Rapidly progressive diffuse leptomeningeal glioneuronal tumor in an adult female: illustrative case.

Background: Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare brain tumor only recently classified by the World Health Organization in 2016 and has few reports on its incidence in adults.

Observations: The authors describe a case of DLGNT presenting in a 47-year-old female with seizures, cranial neuropathies, and communicating hydrocephalus with rapid clinical progression. Workup demonstrated progressive leptomeningeal enhancement of the skull base, cranial nerves, and spine, and communicating hydrocephalus.

Modern Appraisal of Patency and Complications in Cerebral Bypass Surgery: A Single Institution Experience.

Background: Cerebral bypass is a valuable surgical technique in well-selected patient populations. Updated clinical guidelines and improved surgical techniques warrant a contemporary reevaluation of the complications and patency to inform clinical practice and enhance postoperative patient care.

Objective: To assess the complication rates and postoperative graft patency for the 3 most common indications for bypass surgery: moyamoya disease, intracranial atherosclerosis, and intracranial aneurysms.

Bilateral Nervus Intermedius Sectioning for Geniculate Neuralgia: Case Report and Operative Video.

Background And Importance: Geniculate neuralgia is a rare condition characterized by excruciating ear pain. Surgical options for geniculate neuralgia include microvascular decompression and sectioning of the nervus intermedius. We report herein a case of bilateral geniculate neuralgia treated by nervus intermedius sectioning without prior microvascular decompression.

Endoscopic Endonasal Versus Transoral Odontoidectomy for Non-Neoplastic Craniovertebral Junction Disease: A Case Series.

Background: Odontoidectomy is a challenging yet effective operation for decompression of non-neoplastic craniovertebral junction disease. Though both the endoscopic endonasal approach (EEA) and the transoral approach (TOA) have been discussed in the literature, there remain few direct comparisons between the techniques.

Objective: To evaluate the perioperative outcomes of EEA vs TOA odontoidectomy.

Changing Enhancement Pattern and Tumor Volume of Vestibular Schwannomas After Subtotal Resection.

Background: Surgical strategy in vestibular schwannomas may require subtotal resection to preserve neurologic function. Residual tumor growth pattern and contrast enhancement in the immediate postresection period remain uncertain. We sought to evaluate changes in the enhancement pattern and volume of vestibular schwannomas after subtotal resection in the immediate postoperative period.

Facial nerve outcomes following gamma knife radiosurgery for subtotally resected vestibular schwannomas: Early versus delayed timing of therapy.

Objectives: Initially treating vestibular schwannomas (VSs) with subtotal resection (STR) followed by Gamma Knife radiosurgery (GKRS) for progression of tumor residual is a strategy that balances maximal tumor resection with preservation of neurological function. The effect of timing of GKRS for residual and recurrent VSs remains poorly defined. We developed a simple and practical treatment algorithm for the timing of GKRS after STR of VSs and reviewed our follow-up results to determine outcomes between patients treated with early vs.

Occipital teratoma in a neonate with CHARGE syndrome: a case report.

Introduction: Teratomas of the head and neck region are rare lesions, representing just 5% of all congenital teratomas. Usually found in the pineal region orneurohypophysis, teratomas are uncommonly located in the posterior occiput.

Case Presentation: Herein, we present a case of a female neonate born at 37-week gestation with hydrocephalus, an occipital scalp lesion, and several craniofacial abnormalities consistent with a diagnosis of coloboma, heart defect, atresia choanae, retarded growth, genital abnormality, and ear abnormality (CHARGE) syndrome.

Colloid Cysts: Evolution of Surgical Approach Preference and Management of Recurrent Cysts.

Background: Optimal management of third ventricular colloid cysts remains debated. While microsurgery offers greater resection rates and lower recurrences, endoscopy offers a perceived less invasive option.

Objective: To describe the evolution of our practice to favor microsurgery and determine the optimal management of recurrent colloid cysts.

High p16 Expression Is Associated with Malignancy and Shorter Disease-Free Survival Time in Solitary Fibrous Tumor/Hemangiopericytoma.

