World Neurosurg
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Ventriculoperitoneal shunt (VPS) is a common treatment for patients with hydrocephalus (HC). VPS is associated with complications that may lead to shunt revisions. We studied the surgical outcome of pediatric patients with HC in a population-based setting. ⋯ Half of patients with shunts required revision. Age ≤6 months and intraventricular hemorrhage and congenital defects etiologies of HC were associated with increased risk for shunt revision. Most revisions were done during the first year after the initial VPS.
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Review Historical Article
The Unforgettable Neurosurgical Operations of Musicians in Last Century.
There has been no study of craniotomies of famous musicians throughout history. This subject was investigated. ⋯ Neurosurgical operations affected the musical careers and lives of mentioned musicians and two of them died. Neurosurgeons can understand the effect of limited diagnostic tools such as magnetic resonance imaging and computed tomography at the time on the poor outcome of 2 musicians.
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Atypical (World Health Organization grade II) and anaplastic (World Health Organization grade III) meningiomas are rare, accounting for less than 5% of all meningiomas. Histologic grading has a significant impact on prognosis, risk of recurrence, and the need for adjuvant radiation or chemotherapy. Extracranial metastases are even more infrequent and occur in 0.1% of all cases. ⋯ We reviewed the literature pertaining to this phenomenon and subsequently assessed the clinical benefits of adjuvant chemotherapeutic agents in patients with meningioma with metastatic disease.
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Review Case Reports
Overt and subclinical baroreflex dysfunction following bilateral carotid body tumor resection: pathophysiology, diagnosis, and implications for management.
Carotid body paragangliomas are rare, usually benign, tumors arising from glomus cells of the carotid body. Bilateral involvement is present in ∼5% of sporadic cases and up to one third of familial cases. In most patients undergoing bilateral resection of carotid body tumors, a condition known as baroreflex failure syndrome (BFS) develops after resection of the second tumor characterized by headache, anxiety, emotional lability, orthostatic lightheadedness, hypertension, and tachycardia. This condition is believed to result from damage to the carotid baroreceptor apparatus. Patients without overt cardiovascular abnormalities may have subclinical baroreceptor dysfunction evident only on specific testing, measuring heart rate and sympathetic nerve responses to baroloading (e.g., phenylephrine) and barounloading (e.g., Valsalva maneuver). Given the high incidence of BFS in patients undergoing bilateral resection of carotid body tumors, it is suggested that operation is limited to unilateral resection of the dominant/symptomatic lesion and nonsurgical intervention (i.e., embolization, radiotherapy) on the contralateral side. Alternatively, refinement of surgical technique to prevent injury to elements of the baroreceptor apparatus may prevent this complication of bilateral tumor resection. ⋯ Our case shows the generalizability of BFS to patients with tumors involving the vagal baroafferent fibers.
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Review Case Reports
Congenital glioblastoma with distinct clinical and molecular characteristics: case reports and a literature review.
The molecular diagnosis of brain tumors is important in classifying tumors and determining appropriate treatment. Congenital glioblastoma multiforme (GBM) is a rare tumor that occurs in infants, and the prognosis is poor. Approximately 60 patients diagnosed with congenital GBM have been reported. However, few reports have conducted molecular analyses of congenital GBM. ⋯ Congenital GBM demonstrates clinical and molecular characteristics that are different from those of pediatric or adult GBM.