World Neurosurg
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Triplicate A2 segment of the anterior cerebral artery is a rare anatomical variant (1%-3% prevalence) that which is thought to result mainly from persistence of the embryonic median artery of the corpus callosum. We sought to determine whether the triple-A2 variant is specifically associated with anterior communicating artery (ACoA) aneurysm. ⋯ Compared with the normal population, patients with ACoA aneurysms deemed to require treatment have a significantly higher likelihood of having triplicate A2 segment. Knowledge of this anatomical variation is of critical importance in planning and executing endovascular and microsurgical treatment of ACoA aneurysms.
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In-stent thrombosis is a potentially dangerous complication of flow diversion for cerebral aneurysms. The optimal management strategy for such thrombosis is not known. Here we present a case of acute ischemic stroke caused by occlusion of a Pipeline Embolization Device (PED) construct placed 18 months earlier for treatment of a fusiform middle cerebral artery aneurysm. This was successfully treated with mechanical thrombectomy with good neurologic outcome. ⋯ Mechanical thrombectomy with a stent retriever and aspiration is a therapeutic option for treatment of delayed thrombosis of a flow-diverting stent.
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Endodermal cysts of the oculomotor nerve are rare presentations. Only case reports are available to help guide clinicians with managing this rare entity. ⋯ Magnetic resonance imaging is an essential modality in the follow-up of these patients postoperatively in the setting of unchanged or deteriorated neurology. Fenestration of the cyst is appropriate first-line surgical management; however, a cysto-subarachnoid shunt is a safe consideration in recurrent, symptomatic cysts and provides sustained symptom resolution.
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Case Reports
Isolated Bilateral Hypoglossal Palsy Complicating a Fourth Ventricle Ependymoma Surgery.
Isolated bilateral hypoglossal palsy is a rare condition that has never been described after surgery in the lower part of the fourth ventricle. In this article, we discuss various possible etiologies and relevant anatomy considerations of the rhomboid fossa. ⋯ Intraoperative neurophysiologic monitoring of hypoglossal nerves, in addition to facial nerves, should be performed for tumors in this location.