World Neurosurg
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Sparing the hypothalamus after craniopharyngioma treatment is a prerequisite to ensure a good quality of life. In this study, the functional prognosis of craniopharyngioma after endoscopic endonasal skull base surgery (EES) was examined in function of the degree of hypothalamic extension. ⋯ EES provides optimal resection rate and limited complications because of the preservation of the hypothalamus, regardless of the degree of preoperative hypothalamic involvement. Consequently, the rate of obesity occurrence is also decreased. This study indicates that EES protects hypothalamus function and improves tumor removal rate, and that it will become the first choice of surgical procedure for managing craniopharyngiomas.
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Proper closure of the pia matter is necessary to restore normal anatomy and prevent postoperative painful dysesthesia after excision of intramedullary spinal cord tumor. Two methods of closure of the pia have been described: welding technique and conventional suturing. Here, we report our initial experience with a new "pial press" or "zip lock" technique for pial closure, where pial layers are simply held together and plunged into each other with small microtooth forceps. Advantages of the technique over other techniques are it has less chance of suture-related complications or trauma to the posterior column and the simplicity of the technique.
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Spinal cord stimulation (SCS) is an efficacious treatment for various chronic pain syndromes culminating predominantly into spinal nerves. To improve intraoperative electrode placement, several groups have advocated the use of intraoperative neuromonitoring for localization of the spinal cord midline. In our study we present the case series of patients undergoing stimulator placement with consistent electromyographic intraoperative testing, with an emphasis on examining reoperation rates and complications. ⋯ Our retrospective chart review of 103 patients indicates that patients receiving SCS implantation in conjunction with electromyographic monitoring have low complication rates and rarely return to the operating room for electrode repositioning or removal.
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Experience with intra-arterial infusion of abciximab for the treatment of endovascular thrombotic complications is limited to short case series. Our objective is to evaluate the safety and effectiveness of this drug for the treatment of thromboembolic complications during aneurysm coiling and to determine the risk factors. ⋯ Successful recanalization of a vessel occluded by thrombus formation during aneurysm coiling using abciximab (Reopro) infusion is less than optimal. There are risks related to abciximab, including bleeding and aneurysm recanalization.