World Neurosurg
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Case Reports
Indocyanine green (ICG) temporary clipping test to assess collateral circulation before venous sacrifice.
As a general principle, sacrifice of cerebral veins at surgery is avoided. However, at times sacrifice of a vein may be desirable to increase surgical exposure. At present, no method exists to predict whether such sacrifice will be accommodated by the presence of collateral venous drainage. We show a simple technique to examine cerebral venous blood flow using indocyanine green videoangiography. ⋯ Although our limited study cannot prove that venous congestion or infarction can be avoided with this technique, it does provide direct evidence of the presence or absence of collaterals that can help guide intraoperative surgical decision-making.
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To create a simple artificial neural network (ANN) to predict the occurrence of symptomatic cerebral vasospasm (SCV) after aneurysmal subarachnoid hemorrhage (aSAH) based on clinical and radiographic factors and test its predictive ability against existing multiple logistic regression (MLR) models. ⋯ A simple ANN model was more sensitive and specific than MLR models in prediction of SCV in patients with aSAH. The conception of ANN modeling for cerebral vasospasm is introduced for a neurosurgical audience. With advanced ANN modeling, the clinician may expect to build improved models with more powerful prediction capabilities.
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Conventional surgical treatment of bilateral ophthalmic aneurysms would require bilateral craniotomies and bilateral neck dissections for proximal control of the cervical internal carotid artery (ICA). We present a semiemergent case where bilateral ophthalmic artery aneurysms were clipped using a unilateral mini-pterional craniotomy and contralateral proximal cervical ICA control while employing the Sugita head frame. ⋯ Our case illustrates safety and control while clipping bilateral ophthalmic artery aneurysms via a unilateral mini-pterional approach and utility of the Sugita head frame.
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The coexistence of a primary brain tumor such as high-grade glioma and superimposed abscess is a rare entity and can present a diagnostic and therapeutic challenge. The concomitant abscess may not be recognized until surgery, and the overall course of treatment may require adjustment in the presence of a coinciding infection. In the present report we evaluate the diagnosis and treatment of a glioblastoma multiforme with an intratumoral abscess. ⋯ There are insufficient guidelines on the treatment of a primary brain tumor with intratumoral abscess. In this report we present our therapeutic decisions in this rare case.
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Case Reports
Abnormal white matter changes after cerebral aneurysm treatment with polyglycolic-polylactic acid coils.
Polyglycolic-polylactic acid (PGLA) coils induce inflammation within a cerebral aneurysm, which in turn is hypothesized to decrease aneurysm recurrence. We present 2 patients, who after aneurysm coiling with PGLA coils, developed mild symptoms and extensive magnetic resonance imaging (MRI) white matter changes. ⋯ Conclusions: After extensive evaluation for alternate causes of disease, we hypothesize that the patients' symptoms and MRI findings, which were not all within the territory supplied by the coiled vessel, were due to an overexuberant inflammatory response related to the PGLA coils. These cases highlight the importance of heightened clinical suspicion of neurologic complaints in the subacute period after aneurysm coiling. We recommend a low threshold for neuroimaging of these patients.