World Neurosurg
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Hydrocephalus is a serious complication of subarachnoid hemorrhage (SAH). Obstruction of the cerebral aqueduct may cause hydrocephalus after SAH. Although various etiologic theories have been put forward, choroidal artery vasospasm-related ependymal desquamation and subependymal basal membrane rupture as mechanisms of aqueductal stenosis have not been suggested in the literature. ⋯ Ependymal cell desquamation and subependymal basal membrane destruction related to choroidal artery vasospasm may lead to aqueductal stenosis and hydrocephalus after SAH.
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Arteriovenous malformations (AVMs) represent a complex pathologic entity in terms of their associated angioarchitecture and blood flow dynamics. ⋯ This report represents a novel application of 3D printing in neurosurgery and a means to model dynamic blood flow in 3 dimensions. The 3D printed models may improve on our ability to plan for and treat complex vascular pathologies.
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Conventional approaches to deep-seated cerebral lesions range from biopsy to transcortical or transcallosal resection. Although the former does not reduce tumor burden, the latter are more invasive and associated with greater potential for irreparable injury to normal brain. Disconnection syndrome, hemiparesis, hemianesthesia, or aphasia is not uncommon after such surgery, especially when lesion is large. By contrast, the transsulcal parafascicular approach uses naturally existing corridors and a tubular retractor to minimize brain injury. ⋯ This technique is safe and effective for the treatment of intraventricular and periventricular lesions. Surgery-related morbidity is minimal and often transient. Lesions are satisfactorily resected and residuum occurs only when the neoplasm involves vital structures. The tubular retractor minimizes trauma to brain incident in the surgeon's path.
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Multiple regimens for stereotactic radiosurgery (SRS) at the postoperative bed have shown a high local control rate and a low toxicity profile with no decrease in overall survival with the omission of whole-brain radiation therapy. ⋯ SRS with a dose of 25 Gy in 5 sessions is associated with excellent local control at the resection site with minimal toxicity in the postoperative settings in our patient population. Further investigation is required to determine if dose escalation to the postoperative cavity of radioresistant tumors improves outcomes.