World Neurosurg
-
Preoperative visualization of the facial nerve could help neurosurgeons to prevent facial nerve injury during vestibular schwannoma surgery. Some studies have addressed diffusion tensor tractography (DTT) for preoperative identification of the facial nerve. However, few studies have focused on tractography-integrated neuronavigation for DTT verification. This study aimed to explore the appropriate DTT tracing parameters and evaluate the effect of intraoperative facial nerve tractography-integrated neuronavigation for verifying the DTT accuracy. ⋯ We consider preoperative DTT with intraoperative tractography-integrated neuronavigation to be a useful method for identifying the location of the facial nerve. This method might improve facial nerve preservation.
-
Surgical management of hemifacial spasm associated with chiari I malformation: analysis of 28 cases.
Hemifacial spasm (HFS) associated with Chiari I malformation (CIM) is rare. This study aimed to analyze the frequency of HFS associated with CIM in our department and further to investigate the clinical characteristics, treatment strategies, and outcomes of these cases. ⋯ The results suggest that MVD can still be an effective treatment for HFS when it coexists with CIM. Furthermore, posterior fossa crowdedness may be a common risk factor for the 2 diseases, and foramen magnum decompression should be considered as the primary procedure in patients with HFS and symptomatic CIM.
-
Case Reports
Takotsubo cardiomyopathy triggered by venous air embolism during craniotomy in sitting position: a case report.
We present a case of stress-induced cardiomyopathy (Takotsubo cardiomyopathy) caused by a venous air embolism during a craniotomy performed in the sitting position. ⋯ Intensivists and anesthesiologists in the operating room and in intensive care units need to be aware of stress-induced cardiomyopathy as a probably underdiagnosed disease entity, especially as management differs significantly from other forms of cardiogenic shock. Diagnosis can be accomplished quickly by bedside echocardiography, emphasizing the need for availability of this tool and the integration of stress-induced cardiomyopathy in diagnostic algorithms in the intensive care unit.
-
Case Reports
Video Telescope Operating Monitor (VITOM) 3D: preliminary experience in cranial surgery. Technical Case Report.
Optimal vision and ergonomics are important factors contributing to achievement of good results during neurosurgical interventions. The operating microscope and the endoscope have partially filled the gap between the need for good surgical vision and maintenance of a comfortable posture during surgery. Recently, a new technology called video-assisted telescope operating monitor or exoscope has been used in cranial surgery. The main drawback with previous prototypes was lack of stereopsis. We present the first case report of cranial surgery performed using the VITOM 3D, an exoscope conjugating 4K resolution view and three-dimensional technology, and discuss advantages and disadvantages compared with the operating microscope. ⋯ VITOM 3D is a video system that has overcome the lack of stereopsis, a major drawback of previous exoscope models. It has many advantages regarding ergonomics, versatility, and depth of field compared with the operating microscope, but the holder arm and the mechanism of repositioning, refocusing, and magnification need to be ameliorated. Surgeons should continue to use the technology they feel confident with, unless a distinct advantage with newer technologies can be demonstrated.
-
Case Reports
IgG4-Related Disease: A New Etiology Underlying Diffuse Intracranial Dilating Vasculopathy.
Diffuse intracranial aneurysmal vasculopathy is a rare condition, previously described in patients with human immunodeficiency virus infection. IgG4-related disease (IgG4-RD) is a recognized inflammatory disease of systemic organs, leading to fibrosis of connective tissues. It also has been linked to inflammatory dilating aortic aneurysms, coronary vascular disease, hypophysitis, orbital pseudotumor, and pachymeningitis. It has not yet been described as a cause of diffuse intracranial dilating vasculopathy. Histologically, this disease is characterized by IgG4-plasma cell infiltration, fibrosis, and phlebitis. ⋯ This is the first reported case of a diffuse intracranial dilating vasculopathy secondary to IgG4-RD. Recognition of similar pathologic findings in clinical presentation and radiologic workup should prompt further rheumatologic workup and possible immunosuppressive therapies.