World Neurosurg
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Review Meta Analysis Comparative Study
Endoscopic versus microsurgical resection of colloid cysts: a systematic review and meta-analysis of 1,278 patients.
Colloid cysts of the third ventricle have been successfully treated with transcranial microsurgical approaches. However, the endoscopic approach has recently been advocated as a lesser invasive technique. We conducted a systematic review and meta-analysis of published studies to compare the outcomes between the two approaches. ⋯ Microsurgical resection of colloid cysts is associated with a higher rate of complete resection, lower rate of recurrence, and fewer reoperations than with endoscopic removal. However, the rate of morbidity is higher with microsurgery than with endoscopy.
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Review
The endoscopic endonasal approach to the Meckel's cave tumors: surgical technique and indications.
Many benign and malignant tumors as well as other inflammatory or vascular diseases may be located in the areas of Meckel's cave or the cavernous sinus. Except for typical features such as for meningiomas, imaging may not by itself be sufficient to choose the best therapeutic option. Thus, even though modern therapy (chemotherapy, radiotherapy, or radiosurgery) dramatically reduces the field of surgery in this challenging location, there is still some place for surgical biopsy or tumor removal in selected cases. ⋯ Percutaneous biopsy using the Hartel technique has been developed for biopsy of such tumors but may fail in the case of firm tumors, and additionally it is not appropriate for anterior parasellar tumors. With the development of endoscopy, the endonasal route now represents an interesting alternative approach to Meckel's cave as well as the cavernous sinus. Through our experience, we describe the modus operandi and discuss what should be the appropriate indication of the use of the endonasal endoscopic approach for Meckel's cave disease in the armamentarium of the skull base surgeon.
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The operative management of cystic vestibular schwannoma is more challenging. In this study, we focus on the peculiarity of cystic vestibular schwannoma in terms of management and outcome. We evaluated a homogenous series of consecutive patients with cystic vestibular schwannomas who were operated on with a similar technique and via the same surgical approach. ⋯ Surgery of cystic vestibular schwannomas is associated with a greater rate of morbidity and facial nerve dysfunction compared with the solid variant. Special attention is required during facial dissection to allow functional preservation, especially with tumors with medially located thin walled cysts. Meticulous hemostasis also is required to avoid postoperative hematoma. Close postoperative care is mandatory for early detection and prompt management of possible postoperative complications.
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Decompressive hemicraniectomy (DHC) for malignant middle cerebral artery (MCA) infarction has been shown to reduce mortality and improve functional outcomes in young adults; however, there is currently debate regarding how routinely such surgery should be performed in the clinical setting, considering the very high rate of disability and functional dependence among survivors. We herein report the current status of the frequency of and indications for DHC for malignant MCA infarction in Japan. ⋯ In the present study, less than one-tenth of candidates with malignant MCA infarction in Japan underwent decompressive surgery, and the vast majority of patients were elderly. Age was not found to be an independent factor for immediate mortality in this study, and performing surgery in the elderly may be justified based on additional evidence of functional improvements.