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Scientific Articles

Ganglioglioma is a rare and slowly growing low-grade glioma, usually occuring in the cerebral hemispheres with a predilection for the temporal lobe. Patients frequently present with seizures which are resistant to pharmacological treatment. For this reason surgical resection or gamma knife irradiation are the best choices in the management of this pathology. This article describes the case of a 26-year-old woman with a frontal ganglioglioma, who presented with epilepsy and cerebrospinal fluid (CSF) rhinorrhea caused by skull base erosion.

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Diffuse villous hyperplasia of the choroid plexus (DVHCP) associated with genetic abnormalities could be rare cause of communicating hydrocephalus. The article describes the case report of a 14-month-old girl diagnosed with partial trisomy 9p and hydrocephalus with DVHCP. A ventriculoperitoneal shunt (VPS), adjuvant bilateral endoscopic choroid plexus coagulation (CPC) and embolization of anterior choroidal artery were performed to control the symptoms connected to CSF overproduction. The authors go on to review the literature regarding DVHCP.

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The resection of primary spinal tumors necessitates a multidisciplinary approach. Not only neurosurgeons but also other clinicals such as medical and radiology specialists have to collaborate to obtain the best prognosis for their patients. Biomedical engineers are playing an increasingly important role thanks to the creation of patient-specific 3D-printed models which help surgeons to understand the features of lesions and their anatomical relationship with adjacent structures. In this article the authors underline the role of 3D-printed patient models and neoadjuvant therapies on two complex clinical cases for which this multidisciplinary management was employed.

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Wednesday, 27 March 2019 07:22

Arteriovenous Malformations of the Brain

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Arteriovenous malformations (AVMs) develop when abnormal shunts form between arteries and veins, bypassing the capillary network. Cerebral AVMs typically present following haemorrhage or seizures. This article outlines the risks associated with AVMs, the various treatment options available and how these relate to the Spetzler-Martin grade.

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Invasive orbital apex aspergillosis (IOAA) is a rare and pernicious manifestation of aspergillus infection. The authors describe a series of cases in which immunocompetent patients with IOAA developed mycotic aneurysms and subsequently subarachnoid haemorrhage.

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Chordomas continue to present a significant clinical challenge in skull base neurosurgery. Not only does the location of these lesions often necessitate anatomically complex approaches, but seeding along the surgical tract and the neuraxis is common. Optimal surveillance imaging regimes following surgery for chordoma resection is a source of some contention. The authors of this article compare various protocols to identify which is superior in elucidating recurrences.

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Neurosurgical training is usually based on traditional sources of education, such as papers, books, direct surgical experience, and cadaveric hands-on courses. In low-middle income countries, standard education programs are often unavailable, mainly owing to the lack of human and economic resources. Introducing digital platforms in these settings could be an alternative solution for bridging the gap between Western and poor countries in neurosurgical knowledge.

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The possibility of Central Nervous System regeneration after acute trauma is arguably one of the most interesting fields of neurosurgical research. In this article, authors evaluate the therapeutic role of nAG protein in the healing of an acute spinal injury in a rat model. Motor recovery scores, MRI signals and histopathology evaluations demonstrate a significant improvement in experimental subjects. Since nAG protein reduces gliosis, reduces vacuole and granulation tissue formation and enhances neuro-restoration, it is a promising candidate for assisting the recovery of acute spinal trauma.

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Traumatic brain injury (TBI) remains a major cause of death and disability in those <40 years old worldwide. There is evidence from large cohort studies that intracranial hypertension is associated with higher mortality. Decompressive craniectomy (DC) leads to a reduction of the ICP, increasing the volume which the intracranial contents can occupy. However, uncertainties still remain regarding the optimal timing, long- and short-term clinical effects of DC and indications of the procedure. Current evidence (thanks to different trials) suggests that for patients with diffuse TBI, early bifrontal DC is not superior to medical therapy. Primary DC for patients with ASDH is evaluated in the RESCUE-ASDH trial, and secondary DC (applied to refractory ICP) is the subject of the RESCUEicp study. The evidence base suggest that, considering also the potential complications with DC, patients with TBI must be carefully selected to undergo DC to optimise outcomes.

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In this study, Kolias et al. Observe the work done by Soleman and colleagues about the pharmacotherapy in cSDH management, highlighting the limited evidence base for its application. At last, the authors hope that the randomised trials that are currently underway will change this situation by providing robust evidence.

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