 Solitary fibrous tumors (SFT) and hemangiopericytomas (HPC) are now classified along a single spectrum of fibroblastic mesenchymal tumors with NAB2-STAT6 fusion. This fusion acts as a driver mutation that constitutively activates EGR1, which is known to be involved in the p16 pathway. Overexpression of p16 is associated with malignancy and worse prognosis in multiple mesenchymal tumors.

Orbital reconstruction for tumor-associated proptosis: quantitative analysis of postoperative orbital volume and final eye position.

Objective: Surgical resection of sphenoid wing tumors and intraorbital pathology carries the dual goal of appropriately treating the target pathology as well as correcting proptosis. Residual proptosis following surgery can lead to cosmetic and functional disability. The authors sought to quantitatively assess the effect of orbital volume before and after reconstruction to determine the optimal strategy to achieve proptosis correction.

Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center.

The authors looked at all of the pediatric patients with a head injury who were transferred from other hospitals to their own over 12 years and tried to identify factors that would allow patients to stay closer to home at their local hospitals and not be transferred. Many patients with isolated, nondisplaced skull fractures or negative CT imaging likely could have avoided transfer. While hospitals should be cautious, this may help families stay closer to home.

Regression of a nonfunctioning pituitary macroadenoma on the CDK4/6 inhibitor palbociclib: case report.

A 71-year-old female patient was referred in 2013 for evaluation of an asymptomatic nonsecreting pituitary adenoma. The adenoma, measuring 13 mm in height by 10 mm in width, was discovered incidentally on imaging in 2012. Biochemical testing demonstrated a nonfunctioning adenoma.

Chiari-related scoliosis: a single-center experience with long-term radiographic follow-up and relationship to deformity correction.

OBJECTIVE Previous reports have addressed the short-term response of patients with Chiari-related scoliosis (CRS) to suboccipital decompression and duraplasty (SODD); however, the long-term behavior of the curve has not been well defined. The authors undertook a longitudinal study of a cohort of patients who underwent SODD for CRS to determine whether there are factors related to Chiari malformation (CM) that predict long-term scoliotic curve behavior and need for deformity correction. METHODS The authors retrospectively reviewed cases in which patients underwent SODD for CRS during a 14-year period at a single center.

Dorsal Cervical Spinal Cord Herniation Precipitated by Kyphosis Deformity Correction for Spinal Cord Tethering.

Introduction: Cervical spinal cord herniation is a rare clinical entity. Reported after previous intradural surgery or surgery complicated by durotomy, patients return several months to years later with symptoms of worsening myelopathy. Herein is presented a case of a 51-year-old female patient with spinal cord herniation in the cervical spine after kyphosis deformity correction.

Flow Diverter Therapy With the Pipeline Embolization Device Is Associated With an Elevated Rate of Delayed Fluid-Attenuated Inversion Recovery Lesions.

Background And Purpose: Flow diversion using the Pipeline Embolization Device is reported as a safe treatment of aneurysms. Complete aneurysm occlusion, however, occurs in a delayed fashion with initial persistent filling of the aneurysm dome. We hypothesized that this transflow across metallic struts may be associated with thromboembolic events.

Y-Stent embolization technique for intracranial bifurcation aneurysms.

Wide-necked bifurcation aneurysms often require the use of the technically complex Y-stent technique, which has recently been shown to narrow bifurcation angle in a hemodynamically favorable manner. We sought to evaluate the single center efficacy and safety of Y-stent supported aneurysm coil embolization. All patients undergoing Y-stent supported coiling between September 2006 and December 2012 were identified; records were analyzed for procedural results and complications, with follow-up evaluated for occlusion rate and neurological adverse events.

Neuro-ophthalmic effects of stenting across the ophthalmic artery origin in the treatment of intracranial aneurysms.

Unlabelled: OBJECT.: The benefits of treating intracranial aneurysms in the region of the anterior visual pathways are well understood. However, the adverse effects of endovascular stenting across the ophthalmic artery have received little attention.

Benefit of cone-beam CT angiography in visualizing aneurysm shape and identification of exact rupture site.

