World Neurosurg
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Cavernous sinus hemangiomas (CSHs) are extraaxial vascular malformations that tend to bleed during surgery. ⋯ A combination of low signal on T1, high signal on T2 and fluid-attenuated inversion recovery, no diffusion restriction and homogenous enhancement should place CSH at the top of the list of differential diagnoses. This is especially true when there is a "filling-in" pattern on dynamic or delayed imaging. Doing so may alert surgeons to the possibility of copious intraoperative bleeding and therefore avoid complications of hemorrhage.
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Permanent cerebrospinal fluid diversion has a lengthy list of complications. We present an unusual clinical image of shunt catheter migration. A 54-year-old female had a history of subarachnoid hemorrhage that resulted in communicating hydrocephalus, which needed a ventriculoperitoneal shunt placement. ⋯ On review of the patient's previous imaging, an area indicative of a minor pleural breach was identified that exposed the catheter to the negative thoracic pressure, which resulted in progressive catheter migration. The patient then underwent removal of the shunt system since her hydrocephalus had resolved. A pleural breach during shunt placement can result in the migration of the shunt catheter into the thoracic cavity under the effect of negative thoracic pressure.
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The current study is an external validation of 4 scoring models proposed in the literature for predicting ventriculoperitoneal shunt insertion after aneurysmal subarachnoid hemorrhage (aSAH) using retrospective patient data from Sheffield Teaching Hospital (STH). ⋯ Scoring model 4 was found to be the best scoring model out of the 4 scoring models externally validated to predict shunt dependency after an aSAH in STH patients. Scoring model 4 is less applicable in modern practice due to a higher proportion of coiling and use of the Hunt and Hess scale grade. A new scoring model is needed to predict shunt insertion in modern practice.
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Neurocysticercosis (NCC) is the commonest parasitic infection of the central nervous system. There is significant difference in incidence of NCC depending on geographic location, and incidence as high as 4% is reported in the endemic areas. It results from human affliction by the larval stage of Taenia solium. Spinal NCC is quite rare as compared with cranial NCC and accounts for 1.5%-3% of all cases. Both spine and cranium can be rarely involved in NCC, and cranial involvement usually precedes the spinal involvement. ⋯ NCC can sometimes follow a very aggressive course and can involve both cranial and spinal compartments. Management of such patients is not standardized given the rarity of such cases.
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Comparative Study
Comparative Cadaveric Analysis for Surgical Corridor and Maneuverability: Far-Lateral Approach and its Transcondylar Extension.
The necessity of partial occipital condyle (OC) resection for lesions in the ventral craniocervical junction is debatable. This study's purpose was to compare the surgical exposure of the classic far-lateral approach (FLA) and transcondylar FLA. ⋯ Transcondylar FLA can significantly increase surgical exposure compared with the classic FLA, although also increasing surgical complications. Therefore, the surgical approach should be individualized according to each lesion and patient. The results of our study may assist in surgical decision-making regarding the need for OC resection.