Surgical neurology international
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Angiography-confirmed complete resection of an arteriovenous malformation (AVM) has traditionally been considered curative. However, recurrence of AVM following angiographically proven complete resection does exist, especially in children. This rare occurrence has been reported 29 times in the English language literature. Although recurrence may be asymptomatic, many reported cases result in epilepsy or intracranial hemorrhage anywhere from 0.5 to 9 years following complete resection. We report a rare case of AVM recurrence that became symptomatic 16 years after complete resection. We review the literature and discuss the relevance of performing follow-up imaging to detect AVM recurrence. ⋯ In children, an AVM may recur after angiography-proven complete resection. Recurrence may be due to persistence and growth of an initially angiographically occult arteriovenous shunt left in place during surgery or the development of a new AVM. In addition to obtaining follow-up angiography 6-12 months after surgery, a late angiography 5 years after resection may be warranted in patients at risk for recurrence. Asymptomatic recurrence detection allows treatment and may prevent the morbidity associated with intracranial hemorrhage.
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Diffuse cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) refractory to medical management can be treated with intra-arterial administration of vasodilators, but valid bedside monitoring for the diagnosis and therapeutic assessment is poorly available. We demonstrate the successful application of regional cerebral oxygen saturation (rSO(2)) monitoring with multichannel near-infrared spectroscopy (NIRS) in assisting intra-arterial infusions of fasudil hydrochloride to a patient suffering from post-SAH vasospasm in the distal vascular territories. ⋯ Continuous rSO(2) monitoring with multichannel NIRS is a feasible strategy to assist intraarterial fasudil therapy for detecting and treating the focal ischemic area exposed to diffuse vasospasm.
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There have been 18 reported cases of primary spinal intradural, extramedullary ependymomas reported in the literature. One of the 18 cases had an extradural component and was benign. Our case is the second spinal intradural, extramedullary ependymoma with an extradural component and the first with its initial presentation as an anaplastic ependymoma. ⋯ Even though spinal intradural extramedullary ependymomas are very rare, surgeons must be aware that on MRI, they can be mistaken for meningiomas or nerve sheath tumors especially if there is an extradural component. Our case report is the first intradural, extramedullary ependymoma that is anaplastic and has an extradural component. A review of the literature provides little information on the treatment and prognosis for these tumors especially if they are anaplastic. We propose that the treatment, as done in our case, should be complete resection of the tumor with spinal radiotherapy to the tumor level.
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Meningioma firmness is a critical factor that influences ease of resection and risk, notably when operating on tumors intimate with neurovascular structures such as the mesial sphenoid wing. This study develops a predictive tool using preoperative magnetic resonance imaging (MRI) characteristics to determine meningioma consistency. ⋯ This tool using T1 and T2 series predicts meningioma consistency. Such knowledge should assist the surgeon in preoperative planning and counseling.
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The spinal dura is anchored within the vertebral canal by connective tissue in the epidural space as well as the spinal roots. Inadvertent disruption of these dural attachments may lead to durotomy and cerebrospinal fluid (CSF) leaks. We observed well-developed connective tissue ligaments connecting the lumbar dura to the spinal column and examined these tissues microscopically. ⋯ Epidural fibrous connections or ligaments between the dura and the lumbar spinal column may be of clinical importance to the neurosurgeon. Care should be taken during lumbar procedures not to disrupt or tear these ligaments as this may cause dural tears and CSF leaks. Identifying these ligaments and cutting them sharply may prevent inadvertent durotomies.