World Neurosurg
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The disadvantages of a contralateral approach (CA) include deep and narrow surgical corridors and inconsistent ability to achieve proximal control of the supraclinoid internal carotid artery (ICA). However, a CA remains as a microsurgical option for selected ICA-ophthalmic (opht) segment aneurysms. ⋯ In selected patients, transient cardiac arrest induced by adenosine during a contralateral approach allows a brief flow arrest and softening of the aneurysm for safer exposure and clipping.
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Brain mapping is considered an important approach in neurosurgery to achieve better functional outcomes. The mirror neuron system (MNS) is a brain network implicated in understanding of action and imitation. No previous study has focused on identifying and monitoring the function of the MNS during the perioperative period in brain lesions. The aim of this study was to describe the application of a functional magnetic resonance imaging (fMRI) protocol to identify the MNS in a patient with a lesion in the premotor region. ⋯ The use of an fMRI protocol with observation and execution conditions based on simple intransitive finger actions allows the easy identification and preservation of the MNS. Increased activity on postoperative fMRI may be associated with improvement in motor functions.
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Endovascular techniques have gained importance in recent years in the treatment of acutely ruptured aneurysms. Sometimes artificial anticoagulation or antiplatelet agents are indicated after endovascular aneurysm occlusion to prevent thromboembolic complications. Because many patients require ventriculostomy secondary to hydrocephalus, we analyzed ventriculostomy-related hemorrhage in patients with and without anticoagulant therapy. ⋯ Patients receiving endovascular treatment were at higher risk for ventriculostomy-related hemorrhage, especially when anticoagulation was administered after aneurysm occlusion. Although no clinically relevant external ventricular drain-related hemorrhage occurred, ventriculostomy should be performed before anticoagulation whenever possible.
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Case Reports
Atypical Teratoid Rhabdoid Tumor in a Teenager with Unusual Infiltration Into the Jugular Foramen.
Atypical teratoid rhabdoid tumor is a rare malignant neoplasm that represents 1%-2% of all pediatric central nervous system tumors. Immunohistochemistry plays an important role in establishing the diagnosis with a loss of INI-1 staining in tumor cells. In this case report, we describe a teenager with an unusual presentation and pattern of infiltration of the tumor. ⋯ This case highlights the diverse clinical presentation and infiltrative potential of atypical teratoid rhabdoid tumors, thus expanding the differential diagnosis of extra-axial tumors invading the jugular foramen.
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Case Reports
Magnetic Resonance Imaging to Evaluate Cervical Spinal Cord Injury from Gunshot Wounds from Handguns.
Patients presenting with gunshot wounds (GSWs) to the neck are difficult to assess because of their injuries are often severe and they are incompletely evaluated by computed tomography (CT) alone. Our institution treats hundreds of patients with GSWs each year and we present our experience using magnetic resonance imaging (MRI) in the evaluation of cervical GSWs. ⋯ For carefully selected patients, MRI can be an effective tool in assessing GSWs to the neck and it can significantly improve the evaluation and management of this cohort. No patient in our series experienced a complication related to MRI.