World Neurosurg
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Previous studies have suggested that postoperative hypopituitarism in patients with nonsellar intracranial tumors is caused by traumatic surgery. However, with development of minimally invasive and precise neurosurgical techniques, the degree of injury to brain tissue has been reduced significantly, especially for parenchymal tumors. Therefore, understanding preexisting hypopituitarism and related risk factors can improve perioperative management for patients with nonsellar intracranial tumors. ⋯ Prevalence of hypopituitarism is high in patients with nonsellar intracranial tumors. The occurrence of hypopituitarism is correlated with factors including an acute or subacute course (≤3 months), intracranial hypertension (ICP >200 mm H2O), and mass effect (P < 0.05). Mass effect is an independent risk factor for hypopituitarism.
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Incidence of intraprocedural rupture (IPR) during endovascular coiling is reported to be 2%-5%. We reviewed a single-center experience of IPR during coil embolization of unruptured intracranial aneurysms. ⋯ Incidence of IPR during endovascular coiling of unruptured aneurysms is relatively low. Early detection followed by rapid occlusion of the aneurysm can lead to a benign clinical course in most cases.
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Giant aneurysms are very high-risk lesions both in terms of natural history and treatment. Bypass with distal occlusion is thought to be a safe treatment option for these aneurysms. Here, we report 2 cases of aneurysm rupture after bypass and distal occlusion, review the literature, and discuss the possible underlying mechanisms, in the hopes of influencing treatment planning and averting such complications in the future. ⋯ Aneurysm rupture can occur after bypass and distal occlusion, despite initial appearances of intraoperative stability. We suggest that the mechanisms are not a simple pressure within the dome and may be due to rapid thrombosis with subsequent aneurysm wall destabilization or stretching and capacitance causing persistent filling. When possible, it seems that complete trapping or proximal occlusion may be preferable to distal occlusion for these giant aneurysms. The optimal management of these highly morbid lesions remains to be determined.
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Traumatic spinal subdural hematoma involving the retroclival region and upper cervical spine is a rare pathology. To our knowledge, there have only been 2 prior cases in an adult trauma patient. We describe a patient with preexisting Chiari 1 malformation, who recently sustained a unilateral type 1 occipital condyle fracture with associated disruption of the tectorial membrane and transverse ligament, which returned with a retroclival subdural hematoma extending down to C7, causing spinal cord compression and symptomatic obstructive hydrocephalus. ⋯ Traumatic spinal subdural hematoma involving both the retroclival region and upper cervical spine can lead to bulbar signs and symptomatic obstructive hydrocephalus. There should be vigilance for this pathology in patients with high-energy craniocervical trauma. Disruption of the tectorial membrane and therapeutic anticoagulation may be risk factors. The clinical scenario can be complicated in the setting of a preexisting Chiari 1 malformation.
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Therapeutic efficacy of patients with hypertensive intracerebral hemorrhage (HICH) with large hematoma volume is poor. This study aimed to explore the efficacy of minimally invasive surgery for patients with HICH with large hematoma volume. ⋯ Minimally invasive surgery is safe and effective in patients with HICH with a hematoma volume >50 mL. Because of its minimal invasiveness, better recovery rate, lower mortality rate, and less complications, this approach is considered superior to craniotomy. However, further validation on a larger sample size is required.