World Neurosurg
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Trans-cell approach for the Neuroform Atlas stent (Stryker Neurovascular, Fremont, CA) is occasionally unsuccessful as a microcatheter can become stuck in the struts. This study aimed to evaluate the passability and impassability of 0.0165-inch microcatheters through the Neuroform Atlas stent using a simplified benchtop model. ⋯ Target crowns and microcatheters affected the use of the trans-cell approach through the Neuroform Atlas stent. The passability was excellent in a lower profile 0.0165-inch microcatheter. Moreover, neurointerventionalists must be knowledgeable of the crown jackpot phenomenon, which might cause fatal stent migration.
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Central nervous system (CNS) embryonal tumors are malignant neoplasms of undifferentiated embryonic cells that typically occur in the pediatric population. They are further divided into many subgroups by distinct histologic and genetic profiles. We present the largest study to date to identify differential survival outcomes within each subgroup by treatment regimen. ⋯ CNS embryonal tumors are highly malignant in all populations and the best survival is seen with aggressive combination therapies. Radiation therapy may have a role in prolonging survival in patients with medulloblastoma ≤3 years of age.
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Cerebral vasospasm and delayed ischemic neurologic deficits are well-known clinical aftereffects of subarachnoid hemorrhage due to rupture of an intracranial aneurysm. However, vasospasm with consequential ischemia after clipping of an unruptured aneurysm is an exceedingly rare sequela encountered in the reported neurosurgical literature. ⋯ To the best of our knowledge, we have reported the first case of recurrent cerebral vasospasm and delayed ischemia neurologic deficits weeks subsequent to clipping of an unruptured aneurysm. The findings from the present case highlight the importance of considering delayed vasospasm as a cause of acute onset neurologic symptoms for patients who have recently undergone elective aneurysm surgery. We also reviewed the current data regarding the epidemiology, surgical factors, and proposed pathophysiologic mechanisms related to vasospasm after elective cases.
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Hypertrophic pachymeningitis (HP) and spontaneous intracranial hypotension are different treatable diseases, which should promptly be recognized and treated to prevent neurologic sequelae. Headache and dural enhancement are the main features of both diseases, thus differentiating between these 2 conditions can be difficult. ⋯ An accurate diagnostic workup is mandatory to distinguish among HP and intracranial hypotension.
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Colloid cysts of the third ventricle are benign congenital lesions. They are at times totally asymptomatic or may be detected in the evaluation for headache, neurologic disturbances, or psychiatric disturbances. They may sometimes cause grave consequences such as coma or even sudden death. The radiologic appearance is unique and important for making decisions in the management. ⋯ This case stands out remarkably because it is only the second case in literature with similar natural history.