World Neurosurg
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The medial opticocarotid recess (MOCR), which contains the lateral tubercular recess (LTR), is an important landmark for the cavernous internal carotid artery (ICA) and for accessing the parasellar and suprasellar regions. These microanatomic landmarks for endoscopic endonasal surgery can be observed using surgical simulation with three-dimensional images. The aim of this study was to analyze the MOCR in patients with pituitary macroadenoma using three-dimensional images. ⋯ Pituitary macroadenomas expand the distance between the left and right MOCR together with the distance between the left and right ICA.
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Recommendations that may help reduce adverse events outside the perioperative period are uncommon. We identified the primary factors that contributed to patient injury in neurosurgical practice both within the perioperative period and outside the perioperative period. ⋯ In addition to excellent surgical technique, checklists, teamwork, outcomes measurement, and regionalization of subspecialty care, improving patient safety in neurosurgical practice requires careful attention to care provided outside the perioperative period. Differential diagnosis, consideration of all relevant clinical data, active pursuit of good physician-patient relationships, and adequate monitoring of patients receiving nonsurgical treatment may also help improve patient safety in neurosurgical practice.
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Clinical Trial
Prevalence of complications in intraoperative MRI combined with neurophysiological monitoring.
High-field intraoperative magnetic resonance imaging (ioMRI) is becoming increasingly available in neurosurgery centers, where it has to be combined with intraoperative neurophysiologic monitoring (IONM). IONM needle electrodes remain on the patient during ioMRI and may cause image distortions and burns. We tested magnetic resonance (MR) -heating experimentally and investigated the prevalence of complications. ⋯ We have corroborated the history of safe use for electrodes with 1.5 m cable in a 3T MRI scanner and demonstrated their use. Nevertheless, heating cannot be excluded, as it depends on location and cable placement. When leaving electrodes in place during ioMRI, risks and benefits have to be carefully evaluated for each patient.
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Medulloblastoma (MDB) is an aggressive embryonal brain tumor, with underlying altered genetics and biological pathways that account for very heterogeneous natural histories and clinical behaviors. Positron emission tomography (PET) using radiolabeled amino acids provides important metabolic information for the diagnosis of cerebral glioma but only a few data are available on amino acid PET in MDB. In particular, no cases of MDB imaging with 6-[(18)F]-fluoro-L-3,4-dihydroxyphenylalanine (F-DOPA) have previously been described. ⋯ The 2 cases reported here suggest that sensitivity of F-DOPA PET in MDB can be low. However, more comprehensive data are needed to conclude on the overall accuracy of F-DOPA PET in MDB.
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Ventriculitis is a serious infection associated with high mortality even when both intravenous (IV) and intrathecal (IT) antibiotics are administered. Poor outcome in patients with ventriculitis indicates the need to be more aggressive in our attempts to expeditiously eradicate the infection. The purpose of this study was to evaluate the role of endoscopic lavage (EL) in patients with severe purulent ventriculitis, unresponsive to IV and IT antibiotics. ⋯ The addition of IT antibiotics has resulted in improved outcome in patients with ventriculitis; however, some patients continue to be unresponsive to antibiotics. EL can play a complementary role in eradicating such recalcitrant infections. EL should be considered in any patient with ventriculitis, if infection persists even after ∼7-10 days of IVand IT antibiotics.