World Neurosurg
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VerifyNow-directed personalized antiplatelet therapy for aneurysm embolization with a Pipeline Embolization Device (PED) remains controversial. Evaluate thrombotic complications between patients who received VerifyNow-directed personalized antiplatelet therapy versus those who did not after PED flow diversion of complex cerebral aneurysms. ⋯ The role of VerifyNow and personalized antiplatelet therapy in patients undergoing flow diversion with PED to treat complex aneurysms did not demonstrate a benefit in reducing thrombotic complications.
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Case Reports
Nasal Packing Causing Occlusion of Contralateral ICA during Control of Pseudoaneurysm Bleed.
Carotid pseudoaneurysm is a rare complication of pituitary surgery and can present with epistaxis. Nasal packing is considered first-line treatment for the control of carotid bleeding. We describe a case of complete occlusion of the contralateral cavernous carotid artery because of nasal packing placed to control hemorrhage from a cavernous carotid pseudoaneurysm. ⋯ To our knowledge, this is the only report that describes complete occlusion of the contralateral cavernous carotid artery because of extrinsic compression of the lateral sphenoid wall, in the setting of a symptomatic pseudoaneurysm.
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Osteoradionecrosis (ORN) refers to the degenerative changes seen in bone after local radiation, particularly in head and neck cancer. ORN can present as neck or facial pain and may be confused with tumor recurrence. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are often inconclusive, requiring percutaneous biopsy to differentiate ORN from infection and recurrent disease. We reviewed the utility of preprocedural imaging in guiding the decision to biopsy in cases of ORN. ⋯ This case series highlights that PET scanning may not be useful in predicting which patients will benefit from biopsy for ORN because no patients with PET-positive lesions had histopathologic evidence of tumor recurrence or metastasis on biopsy.
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Review Case Reports
Primary Brain Rhabdomyosarcoma Causing Extracranial Metastases. Case Report with Narrative Review of Atypical Presentations and Their Diagnostic Challenges.
Rhabdomyosarcoma is a rare malignant tumor originating from striated muscle cells. It accounts for only 3% of all soft tissue sarcomas in adults, and its metastases can also reach the central nervous system. Only sporadic cases of primary brain rhabdomyosarcoma (PBRMS) have been reported so far. ⋯ PBRMS can be hardly distinguished from other malignant brain tumors during preoperative radiologic workup; only histology can raise the suspicion of primary or metastatic rhabdomyosarcoma, depending on the presence of other distant lesions. Our review of the literature demonstrates that prognosis is poor: 44% of patients die within 1 year from diagnosis. Overall, survival seems to correlate with radical resection, tolerance of stereotactic or if necessary full neuraxis radiotherapy, and adjuvant chemotherapy. Given the high relapse rate, close monitoring and restaging are imperative.
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Case Reports
Delayed vasospasm associated with mechanical thrombectomy for acute ischemic stroke: A Case report.
Vasospasm related to mechanical thrombectomy for acute ischemic stroke sometimes occurs as a periprocedural complication, although it is usually a transient and asymptomatic event. Herein we describe the second case of symptomatic delayed vasospasm associated with mechanical thrombectomy, highlighting its unique device-related adverse event. When intraoperative vasospasm occurs, we should pay attention to this phenomenon, and close follow-up is necessary.