World Neurosurg
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Subthalamic deep brain stimulation (DBS) is a well-established treatment for patients with Parkinson's disease who suffer from severe motor fluctuations. The most common surgery-related complications are temporary confusion, bleedings, infections, and seizures. Seizures have been described to occur mainly around the time of the implantation of electrodes and, at present, the best established risk factors for seizures in association with DBS surgery are bleedings. A postoperative status epilepticus as complication of DBS surgery has never been described before. ⋯ This is a first report on a status epilepticus after DBS surgery, implicating that this complication has to be considered as differential diagnosis in somnolent patients after this operation.
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Review Case Reports
Trans-nasal penetration of a ballpoint pen: Case report and Review of Literature.
Transnasal penetration by a nonmissile foreign body is a rare injury. Consequently, appropriate management remains controversial. We report a case of transnasal penetration by a ballpoint pen and review the literature. To our knowledge, this is the first living patient who sustained carotid artery damage from a transnasal penetrating intracranial injury. ⋯ Injuries such as the one described here should be managed through a multidisciplinary approach. The trajectory of the foreign body should be delineated through CT imaging, along with vascular imaging if appropriate. If there are signs of vascular injury, then attempts to maintain proximal and distal control are prudent to avoid hemorrhagic complications. This combined endovascular-endoscopic-open craniotomy approach has not been reported previously in the literature.
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Review Case Reports
Case Report and Review of Literature of Delayed Acute Subdural Hematoma.
The authors present a case of delayed acute subdural hematoma and review all reported cases in the literature. The focus of this paper is to identify the subset of the population who are at risk, and determine whether they should be admitted for observation in the setting of mild traumatic brain injury. ⋯ Delayed acute subdural hematoma occurs mainly in the middle-aged or older population who are taking anticoagulation or antiplatelet therapy. Most patients have a GCS score of 15 with no loss of consciousness. Neurological deterioration occurs within the first 24 hours for 70% of the patients. Therefore, we recommend admission and observation of these selected group of patients. Due to small reported population of patients, we could not determine whether the patients taking anticoagulant, antiplatelet, or both anticoagulant and antiplatelet medication are at higher risk. In addition, the role of delayed CT of the head without change in the examination result needs to be explored further.
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Case Reports
Clinical Image: A meningoencephalocele caused by a chronic growing skull fracture in a 76-year old patient.
We present a case of a growing skull fracture in adult male, with an interval of 43 years after initial trauma. This finding is extremely rare, especially because growing skull fractures are mostly seen as an uncommon complication of pediatric head trauma with calvarial fracture. In our patient, this finding was incidental, existed for many years, and had no clinical consequences. Therefore, we advised a conservative treatment for our patient.
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Review Meta Analysis
Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-analysis of Radiological Criteria and Comparison of Endoscopic and Microscopic Surgery.
Despite the substantial impact of cavernous sinus invasion (CSI) in pituitary adenoma surgery, its radiologic determination has been inconsistent and variable, and the role of endonasal endoscopic surgery has been unclear. This is a systematic review and pooled data meta-analysis of the literature to ascertain the best radiologic criteria for CSI and verify the efficacy and safety of an endonasal endoscopic approach. ⋯ Knosp 3-4 remains the best objective indicator of CSI. Microscopy tends to overestimate intraoperative CSI compared with endoscopy. Among pituitary adenomas with CSI, GTR in endoscopic series is higher than microscopy and improves with experience without significant additional morbidity.