World Neurosurg
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Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening disease with an often fatal clinical course leading to irreversible loss of brain function (ILBF) (i.e., brain death). The purpose of this study was to assess the prevalence and characteristics of patients with aSAH who became organ donors after diagnosis of ILBF. ⋯ ILBF in the setting of fatal aSAH is a prevalent diagnosis with complex demands for neurointensive care physicians. We demonstrated the clinical characteristics and epidemiologic factors of patients with aSAH converting to organ donors.
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The premotor cortex (PMC) is known to have a dual role in movement and language processing. Nevertheless, surgical outcomes of brain arteriovenous malformations located in PMC (PMC-BAVMs) have not been well defined. The aim of this study was to determine surgical outcomes and risk factors for neurologic deficits (NDs) after surgery in patients with PMC-BAVMs. ⋯ Varying degrees of motor and language deficits can be induced immediately after resection of PMC-BAVMs. Permanent and long-term severe motor or language deficits are rare. Shorter lesion-to-eloquent fiber distance is a risk factor for short-term NDs. Larger nidus size is a risk factor for short-term and long-term NDs.
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Clinical Trial
Awake High-Flow Extracranial to Intracranial (HFEC-IC) Bypass for Complex Cerebral Aneurysms: Institutional Clinical Trial Results.
Assess the potential added benefit to patient outcomes of "awake" neurological testing when compared with standard neurophysiologic testing performed under general endotracheal anesthesia. ⋯ Temporary ICA occlusion during HFEC-IC bypass for ICA aneurysms in conjunction with awake intraoperative clinical testing was effective in detecting a subset of patients (n = 3, 10%) in whom neurological deficit was not detected by neurophysiologic monitoring alone.
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Pituitary sarcomas are rare clinical entities most often encountered as secondary neoplasms representing late sequelae of radiation therapy to the sellar region. Primary pituitary fibrosarcomas (PPFS), in contrast, are exceptionally rare tumors with very few cases described in the literature thus far. Herein, we present a case of PFFS and describe it in the context of the existing literature. ⋯ This is a rare case of PFFS that highlights the need for close surveillance in affected patients. Through this case, we review the existing literature and discuss both surgical management and aggressive adjuvant therapy of this rare disease entity.
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To evaluate visual acuity (VA) and visual fields (VF) quantitatively before and after endoscopic transsphenoidal surgery (ETS), with special attention to prognostic factors such as the pituitary adenoma (PA) suprasellar extension (SSE), volume and the patients' age. ⋯ The visual outcome after ETS for PAs was excellent, and serious complications were rare. Severe preoperative visual impairment resulted in poorer postoperative visual outcomes. The SSE of the PA was the most important predictor of visual outcome after ETS.