World Neurosurg
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Brain arteriovenous malformations (bAVMs) are uncommon and represent a heterogeneous group of lesions. Although these 2 facts have delayed research on this topic, knowledge about the pathophysiology, diagnosis, and treatment of bAVMs has evolved in recent years. ⋯ The latest investigations have helped in defining some molecular pathways involved in the pathology of bAVM. Although there is still more to learn and discover, describing these pathways will allow the creation of targeted treatments that could improve the prognosis of patients with bAVMs.
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Multicenter Study
Factors Affecting Neurosurgeons' Decisions to Forgo Life-Sustaining Treatments after Traumatic Brain Injury.
Traumatic brain injury (TBI) is a multifaceted condition that causes mortality and disability worldwide. Limited data are available on the factors associated with the decision for the withdrawal of life-sustaining treatment (WLST) for patients with TBI. In the present study, we aimed to determine the risk factors and attitudes affecting neurosurgeons when deciding on WLST for patients with TBI using a multicenter survey. ⋯ To the best of our knowledge, the present study is the first to evaluate neurosurgeons concerning their opinions and behaviors regarding WLST decisions after TBI. Increased patient age, Glasgow coma scale score, pupillary response, the presence of comorbidities, candidacy for a vegetative state, and impaired neurological function were the main factors contributing to the decision for WLST. We also found that the family, ICU consultants, and the attending neurosurgeon had the most effective roles in the decisions regarding WLST.
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Case Reports
Microsurgical treatment for a Cerebral Arteriovenous Malformation of the Central Sulcus.
Arteriovenous malformations (AVMs) are congenital neurovascular disorders frequently manifested in young adults. The clinical presentation is variable and depends on its location, size, and ability to steal flow from adjacent areas, but it depends mainly on the occurrence of bleeding.1 The treatment of these lesions when located in eloquent areas, especially around the central sulcus, is controversial. ⋯ We consider that surgical removal of many of these lesions is feasible when preoperative planning is performed,3 when it is based on deep anatomic knowledge, and particularly when using a refined microsurgical technique.1 In this 3-dimensional Video 1, we present a case of a cerebral AVM of the central sulcus in which we achieved complete resection with microsurgical treatment without any neurologic sequelae for the patient. The patient consented to publication of images.
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Traumatic dural sinus injuries following penetrating brain injury are rare but are often associated with significant morbidity and mortality. The management of significant defects is operative and can be challenging. In modern civilian practice, patients with these injuries typically receive extensive preoperative investigation and advanced perioperative monitoring. ⋯ Immediate repair of dural sinus injuries is feasible in the context of a low-resource wartime environment and should be attempted without delay. To our knowledge, this is the first case of successful use of a synthetic vascular graft for repair of a dural venous sinus injury in an ill-equipped hospital.
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Subependymal giant cell astrocytoma (SEGA) is a World Health Organization grade 1 neoplasm, which, due to its dubious morphologic features, may be misdiagnosed as a high-grade tumor at times. This tumor shows binary immunoexpression including both glial and neural markers, leading to a state of diagnostic quandary. Recent evidences have surmised the diagnostic utility of thyroid transcription factor 1 (TTF-1), spurring us to study the practicality of this marker in distinguishing SEGAs from its mimics. ⋯ The congruous finding of TTF-1 expression in SEGA and cells of the developing neuroepithelium in the medial ganglionic eminence hint toward a primogenitor cell with neoplastic potential in the presence of impelling factors.