World Neurosurg
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Perioperative complications after transsphenoidal surgery for pituitary adenomas have been well documented in the literature; however, some complications can occur in a delayed fashion postoperatively, and reports are sparse about their occurrence, management, and outcome. Here, we describe delayed complications after transsphenoidal surgery and discuss the incidence, temporality from the surgery, and management of these complications based on the findings of studies that reported delayed postoperative epistaxis, delayed postoperative cavernous carotid pseudoaneurysm formation and rupture, vasospasm, delayed symptomatic hyponatremia, hypopituitarism, hydrocephalus, and sinonasal complications. ⋯ Sinonasal complications are commonly reported after transsphenoidal surgery, but spontaneous resolutions within 3-12 months have been reported. Although the incidence of some of these complications is low, providing preoperative counseling to patients with pituitary tumors regarding these delayed complications and proper postoperative follow-up planning is an important part of treatment planning.
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Recently, with improvements in computed tomography angiography and digital subtraction angiography, the assessment of certain morphologic traits of anterior communicating artery aneurysms (ACoAA) has drawn great attention. The determination of specific factors associated with rupture would provide much-needed guidance for the treatment of unruptured intracranial aneurysms, such as surgical clipping or endovascular coiling. Morphologic factors include, but are not limited to, aneurysm size, number, shape, dome direction, neck/dome ratio, and relationship of the aneurysm to the surrounding vessels. However, the results of previous investigations concerning morphologic parameters have yielded inconsistent results. ⋯ The size ratio, direction of the dome, and fenestration should be examined most meticulously when deciding when to treat an ACoAA.
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Review Biography Historical Article
The History of Neurosurgery in the Hawaiian Islands.
The field of neurosurgery has a rich and fascinating history. The development of the specialty in Hawaii has been particularly unique, given the state's remote location, indigenous population, and military presence. The life of Dr. ⋯ This article will review and chronicle the development of neurosurgery in Hawaii with special attention to 3 topics: the traveling neurosurgeons of the early 20th century, such as Dr. Frederick Reichert; Hawaii's first full time neurosurgeon, Dr. Cloward; and finally, the current state of neurosurgery in Hawaii.
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We investigated the prevalence, onset, characteristics, and long-term course of epilepsy disease in children who underwent surgical intervention for diagnosed brain tumors. ⋯ We show a high incidence of epilepsy in the late course of pediatric brain tumor disease. In the long term, seizure outcome was excellent. However, postsurgical onset of epilepsy was associated with a less favorable neurologic outcome.
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Comparative Study
Long-term efficacy of initial microvascular decompression versus subsequent microvascular decompression for idiopathic hemifacial spasm.
Hemifacial spasm (HFS) is a disorder characterized by intermittent, involuntary facial muscle contractions. Microvascular decompression (MVD) is the gold treatment for HFS. The aim of this research was to discuss whether patients undergoing MVD as their initial surgical intervention experience greater spasm control than patients experiencing an MVD performed as a subsequent surgical intervention. ⋯ Patients undergoing MVD for HFS as the primary treatment experience better long-term efficacy than patients first treated with botulinum neurotoxin type A.