World Neurosurg
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Surgical resection of a lesion that correlates with seizure onset in patients with epilepsy can dramatically improve seizure burden and quality of life. For bilateral hippocampal lesions, bilateral resection comes with a risk of severe cognitive deficits. Responsive neurostimulation (RNS) devices offer a new modality to treat multifocal lesions in a reversible manner including bilateral hippocampal stimulation. We describe technical aspects of Nexframe-assisted placement of bilateral NeuroPace mesial temporal electrodes and case examples. ⋯ We report herein the technical nuances of adapting Nexframe to hippocampal-based depth electrode RNS system placement. Our group has extensive experience with Nexframe for accurate and safe deep brain stimulation electrode placement. Our preliminary data with bitemporal RNS placement suggest similar accuracy and safety.
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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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The population of Sub-Saharan Africa suffers from a critical shortage and maldistribution of health care professionals, especially highlighted in surgical subspecialties, such as neurosurgery. In light of The Lancet report and the World Health Organization's directive to provide essential surgical care through the developing world, solutions need to be found to close this training and distribution gap. ⋯ This paper provides both a historic and topical overview of the forces at work which need to be addressed for success in delivering specialized care. This must always result in a self-sustaining program operated by the people of the home country with worldwide support through philanthropy and partnerships.
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Glioblastomas are highly aggressive and heterogeneous tumors, both in terms of patient outcome and molecular profile. Magnetic resonance imaging of tumor growth could potentially reveal new insights about tumor biology noninvasively. The aim of this exploratory retrospective study was to investigate the prognostic potential of pretreatment growth rate of glioblastomas, after controlling for known prognostic factors. ⋯ Pretreatment glioblastoma growth harbors prognostic information. Patients with slower growing tumors have higher odds of survival beyond 2 years, adjusted for other prognostic factors.
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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.