World Neurosurg
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Shunt complications are common despite advances in surgical techniques and shunting technology. Proximal and/or distal catheter malfunctions are detected in pediatric and adult patients. However, valve dysfunction is rare in such cases. ⋯ This case is a very rare example of shunt valve dysfunction that required further investigation and a new valve replacement even though the preoperative imaging was normal.
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Case Reports
Carotid endarterectomy for intractable repetitive stenosis following carotid artery stenting.
Restenosis after carotid artery stenting has raised concerns regarding the long-term durability of carotid stenting. Recurrent restenosis after multiple endovascular interventions may pose a challenge for clinicians. ⋯ Carotid endarterectomy could be considered as a first-line treatment for recurrent stenosis that proves refractory to multiple endovascular interventions.
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The efficacy and safety of endoscopic procedures for slit ventricle syndrome (SVS) have been presented in recent studies. However, inserting a sheath into a target ventricle is essential in the beginning of endoscopic procedures for SVS, and this maneuver is challenging owing to the quite narrow ventricular space. We report a novel flexible endoscopic technique, the water-slide technique, that can effectively guide a sheath into a slit ventricle without the use of other adjunctive devices, such as a neuronavigation system and an ultrasound machine. ⋯ This novel endoscopic technique is effective and safe for inserting a sheath into a target ventricle in the management of SVS.
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Tuberculum sellae meningiomas are challenging tumors often compressing the optic apparatus and involving the optic canals. Traditional approaches provide wide exposure, but optic canal access can remain difficult. Endonasal approaches offer a less invasive option that allows access to the medial optic canals, but larger tumors can still be challenging along with a higher risk of postoperative spinal fluid leak. We present the use of a keyhole superior interhemispheric approach for tuberculum sellae meningioma resection. ⋯ The keyhole superior interhemispheric approach provides a transcranial alternative that allows excellent exposure of the vasculature and both optic canals, resulting in good extents of resection and recovery of vision.