World Neurosurg
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Case Reports
Primary Obstruction of the Foramen of Luschka: Anatomy, Histology, and Clinical Significance.
The foramen of Luschka is a natural aperture between the fourth ventricle and the subarachnoid space at the cerebellopontine angle. Membranous closure of this foramen is referred to as primary obstruction. Available information about this variant and its role in the development of the cysts of the posterior fossa is contradictory. ⋯ The rhomboid lip is a remnant of the roof of the fourth ventricle. Imperforation of the foramen of Luschka results in a pouch in the cerebellopontine angle that contains choroid plexus (Bochdalek's flower basket) and communicates with the fourth ventricle. This pouch has the potential to grow to a diverticulum and cause clinical symptoms. Based on our clinical observations, detailed radiologic and surgical-anatomic criteria were proposed to support the differential diagnosis of a diverticulum of the foramen of Luschka. Treatment strategies were also suggested.
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The endoscopic endonasal approach to the anatomically complex lateral skull base presents technical challenges. The use of the eustachian tube as a landmark to identify the petrous internal carotid artery has recently been reported, and this study aims to define the anatomic relationship between the eustachian tube and its surrounding structures using cadaveric dissection and radiologic analysis. ⋯ The eustachian tube is a useful landmark for predicting the course of the internal carotid artery when accessing the lateral skull base regions via an endonasal route. A profound understanding of the relationship between the eustachian tube and the surrounding skull base structures is important for endoscopic endonasal skull base surgeries.
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To optimize follow-up and surveillance routines after intracranial surgery, knowledge about when complications occur is needed. We sought to explore when postoperative complications are detected after brain tumor surgery and assess their severity. ⋯ Mild and moderate complications, dominated by extracranial infections such as urinary tract infections and pneumonias, are very common after intracranial tumor surgery. Detection rates for mild and moderate complications are probably greatly affected by local routines for surveillance, screening, discharge, documentation, and follow-up, perhaps limiting their usefulness as a quality measure. Severe and fatal complications are mainly detected in the early postoperative course.
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The purpose of this study was to perform a survival analysis of patients with high-grade multicentric gliomas and to assess the influence of various prognostic factors on overall survival (OS). ⋯ This comprehensive analysis of multicentric glioma patients revealed that age younger than 54 years, surgical resection, and radiotherapy were significantly associated with improved survival and were independent prognostic factors for OS. Radiotherapy and radiotherapy combined with chemotherapy were independent prognostic factors for surgical patients' OS as well.
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A few options of extracranial donor vessels exist for use in intracranial vascular bypass procedures. To our knowledge, the use of an internal thoracic artery for cerebral revascularization has not been studied previously. Hence, this cadaveric feasibility study was performed. ⋯ In this cadaveric study, we demonstrated the suitability of the internal thoracic artery in use as a donor vessel for a single site anastomosis in a high-flow cerebral bypass procedure.