World Neurosurg
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The plasticity of the Circle of Willis represents an underexplored yet intriguing dimension of vascular anatomy in cerebrovascular disorders. We outline distinct patterns of change in response to aneurysm treatment using flow diversion (FD) after covering major branches. ⋯ The circle of Willis displays both hemodynamic and anatomic plasticity after major branch coverage with a flow diverter. This phenomenon is aimed at preserving blood flow in the distal territory of the covered vessel.
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Distal anterior cerebral artery (ACA) aneurysms constitute 4%-5% of all intracranial aneurysms.1-3 Rarely, these aneurysms can be complex and less amenable to conventional clipping or endovascular techniques, requiring alternative treatment strategies.4,5 Surgical modalities utilized in these situations may involve trapping and flow replacement techniques to exclude the aneurysm while maintaining normal perfusion to the affected territories.4-7 In this Video 1, we describe the modified trapping technique for cases where 2 branches arise from the aneurysm and cannot be sacrificed. This technique involves the transposition of 1 of the branches and its reimplantation distally to the lesion. The aneurysm is then clipped, trapping the segment from which the disconnected branch originated, while preserving anterograde blood flow to both non-occluded and reimplanted branches. ⋯ The patient tolerated the procedure well, and postoperative imaging showed complete aneurysm occlusion and patency of both the non-occluded and reimplanted pericallosal arteries. The patient consented to the procedure and the publication of her images. Institutional review board approval was deemed unnecessary.
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Virtual angioscopy (VA) has been used for vessel investigation and treatment planning in vascular surgery. To our knowledge, the use of VA in neurointerventional cases has not been demonstrated. ⋯ Endoluminal visualization of the fistula served as an additional tool that improved anatomic understanding and treatment planning. These cases demonstrate the utility of VA in endoluminal visualization of dural arteriovenous fistula to aid in treatment planning.
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Epidural extramedullary hematopoiesis (EMH) is a rare, underreported phenomenon in which hematopoiesis occurring outside of the medullary environment can cause spinal cord compression. In this systematic review, we evaluate clinical characteristics and evidence-based guidelines for clinical management of EMH and present an illustrative case. ⋯ Epidural EMH is a pathology with limited reporting; this systematic review is the most comprehensive to date. Although available case series data were heterogeneous, our analysis suggested that multimodal treatment with surgical intervention was beneficial. Given the young patient population, we recommend prompt surgical management via decompression of the spine because of the associated low risk of complications and recurrence, and better neurological recovery.
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Hypertrophic olivary degeneration (HOD) is a rare form of transsynaptic degeneration, caused by injury to the dentato-rubro-olivary pathway (DROP). Radiologically, this manifests as T2 hyperintensity, with or without enlargement of the inferior olivary nucleus. The purpose of the study was to evaluate the incidence, associated imaging characteristics, potential etiologies, latency period, and temporal progression of HOD in patients undergoing surgical resection of posterior fossa tumors (PFTs). ⋯ HOD is a frequently overlooked postoperative complication following PFT resection. Increased recognition of HOD by neuroradiologists is essential for timely diagnosis and avoidance of unnecessary diagnostic procedures.