World Neurosurg
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Primary intracranial neuroendocrine carcinomas (NECs) are extremely rare malignant tumors with no previous reports of multiple ones in the literatures. ⋯ Multiple primary intracranial NECs are extremely rare. The tumor might be of arachnoidal or leptomeningeal origin, with histologic patterns that might lead to transformation and/or progression. Maximal surgical resection is warranted for symptomatic mass effect. Postoperative adjuvant treatments including radiotherapy and chemotherapy should be a recommended therapeutic modality.
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The optimal management of pituitary apoplexy (PA) remains debated. The aim of this study was to assess the outcome of the transsphenoidal approach for PA in a large surgical experience. ⋯ The endoscopic endonasal approach represents a valid, effective, and safe technique in the management of PA. Favorable outcomes can be achieved by referring patients to dedicated pituitary centers with a multidisciplinary team. Further studies are still needed to define criteria for surgical indication and to identify outcome predictors.
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Endovascular coil embolization and craniotomy with clip ligation are the 2 most commonly used treatments for ruptured cerebral aneurysm. Although coiling maintains the advantages of brevity and complete avoidance of brain retraction and manipulation, clipping offers the benefits of decompression of the injured brain and lower rates of aneurysm recurrence. A combined, immediately sequential treatment strategy for acutely ruptured cerebral aneurysm that simultaneously maximizes the advantages of both techniques, while minimizing their respective disadvantages, may be a useful paradigm. ⋯ A deliberate combined treatment strategy that uses clipping immediately preceded by subtotal coiling under a single anesthetic may be ideal for selected ruptured cerebral aneurysms, takes advantage of the unique strengths of both techniques, makes both techniques easier, and maximizes opportunity for brain protection against delayed complications in the prolonged aftermath of aneurysmal subarachnoid hemorrhage.
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We reviewed our 7-year experience to assess the efficacy of stereotactic radiosurgery (SRS) for dural carotid cavernous fistulas (DCCFs). We analyzed the clinical outcome, complications, and angiographic results. ⋯ SRS for DCCFs offered a high obliteration rate with low risk of radiation-induced complications. In patients with benign DCCFs that are not amenable to embolization or microsurgery, SRS is a safe and effective treatment for complete obliteration of the arteriovenous shunt and for improving quality of life.
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Observational Study
Outpatient lumbar microdiscectomy in France: From an economic imperative to a clinical standard - An observational study of 201 cases.
The outpatient lumbar discectomy procedures have been established for more than 2 decades. However, especially in Europe, there are still obstacles to the development of these procedures, which may be related to medicoeconomic imperatives, and to several factors concerning both surgeons and patients. We describe our initial experience in introducing this method in our institution. ⋯ Reducing hospitalization for lumbar discectomies to a few hours is not a reduction in the quality of care. It is not necessarily simple to overcome the resistances of all protagonists, but placing the patient as the main actor of an integrated management plan is the key to transforming a medicoeconomic incentive into a clinical success.