World Neurosurg
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Case Reports
Neurological Deterioration Due to Brain Sag Following Bilateral Craniotomy for Subdural Hematoma Evacuation.
Intracranial hypotension from cerebrospinal fluid (CSF) hypovolemia resulting in cerebral herniation is a rare but known complication that can occur after neurosurgical procedures, usually encountered in correlation with perioperative placement of a lumbar subarachnoid drain. Decrease in CSF volume resulting in loss of buoyancy results in downward herniation of the brain without contributing mass effect, causing a phenomenon known as brain sag. Unreported previously is brain sag occurring without concomitant occult CSF leak or lumbar drainage. ⋯ This case is unique in comparison with previous reports of intracranial hypotension after craniotomy in that the symptoms were completely reversed with positioning alone, without any evidence of active or occult CSF drainage. This report emphasizes that the diagnosis of brain sag should be taken into consideration when there is an unknown reason for neurologic decline after craniotomy, particularly bilateral craniotomies, if the imaging indicates herniation with imaging findings consistent with intracranial hypotension, without evidence of overlying mass effect.
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Petrous face meningiomas (PFMs) are challenging tumors because of their proximity to the cranial nerves, brainstem, and critical vasculature. The objective of this study is to present surgical outcomes and support an anatomic classification for PFM based on clinical presentation. ⋯ PFMs present with distinct clinical syndromes based on their location along the petrous face: anterior with trigeminal symptoms, middle with auditory/vestibular symptoms, and posterior with symptoms of mass effect/hydrocephalous. Surgical resection is associated with excellent long-term survival and a low rate of recurrence, which can be managed with radiotherapy.
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Aberrant medial retropharyngeal prevertebral course of the internal carotid arteries (ICAs) is extremely uncommon. In oropharyngeal surgeries, like transoral odontoidectomy (TOO), this unrecognized aberrant retropharyngeal course of ICAs can result in devastating complications secondary to inadvertent injury of ICAs. We describe this aberrant course of ICAs in a patient with a craniovertebral junction (CVJ) anomaly with a dysmorphic C1 lateral mass on one side and discuss in detail various management issues in this complex case. ⋯ Identification of this rare aberrant prevertebral course of ICAs in a patient with a CVJ anomaly is critical because it precludes TOO as a treatment option. Correction of BI and AAD is possible even with a unilateral C1-C2 joint spacer when placement of a joint spacer on the other side is not technically feasible.
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Traumatic brain injury associated with alcohol consumption is a global public health problem. It is important to identify and rethink the strategies to approach this challenge for health care institutions from a professional perspective. ⋯ These findings confirm a lack of systematic strategies for management of patients with TBI and associated comorbidity of alcohol intoxication in the acute phase. It is important to define specific management guidelines to improve treatment efficacy and limit complications in patients with TBI and alcohol intoxication.
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We describe the technique for surgical "transaneurysmal" embolectomy in a patient with subarachnoid hemorrhage and multiple cerebral aneurysms who manifested large-vessel occlusion during coil embolization. ⋯ Transaneurysmal thrombectomy may be useful and safe for large-vessel occlusion just distal to cerebral aneurysms.