World Neurosurg
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The most common bone flap storage strategies after decompressive hemicraniectomy for malignant intracranial hypertension include freezer cryopreservation (CP) and subcutaneous abdominal implantation (AP). Numerous series have reported on patient outcomes after cranioplasty in terms of infection, cosmesis, and resorption. This meta-analysis compares published outcomes of bone flap CP and subcutaneous storage with respect to efficacy and complication risk in patients undergoing cranioplasty after hemicraniectomy. ⋯ This is the largest and most robust review comparing published outcomes of CP and subcutaneous storage of bone flaps in patients who have undergone decompressive hemicraniectomy. This review found no statistically significant differences in clinical outcomes (infection, resorption, reoperation) when comparing storage methods for bone flap preservation. This study suggests that both strategies may be used safely and successfully.
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Multicenter Study
Aneurysm surgery with pre-operative 3D planning in a virtual reality environment: Technique and outcome analysis.
Aneurysm surgery demands precise spatial understanding of the vascular anatomy and its surroundings. We report on a decade of experience planning clipping procedures preoperatively in a virtual reality (VR) workstation and present outcomes with respect to mortality, morbidity, and aneurysm occlusion rate. ⋯ Meticulous three-dimensional surgical planning in a VR environment enhances the surgeon's spatial understanding of the individual vascular anatomy and allows clip preselection and positioning as well as anticipation of potential difficulties and complications. VR planning was associated, in this multi-institutional series, with excellent clinical outcomes and rates of complete aneurysm closure equivalent to benchmark cohorts.
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Review Case Reports
Neurofibromatosis type 1-associated extracranial vertebral artery aneurysm complicated by vertebral arteriovenous fistula after rupture: Case report and literature review.
Extracranial vertebral artery aneurysm related to neurofibromatosis type 1 (NF1) is rare. Aneurysmal rupture typically induces such symptoms as cervical hematoma, hemothorax, and hypotension. Here we report a case of ruptured extracranial vertebral artery aneurysm in a patient with NF1 who, rather than cervical hematoma, hemothorax, or hypotension, developed a vertebral arteriovenous fistula (AVF) after aneurysm rupture. ⋯ This patient's clinical course suggests that if there is minimal bleeding from an NF1-associated ruptured extracranial vertebral artery aneurysm, then typical symptoms, such as cervical hematoma, hemothorax, and hypotension, may be absent. Thus, ruptured extracranial vertebral artery aneurysm should be considered in the differential diagnosis of patients with NF1 with sudden-onset radiculopathy, even in the absence of typical symptoms. The detection of a vertebral AVF provides a useful clue to the diagnosis of aneurysm rupture in such cases.
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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
Fatal superior sagittal sinus and torcular thrombosis following vestibular schwannoma surgery- report of a rare complication and review of literature.
Cerebral venous sinus thrombosis (CVST) is a rare condition with the potential to cause severe morbidity and mortality. CVST can also occur after vestibular schwannoma (VS) surgery with the thrombosis of transverse and sigmoid sinus. However, there is not a single report of superior sagittal sinus (SSS) thrombosis after VS surgery reported in the literature. ⋯ This case underscores the significance of adequate optimization of the patients prior to surgery, besides adequate operative skills to avoid this rare but serious complication of SSS and torcular thrombosis after VS surgery.