World Neurosurg
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Extraforaminal lumbar disc herniation (EFLDH) accounts for 7%-12% of all lumbar disc herniations. We report on a surgical technique for EFLDH, which requires only minimal resection of the facet joint and also allows access to the preforaminal space, if necessary. ⋯ Disc fragment herniectomy through a facet joint quadrantectomy for EFLDH is a safe and minimal invasive technique resulting in very satisfactory results. Preservation of facet joint stability and the possibility to convert to a classic approach to reach for preforaminal components, if necessary, are major advantages of this technique.
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Giant pituitary adenomas carry higher surgical risks despite recent advances in microsurgical and/or endoscopic surgery, and postoperative acute catastrophic changes without major vessel disturbance are still extremely difficult to predict, may manifest as postoperative pituitary apoplexy, and are associated with poor outcomes. ⋯ Major blood supply of giant pituitary adenomas originates from branches of the infraclinoidal portion of the internal carotid artery, different from the normal anterior pituitary gland. Surgical route should depend on not only tumor shape and extension but also feeding systems.
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Several studies have reported treatment methods and results for pediatric craniopharyngiomas; however, few have evaluated patients' quality of life (QOL) after long-term follow-up. To evaluate treatment options, we assessed the QOL of patients with pediatric craniopharyngioma approximately 19 years after surgery and analyzed factors affecting QOL. ⋯ Long-term survivors lived independently but had a lower overall QOL. Not only monitor short-term results based on estimation of the initial resection or recurrence rate, it is important to preserve visual and hypothalamic function and monitor arising complications for extended periods to improve patients' long-term QOL.
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Case Reports
Perioperative bioccipital watershed strokes in bilateral fetal posterior cerebral arteries during spinal surgery.
Vision loss due to cerebral infarction during spinal surgery is less described. Intraoperative hypotension would be a leading cause. Patients with variation of the circle of Willis could be more prone to present stroke in this context, but reports are lacking to sustain the theory. Bilateral occipital watershed ischemic strokes have never been described before. We report the case of a patient with a fetal origin of both posterior cerebral arteries (PCAs), presenting this particular anatomic stroke following lumbar laminectomy surgery for spinal stenosis during which intraoperative hypotension was observed. We discuss how this common anomaly associated with intraoperative hypotension could have promoted this serious complication. ⋯ The standing hypothesis would be posterior low-flow infarctions resulting from intraoperative hypotension on a variation of the circle of Willis more prone to decrease in cerebral blood flow. Moreover, this case supports the hypothesis of vascular insufficiency due to intraoperative hypotension as cause of stroke during spinal surgery.
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Facial nerve schwannomas are rare lesions that constitute only 0.8% of all intrapetrous mass lesions. The least frequent lesions are tumors originating in the greater petrosal nerve (GPN). We present a case of a GPN schwannoma with temporal lobe edema in which the patient was operated on using an extradural and intradural approach to prevent complications. ⋯ GPN schwannomas are very rare lesions. The extradural and intradural middle fossa approach was used to preserve the tumor capsule around the GPN. Using this technique, one can safely protect the geniculate ganglion and the GPN.