Surg Neurol
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Preoperative shaving for cranial neurosurgical procedures is still recommended in textbooks. There are reports demonstrating the success of nonshaved surgery. The objective of this study was to compare the surgical infection rate of cranial neurosurgical procedures with two different scalp preparations: shaved or nonshaved. ⋯ Nonshaved scalp preparation is recommended for nonemergency cranial neurosurgical procedures.
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Clostridium perfringens is a rare cause of central nervous system infections, particularly meningitis. The case of a 76-year-old man who developed fatal C. perfringens meningitis after routine decompressive laminectomy for spinal stenosis is described. ⋯ No significant enteral pathology or source of endogenous infection was determined, suggesting postoperative wound contamination and meningeal seeding with this ubiquitous organism. Clostridial infection, although rare, should be considered in any patient with meningitis with a history of surgical intervention. Survival with minimal neurological deficits was achieved in half of the previously reported cases.
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Petroclival meningiomas represent a difficult surgical challenge. The introduction of modern techniques of skull base surgery has stimulated the interest of the neurosurgical community in the surgical management of these lesions, although very good results have been obtained by experienced neurosurgeons in cases of petroclival meningioma operated using traditional surgical approaches. ⋯ Skull base approaches facilitate tumor dissection and removal at the expense of increased surgical complications. However, the widened surgical field and increased angle of approach that the techniques of skull base surgery may offer can play a significant role in the removal of sizeable, infiltrative, and/or recurrent petroclival meningiomas.
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Anastomotic bypass surgery for childhood moyamoya disease provides more rapid improvement of blood circulation than indirect non-anastomotic bypass surgery, but there are several problems, such as the technical difficulty of the operation, the extended period of anesthesia, and temporary occlusion of blood flow in the vessels of the brain surface. ⋯ Childhood moyamoya disease is progressive, so repeated bypass surgery may be required. Therefore, non-anastomotic bypass surgery is better for the first operation because the STA is preserved. The present procedure using temporal muscle, galea, and dura can be extended over a wider brain surface than the operative field, and is suitable for establishing collateral circulation in the frontal lobe. Blood flow in the skin flap is maintained, so the cosmetic result is satisfactory.
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The incidence of multiple skull base meningiomas varies from 1 to 3% in different series. Skull base meningiomas are rare. The pathogenetic role of low-dose radiation seems to be fairly well established in the oncogenesis of meningiomas. Calvarial location and multiplicity seem to be among the distinctive features of radiation-induced meningiomas. Skull base location is a very rare occurrence, mainly because the path of irradiation does not significantly involve this region. ⋯ The actual role of previous head irradiation in the oncogenesis of the present meningiomas remains somewhat unclear. Proper management and judicious use of skull base surgery techniques were key factors in the successful treatment of the patient.