While high-resolution cone-beam computational tomographic (CBCT) angiography has gained use in intracranial vascular imaging, digital subtraction angiography (DSA) and 3-dimensional-rotational angiography (3D-RA) remain the preferred acquisition modalities for intracranial aneurysm imaging. This case report highlights the utility of the greater spatial resolution afforded by CBCT for cerebral aneurysm imaging. A 54-year-old man presenting with subarachnoid hemorrhage was confirmed to harbor a ruptured anterior communicating artery aneurysm by conventional angiography.

Use of concentric Solitaire stent to anchor Pipeline flow diverter constructs in treatment of shallow cervical carotid dissecting pseudoaneurysms.

The flow-diverting Pipeline Embolization Device (PED; ev3 Neurovascular, Irvine, CA, USA) provides proven flow diversion for intracranial wide-necked and fusiform aneurysms. The tendency of the PED to migrate and foreshorten when its size is mismatched with the parent vessel makes its use more difficult for cervical carotid pseudoaneurysms, as the parent vessel regains its luminal diameter during the healing phase, and because of its mobility during head movement. We present a novel technique of using a Solitaire detachable stent (ev3 Neurovascular) to anchor PED constructs to mitigate these shortcomings.

Effect of antiplatelet therapy on thromboembolism after flow diversion with the pipeline embolization device.

Object: Flow-diverting stents offer a novel treatment approach to intracranial aneurysms. Data regarding the incidence of acute procedure-related thromboembolic complications following deployment of the Pipeline Embolization Device (PED) remain scant. The authors sought to determine the rate of embolic events in a bid to identify potential risk factors and assess the role of platelet inhibition.

Neuroform intracranial stenting for aneurysms using simple and multi-stent technique is associated with low risk of magnetic resonance diffusion-weighted imaging lesions.

Background: Detection of procedural thromboembolism by diffusion-weighted magnetic resonance imaging (MR-DWI+) can help identify and mitigate endovascular risk factors. Data remain scant on procedural MR-DWI+ following the use of the Neuroform open-cell design stent in aneurysm embolization.

Objective: We sought to evaluate the incidence of MR-DWI+ in Neuroform simple and multi-stent construct stenting for intracranial aneurysms in an attempt to delineate baseline risk and identify possible associated procedural factors.

Successful detection of embologenic ulceration in a symptomatic non-hemodynamic intracranial stenosis using C-arm cone beam CT.

Objective: The gold standard for the diagnosis of intracranial atherosclerosis remains catheter based digital subtraction angiography (DSA). A symptomatic hemodynamically non-significant intracranial atherosclerotic lesion is described, whose underlying embologenic characteristics were not detectable by either DSA or three-dimensional rotational angiography (3DRA) but fully realized by C-arm cone beam CT (CBCT) angiography.

Clinical Presentation: A 73-year-old man presented with crescendo transient ischemic attacks consisting of right arm tingling and hand weakness despite long term dual antiplatelet therapy with aspirin and clopidogrel for coronary artery stent.

Double-barrel entanglement of intracranial Enterprise stents resulting from undetected incomplete stent apposition.

Objective: Although intracranial stents have expanded the spectrum of aneurysms amenable to coiling, closed cell design variants can be prone to incomplete stent apposition around tightly curved arterial bends. A case is presented illustrating the technical ramifications of this phenomenon during subsequent treatment.

Clinical Presentation: A 49-year-old woman who had previously undergone Enterprise (closed cell design) stent mediated coiling of a wide necked ophthalmic carotid artery aneurysm was noted to harbor residual central filling on follow-up imaging, and was scheduled for additional embolization.

Delivery technique plays an important role in determining vessel wall apposition of the Enterprise self-expanding intracranial stent.

Background: The Enterprise (EN) vascular reconstruction device is a self-expanding nitinol stent used as adjunctive support in wide-necked aneurysm coiling. We sought to evaluate the effect of deployment technique on how well the EN stent conforms to the vessel wall around a curve.

Methods: A flow model consisting of a 3.