World Neurosurg
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Patients with large and giant intracranial aneurysms (IAs) can experience neurological deterioration within 6 months after successful flow diverter (FD) placement. The purpose of the present study was to assess whether the occurrence of neurological deterioration can be linked to IA expansion within 6 months after FD treatment. ⋯ The volume of large and giant IAs can increase in the first 6 months after FD treatment. More patients presenting with mass effect-related symptoms showed IA expansion than patients with ischemia-related symptoms.
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Sequestered disc fragments may present as a lesion with peripheral enhancement on magnetic resonance imaging. When located in the psoas muscle compartment, this finding could mimic an abscess. ⋯ Herniated disc fragments should be considered as a differential diagnosis of psoas abscesses. Coronal plane images may show the continuity of bilateral herniated disc fragments, mimicking psoas abscesses.
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A duplicated middle cerebral artery (dMCA) is a rare anatomical variant that can be associated with aneurysm formation and rupture. The dMCA arises from the terminal portion of the internal carotid artery, with the caudal trunk supplying the temporal lobe and the cranial trunk supplying the frontal lobe and the lenticulostriate perforators. Previous reported cases were all treated with open surgical clipping with or without cerebral revascularization to reconstruct the dMCA. ⋯ We have demonstrated the unique anatomical relationship among the dMCA, internal carotid artery, and the anterior choroidal artery. Understanding and preserving the dMCA anatomy is essential in such cases to prevent ischemic complications. This was achieved endovascularly by balloon remodeling and coil embolization of the aneurysm in this location.
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Glioblastoma multiforme (GBM) is usually characterized by diffuse, infiltrative growth and local tumor progression. Extensive leptomeningeal metastases are rarely observed. It is unclear which GBMs are prone to this specific growth pattern and progression, and standardized salvage treatment protocols are unavailable. ⋯ High-risk genetic profiles for GBMs prone to develop extensive leptomeningeal metastases need to be identified. Guidelines on preemptive, complete neuraxis imaging in certain patients with GBM as well as treatment guidelines need to be developed.
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Fluoroscopy use in spine surgery is increasing owing to the increasing popularity of minimally invasive techniques. The effectiveness and safe distance for protective barriers might have been commonly misrepresented. The present study evaluated x-ray propagation and the efficacy of protective barriers in the setting of spine surgery. ⋯ Spine surgeons who wear lead gowns during fluoroscopy could still be exposed to <80% of the radiation produced. Safe distances from fluoroscopy machines might be much farther than commonly believed. Alternatives to reduce the use of fluoroscopy for intraoperative imaging should be explored.