World Neurosurg
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To summarize therapeutic efficacy of modified pial synangiosis in children with moyamoya disease and our experience with this method. ⋯ Our clinical findings provide data on efficacy and safety of modified pial synangiosis, but analysis of more cases is necessary to draw solid conclusions. A randomized controlled study is required to verify improved surgical efficacy of modified pial synangiosis.
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Craniopharyngioma (CP) adherence represents a heterogeneous pathologic feature that critically influences the potentially safe and radical resection. The aim of this study was to define the magnetic resonance imaging (MRI) predictors of CP adherence severity. ⋯ A position of the hypothalamus around the middle portion of the tumor, an amputated or infiltrated appearance of the pituitary stalk, and the elliptical shape of the tumor are reliable predictors of strong and extensive CP adhesions to the hypothalamus.
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Chordomas are rare primary bone tumors with a low-grade histology but an aggressive clinical behavior characterized by local invasion and recurrence. When occurring in the skull base, their treatment is limited by proximity to critical neurovascular structures. Open surgical approaches can carry high morbidity, making the development of alternative approaches desirable. We describe our experience with endoscopic endonasal approaches to clival chordomas over 13 years. ⋯ Clival chordoma are challenging entities to treat. The best outcomes are achieved with gross total resection followed by adjuvant radiotherapy treatment. We show that the endonasal endoscopic corridor is a viable alternative approach to these lesions.
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Headache is the main and often isolated symptom of patients with Chiari type 1 malformation (CM1). Classically described as occipital and exacerbated by cough, headaches may be poorly characterized, making it difficult to establish CM1 as the underlying cause. Current guidelines for surgical posterior fossa decompression are undefined. The challenge is to distinguish headaches related to CM1 from headaches coincidentally coexisting with CM1. We aimed to determine predictive factors of headache resolution after surgery and applied to our cohort the Chiari Severity Index, a recently developed predictive prognostic score. ⋯ This study confirms the relevance of International Headache Society criteria to identify headaches related to CM1. We propose their systematic use in a preoperative questionnaire.
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Microvascular decompression (MVD) is useful treatment for hemifacial spasm (HFS) with refractory hypertension (RHTN). The biomedical glue sling technique is a new method for MVD. In this study, we retrospectively compared the outcome of the biomedical glue sling technique with traditional technique in MVD for HFS with RHTN. ⋯ When HFS is associated with RHTN, the efficacy of the biomedical glue sling technique for MVD is higher than that of the traditional technique for both HFS and RHTN.