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Kiyoharu Shimizu, Masaaki Takeda, Takafumi Mitsuhara, Shunichi Tanaka, Yushi Nagano, Hitoshi Yamahata, Kaoru Kurisu, and Satoshi Yamaguchi

incidentally found asymptomatic SDAVFs. 41 We present 5 cases of asymptomatic SDAVFs and report the results of our systematic review to investigate the differences between symptomatic and asymptomatic SDAVFs in terms of clinical features, imaging findings, and therapies. Methods The protocol of this study was approved by the ethics committees of Hiroshima University and Kagoshima University. Because this was a retrospective noninvasive study, written informed consent was not obtained from patients. The methods and guidelines of this systematic review followed PRISMA

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Mark Attiah, Bilwaj Gaonkar, Yasmine Alkhalid, Diane Villaroman, Rogelio Medina, Christine Ahn, Tianyi Niu, Joel Beckett, Christopher Ames, and Luke Macyszyn

within which an individual of a certain age is likely to remain asymptomatic. Thus, the aim of the present study is to develop a quantitative atlas of the natural history of radiographic spinal parameters as the spine ages. We determined these parameters from asymptomatic patients representing all age groups from 20 to 90 years in order to better elucidate a range of normal values to aid in the diagnosis and treatment of patients with spinal disorders and deformities. Methods Patients evaluated between 2013 and 2017 and who had no personal history of a spinal disorder

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Mariano M. Alvira and Robert L. McLaurin

skeletal-type extra-osseous intracranial chondrosarcomas are rare, and appear to have a better prognosis. 1 This report deals with a case of a large, asymptomatic, subdural skeletal-type chondrosarcoma originating from extra-osseous structures in a young woman who incidentally had Hodgkin's disease. Case Report A 21-year-old woman was found to have mediastinal Hodgkin's disease in March, 1976. Skull x-rays at that time revealed discrete calcifications in the left frontoparietal area ( Fig. 1 ). A brain isotope scan, computerized tomography scan, and angiography

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Jun-ichi Kuratsu, Masato Kochi, and Yukitaka Ushio

W e previously determined the incidence of primary intracranial lesions in Kumamoto Prefecture, Japan and found that the most common tumors were meningiomas. 11, 12 The increased use of sophisticated diagnostic methods such as CT and MR studies has led to an increase in the detection rate for asymptomatic meningiomas, although the exact incidence and distribution of primary intracranial tumors, as well as the surgical indication for asymptomatic meningiomas, remain undetermined. Therefore, to clarify the exact incidence and the natural course of asymptomatic

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William T. Couldwell

With the increasing availability and use of contemporary neuroimaging, the diagnosis of asymptomatic intracranial meningiomas has become commonplace. Although the growing use of magnetic resonance and computed tomography imaging for justifiable indications (such as headache or neurological deficit) has facilitated the diagnosis of these lesions, private consumers now also have the opportunity to undergo “imaging checkups” in many parts of the developed world and a significant proportion of incidental lesions identified will be meningiomas. 5 In this issue

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Kenichi Sato, Karel G. TerBrugge, and Timo Krings

However, this concept has never been proved in vivo given that until now no asymptomatic patients with SDAVF have been reported. Here, we evaluated this hypothesis by investigating 2 patients with asymptomatic SDAVF at the upper thoracic level, in whom we were able to demonstrate early radicular venous outflow as a potential alternate route for the venous hypertension to be released. We compared clinical and radiological features between these asymptomatic patients and all patients in our database who had a fistula located at the same region to assess the

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Duke S. Samson, Richard M. Hodosh, and W. Kemp Clark

aneurysm is accessible and the patient's clinical state and age are favorable.” 9 We have been confronted with a significant number of SAH patients with multiple aneurysms that have been surgically injudicious to approach at a single operative sitting. We have also seen an increasing percentage of patients carry asymptomatic incidental aneurysms in addition to a variety of disease processes. We have therefore adopted, not without initial misgivings, a significantly more aggressive approach than that generally expressed in the literature. Since we are unable to identify

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Christopher Doe, Pinakin R. Jethwa, Chirag D. Gandhi, and Charles J. Prestigiacomo

. Multiple trials have been performed to help elucidate the best treatment strategy for ACAS. 9 In the 1980s and 1990s, trials were designed to examine CEA and medical management. Examples of these trials include the NASCET and the ECST. Although focused on symptomatic stenosis, both NASCET and ECST included information regarding the nonsymptomatic artery. These data have been used for analyses of the efficacy of CEA in asymptomatic stenosis; however, the data cannot be generalized to the truly asymptomatic population as these trials involved patients who were symptomatic

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Adrian W. Laxton, Patrick Shannon, Sukriti Nag, Richard I. Farb, and Mark Bernstein

become symptomatic. 9 In this report, we present a case of rapid, nonhemorrhagic expansion associated with necrosis in a previously asymptomatic subependymoma. Case Report Presentation and Examination This 39-year-old man presented with a 6-month history of new-onset occipital headaches, hypertension, and fatigue, as well as occasional blurry peripheral vision and lower-extremity paresthesias. His neurological status was normal. Magnetic resonance imaging revealed a 3.5 × 3 × 2.7—cm midline fourth ventricle irregularly shaped, variably enhancing mass

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Florian Jalbert, Patrick Chaynes, and Jacques Lagarrigue

results of the osmotic fragility test. Clinically, the disease can present with variable severity. Mild and moderate forms are most frequently (70–80%) observed at presentation. The disease can be asymptomatic for extended periods when the excessive destruction of cells is compensated by increased erythropoiesis. Anemia is generally not present because the bone marrow is able to compensate fully for the ongoing destruction of RBCs. Little or no splenomegaly occurs. These patients are usually asymptomatic, and a diagnosis is not established until later in life. In our