J Neurosurg Sci
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Randomized Controlled Trial
Dexmedetomidine could enhance surgical satisfaction in trans-sphenoidal resection of pituitary adenoma.
Excessive bleeding is an unwanted complication of trans-sphenoidal resection of pituitary adenoma due to increases in intracranial pressure (ICP) and hemodynamic instability. Dexmedetomidine (Dex) anα2-agonists is the drug of choice in intensive care units (ICU) and cardiac surgeries to control abrupt changes in hemodynamic. Severe cardiovascular responses occur during trans-sphenoidal resection (TSR) of the pituitary adenoma despite adequate depth of anesthesia. The aim of this paper was to determine the effect of Dexmedetomidine on bleeding as primary outcome, and surgeon's satisfaction and hemodynamic stability as secondary outcomes in patients undergoing trans-sphenoidal resection of pituitary adenoma. ⋯ Dexmedetomidine infusion (0.6µg/kg/hour) could reduce bleeding and provide surgeon's satisfaction during trans-sphenoidal resection of pituitary adenoma.
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Cavernous sinus (CS) invasion is one of the most unfavorable features of pituitary adenomas. The most widely used classification was proposed by Knosp in 1993 and revised in 2015. The aim of this study is to extend our previous experience by comparing the pre-operative neuroradiological assessment with the intra-operative endoscopic endonasal inspection in order to evaluate the real rate of CS invasion and analyze its correlation with the surgical outcome. ⋯ The endoscopic endonasal inspection is the most effective technique to detect CS invasion. Indeed, it can provide a direct visualization of the medial wall, permitting the assessment of its invasion and the management of those cases with diffuse involvement. We confirm that the revision to the Knosp classification has improved its prognostic role.
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Review
Transorbital endoscopic approaches to the skull base: current concepts and future perspectives.
Transorbital endoscopic surgery is one of the most recent fields of skull base surgery. This paper presents the emerging applications of transorbital endoscopic approaches to the skull base and their current results on the treatment of selected extradural and intradural lesions, based on a review of meta-analysis and recent clinical series. ⋯ Minimally-invasive endoscopic skull base surgery has substantially evolved in the last decades through the collaboration of different teams around the world. The transorbital endoscopic approaches directed to the anterior and middle cranial base may represent safe and feasible techniques with great potential for new applications in the nearby future.
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The purpose of this study was to clarify the morphologic features, location and variations of the dorsal root ganglion (DRG). ⋯ The DRG in the lumbar region play a key role in the occurence of low-back pain and sciatica; therefore, it is important to understand the anatomy of DRG. The accurate anatomic information about the position of DRGs would be useful to perform a safe surgical intervention in the lumbar foraminal region.
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External ventricular drains (EVDs) are used to manage acute hydrocephalus and facilitate brain relaxation after subarachnoid hemorrhage (SAH). We conducted a retrospective study on the relationship between CSF drainage volume and requirement and timing (early vs. late) for ventriculoperitoneal shunt (VPS) placement after EVD removal. We also sought to examine what factors were associated with volume of CSF drainage. ⋯ High CSF output is associated with early VPS placement. Prospective research on targeted CSF drainage volume is warranted.