World Neurosurg
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This meta-analysis was conducted to evaluate the therapeutic effects in clinical and radiologic outcomes of a self-locking stand-alone cage (SSC) and cage-with-plate (CP) for multilevel anterior cervical discectomy and fusion (ACDF). ⋯ ACDF with SSC and CP in multilevel cervical spondylosis achieved similar clinical relief. Although CP maintained better cervical lordosis, SSC contributed to less surgical pain and fewer complications. ACDF with SSC is safe and efficient in treating multilevel cervical spondylosis.
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The location of the origin of the posterior inferior cerebellar artery (PICA) is highly variable. An extracranial origin PICA from the vertebral artery (VA) is not rare. But the PICA originated extradurally where the VA ascends between the transverse foramina of C-2 and C-1, a rare anatomic variant. Double-origin PICA is another rare anatomic variant observed in 1%-4% of patients in whom 2 PICA branches converge distally. ⋯ To our knowledge, this is the first report of a cadaveric anatomy case of bilateral PICA that originated extradurally between the vertebrae C-1 and C-2, and simultaneously there existed a right double-origin PICA. Such a case is rare, but understanding of the anatomic variation is important. To avoid complications during surgery at the craniovertebral junction, these potential variations should be correctly identified preoperatively.
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Review Case Reports
Atypical manifestation of a direct low flow carotid-cavernous fistula: case report and review of the literature.
Carotid cavernous fistula (CCF) is a rare type of arteriovenous shunt that develops within the cavernous sinus (CS). Direct CCFs entail a direct communication between the cavernous internal carotid artery and the CS and are typically high-flow lesions. Most CCFs drain into the ophthalmic veins (typical venous drainage pattern), leading to the pathognomic ocular clinical triad associated with a CCF. When an obstruction of the typical venous outflow is present, the arterial pressure generated by the fistula is transmitted into the cerebral venous system via the sphenoparietal sinus, which might lead to intracerebral hemorrhage. We present a rare case of posttraumatic, direct, low-flow CCF associated with cerebral hemorrhage, a typical venous drainage pattern, and without ocular symptoms at presentation. ⋯ Direct low-flow CCFs are exceedingly rare lesions. Five cases have been described in the literature, 4 of which were associated with spontaneous rupture of a cavernous carotid aneurysm while only 1 case was associated with posttraumatic rupture of a cavernous internal carotid artery pseudoaneurysm. In addition, despite our patient having developed an intraparenchymal hemorrhage most probably correlated to the CCF, the latter was associated with a typical venous drainage via the superior ophthalmic vein, which is uncommonly correlated to intraparenchymal bleeding.
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Brainstem arteriovenous malformations (AVMs) represent ∼5% of all intracranial AVMs and carry a higher risk of hemorrhage than their supratentorial counterparts. There is a high and near-uniform mortality with initial and recurrent episodes of hemorrhage. Brainstem AVMs may also present symptomatically with focal neurologic deficits or hydrocephalus. ⋯ Embolization may also be used effectively as stand-alone monotherapy for small lesions with 1 or 2 arterial feeders not supplying eloquent parenchyma. Although an extensive evidence base exists for clinical usefulness of stereotactic radiosurgery as monotherapy or in combination with other therapeutic modalities, only a few studies have reported specifically on obliteration and complication rates with monotherapeutic embolization in the treatment of brainstem AVMs. The potential role of embolization as monotherapy for brainstem AVMs is reviewed and discussed.
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Review Case Reports
Lipoma with agenesis of the corpus callosum: about 02 cases with literature review.
Intracranial lipomas are extremely rare fat-containing lesions, comprising 0.1-0.5% of all primary brain tumors. Lipoma of corpus callosum, the commonest variety of all intracranial lipomas (40%-50%), is associated with varying degrees of dysgenesis of corpus callosum and generally remains asymptomatic. ⋯ Lipomas of the corpus callosum are rare, fat-containing asymptomatic lesions, mostly associated with dysgenesis of the corpus callosum. Diagnosis accidentally occurs during diagnostic procedures in case of an encephalic disorder. Magnetic resonance imaging is the most useful modality for a differential diagnosis. Prognosis and symptoms depend on associated malformations. Surgical treatment is mostly not indicated and should be avoided.