World Neurosurg
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To assess the incidence of cerebrospinal fluid (CSF) leak and meningitis, and the need for prophylactic antibiotics, antipneumococcal vaccination, and surgical interventions, in children with a skull base fracture. ⋯ This is the largest pediatric series of skull base fractures reporting rates of morbidity and long-term outcomes published to date. The rate of meningitis following skull base fracture in children is low, supporting a policy of not administering prophylactic antibiotics or pneumococcal vaccine. Long-term follow up is important to identify delayed complications.
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To provide a simple and reliable method for the diagnosis of ventriculoperitoneal shunt malfunction. ⋯ The proposed method is reliable, safe, and relatively simple for the diagnosis of ventriculoperitoneal shunt malfunction and provides a reference for treatment.
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Many investigators endeavor to predict the outcome based on admission characteristics using some established models to determine which management should be applied. However, the efficacy and applicability of the models using in the geriatric patients with severe traumatic brain injury (TBI) have not yet been evaluated. ⋯ The IMPACT prognosis calculator showed just fair discrimination when predicting the outcome of the elderly patients with severe TBI. Management decisions should be made on a case-by-case basis rather than by relying on the predicted risks identified by this model; conservative treatment might be preferable when expected risk of fatal outcome is >90%.
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Typical recurrence of glioblastoma occurs locally, usually within 2 cm from the original lesion. With improvement of surgical techniques, more aggressive surgical strategies have become feasible, resulting in a significantly increased rate of complete resection. We investigated whether these improvements are also reflected by tumor recurrence pattern. ⋯ Despite complete resection of contrast-enhancing tumor, most recurrences occurred locally. Patients with distant tumor recurrence demonstrated increased progression-free survival. Therefore, to gain local control, we may need to shift toward a more aggressive supramarginal resection, using extensive intraoperative monitoring to avoid permanent deficits.
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The use of the retrosigmoid approach has recently been expanded by several modifications, including the suprameatal, transmeatal, suprajugular, and inframeatal extensions. Intradural temporal bone drilling without damaging vital structures inside or beside the bone, such as the internal carotid artery and jugular bulb, is a key step for these extensions. This study aimed to examine the microsurgical and endoscopic anatomy of the extensions of the retrosigmoid approach and to evaluate the clinical feasibility of an electromagnetic navigation system during intradural temporal bone drilling. ⋯ The combination of endoscopic and microsurgical techniques aids in achieving optimal exposure for retrosigmoid intradural temporal bone drilling. The electromagnetic navigation system had clear advantages with acceptable accuracy including the usability of small devices without line of sight limitation.