World Neurosurg
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Treatment of multiple intracranial aneurysms is challenging. Neurologic status, aneurysm morphology, location, ruptured/unruptured status, availability of equipment, and patient preference are among the factors influencing the choice of treatment modality.1 Ideally, a 1-stage procedure is recommended whenever possible.2 However, patients with multiple aneurysms located in both the anterior and posterior circulation are less likely to be treated with a single procedure.3 We present the case of a 52-year-old patient who presented with recurrent headaches and progressive onset of a right eye ptosis evolving for 2 months. Her medical history was significant: an episode of eclampsia 20 years ago and high blood pressure managed with amlodipine. ⋯ Thirty days later, she underwent an endovascular coiling of the vertebro-basilar junction aneurysm uneventfully. She was able to return to work 2 weeks after discharge. The patient consented to publication of her images.
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This study assesses cervical alignments after 2-level cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) with anterior plate fixation. ⋯ ACDF and CDA are viable options for 2-level degenerative disc disease in carefully selected patients. Both approaches produced equivalent postoperative alignment changes in a 2-level operation.
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Case Reports
Simultaneous clipping and STA-MCA bypass for unruptured MCA aneurysm concomitant with proximal stenosis.
Management of unruptured intracranial aneurysms concomitant with proximal stenosis remains challenging. Video 1 demonstrates simultaneous clipping and superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for unruptured MCA aneurysm concomitant with proximal stenosis. A 56-year-old man presented with paroxysmal left limb weakness for 2 years. ⋯ Six-month follow-up angiography confirmed complete obliteration of the aneurysm and patent STA-MCA anastomosis. For unruptured MCA aneurysms concomitant with proximal stenosis, 1-stage surgical treatment with simultaneous clipping and STA-MCA bypass is a feasible alternative. Further studies are needed to compare the safety and efficacy of 1-stage surgical treatment and endovascular embolization of intracranial aneurysms concomitant with proximal stenosis.
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Case Reports
Operative Technique for Resection of a Ventral Trans-Dural Retro-Odontoid Pannus: A 2-Dimensional Operative Video.
Retro-odontoid pseudotumors are rare inflammatory complications of atlantoaxial instability often associated with cervical degenerative disease and rheumatoid arthritis. While propagation of these lesions has been shown to cause spinal cord compression and cervical myelopathy, intradural extension has rarely been reported. ⋯ Our outcome in this rare complication suggests a posterior approach may be effective in treating similar patients.
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The long-term outcomes of cognitive function in moyamoya disease remain unknown. We aimed to assess 5-year changes in cognitive function in adult moyamoya disease patients and to evaluate the value of the magnetic resonance angiography (MRA) steno-occlusive score to predict cognitive changes. ⋯ Specific cognitive domains can decline over time in patients with adult moyamoya disease. MRA findings might be useful for predicting future declines in cognitive function.