World Neurosurg
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Recent literature suggests there are sex differences in delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Our study serves to compare sex differences in radiographic vasospasm, DCI, and clinical outcome after aSAH, and to determine whether there are age-dependent differences. ⋯ Female sex is associated with a higher risk of radiographic vasospasm, clinical deterioration, and cerebral infarction. Furthermore, this association appears to be age-dependent. This study further supports the unique role of sex, and highlights the need to better understand the possible role of female hormones in the development of complications of subarachnoid hemorrhage.
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Oligodendrogliomas, the third most common primary gliomas, have a strict molecular definition, characterized by the combined presence of isocitrate dehydrogenase mutation and 1p19q codeletion. Herein, we describe an extremely unusual case of molecularly defined anaplastic oligodendroglioma with transdural extension into the frontal and ethmoid sinuses, without prior neurosurgical intervention or radiotherapy. The molecular profile of the tumor is also provided. ⋯ Most of the previously reported glial tumors with transdural extension were cases of histologically proven glioblastomas and gliosarcomas, typically seen in the context of prior neurosurgical intervention and/or radiotherapy. This case adds to the limited literature on oligodendrogliomas with transdural extension. Further studies are necessary to elucidate the relationship between the incidence of transdural extension and molecular subtypes of oligodendrogliomas.
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Case Reports
3D, HD exoscopic Anterior Cervical Discectomy and Fusion: a valid alternative to microscope-assisted surgery.
Anterior cervical discectomy and fusion (ACDF) remains one of the most commonly taught procedures during residency and one of the most frequently performed by neurosurgeons. Neurosurgeons use microscopes to perform surgery and to train other surgeons. Although the microscope provides excellent illumination and magnification, its use will be limited to 2 people: the surgeon and the assistant. Consequently, the scrub nurse and residents watching 2-dimensional images on monitors will have a reduced perception of the surgical field depth and anatomical details. The exoscope has been introduced as an alternative to microscopes and endoscopes. We used a 3-dimensional (3D), high-definition exoscope (3D Vitom [Karl Storz, Tuttlingen, Germany]) in 2 patients undergoing 2-level ACDF for cervical myeloradiculopathy. ⋯ We believe that exoscope-assisted surgery could become a safe and effective alternative to microscope-assisted surgery in ACDF.
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Interleaving stimulation (ILS) is a stimulation strategy that can help the physician manage more challenging cases of patients with deep brain stimulation (DBS) for Parkinson disease (PD). It consists of altering 2 different programs on the electrode with the same frequency. ⋯ Overall, ILS is useful 1) to use 2 contacts that optimally improve 2 specific symptoms but have different therapeutic windows; 2) to avoid side effects related to current spreading to nearby areas; 3) to increase frequency in a small region; or 4) to stimulate a larger target area.
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The anterior skull base (ASB) remains one of the greatest challenges for reconstructive surgeons. The current armamentarium includes endoscopic placement of free grafts, endonasal vascularized pedicled flaps, regional flaps, and microvascular free flaps. As the defect size increases, reconstruction complexity increases along with potential complications. Here, we report an endoscopic-assisted paramedian forehead flap, a novel adaptation of an age-old technique, for ASB reconstruction. ⋯ The endoscopic-assisted paramedian forehead flap is a robust regional flap whose advantages include the utilization of muscle, low donor morbidity, and endoscopic placement with avoidance of craniotomies. Therefore it should be considered an important option for ASB reconstruction of recalcitrant CSF leaks when all other options are unavailable.