World Neurosurg
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Review Case Reports
Unique diagnostic features and surgical strategy for intracranial carotid sympathetic plexus schwannoma: case report and literature review.
Intracranial carotid sympathetic plexus schwannoma (CSPS) is extremely rare; thus differential diagnostic criteria, optimal surgical strategies, and even a precise definition are lacking. Here we describe a case of CSPS and propose a definition and classification for previously reported cases. ⋯ Preoperative diagnosis of petrous apex schwannoma is difficult: characteristic findings such as diplopia, hypacusis, and laterally displaced ICA may help. In addition, assessment of the relationship between the tumor and cavernous sinus could be useful in the determination of the surgical approach. Complete resection with good clinical outcome could be expected using Dolenc's approach (type A) and by the middle fossa extradural approach (type B) for intracavernous and extracavernous CSPS, respectively.
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Review Case Reports
Surgical treatment of metallic foreign body embolization in the middle cerebral artery: case report and literature review.
Intracranial artery embolization cases caused by foreign bodies are extremely rare clinically. Twenty-four cases in total have been reported in the literature; among them, 20 cases were caused by firearms, and only 4 cases originated from nonfirearm injuries in daily life. ⋯ Based on our experience, as well as on the premise that the surgical technique is mature and the medical facilities are well equipped, such patients should undergo embolectomy as soon as possible to avoid severe cerebral hemorrhage due to mechanical injury and vascular wall corrosion.
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Review Case Reports
High-definition fiber tractography in evaluation and surgical planning of thalamopeduncular pilocytic astrocytomas in pediatric population: case series and review of literature.
Thalamopeduncular tumors (TPTs) of childhood present a challenge for neurosurgeons due to their eloquent location. Preoperative fiber tracking provides total or near-total resection, without additional neurologic deficit. High-definition fiber tractography (HDFT) is an advanced white matter imaging technique derived from magnetic resonance imaging diffusion data, shown to overcome the limitations of diffusion tensor imaging. We aimed to investigate alterations of corticospinal tract (CST) and medial lemniscus (ML) caused by TPTs and to demonstrate the application of HDFT in preoperative planning. ⋯ Displacement patterns of the perilesional fiber bundles by TPTs are not predictable. Fiber tracking, preferably HDFT, should be part of preoperative planning to achieve maximal extent of resection for longer survival rates in this young group of patients, while preserving white matter tracts and thus quality of life.
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Review Case Reports
Asystole during Onyx embolization of a Pediatric Arteriovenous Malformation: a severe case of the Trigeminocardiac reflex.
Trigeminal-cardiac reflex (TCR) from the stimulation of sensory branches of trigeminal nerve can lead to hemodynamic instability. This phenomenon has been described during ophthalmologic, craniofacial, and skull base surgeries. TCR has been reported rarely with endovascular onyx embolization of dural arteriovenous fistulas. ⋯ TCR can lead to significant hemodynamic changes during endovascular Onyx embolization of vascular malformations (both pial AVM and dural arteriovenous fistulas) involving receptive field of trigeminal nerve. Therefore, the anesthesiologist should be made aware of treatment approach before intervention and appropriate precautions taken.
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Multicenter Study
Increased peri-operative crystalloid transfusion is associated with better outcomes after spontaneous hypertensive putamen hemorrhage: A retrospective study.
The appropriate amount of transfused fluids, and which types of fluids should be transfused during the peri-operative period, is a matter of controversy among neurosurgeons. Thus, a retrospective study was conducted to assess whether crystalloid transfusion is associated with better outcomes after spontaneous hypertensive putamen hemorrhage (HPH). ⋯ Increased perioperative crystalloid transfusion was independently associated with better outcome across a spectrum of surgical risk profiles after spontaneous HPH.