World Neurosurg
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The management of complex hydrocephalus is challenging. There is no consensus of the best treatment for isolated fourth ventricles, arachnoid cysts, and multiloculated hydrocephalus, although the avoidance of multiple shunts is desirable. We reviewed our experience with the use of endoscopic techniques to simplify complex multicompartmental hydrocephalus to determine its efficacy and safety. ⋯ Endoscopic simplification of complex hydrocephalus enables dependence on only a single shunt in the majority of patients, and a significant proportion achieve shunt independence. Endoscopic management should be considered before the placement of a second shunt, and some cases require staged endoscopic procedures to adequately communicate multicompartmental hydrocephalus.
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Radiation exposure represents significant risk to both operating room health care workers and their patients. The commonplace surgical implantation of spinal instrumentation often relies on fluoroscopy for guidance and verification. Advances in computerized tomography (CT)-based intraoperative navigation have improved accuracy of screw placement. The objective of this article is to quantify the radiation exposure from fluoroscopic and CT-based intraoperative navigation and to provide guidance in mitigating the exposure to patient and operating room (OR) staff. ⋯ Use of intraoperative CT-based navigation systems results in lower radiation dose to the surgeon compared with fluoroscopic-based methods. There is an increase in the radiation to the patient. In addition, it is necessary to consider and eliminate other perioperative sources of radiation, such as a postoperative CT scan, which are made redundant by this technology.
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Case Reports
Adrenocorticotropic hormone-producing pituitary carcinoma with intracranial metastases.
Pituitary carcinomas are rare and challenging clinical entities. Because of the paucity of cases, there is limited information in the literature on how best to diagnose and treat pituitary carcinomas. ⋯ Pituitary carcinomas are rare, may present many years after diagnosis of a primary pituitary adenoma, and should be suspected in patients with persistent or recurrent disease. Reliable histopathologic ways to distinguish between carcinoma and adenoma are difficult because the features of hypercellularity, nuclear pleomorphism, and mitotic figures are not always helpful.
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Motor palsy is a serious complication that can result from cervical surgery. We introduced cases of motor palsy after posterior cervical foraminotomy (PCF) and consider cervical anatomy. ⋯ Although PCF is a good alternative treatment with minimal morbidity for cervical radiculopathy, surgeons should keep in mind the possibility of motor palsy, especially at C4-5.
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This paper discusses indications for and the technique of endoscopic aqueductoplasty with stenting. ⋯ Aqueductoplasty with stenting is the procedure of choice for the treatment of isolated fourth ventricle. Membranous and tumor-related aqueductal stenosis should be treated by endoscopic third ventriculostomy.