Neurosurgery
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This investigation was performed to construct a grading system for cranial base meningiomas that augments the current system of topographic labeling. This new system classifies cranial base meningiomas based on predicted surgical resection and patient outcomes. ⋯ The current system of classifying cranial base meningiomas provides no information regarding the tumor except location and no information concerning patient prognosis. We present a more useful system to categorize these tumors. Our scheme must be tested at other centers to corroborate our findings. This new grading system should serve to guide surgical treatment, inform patients, and improve communication among surgeons.
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Corpus callosotomy is a surgical option for medically uncontrolled generalized epilepsy in appropriate patients. Because numerous complications related to open callosotomy are still reported, we performed radiosurgical corpus callosotomy with the gamma knife. ⋯ The outcomes suggest that radiosurgical corpus callosotomy may be a promising alternative treatment to open callosotomy.
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To determine whether perioperative subcutaneous heparin is safe to use for patients undergoing craniotomy and to determine the incidence of venous thromboembolism in patients undergoing craniotomy. ⋯ Perioperative heparin may be safe to administer to patients undergoing craniotomy, but a larger study is needed to demonstrate efficacy.
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Review Case Reports
Brainstem dysfunction in chiari malformation presenting as profound hypoglycemia: presentation of four cases, review of the literature, and conjecture as to mechanism.
We report four patients whose cases resulted in our observation that profound hypoglycemia resulting from intermittent hyperinsulinism plays a significant role in patients with brainstem dysfunction from Chiari I or II malformations who have intermittent autonomic dysfunction ("blue spells"). ⋯ Patients with severe intermittent brainstem dysfunction after decompression of Chiari I or Chiari II malformations should have laboratory studies of glucose levels performed at the time of the episodes to rule out hypoglycemia.
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An alternative endovascular treatment to conventional transarterial embolization of cerebral arteriovenous malformations (AVMs) is proposed. ⋯ Instead of relying on access to an AVM nidus from the arterial side (with its usual complexity), TRENSH would require retrograde access to the lesion via much larger and anatomically simpler draining veins. Retrograde permeation of the AVM nidus may then be possible with a liquid sclerosant (to effect a "chemical embolization") provided that the arterial inflow is reduced sufficiently by temporary controlled systemic hypotension, with or without the aid of temporary balloon occlusion of the main arterial feeder(s). Retrograde spread of sclerosant within the nidus that falls short of filling arterial feeders and their branches to normal brain tissue may then be possible. Angioarchitectural and hemodynamic considerations are addressed, as are the potential role and limitations of TRENSH in the management of cerebral pial AVMs. Future implementation of this new technique in some specific selected cases in which the anatomic configuration of the AVM and its draining veins might be favorable could prove to be a potentially useful addition to the armamentarium of AVM therapies, which currently includes microsurgery, radiosurgery, and transarterial embolotherapy. Experimental studies directed at assessing the feasibility of TRENSH before potential future clinical application seem justified.