World Neurosurg
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The goals of the present study were to identify predictors of better survival and to propose appropriate management strategies for recurrent hemangiopericytomas (HPC) and anaplastic hemangiopericytomas (AHPC). ⋯ Treatment is imperative for the first recurrence of HPC or AHPC. More attention should be paid to patients with shorter first recurrence-free survival. Surgery is the first choice for their first recurrence and radiotherapy should be administered if there is no history of radiotherapy.
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A frontal sinus infection, following a transsinus skull base procedure, portends potentially life-threatening complications, making surgical revision mandatory in refractory infections. The authors describe the application of the bilateral temporal myofascial flap (BTMF) as a valuable option for frontal sinus reconstruction, when pericranial or galeal-frontalis myofascial flap (GFMF) is no longer available. ⋯ The BTMF should be considered as a valuable option for frontal sinus reconstruction after transsinus skull base procedures when GFMF is not available.
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Case Reports
It's time to reduce free-hand manipulation: case report of our proposal for an innovative one step cranioplasty.
Cranioplasty is a well-known procedure, and autologous graft bone is usually considered the best choice in this procedure, but it cannot be used in conditions such as bone-infiltrating tumors, spheno-orbital en plaque meningiomas, and bone infections. Polymethylmethacrylate (PMMA) offers great possibility of intraoperative adaption. We describe a case of 1-step cranioplasty performed in a patient with a meningeal fibrosarcoma using a custom-made silicon mold. ⋯ We performed a 1-step cranioplasty after resection of a meningeal fibrosarcoma that infiltrated bone with a new technique to reproduce during intervention a preoperative simulated craniectomy and a computer-assisted design PMMA flap.
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Chordomas and chondrosarcomas can occur in the skull base. Currently, 45% of chordomas and 56% of chondrosarcomas recur within 5 years of surgery. The role of adjuvant therapy is highly debated. No pharmacotherapies have been approved by the U.S. Food and Drug Administration for chordomas or chondrosarcomas. High propensity for recurrence and lack of definitive adjuvant therapy necessitate additional basic science research to identify molecular anomalies associated with recurrent disease. ⋯ These data provide clinicians with a means to screen skull base chordomas and chondrosarcomas to help identify tumors with a propensity to recur. Many of these kinases can be efficaciously inhibited by Food and Drug Administration-approved drugs that have not yet been used in clinical trials for treatment of skull base chordomas or chondrosarcomas. Validation of kinases identified in this study may advance treatment options for patients with these tumors.
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The origin of chronic subdural hematomas (CSDH) and the pathophysiology of its enlargement remain unknown. The chemical fluid composition of CSDH, the contribution of cerebrospinal fluid (CSF) to its enlargement, and the relationship to its appearance on computed tomography (CT) also are not entirely clear. ⋯ Our study confirms that the origin and enlargement of CSDH is multifactorial, but the contribution of individual factors and condition under which it occurs still remains unclear. CT scan findings do not correlate with the chemical composition or the presence of CSF in the CSDH.