World Neurosurg
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The brainstem comprises a large variety of fiber tracts and nerve nuclei and is unarguably one of the most crucial parts of the brain. Reliable noninvasive visualization of its anatomy may help relate normal and pathological anatomic variations to neurologic/psychiatric disorders. In this study, we explored the potential of direction-encoded track-density imaging (TDI) for depicting the intricate anatomy of the brainstem. ⋯ TDI images provide optimal delineation of nerve nuclei and fibers in the upper brainstem, but have more difficulty identifying more caudal structures.
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Observational Study
Outcome after decompressive craniectomy in different pathologies.
We compare the outcome after decompressive craniectomy for various neurologic diseases with the final common pathway of coma, compression of the basal cisterns, a midline shift, or refractory intracranial hypertension. ⋯ The outcome after decompressive craniectomy does not differ significantly in different diseases once the final pathophysiologic pathway of refractory intracranial hypertension, coma, compression of the basal cisterns, or midline shift has been reached.
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Pseudocapsular resection is a useful surgical technique for removing functioning pituitary adenomas; however, the significance of this procedure in nonfunctioning pituitary adenomas (NFPAs) had not been discussed in detail. We clarify the safety of pseudocapsular resection in NFPAs based on the incidence of surgical complications and evaluation of pituitary function. ⋯ Pseudocapsular resection in NFPAs does not increase the risk of surgical complications or aggravate postoperative pituitary function.
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Colloid cyst is the most common neoplastic lesion of the third ventricle, and the occurrence of 2 colloid cysts in the ventricular system is rare. ⋯ This report illustrates the importance of proper radiologic study in a case of colloid cyst and preparing preoperatively and excision of both the colloid cyst whenever present, to prevent the recurrence.
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Although age already is known as a crucial factor affecting the functional outcome after a hemicraniectomy for malignant hemispheric infarction, previous studies have used arbitrary age cut-offs of 50, 60, or 70 years. Therefore, this study investigated predictors of the functional outcome after a hemicraniectomy and attempted to determine the critical age for an unfavorable functional outcome. ⋯ Advanced age was identified as a significant predictor of an unfavorable outcome and functional dependency. The PPV of a patient age >58 years and >67 years for predicting an unfavorable outcome with functional dependency was 82% and 100%, respectively.