World Neurosurg
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Torcular meningiomas involving major dural venous sinuses are rare entities and a great challenge for neurosurgeons. The deep knowledge of the patency of occlusion of the sinuses, the extent of the occlusion and potentially new developing of extra and intracranial collateral venous drainage as compensatory venous channels, are at the base of a correct operative strategy. ⋯ We report our experience with a huge torcular meningioma with multi-venous sinus invasion and a literature review, with a special emphasis on compensatory drainage veins and surgical strategy.
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Chordoma that occurs primarily in the sella turcica is rare and presents unique treatment challenges. ⋯ Intrasellar chordoma presents frequently with visual disturbances and hyperprolactinemia and has a slightly higher incidence in females. Young age predicts a better prognosis. Intrasellar chordoma has a lower overall survival than has skull base chordoma.
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Bilateral trigeminal neuralgia is a relatively rare disease. Microvascular decompression (MVD) is a safe and effective treatment for unilateral trigeminal neuralgia; however, its utility in bilateral trigeminal neuralgia is unclear. Here, we report our experience with MVD in 13 cases of primary bilateral trigeminal neuralgia. ⋯ Vascular compression plays a causative role in bilateral and unilateral trigeminal neuralgia. MVD appears to be a safe and effective treatment option in patients who are refractory to pharmacotherapy.
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Observational Study
Quality and quantity of memories in patients who underwent awake brain tumor resection.
Awake craniotomy is performed with increasing frequency for brain tumor surgery in eloquent areas; however, little is known about patients' memories of this procedure. Here we retrospectively analyzed the quality and quantity of memories in a series of patients treated following a standardized protocol. ⋯ Awake craniotomy can be performed following our protocol in such a way that it is experienced as (very) comfortable. However, there are moments of discomfort, which can be managed by the team. Extensive preoperative preparation may be considered a crucial part of the procedure. Less amnesia seems to improve patient satisfaction. The results of this study can help guide protocol optimization, expectation management, and information for future patients.
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Ventriculoatrial (VA) shunt is a routine technique for the treatment of hydrocephalus. The correct position at the superior vena cava-right atrium junction is generally assessed by radiography. We present the first experience of an alternative, nonradiographic technique to assess the distal end of the VA shunts through an electrocardiographic (EKG) method. The technique has developed from the large experience of central venous catheters (CVC) worldwide; the EKG-guided method is a common and validated alternative to standard radiologic control of the location of the tip of any CVC. ⋯ The EKG-guided technique for VA shunts is as accurate as fluoroscopy, but simpler, more readily available, less expensive, safer, and more cost effective. It reduces the need of radiography and radiologic exposition for both patients and operators. The EKG method may be a valid and cost-effective alternative to standard radiologic control in VA shunts, as for any central venous access device, and could become the preferential method for confirming tip position during VA shunt surgery.