World Neurosurg
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Studies focusing on hemorrhagic presentation of brain arteriovenous malformations (AVMs) have largely limited their analysis to angiographic features. We report the importance of race/ethnicity as a clinical factor associated with hemorrhagic AVM presentation in addition to previously reported angiographic features. ⋯ To our knowledge, this is the first study demonstrating that race/ethnicity is significantly associated with hemorrhagic presentation of AVMs. We also confirmed previous observations that AVM size and location are associated with hemorrhagic presentation.
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Monitoring pharyngeal motor evoked potential (PhMEP) with a modified endotracheal tube is useful for predicting postoperative swallowing dysfunction. However, the relationship between intraoperative PhMEP findings and recovery from postoperative swallowing dysfunction has not been clarified. The aim of this study was to determine whether PhMEP monitoring predicts swallowing dysfunction not only immediately after surgery but also in the postoperative recovery period. ⋯ PhMEP monitoring allowed us to predict not only immediate swallowing dysfunction but also recovery from the dysfunction in the postsurgery period.
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The treatment goal for vestibular schwannomas (VS) has been changed from total removal of the tumor to functional preservation with long-term tumor growth control. The small- to medium-sized VS can be treated by stereotactic radiosurgery, but large VS require surgical decompression for the relief of cerebellar dysfunction and increased intracranial pressure. We have been performing planned partial surgical resections followed by gamma knife radiosurgery (GKS) for large VS. Here, we evaluate a recent series of such cases from the standpoint of functional outcomes. ⋯ Planned partial removal of large VS followed by GKS achieved a high rate of facial nerve and hearing preservation. To achieve long-term tumor growth control, the tumor volume at GKS after planned partial surgical resection should be smaller than 6 cm(3). Our results revealed that patients with hearing preservation postoperatively have a chance of maintaining hearing function, even though the possibility exists of deterioration by long-term follow-up after surgical intervention and GKS. Furthermore, some patients with severe hearing loss before treatment have the chance of hearing improvement, even those with large VS.
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Custom-made porous hydroxyapatite (HA) implant (Fin-Ceramica Faenza S.p.A., Italy) is a biomimetic, osteoconductive material. Margin fusion at the bone-implant edge, cell proliferation within implant pores, and osteointegration in an animal model have already been described. ⋯ Custom-made porous HA implant is an osteoconductive material able to promote osteogenesis, osteointegrate with bone tissue, provide an effective cranial reconstruction, and restore functional features of the skull. However, complete bone healing is still a complex and long process.
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Although the ventricular size is significantly reduced after endoscopic third ventriculostomy (ETV) in most successfully treated patients, ventricular size reduction is not always seen after a successful ETV. Practical and reliable radiologic parameters are still needed to assess the clinical success of an ETV. ⋯ The degree of reduction of the angle of the infundibular recess of the third ventricle correlated with the amount of third ventricular decompression after ETV. Most importantly, such a reduction was noted to occur during the early postoperative period when radiologic changes are less pronounced. Assessment of change in infundibular recess angle measurement is easy to perform and may prove helpful in cases with no clear-cut clinical evidence of success of ETV.