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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Neuronavigation has become a common means of placing pedicle screws in vertebral arthrodesis, because it reduces the incidence of complications related to poor screw positioning. ⋯ When coupled with fpCT, the ROSA Spine robot is a reliable, accurate means of performing lumbar pedicle screwing.
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To determine the predictive factors for endocrinological remission of patients with growth hormone (GH)-secreting pituitary adenomas. ⋯ Our scoring system, which incorporated GH measurements and surgical observations, predicted postoperative remission. Complete tumor removal was critical to achieve intraoperative scores over 3.
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Although an asymptomatic spinal dural arteriovenous fistula (SDAVF) can sometimes be incidentally detected on magnetic resonance imaging (MRI), there are no previous reports showing the development of an SDAVF on MRI or magnetic resonance angiography (MRA). ⋯ This may be the first report in which serial MRA studies demonstrated the course of this condition, from the appearance of an SDAVF to the development of SAH. An abnormal vascular structure detected on MRA indicated abnormal enlargement of the perimedullary vein and the presence of a cervical SDAVF. A lower cervical SDAVF should be suspected if such an abnormal vascular structure is detected on MRA.
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Dural arteriovenous fistulas (dAVFs) often are treated via transarterial or transvenous embolization. Incomplete penetration of the draining vein/occult residual often will become apparent on follow-up angiography, requiring repeat embolization, or at times, surgical resection. ⋯ Although endovascular treatment of dAVFs is generally first-line therapy, surgical disconnection of fistulas, particularly high-risk residual/recurrent fistulas, is an excellent option in well-selected cases.