World Neurosurg
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It is important to recognize the incidence and risk factors for ischemic complications after surgical revascularization for moyamoya disease (MMD). However, most studies focus on pediatric MMD or pediatric and adult MMD. Our study identified the incidence and risk factors of newly developed cerebral infarction after surgical revascularization for adult MMD. ⋯ Our findings demonstrate that newly developed, silent cerebral infarction developed more frequently than symptomatic cerebral infarction in adult patients. Cerebral infarction as initial presentation, frequent TIA before surgery, and PCA involvement were also independent risk factors for newly developed cerebral infarction after surgical revascularization for adult MMD.
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To study the influence of tumor location (cervical vs. thoracic; extramedullary vs. intramedullary) on predictive value of intraoperative myogenic motor-evoked potentials (iMEP) changes in patients undergoing surgery for spinal cord tumors. ⋯ A strong association was observed between worsening of iMEPs and postoperative new neurological deficits in patients with TIM tumor.
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Case Reports
Failed Ventriculoperitoneal Shunt: is Retrograde Ventriculosinus Shunt A Reliable Option?
Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. ⋯ We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence.
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To elucidate venous drainage patterns to avoid damage to the venous drainage route in the middle cranial fossa and superior petrosal sinus when employing the transpetrosal approach. ⋯ In cases of venous drainage impairment secondary to PCM progression, the drainage route changed to the pterygoid plexus route through the emissary foramen and/or superior sagittal sinus and to the transverse sinus route through the greater anastomosis of the superficial middle cerebral vein. In the anterior transpetrosal approach, peeling off the dura propria of the trigeminal nerve of the foramen rotundum for petrous apex exposure may be associated with the potential risk of pterygoid plexus drainage route impairment.
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The middle fossa approach (MFA) is not used as frequently as the traditional translabyrinthine and retrosigmoid approaches for accessing vestibular schwannomas (VSs). Here, MFA was used to remove primarily intracanalicular tumors in patients in whom hearing preservation is a goal of surgery. ⋯ Preliminary results from this single-center retrospective study of patients undergoing MFA for resection of VS showed that good hearing preservation and facial nerve outcomes could be achieved with few complications. These results suggest that resection via the MFA is a rational alternative to watchful waiting or stereotactic radiosurgery.