World Neurosurg
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Spontaneous intracranial hypotension (SIH) is a well-known, but under- or misdiagnosed, condition caused by cerebrospinal fluid leak resulting from idiopathic dural breach. Blind lumbar epidural blood patch is an effective treatment in most cases, but occasionally, even targeted epidural blood patch fails to lead to improvement. In these cases, the cerebrospinal fluid leak is usually repaired surgically, especially for large dural breaches (>5 mm), once the site has been identified by imaging techniques (magnetic resonance myelography/computed tomography [CT] myelography/isotopic transit). ⋯ We report 2 cases with good technical and clinical outcome after 1 and 8 years of follow-up (clinical evaluation and brain imaging control by CT). The technique we describe here is of high interest in refractory SIH or for the serious form of the disease, before considering surgical repair. Further prospective studies are required to provide general guidelines in treatment options for patients with SIH.
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Medical complications severely impair recovery of neurosurgical patients after craniotomy. The purpose of this study was to identify patients at risk of peri- and postoperative medical complications. Therefore, we present a large population of patients with different medical complications after elective craniotomy. ⋯ In this study, we identified predictors that help characterize patients at risk of medical complications after elective neurosurgical procedures. These correlations should be taken into account when advising patients on craniotomy.
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Brain cognitive functions affect patient quality of life. The frontal lobe plays a crucial role in advanced cognitive functions, including executive function, meta-cognition, decision-making, memory, emotion, and language. Therefore, frontal tumors can lead to serious cognitive impairments. ⋯ The treatment may both resolve the effects of the tumor to improve cognitive function or cause permanent disabilities resulting from damage to healthy functional brain tissue. Previous studies have focused on the influence of frontal lesions and surgical treatments on patient cognitive function. Here, we review cognitive impairment caused by frontal lobe brain tumors.
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Aneurysm recanalization after coiling, with or without stent assistance, is a major issue in the endovascular management of intracranial aneurysms. Multiple intracranial aneurysms with different outcomes after endovascular treatment may represent a useful disease model in which patient-specific risk factors can be balanced to investigate possible features linked to aneurysm recanalization. In the present study, we evaluated the impact of aneurysm-specific, treatment-related, and hemodynamics-related factors on multiple aneurysms and to explore the reason why one aneurysm recanalized and the other did not. ⋯ Small aneurysm size and neck width, unruptured aneurysm, and perianeurysmal hemodynamics with marked reduction may be important factors associated with the midterm durability of aneurysm embolization.
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Mannitol is the most commonly used intraoperative hypertonic solution in patients undergoing craniotomy. However, its use has been reported to be associated with hyperkalemia, which can occasionally be life threatening. ⋯ Knowledge of the existence of mannitol-induced hyperkalemia is paramount for the neurosurgeon and the anesthesiologist, because early treatment with insulin and calcium can quickly restore normal cardiac rhythm and prevent intraoperative death.