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Background Fibrous dysplasia is a rare, benign fibro-osseous malformation whose occurrence in the craniofacial area can result in optic nerve compression, a cerebral mass effect, and cosmetic deformity. Most lesions will progress slowly, and the risk of malignant progression is rare. Case description We present the case of a 21-year-old woman who had presented with acute worsening visual loss secondary to hemorrhagic fibrous dysplasia with ensuing optic nerve compression. Emergent surgical decompression resulted in rapid improvement of her visual dysfunction. The pathological features demonstrated a mixed pattern of woven bone in a fibrous background and secondary aneurysmal bone cyst-like changes. Conclusions Hemorrhagic transformation of craniofacial FD remains rare but can present with acute neurologic deterioration. Rapid diagnosis and treatment can allow reversal of patient morbidity. We have also included Supplementary Video 1 to illustrate the surgical principles, and we review the reported data of similar cases.Background The present study aims to draw attention to the fact that endurance sport could be a risk factor for dural arteriovenous fistula (DAVF) development. DAVFs have been correlated with acquired dural venous sinus anomalies owing to trauma, infection, neoplasia, or other classic risk thrombogenic factors. Here we report 3 cases of intracranial DAVF in young healthy patients who had no known thrombogenic risk factors other than amateur intensive sports practice. Case description Three young healthy individuals not fitting into the classical clinical picture of a DAVF patient presented to our institution. One was a 40-year-old man with an acute subdural hematoma secondary to an ethmoidal DAVF. Another 41-year-old man presented with a cerebellar hematoma due to a tentorial DAVF. A third 41-year-old man presented with numbness of his right arm in relationship to a superior sagittal sinus DAVF. None of them had a relevant medical history. All the usual thrombogenic risk factors for DAVF development were ruled out. Interestingly, the 3 patients had outstanding training and practice routines for endurance sports. Conclusions Dehydration, microfractures, muscular contractures, low heart rate, long distance travel, and high altitudes are all well documented thrombogenic risk factors affecting endurance sports amateur athletes and might represent a plausible mechanism for the development of DAVF. Despite its limitations, to our knowledge, this is the first work suggesting a possible link between such sport practice and DAVF development. Further prospective research from larger dedicated vascular centers might shed further light on this hypothetic but intriguing link.Background Carotid-cavernous fistulas (CCFs) are abnormal communications between the arterial and venous circulation within the cavernous sinus, manifesting in myriad neurological and ophthalmological sequalae. selleckchem In rare circumstances patients' unique vascular anatomies preclude standard endovascular treatment for this pathology, warranting combined surgical and endovascular approaches wherein the cavernous sinus is accessed via superior ophthalmic vein (SOV) exposure, cutdown, and cannulation. Case description We describe 3 cases of CCF treated at our quaternary neurovascular referral center between 2017 and 2019. The first is a 35-year-old man with symptomatic, traumatic, right-sided CCF, treated with endovascular therapy (transarterial detachable balloon placement). The other cases were treated with contrasting surgical and endovascular combined approaches because of unique vascular challenges. The second is a 71-year-old woman with spontaneous right-sided CCF whose carotid sinus was accessed and embolized through a transpalpebral cutdown of the SOV. The third case is a 70-year-old man with symptomatic, spontaneous bilateral CCF. After unsuccessful transarterial and transvenous endovascular approaches, transorbital (intracranial) SOV cutdown and cannulation were performed to embolize the shunting fistula. Conclusions Endovascular approaches are well described as the mainstay of treatment for CCF but are not possible for all patients. In circumstances where individual vascular anatomy is not amenable to transarterial or transvenous access or embolization, a combined surgical and endovascular approach may be appropriate. We describe 3 cases that illustrate the spectrum of interventions for CCF, as well as the technical aspects of treatment for 2 patients with complex, direct CCF, using an embolization approach reliant on SOV cutdown and cannulation.Objective A 9-French (Fr) sheath is routinely used during mechanical thrombectomy (MT) for treating acute ischemic stroke (AIS). However, the use of a large sheath is a risk factor for access site complications (ASCs). Previous studies focused on preventing intracranial complications, and only a few have explored ASCs. We investigated the technical feasibility and efficacy of a sheathless procedure for AIS (SPAIS) that uses a 9-Fr balloon-guiding catheter as a guiding sheath to reduce the sheath size and prevent ASCs during MT. Methods We retrospectively analyzed the data of 133 patients who underwent MT at our center. Patients treated between January 2015 and August 2017 received conventional treatment (C) using a 9-Fr sheath, and SPAIS was attempted in patients treated between September 2017 and October 2019. We first assessed the technical feasibility of SPAIS, and subsequently compared the incidence of ASCs between the SPAIS and C groups. Routine postsurgical ASC assessments using duplex ultrasonography were performed during the post-MT bed-rest period. Results The technical success rate of SPAIS was 97.6% (81 of 83 patients). The incidence of ASCs was significantly lower in the SPAIS group (2 of 81, 2.5%) than in the C group (7 of 52, 13.4%) (P less then 0.05). Moreover, developed pseudoaneurysms in the SPAIS group showed significantly faster hemostasis than those in the C group (mean 20 minutes vs. 32 minutes; P less then 0.05). Conclusions SPAIS is a feasible technique that effectively reduces MT-associated ASCs; thus, this approach should be adopted to improve patient outcomes.
Homepage: https://www.selleckchem.com/
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