World Neurosurg
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The endoscopic endonasal approach has recently become an acceptable option for resection of all pituitary adenomas. We assessed biochemical outcome of endoscopic endonasal surgery in growth hormone (GH)-secreting adenomas, including remission rate, predictors of remission, and associated complications. ⋯ Endoscopic endonasal adenoma resection leads to a high rate of endocrinologic remission in GH-secreting adenomas with a low complication rate. Patients with older age, higher preoperative GH levels, and higher Knosp grades are less likely to achieve remission.
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Pediatric hydrocephalus is a health burden for East African countries, with an estimated incidence of 6000 new cases per year. The objective of this study is to describe the epidemiology and surgical outcomes of patients treated for pediatric hydrocephalus in the single neurosurgical center of Zanzibar. ⋯ It seems that hydrocephalus in Zanzibar has similar causes, progression, and complication rates to previous reports from other African hospitals. Further studies of postinfectious hydrocephalus need to be conducted because recent findings suggest that it is a potentially preventable cause of the disease.
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Vascular pineal malformations are rare and technically demanding lesions. Because the locations of these lesions, endovascular techniques and radiosurgery have been increasingly used in the recent decades to accomplish safe occlusion. Nevertheless, microsurgical treatment may be required sometimes. ⋯ The pineal region is an infrequent but challenging location for vascular lesions. A careful and stepwise operative strategy for the different types of vascular lesion is paramount to accomplish an effective and safe microsurgical treatment when other alternatives fail or are not available.
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Case Reports
Positioning-Related Neuromonitoring Change During Anterior Cervical Discectomy and Fusion.
Intraoperative neuromonitoring (ION) signal changes during spine surgery may portend a potentially catastrophic neurologic injury that, if identified and addressed expediently, may allow the surgeon to take correction actively and prevent permanent neurologic injury. ⋯ The use of multimodality ION is recommended for ACDF with shoulder traction to prevent postoperative neurologic deficit associated with a position-related injury. Baseline ION should be established before positioning.
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Case Reports
Flow Diversion via LVIS Blue Stent within Enterprise Stent in Patients with Vertebral Artery Dissecting Aneurysm.
A new Low-profile Visualized Intraluminal Support device (LVIS Blue) is a braided stent that provides a higher degree of metal coverage. This stent may be beneficial for complete obliteration of an aneurysm due to not only its support of a higher occlusion rate using coils inside of the aneurysm but also its flow-diverting effect. We introduce and describe a new flow-diversion technique using an LVIS Blue stent within an Enterprise stent for patients with vertebral artery (VA) dissecting aneurysms. ⋯ An LVIS Blue stent was introduced and positioned such that it overlapped the previous stent in order to divert blood flow away from the dissecting segment. We present a case in which this technique was used to successfully obliterate a dissecting aneurysm while maintaining the VA patency with vessel wall remodeling. The LVIS Blue stent-within-an-Enterprise stent technique may be an effective treatment option for patients with VA dissecting aneurysms as an alternative technique to flow diverters.