World Neurosurg
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Over the past 2 decades, management of idiopathic normal pressure hydrocephalus (iNPH) has evolved significantly. In the current study, we sought to evaluate the national prevalence and management trends of iNPH in the United States using a national database. ⋯ We have summarized the national prevalence of iNPH, trends in its management over the previous decade and trends by region and hospital type.
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An intracranial dural arteriovenous fistula (DAVF) is an uncommon acquired dural shunt between an artery and a vein without a parenchymal nidus. DAVF occlusion may be achieved using either endovascular or open surgical means. Combining both techniques is also frequently used in clinical practice. ⋯ As demonstrated in this Video 1, microsurgical obliteration of DAVFs is relatively straightforward. This provides a valuable treatment option of some selected DAVFs and should be considered as a primary initial treatment option of complex DAVFs in certain locations. Open surgical obliteration is the best possible, most durable, and most effective therapeutic option when there are failures or shortcomings with endovascular management.
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Case Reports
Spontaneous Spinal Subarachnoid Hemorrhage from a Ruptured Radiculopial Artery Aneurysm.
Spontaneous spinal subarachnoid hemorrhage is an uncommon entity and is even rarer when secondary to intraspinal ruptured aneurysm. The clinical presentation of these cases usually includes back pain and headache; however, we report a unique case in which the patient became acutely paraplegic. ⋯ This unique clinical case highlights a rare cause of spontaneous acute paralysis and further demonstrates the safety of obliterating an intraspinal aneurysm via operative resection.
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Congenital midline spinal hamartoma is a very rare tumor-like proliferation that mostly occurs during childhood. It consists of mature, well-differentiated ectodermal and mesodermal elements that present in an abnormal location and are mostly associated with neurofibromatosis type 1 and spinal dysraphism. ⋯ Congenital midline spinal hamartoma is very rare and seldom addressed. Most patients present with a cosmetic defect and rarely with associated symptoms. Tissue biopsy is still the best modality to definitively diagnose hamartoma and to exclude other diagnoses. Surgical excision of the tumor is still the mainstay treatment, especially for patients who are not neurologically intact and to correct the cosmetic skin defect.
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Case Reports
Microvascular Decompression for Oculomotor Nerve Palsy due to Nonaneurysmal Vascular Compression.
Diabetes mellitus and aneurysmal compression are well-known causes of oculomotor nerve palsy (ONP), but nonaneurysmal vascular compression of the oculomotor nerve has rarely been reported. ⋯ Whether nonaneurysmal vascular compression of the oculomotor nerve is a true cause of ONP is sometimes controversial. However, recent developments in magnetic resonance imaging can clearly demonstrate the spatial relationship between the oculomotor nerve and vessels. Detailed magnetic resonance imaging should be used to diagnose compression of the oculomotor nerve by blood vessels. Microvascular decompression is the treatment of choice in this situation.