World Neurosurg
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Postoperative cerebrospinal fluid leak after endoscopic pituitary surgery ranges from 1.9% to 10% in different series. Vascularized flaps have reduced the incidence of leak; however, this carries nasal morbidity. This study presents a technique for sellar reconstruction with free mucosal graft from the nasal cavity floor including inferior meatus mucosa. This technique aims to standardize sellar reconstruction without the use of the nasoseptal flap and to keep the advantage of mucosal coverage of the defect in all cases. ⋯ The nasal cavity floor free mucosal graft is an easy and safe technique, with minimal nasal morbidity. There were no postoperative cerebrospinal fluid leaks, despite aggressive tumor resection. No lumbar drains or fat graft were used. The harvest of mucosal graft does not worsen the quality of life measured with the SNOT-22 test.
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Case Reports
Endovascular Treatment of Intracavernous Internal Carotid Aneurysm Secondary to Pituitary Infection: A Case Report.
Intracavernous internal carotid artery (ICICA) aneurysm secondary to pituitary infection is exceedingly rare. ⋯ This rare case highlights a life-threatening complication of a pituitary infection. Moreover, enlargement of the infected ICICA aneurysm could not be relieved by conservative anti-infective therapy. Endovascular treatment may be an alternative therapy for an infected ICICA aneurysm.
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Traditionally, the dural venous sinuses have been described only in the cranium. However, anecdotally, during various neurosurgical intradural procedures in the lumbosacral spine, we noticed an intradural collection of blood. With no prior studies on this in the extant medical literature, the following anatomic investigation seemed warranted. ⋯ Our study identified a dural venous sinus located in the dorsal lumbosacral region and near the midline. We suggest this structure be called the lumbosacral venous sinus. Although the function of such a sinus is speculative, knowledge of its presence might benefit those interpreting imaging of this region, especially with regional pathology such as dural arteriovenous fistulas.
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Observational Study
Sedation during surgery for movement disorders and perioperative neurological complications: an observational study comparing local anesthesia, remifentanil and dexmedetomidine.
The anesthetic management of patients requiring surgery for movement disorders needs to balance microrecording quality and patient cooperation with safety and comfort. Anesthetics can alter microrecording, although the effect on outcome is debatable. They also provide a rested and cooperative patient and minimize complications such as intracranial hemorrhage by providing better hemodynamic control. Most teams use local anesthesia with monitored anesthesia care or conscious sedation with propofol. Recently, dexmedetomidine has emerged as an alternative that, at low doses, does not affect microrecording, and that does not impair respiratory drive. ⋯ Sedation can be used safely without affecting outcome, and dexmedetomidine provides better hemodynamic management. Clinical significance remains unclear and larger studies need to be undertaken.
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Case Reports
Contusional Cerebellar Hemorrhage Related to Placement in the Protrusion Position After Atlantoaxial Fusion.
Various complications after C1 lateral mass and C2 pedicle screw fusion surgery (C1LM-C2PSFS) have been reported. However, to our knowledge, this is the first report of contusional cerebellar hemorrhage caused by placement in the protrusion (chin-out) position after C1LM-2PSFS. ⋯ We report a case of contusional cerebellar hemorrhage caused by the intrusion of a rod into the occipital bone when the patient was placed in the protrusion position. The rod length on the cranial side must be as short as possible, with careful consideration of placing the head in the protrusion position after C1LM-2PSFS surgery.