World Neurosurg
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Review Case Reports
Orbitocranial low-velocity penetrating injury: A personal experience, case series, review of the literature; and a proposed management plan.
Orbitocranial penetrating injuries (OPI) are an unfamiliar subset of head injury and are particularly rare in clinical practice. They are usually the result of falls or motor vehicle collisions and occur more commonly in children, who are prone to trauma while playing games improperly. ⋯ Computed tomography, magnetic resonance imaging, and computed tomography angiography are key imaging modalities that are frequently used to determine the course of the foreign object and the extent of brain tissue injury as well as to rule out vascular injury in these types of cases. Early surgical exploration by a multidisciplinary team approach is essential to attain good recovery and a favorable outcome.
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Traumatic brain injury (TBI) stands out as a grave social and economic problem. Emerging countries possess few epidemiologic studies on the range and impact of TBI. ⋯ TBI should be recognized as an important public health problem in Brazil because it is responsible for considerable social and economic costs. Besides the young adult age group (20-29 years old), the geriatric age group is especially vulnerable to the frequent and devastating consequences of TBI. The implementation of a system of effective epidemiologic vigilance for neurotrauma is urgent in Brazil and other countries worldwide.
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Language dysfunction, visual deficit, numeracy impairment, and Gerstmann syndrome often occur in the cortical area; furthermore, the subcortical white matter is the inviolable limit of "functional neurosurgery." Preoperative functional magnetic resonance imaging (fMRI) and tractography are capable of providing the data required for safe "surgical planning" at both the cortical and subcortical levels. ⋯ Our results suggest that this approach is completely safe and effective as an alternative to awake surgery.
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Sellar/suprasellar cystic lesions can cause compression of the optic pathways and result in a decline in vision. There have been reports of optic pathways being fenestrated by intracranial aneurysms. This is the first report of a sellar/suprasellar arachnoid cyst causing fenestration of an optic nerve. ⋯ Sellar/suprasellar arachnoid cysts likely form when a communication exists between the suprasellar arachnoid space and the sella turcica. We believe that our patient's cyst grew slowly enough to allow normal functioning of the optic nerve as it was being penetrated. Though visual symptoms may be gradual and not present until after the optic nerve has been penetrated, these symptoms and signs may still improve with removal of the cyst. Prognosis for visual improvement is difficult to predict with cases of compressive sellar/suprasellar cystic masses. Improvement in the vision examination after surgical resection is possible even when the optic nerve has been penetrated.
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We used microscopy to conduct qualitative and quantitative analysis of 4 surgical approaches commonly used in the surgery of the ambient cistern: infratentorial supracerebellar (SC), occipital interhemispheric, subtemporal (ST), and transchoroidal (TC). In addition, we performed a parahippocampal gyrus resection in the ST context. ⋯ This study has demonstrated that surgical approaches expose dissimilarly the different regions of the ambient cistern and an approach should be selected based on the specific need of anatomic exposure.