World Neurosurg
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Cervical nerve root avulsion after trauma is a well-known occurrence. It is associated with traction injuries to the brachial plexus, commonly after high-speed motor vehicle collisions. Traumatic nerve root avulsion occurs when traction forces pull the nerve root sleeve into the intervertebral foramen with associated tearing of the meninges. The proximal nerve root retracts, and the neural foramen fills with cerebrospinal fluid and eventually forms a pseudomeningocele. Although imaging characteristics often include nerve root edema and pseudomeningoceles, there has only been one description of associated epidural hematoma in the literature. ⋯ Although pseudomeningocele formation after cervical nerve root avulsion is commonly cited, associated epidural hematomas are not well described. It is important to consider this etiology in patients with asymmetric examinations and epidural hematomas before surgical evacuation.
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The goal of this study was to discuss the surgical indications, surgical approaches, and prognostic factors of cerebellar cavernous malformation (CM). ⋯ Patients with cerebellar CMs usually achieve favorable outcomes via surgery. Cerebellar peduncle CMs cause significantly more neurologic deficits than other locations. A reasonable surgical approach and meticulous manipulation are necessary to prevent impairment of neurologic function.
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Glioblastoma (GBM) occurs more commonly in elderly patients. However, these patients are often excluded from clinical trials. The absence of solid evidence has resulted in a nihilistic view of GBM in the elderly and a traditionally conservative treatment approach. In particular, the safety of surgical resection for both primary and recurrent GBM is poorly understood in elderly patients. ⋯ We conclude that in select patients, age alone should not preclude the decision to pursue aggressive surgical management.
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Decompressive craniectomy (DC) requires later cranioplasty (CP) in survivors. However, if additional ventriculoperitoneal shunt (VPS) placement due to shunt-dependent hydrocephalus is necessary, the optimal timing of both procedures still remains controversial. We therefore analyzed our computerized database concerning the optimal timing of CP and VPS regarding postoperative complications. ⋯ We provide detailed data on surgical timing and complications for cranioplasty and ventriculoperitoneal shunt placement after DC. The present data suggest that patients who undergo staged CP and VPS procedures might benefit from a lower complication rate. This might influence future surgical decision making regarding optimal timing of CP and VPS placement.
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Wartime penetrating brain injury can result in deep-seated parenchymal and intraventicular shrapnel, bullets, and bone. Large fragments pose a risk of secondary injury from migration, infection, and metal toxicity. It has been recommended that aggressive removal of fragments be avoided. The goal of this study is to report our technique of minimally invasive removal of select deep-seated fragments using a tubular retractor system. ⋯ Deep parenchymal and intraventricular fragments can be safely removed using a tubular retractor system.