World Neurosurg
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Endoscopic endonasal transsphenoidal surgery (EETS) is a common treatment for patients with pituitary adenomas (PAs). A disadvantage of endoscopic surgery has been the lack of stereoscopic vision and depth perception. Recent developments offer high-definition 3-dimensional (3D-HD) visualization with a higher resolution and better image quality compared with 3D standard endoscopy (3D-SD). In this study, we compared treatment results of surgically treated patients with PAs using 3 different visualization systems: 2-dimensional (2D)-HD, 3D-SD, and 3D-HD. ⋯ Although the resection rate was higher in the 3D-HD group, and subjective advantages of the 3D-HD endoscopes were noted, there were no significant differences in terms of gross total resection or new hormonal deficits among the 3 groups.
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To assess outcomes and complications of stereotactic radiosurgery treatment for trigeminal schwannoma (TS). ⋯ GKRS provides effective control for most TS. Increased margin doses are associated with tumor expansion, which was a poor prognostic event associated with progression and clinical decline. Based on these results, combined with analysis of available data from other series of TS treated with GKRS, we believe that margin dose between 13 and 14 Gy offers a high probability of tumor control, yet minimizing risk of adverse radiation effects.
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Case Reports
Skin Augmentation as a Last-Resort Operative Technique During Decompressive Craniectomy.
Since 2009, we have performed skin augmentation using a Gore-Tex patch as a last-resort measure to reduce intracranial pressure (ICP) in uncontrollable brain swelling during decompressive craniectomy (DC). Here, we report our experience and outcome in a consecutive series of patients undergoing DC with skin augmentation (DC+S). ⋯ Decompressive craniectomy with skin augmentation may be used as a last-resort measure in cases of severe brain swelling despite DC.
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To define the role of neuroendoscopy as an adjuvant technique for the management of pediatric complex hydrocephalus. ⋯ We have confirmed that neuroendoscopy has a main role in the long-term management of complex hydrocephalus, significantly contributing to the reduction of the number of shunts and the shunt revision rate. Neuronavigation should be performed in all cases in which the ideal trajectory should be established.
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The optimal surgical treatment for cavernous malformation-related temporal lobe epilepsy (CRTLE) is still controversial because it frequently involves the hippocampus as an epileptogenic zone. Here we describe our unique surgical strategy of performing hippocampal transection (HT) plus tumor resection for CRTLE to solve the question of how to balance postoperative seizure outcomes and neuropsychologic outcomes. ⋯ Despite the small sample size and noncontrolled study design, postoperative seizure outcomes were deemed acceptable with favorable memory outcomes, which rather improved postoperatively with marginal statistical significance. In patients with CRTLE, additional HT is a reasonable treatment option.