World Neurosurg
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Intraosseous petrous apex schwannomas are an exceedingly rare entity; little is known about their epidemiology, natural history, and postoperative outcomes. ⋯ Our 2-year follow-up demonstrates slow growth and success of multimodal management in the treatment of these tumors. We review the 3 prior reports of petrous apex schwannomas and identify unifying radiographic and clinical characteristics to aid future diagnostic considerations of lesions of the petrous apex.
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Intracranial epidermoid cysts are developmental central nervous system abnormalities that arise from erroneous ectodermal inclusion during neural tube closure. Epidermoids are relatively common, representing 1% of all intracranial masses, and are particularly predominant in the cerebellopontine angle (CPA), where they are the third most prevalent diagnosis after schwannomas and meningiomas. ⋯ By use of a 2-surgeon 4-hands technique, the mass was dissected from the surrounding neurovascular structures, and a gross total removal was achieved with no postoperative neurologic deficits. Our video highlights the critical nuances pertinent to the fully endoscopic resection technique, with special attention to the relative restrictions of a small working corridor parallel to the tentorium and the petrous bone.
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Dural reconstruction after transpetrosal approaches is complicated because complete primary closure of presigmoid dura mater is difficult to achieve. To address this problem, we use biocompatible polyglycolic acid (PGA) felt (Durawave) to reconstruct dural defects. To evaluate the use of PGA felt in dural reconstruction, we compared these results with those after conventional duraplasty using autologous fascia grafts. ⋯ Using PGA felt for presigmoid dura simplifies dural reconstruction because it obviates the need to suture in a deep field. PGA felt has the potential to prevent CSF-related complications after transpetrosal approaches.
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Management of pediatric skull defects after decompressive craniectomy (DC) poses unique problems, particularly in children younger than 24 months. These problems include complications such as resorption and infection as well as difficulties with plagiocephaly and reconstruction. The goal of this study was to evaluate bone resorption complications after cranioplasty in patients <24 months. ⋯ In patients younger than 24 months undergoing cranioplasty subdural collection, a lack of shunt placement and increased time to cranioplasty were associated with increased rates of resorption.
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To evaluate whether use of partial nondepolarizing neuromuscular blocking agents, at a train-of-four level 1, compromise facial nerve monitoring during vestibular schwannoma (VS) resection. ⋯ Although mean stimulation threshold to elicit a response amplitude was higher in the peripheral neuromuscular blockade group than in the free of neuromuscular blockade group at the proximal site, the stimulation thresholds in both groups were sufficient for facial nerve monitoring in VS surgery, indicating no clinical difference in both groups.