World Neurosurg
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Review Case Reports
Value of targeted epidural blood patch and management of subdural hematoma in spontaneous intracranial hypotension.
Spontaneous intracranial hypotension (SIH) is a more common than previously noted condition (1-2.5 per 50,000 persons) typically caused by cerebrospinal fluid (CSF) leakage. Initial treatment involves conservative therapies, but the mainstay of treatment for patients who fail conservative management is the epidural blood patch (EBP). Subdural hematoma (SDH) is a common complication occurring with SIH, but its management remains controversial. ⋯ Although blind lumbar EBP is often successful, targeted EBP has a lower rate of patients requiring a second EBP or other further treatment. On the other hand, targeted EBP has a larger risk profile. Depending on the clinic situation, treatment of the SDH via surgical evacuation may be necessary.
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Review Case Reports
The Role of Intraoperative Cerebral Angiography in Transorbital Intracranial Penetrating Trauma: A Case Report and Literature Review.
Transorbital intracranial penetrating trauma with a retained intracranial foreign body is a rare event lacking a widely accepted diagnostic and therapeutic algorithm. Intraoperative catheter angiography (IOA) has been advocated by some authorities to rule out cerebrovascular injury before and/or after removal of the object, but no standard of care currently exists. ⋯ In transorbital intracranial penetrating trauma with a retained intracranial object, we advocate microsurgical removal of the object under direct visualization followed immediately by IOA. IOA should be strongly considered even in the setting of minimal intraoperative bleeding and normal findings on videoangiography (a course of action that was not followed in the present case). Given that CT angiography and intraoperative videoangiography may miss a potentially treatable traumatic arterial injury, IOA can help determine whether cerebral revascularization may be necessary.
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Review Case Reports
Spinal Dural Arteriovenous Fistulas with Segmental Arterial Supply Also Giving Rise to a Radiculomedullary Artery: A Case Report and Review of the Literature.
During the past 3 decades, a handful of spinal dural arteriovenous fistula cases have been reported in which the segmental artery giving rise to the fistulous connection also supplies a radiculomedullary artery that contributes to the anterior spinal artery. ⋯ Recognizing this likely rare anatomical variant is critical in optimizing functional outcome.
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Case Reports
Intraoperative Subcortical Electrical Mapping of the Optic Tract In Awake Surgery Using Virtual Reality Headset.
Brain mapping during awake craniotomy is a well-known technique to preserve neurological functions, especially the language. It is still challenging to map the optic radiations due to the difficulty to test the visual field intraoperatively. To assess the visual field during awake craniotomy, we developed the Functions' Explorer based on a virtual reality headset (FEX-VRH). ⋯ Intraoperative visual field assessment with the FEX-VRH during direct subcortical electrostimulation is a promising approach to mapping the optical radiations and preventing a permanent visual field defect during awake surgery for epilepsy or tumor.
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Meta Analysis
Meta-analysis of Microarray-Based Expression Profiles to Identify Differentially Expressed Genes in Intracranial Aneurysms.
To gain comprehensive insight into the molecular mechanism of formation and rupture of intracranial aneurysms (IAs). ⋯ Inflammation, immune response, and loss of contractile vascular smooth muscle cells could potentially contribute to the formation of IAs, whereas the role of angiogenesis and vascular remodeling in IA formation and rupture needs further exploration.