World Neurosurg
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Review Case Reports
Endoscopic endonasal transsphenoidal approach for the removal of optochiasmatic cavernoma: a case report and literature review.
Cavernoma of the optic chiasm is a rare disease, and the most common clinical presentation is chiasmal apoplexy. Almost all the cases reported in the literature were treated surgically with craniotomy. ⋯ Rapid diagnosis and complete resection of a symptomatic optochiasmatic cavernoma are helpful in improving visual dysfunction. EETA is an alternative, minimally invasive technique for resecting this type of lesion.
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Review Case Reports
Iatrogenic vertebral artery injury during anterior cervical spine surgery: A systematic review.
Iatrogenic vertebral artery injury (VAI) during anterior cervical surgery is rare but potentially catastrophic. ⋯ Extensive lateral decompression, loss of landmarks, and anatomic variations or pathologic status of VA increased VAI risk. Evaluation of collateral vessels before definitive treatment helped determine appropriate management and avoid neurologic sequelae. Tamponade was not recommended as definitive treatment. Meticulous preoperative evaluation, cautious intraoperative manipulation, and real-time radiographic guidance reduced VAI risk.
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The absence of evidence-based guidelines for platelet transfusion surrounding invasive neurosurgical procedures leads to uncertainty in management. Multiple studies have illuminated this lack of high quality data, and subsequent reliance on expert opinion. The generally accepted threshold for platelet transfusion has hovered around 100,000/μL. ⋯ The available evidence is sparse and of low quality, but suggests that a platelet count <100,000/μL is associated with increased risk of hemorrhagic complications. In addition, the acuity of thrombocytopenia, magnitude of decrease in platelet count, and responsiveness to platelet transfusions impact the risk of neurosurgical intervention, and should be taken into account when evaluating a patient's surgical candidacy. Higher quality, prospective studies on the subject are unlikely, given a general lack of clinical equipoise on the subject, and the ethical concerns such a study would present.
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Review Case Reports
Cerebral venous sinus thrombosis secondary to idiopathic hypertrophic cranial pachymeningitis: A case report and review of the literature.
Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare fibrosing inflammatory process involving the dura mater. Currently, there is no consensus on the treatments for IHCP, and the usefulness of immunosuppressive agents as a first-line option remains controversial. Cerebral venous sinus occlusion (CVSO) and cerebral venous sinus thrombosis (CVST) secondary to IHCP, which may cause progressive intracranial hypertension and venous obstructive parenchymal lesions, make the diagnosis and treatment of IHCP more complicated. ⋯ We experienced a patient with CVST secondary to IHCP, who was successfully treated with cyclophosphamide pulse therapy. Because IHCP with secondary venous obstruction has various differential diagnoses, venography is necessary to avoid misdiagnosis. The use of immunosuppressive agents may be promising but needs further verification.
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Multicenter Study Comparative Study
Comparison of grading scales regarding perioperative complications and clinical outcomes of brain arteriovenous malformations after endovascular therapy-a multicenter study.
Several scales have been proposed for risk assessment and outcome determination in brain arteriovenous malformations treated by endovascular therapy. We aim to validate and compare the efficacy of these scales in predicting perioperative complications and clinical outcomes. ⋯ The Puerto Rico score predicts complications and unfavorable outcomes better than the SM. The AVMES scale has medium efficacy in predicting complete obliteration.