World Neurosurg
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Intracranial dural arteriovenous fistulas (DAVFs) are an uncommon pathology, and a sphenoparietal drainage pattern is certainly rare. We present a case of a de novo sphenoparietal DAVF in a prepubescent patient previously treated for a cerebellar arteriovenous malformation (AVM) 10 years before. ⋯ This case highlights the different array of presentations that sphenoparietal fistulas may display. Even though most DAVFs are acquired, secondary lesions and spontaneous malformations must be considered in a differential diagnosis.
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Intramedullary schwannomas of the spinal cord are extremely rare. Most previous studies are case reports, which have found that intramedullary schwannomas could be homogeneous or asymmetrically enhanced with gadolinium. However, intramedullary schwannomas with minimal enhancement have not been reported. ⋯ We report a case of intramedullary schwannoma that presented inconspicuous enhancement with gadolinium. MRI is useful but cannot be used to differentiate schwannomas from other intramedullary spinal tumours. Surgical resection is the most vital factor for the treatment of intramedullary schwannoma.
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Pituitary tumors are a heterogeneous group of lesions (usually benign) and proper understanding of the anatomy, physiology, and pathology of the hypothalamic/pituitary region is essential to make an accurate diagnosis and define the essential treatment options (i.e., surgery, medical therapies, and radiotherapy, alone or in combination). Surgery is the primary treatment for acromegaly, Cushing disease, thyroid-stimulating hormone-secreting adenomas, resistant prolactinomas, and nonfunctioning pituitary adenomas causing mass effect. ⋯ In the last decades, tremendous innovations (i.e., targeted drugs and refined surgical tools and techniques) have expanded the treatment strategies for pituitary adenomas. We herein report the current indications for and depiction of the surgical techniques in pituitary surgery, review current medical treatments, and provide a glimpse of future possibilities.
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The unilateral interhemispheric approach for distal anterior cerebral artery aneurysms presents several risks, such as postoperative venous infarction due to occasional sacrifice of parasagittal bridging vein and postoperative frontal lobe damage due to retraction force. To overcome these risks, we used a bifrontal craniotomy with straight dural incision and cutting of the superior sagittal sinus. ⋯ Modified bifrontal interhemispheric approach may be a safe and effective method for treating A2 and A3 aneurysms with relatively good clinical outcome and no surgery-related complications.
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Extradural benign cysts located in close proximity to the facet joints are called juxtafacetal cysts. Only about 3.5% of such cysts occur in the cervical spine. To our knowledge, there has been no published article on the endoscopic resection of a cervical facet cyst, and this is the first report. ⋯ The findings suggest that ankylosing spondylitis may cause formation of a juxtafacetal cyst at the mobile levels in a relatively less mobile cervical spine. The endoscopic resection of such cysts is a minimally invasive novel procedure that can cure such patients successfully without unwanted fusion surgery.