World Neurosurg
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Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a recent addition to the World Health Organization classification schema of brain tumors, under the heading of neuronal and mixed neuronal-glial tumors. DLGNTs have a classic imaging appearance. However, it has often been misdiagnosed owing to its rarity, its resemblance to granulomatous/leptomeningeal etiologies, and the clinical presentation. ⋯ We have described the classic imaging appearance of this rare brain tumor. Radiologists and clinicians should be aware of this entity to avoid misdiagnosis and a delay in management.
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Case Reports
Intra-reservoir administration of alteplase to treat a distal ventriculo-atrial shunt obstruction.
Ventriculoatrial shunts can be afflicted with distal malfunctions due to thrombus formation at the distal tip. Distal tip thrombus formation may occur more commonly in oncologic patients who are predisposed to hypercoagulability. ⋯ Intrareservoir administration of alteplase can be a useful nonoperative treatment strategy for ventriculoatrial shunt malfunction. This strategy may be particularly useful in cases with higher perioperative risk, such as patients with advanced metastatic cancer.
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Case Reports
Diagnosis of a CSF-Venous Fistula Associated with a Venous Malformation using Digital Subtraction and CT Myelography.
Spontaneous cerebrospinal fluid (CSF) leaks can be an intractable cause of orthostatic headaches but have several treatable causes. CSF-venous fistulas are an increasingly recognized cause of rapid CSF leaks. Although CSF-venous fistulas have been previously reported in the literature, their imaging appearance, associated anomalies, and treatment are incompletely understood. We present a case of a CSF-venous fistula draining to adjacent venous malformations with symptoms responding to surgical treatment. This is the first such case to our knowledge showing enhancement of venous malformations on computed tomography myelography. ⋯ CSF-venous fistulas are a relatively uncommon cause of spontaneous CSF leaks. Though difficult to diagnose, they can respond to surgical treatment as seen in this case. In our experience, decubitus digital subtraction myelography combined with computed tomography myelography is instrumental in making the diagnosis and fully characterizing any abnormalities associated with the fistula. This case also supports the suggested association between CSF-venous fistulas and venous malformations, which is worthy of continued study.
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Comparative Study Observational Study
Comparing standard performance and outcome measures in hospitalized pituitary tumor patients with secretory versus non-secretory tumors.
Patient safety indicators (PSIs) and hospital-acquired conditions (HACs) are reported quality measures. We compared their prevalence in patients with secretory and nonsecretory pituitary adenoma using the National (Nationwide) Inpatient Sample (NIS), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. ⋯ Lack of significant difference in outcome measures after controlling for covariation is consistent with our finding that patients with nonsecretory tumor have more comorbidities on presentation for treatment. PSIs and HACs have limited ability to measure complications specific to pituitary tumors.
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Case Reports
Microvascular Decompression and Transposition of the 8th Cranial Nerve Using a Fenestrated Clip.
Neurovascular compression is a potential, yet rare cause of vertigo and unilateral tinnitus. Despite the high success rate of microvascular decompression (MVD) in other vascular compression syndromes, the outcome reported after MVD of the vestibulocochlear nerve is variable.1,2 The presence of combined symptoms of tinnitus and vertigo treated by MVD has demonstrated a higher predictive value for success.3 In this video, we present the case of a 68-year-old male who presented with vertigo and tinnitus refractory to medical management and vestibular therapy. Audiologic evaluation was normal apart from mild sensorineural hearing loss. ⋯ Indocyanine green angiography with Glow-800 was conducted before and after AICA transposition to confirm adequate flow through the mobilized vessel. Postoperatively, the patient's vestibular symptoms improved significantly. This case demonstrates that microvascular decompression can provide a satisfactory outcome in patients with unilateral tinnitus and vertigo associated with vascular compression in appropriately selected cases (Video 1).