World Neurosurg
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The endoscopic approach increasingly is used to treat third ventricular colloid cysts. Our objective was to assess the results of endoscopic resection of colloid cysts of the third ventricle. ⋯ High rates of complete resection of third ventricular colloid cysts, with low morbidity and mortality, are possible with an endoscopic approach. The results of this study support the role of endoscopic resection in the treatment of patients with third ventricular colloid cysts as a safe and effective modality and show how endoscopic resection of third ventricular colloid cysts can produce favorable results.
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Deep brain stimulation (DBS) is an effective therapeutic modality; however, only a percentage of eligible patients undergo the procedure. ⋯ Frame placement, awake surgery, and head shaving did not appear to play a significant role in most patients' decision-making process to undergo DBS, as analyzed in this retrospective cohort. The majority of patients were satisfied with the procedure and reported being comfortable. Managing goals and expectations preoperatively played a significant role in ultimate overall satisfaction.
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Multicenter Study
The Use of Flow Diverter in Ruptured, Dissecting Intracranial Aneurysms of the Posterior Circulation.
Acute dissecting aneurysms of the posterior circulation are a rare cause of subarachnoid hemorrhage. Established endovascular treatment options include parent artery occlusion and stent-assisted coiling, but appear to be associated with an increased risk of ischemic stroke. Vessel reconstruction with flow diverters is an alternative treatment option; however, its safety and efficacy in the acute stage remains unclear. ⋯ Flow diverters might be a feasible, alternative treatment option for acutely ruptured dissecting posterior circulation aneurysms and may effectively prevent rebleeding. Larger cohort studies are required to validate these results.
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Patients with bitemporal lobe epilepsy are generally not considered for surgical resection. Fortunately, responsive neurostimulation provides another avenue for the management of this challenging disease process. In conjunction with our epileptologist, we consider responsive neurostimulation for patients who have clinical features of temporal lobe epilepsy without clear localization on imaging and stereoelectroencephalography. ⋯ Robotically implanted responsive neurostimulation is a safe and effective treatment for bitemporal epilepsy and can possibly lead to valuable diagnostic information to guide future surgical management in patients who previously were not considered candidates for resective or ablative surgery.
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Herpes zoster ophthalmicus (HZO) is caused by reactivation of the herpes simplex virus in the trigeminal nerve. HZO-initiated cerebral vasculopathy is well characterized; however, there are no documented cases that report the efficacy of surgical revascularization for improving cerebral hemodynamics following progressive HZO-induced vasculopathy. We present a case in which quantitative anatomic and hemodynamic imaging were performed longitudinally before and after surgical revascularization in a patient with HZO and vasculopathic changes. ⋯ HZO can lead to progressive, symptomatic intracranial stenoses. This report suggests that surgical revascularization techniques can improve cerebral hemodynamics and symptomatology in patients with aggressive disease when medical management is unsuccessful; similar procedures could be considered in managing HZO patients with advanced or progressive vasculopathy.