additional treatment strategies. Also, if the surgeons are confident that the IHP has been removed completely, additional steroid therapy might not be necessary.
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Gross total resection of arteriovenous malformations (AVMs) of the central nervous system confirmed by formal angiography is accepted as a cure for patients. In some cases, this may not be possible. Even though in these cases other treatment modalities such as endovascular embolization and radiotherapy can be used, long-term follow-up is lacking in the literature. ⋯ The patient subsequently presented (12 years later) with a symptomatic, enlarging, contrast-enhancing mass at the same location that was angiographically occult but ultimately proven to be an AVM on a background of reactive changes on pathology.
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A focused dissection of the brainstem was performed to study the various fiber bundles and gray matter nuclei of the brainstem and to decipher the intricate anatomy. ⋯ This division of the fiber bundles into zones will help neurosurgeons in understanding the course and anatomy of the fibers, which can be cumbersome to remember when only studying the sectional anatomy of the brainstem.
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To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery. ⋯ Incidental durotomy is a rare complication of transforaminal lumbar endoscopic spine surgery and appears to occur more likely in patients who have undergone previous spine surgery at the site of the endoscopic procedure, not unexpectantly. Glues, patches, and bedrest were among the various methods used after durotomy. In this series there were no cases of symptomatic spinal fluid leakage or pseudomeningocele seen. Only 20% of patients who had durotomies noted a headache in the immediate postoperative period.