World Neurosurg
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To determine risk factors and management of intraoperative cerebrospinal fluid (CSF) leakage in endoscopic endonasal transsphenoidal pituitary adenoma surgery. ⋯ Intraoperative CSF leaks have a propensity to occur in cases with fibrous or large tumors. Once an intraoperative leak is identified, our graded cranial base repair method is safe and reliable.
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Evidence regarding whether the polyaxial pedicle screws at the upper instrumented vertebrae (UIV) are superior to monoaxial pedicle screws in prevention of proximal junctional kyphosis (PJK) is not clear. The aim of this study was therefore to explore the influence of different types of pedicle screws at UIV on the incidence of PJK. ⋯ Polyaxial pedicle screws at UIV is not superior to monoaxial pedicle screws in prevention of PJK. Obesity, osteoporosis, and lower instrumented vertebra at sacrum are risk factors for PJK in all the patients. Excessive LL reconstruction is the unique risk factor of PJK when monoaxial pedicle screws were used at UIV.
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The pathophysiology of traumatic brain injury (TBI) largely involves the brains vascular structural integrity. We analyzed the value of an intraoperative cortical indocyanine green (ICG) angiography in patients with severe TBI and acute subdural hematoma who underwent decompressive craniectomy. ⋯ Patients with an unfavorable clinical outcome showed an altered shape of the ICG-derived fluorescence curve, a shorter increase of the ICG-derived fluorescence intensity in the cortical arteries, and significantly greater residual fluorescence intensity. These observations are likely a correlate of an increased intracranial pressure, a capillary leak, and venous congestion. Intraoperative quantification of the ICG-derived fluorescence might help to appreciate the clinical outcome in patients with severe TBI.
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We report a child with misdiagnosed nasal dermal sinus and frontonasal dermoid cyst, that was complicated by brain abscess. Familiarizing physicians with this peculiar clinical picture may allow prompt recognition of this malformation, with subsequent imaging study, and surgical treatment, aimed to preventing fatal infectious complications.
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Temozolomide (TMZ) is now standard adjuvant therapy in combination with radiotherapy for patients with newly diagnosed malignant glioma. Treatment-related myelodysplastic syndrome and acute treatment-related leukemia (t-AML) associated with TMZ chemotherapy for patients with glioma is quite a rare complication. ⋯ In this case study, we continued adjuvant TMZ therapy beyond the recommended 6 cycles. Currently, there is no consensus as to how long the adjuvant TMZ therapy should be continued for the treatment of residual tumor showing no apparent interval change. A new decision-making tool to assess the clinical benefits against the side effects for long-term adjuvant TMZ therapy is needed.