World Neurosurg
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Several endoscopic landmarks for the internal carotid artery (ICA) have been identified, but they have always been proposed in a "static" perspective. The aim of this study was to investigate how the surgical corridor and optical distortion can influence the perception of carotid landmarks in transnasal endoscopic surgery. ⋯ The surgical corridor and endoscope optic distortion can influence ICA visualization and the perception of its anatomic landmarks. In a 2-nostril, 4-handed approach, it is advisable to place the endoscope and instrument for dissection in the nostril that is ipsilateral to the lesion. Awareness of the different perspectives and related optical distortions is essential when working in proximity to the ICA.
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Chronic subdural hematoma (cSDH) is a common neurosurgical condition, with an estimated incidence of 3-15.5 per 100,000 people, with significantly higher rates in the elderly population. Recurrence rates range from 2%-37% after surgical drainage. Studies have shown that leaving a drain postoperatively can reduce recurrence rates, but studies have not looked at whether there is a difference between leaving 1 or 2 drains. ⋯ This study demonstrates that neither the number of burr holes nor the number of drains left after a burr hole drainage of cSDH appear to affect recurrence rates, whereas liver disease does make recurrence more likely.
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Case Reports
Treatment of Refractory Status Epilepticus with Vagus Nerve Stimulator in an Elderly Patient.
One of the risks of a traumatically induced intracranial bleed is development of new onset seizures. Rarely would these seizures progress to status epilepticus (SE) or refractory SE. There is a lack of literature on the use of a vagus nerve stimulator in these situations in older adults. ⋯ A vagus nerve stimulator should be considered in cases of refractory status epilepticus, regardless of age. Excellent outcome can be achieved even if a short course of medication-induced coma is unsuccessful.