World Neurosurg
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Transsphenoidal surgery (TSS) was introduced into the Republic of Uzbekistan in 2005 and has been developing since then. The principal center for the management of all pituitary disease is a single site for a nation with a population of approximately 30 million. Results in surgery for Cushing disease are a marker of surgical technical skill in TSS. All previously published series come from the developed world, where sophisticated investigations and management are available. Many of these investigations are not available in Uzbekistan. ⋯ TSS for Cushing's Disease achieved an early remission of 68.7% (early morning cortisol of <50 nmol/L), although 4 patients relapsed.
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Case Reports
Mutational analysis of recurrent meningioma progressing from atypical to rhabdoid subtype.
Rhabdoid meningioma is rare aggressive meningioma histological subtype that develops predominantly through progression from less malignant tumors. Owing to its low incidence, this tumor's biological background is unknown. The aim of this study was to profile somatic mutations in 4 meningioma samples from the same patient, derived previously from 4 subsequent tumor resections. ⋯ The mutation of ARID1A that encodes the subunit of the SWI/SNF complex represents the most likely driver of the tumor's malignant potential. It also may be involved in the acquisition of the rhabdoid phenotype, given that mutations in chromatin remodeling proteins are the hallmark of atypical teratoid/rhabdoid tumors.
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Preservation of the superficial Sylvian veins (SSVs) is essential to prevent neurologic deficits during Sylvian dissection. We describe an appropriate surgical approach for unruptured middle cerebral artery (MCA) aneurysms to preserve these veins by using indocyanine green videoangiography (ICG-VA). ⋯ Correct dissection strategy using intraoperative ICG-VA is greatly useful to define the optimal surgical approach without vein injury.
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Case Reports
Endoscopic Transnasal Transclival Resection of Endodermal CYST of the Ventral Brainstem: Case Report.
Endodermal cysts are a rare pathology of the central nervous system located mostly in the upper thoracic or cervical regions. Seldomly, the cysts are found intracranially, most often in the subtentorial area (on the ventral surface of the brainstem, pontocerebellar angle, and fourth ventricle). Traditional approaches to the ventral surface of the brainstem are complicated and traumatic, and they do not provide a good view of the tumor's central and contralateral parts. In this case report, we present an alternative approach for resection of the endodermal cyst on the ventral surface of the brainstem. ⋯ The main advantage of the transclival transnasal approach is the direct access to the clivus and ventral surface of the brainstem without traction of the cerebral structures. If the transsphenoidal transclival approach is used, the cranial nerves are out of the approach area that minimizes the risk to damage it. An extended transsphenoidal transclival endonasal endoscopic approach is an alternative to traditional microsurgical approaches to pathologic processes on the ventral surface of the brainstem (cavernomas, endodermal cysts), located centrally.