World Neurosurg
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Review Case Reports
Neurofibromas of the phrenic nerve: a case report and review of the literature.
Phrenic neurofibromas are a rare pathologic entity, with 9 cases described in the English literature. They may occur in conjunction with or independently of neurofibromatosis type 1. Phrenic neurofibromas pose distinct therapeutic challenges compared with the more common phrenic schwannoma. We describe here a 12-year-old boy with neurofibroma of the left phrenic nerve presenting as dextroposition of the heart after paralysis of the left hemidiaphragm allowed herniation of abdominal contents into the left hemithorax and displaced the heart. ⋯ The spectrum of management options ranges from conservative surveillance to open thoracic surgery. Functional preservation of the phrenic nerve is technically challenging, and although phrenic neurofibromas often present with absent function that cannot be recovered, surgical intervention can be fruitful in restoring lung capacity through diaphragmatic reconstruction.
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Review Case Reports
Infundibular hemangioblastoma in a patient with neurofibromatosis type 1: case report and review of the literature.
Supratentorial hemangioblastomas are rare tumors, most commonly occurring in the sellar/suprasellar region, cerebrum, and ventricle. They are generally found in patients with von Hippel Lindau disease but have infrequently been reported in patients without this syndrome. ⋯ Hemangioblastoma should be included in the differential of sellar/suprasellar mass lesions, particularly in patients with von Hippel Lindau disease. Small suprasellar lesions may be safely and effectively removed using an expanded transsphenoidal approach.
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Rupture is the most serious consequence of cerebral aneurysms, and its likelihood depends on nonmodifiable and modifiable risk factors. Recent efforts have focused on analyzing the effects of hemodynamic forces on the initiation, growth, and rupture of cerebral aneurysms. Studies of the role of hemodynamics in the physiopathology of intracranial aneurysms fall between mechanical engineering and molecular biology. ⋯ The size of the aneurysm dome is the most common parameter used in clinical practice to estimate the risk of rupture. However, relying only on aneurysm size means excessively simplifying a more complicated reality. Aneurysms emerge in areas of the vascular wall exposed to high wall shear stress. The direction in which blood flows once an aneurysm forms depends on aspects such as neck diameter, its angle with respect to the parent artery, the parent vessel caliber, the caliber or the angle of efferent vessels, and aneurysm shape. The progression and rupture of aneurysms have been associated with zones of the aneurysm wall exposed to both high and low wall shear stresses. Advances in this challenging and growing field are intended to predict more precisely the risk of rupture of aneurysms and to better understand the mechanisms of origin and growth of aneurysms.
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Clinical Trial
Efficacy of a Self-Expandable Porous Stent as the Sole Curative Treatment for Extracranial Carotid Pseudoaneurysms.
Extracranial carotid pseudoaneurysms are uncommon vascular lesions. Even with conservative management complications can happen, such as delayed cerebral embolization or symptoms due to flow limitation. Although endovascular therapy can be curative, literature demonstrating a preferred technique is scant. Our goal was to evaluate the use of 1 technique only-the deployment of overlapping self-expandable porous stents-to treat a series of extracranial carotid pseudoaneurysms. ⋯ Extracranial carotid pseudoaneurysms can be successfully obliterated with the use of porous, self-expandable stents.
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Spinal meningeal cysts are a rare benign disease that can cause myelopathy. In most cases, spinal meningeal cysts consist of an arachnoid membrane. To the best of our knowledge, few articles have report on intradural spinal meningeal cyst consisting of dura mater. ⋯ The etiology of spinal meningeal cysts remains unclear. Spinal meningeal cysts consisting of dura mater (spinal dural cysts) are extremely rare. Treatment with only decompression with laminectomy causes enlargement of the dural cyst later. Cyst fenestration and placement of a cyst-subarachnoid shunt for the spinal dural cyst resulted in the resolution of myelopathy and cyst shrinkage.