World Neurosurg
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Case Reports
Rapid evolution and rupture of an incidental aneurysm during hyperdynamic therapy for cerebral vasospasm.
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Among the most common sequelae of aSAH is delayed cerebral ischemia. Hyperdynamic therapy (fluid supplementation and hypertension) is used to increase cerebral perfusion. However, the safety of hyperdynamic therapy in patients with separate unruptured, unsecured intracranial aneurysms is not well-established. Herein, a rare case demonstrating the rapid evolution and rupture of an incidental unsecured aneurysm in the setting of hyperdynamic therapy is presented. ⋯ This case demonstrates that enlargement and rupture of an incidental, previously unruptured aneurysm may occur during hyperdynamic therapy.
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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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Although carcinoma metastasis to primary intracranial neoplasms has occasionally been reported, metastasis to a cerebral arteriovenous malformation (AVM) has been exceedingly rare, with only 5 cases reported to date. In the present study, we have reported a case of lung carcinoma that had metastasized to a cerebral AVM. To the best of our knowledge, the present report is the first case in which the pathological examination detected the bleeding mechanism of this rare condition, showing destruction of the feeders by the metastatic tumor. ⋯ Although rare, clinicians should recognize that undifferentiated carcinomas can metastasize to AVMs and cause bleeding. Because the preoperative diagnosis can be difficult, even using the latest imaging modalities, careful examination of the resected specimen is required to reveal such pathological conditions.
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Surgical management of thoracic ossification of the posterior longitudinal ligament (OPLL) remains challenging because of the fragility of the thoracic spinal cord. Posterior approach with long instrumentation has been predominantly performed. However, this procedure includes the risk of neurologic deterioration caused by the progression of OPLL during long-term follow-up and the need for long instrumentation to achieve dekyphosis, even for so-called beaked-type OPLL between 1 vertebra. ⋯ Microsurgery via the transthoracic anterolateral approach enables direct visualization of the thoracic ventral ossified lesion. Relatively narrow and little resection of the vertebral body under the presently demonstrated microsurgical procedures might negate the need for bone grafting or spinal instrumentation. The patient gave informed consent for surgery and video recording (Video 1).