World Neurosurg
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Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. We aimed to investigate the predictive factors for the postsurgical recurrence of CSDH. ⋯ Burr hole craniostomy with irrigation and closed-system drainage is effective for the surgical treatment of CSDH. Mixed density hematoma is an independent predictor for the recurrence of CSDH. Presence of thick inner neomembrane might be the primary cause of CSDH recurrence.
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The use of nonadhesive liquid embolic agents (NALEAs) has gained great popularity in the treatment of brain vascular malformations, with a lower rate of local complications than surgery. However, we describe the formation of brain abscesses after endovascular treatment of a brain arteriovenous malformation (bAVM) and how important removal of the NALEAs was in the treatment of these abscesses. ⋯ This is the first reported case of a bAVM treated with Squid complicated with brain abscesses, a rare but very serious complication. This complication should be treated not only using antibiotherapy but with complete safe removal of the embolic material.
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Treatment of cystic craniopharyngiomas can be challenging and recurrences are frequent, even after total resection. In selected cases, less-aggressive surgery with the sole drainage of the cyst reliefs symptoms caused by mass effect and represents a valid alternative option, notably in pediatric population. We herein analyze a series of adult cystic craniopharyngiomas, managed with Ommaya Reservoir implant, focusing on local tumor control and eventual complications. ⋯ In selected patients, tailored procedures are required to achieve long-term tumor control and as well limit surgery-related morbidity. ORS could represent a safe and effective treatment option for cystic craniopharyngiomas, providing also reduced surgical-related morbidity, especially in recurrent lesions and in patients not suitable for radical surgery.
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Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) is an emerging minimally invasive procedure for the treatment of deep intracranial lesions. Insular lesions are challenging to treat because of the risk of damaging important surrounding structures. The precise knowledge of the neural structures that are at risk along the trajectory and during the ablation is essential to reduce associated complications. This study aims to describe the relevant anatomy of the anterior frontal LITT trajectory to the insular region by using sectional anatomy and fiber dissection technique. ⋯ Independent of the insular area treated, an understanding of the neuroanatomy related to the anterior frontal laser trajectory is essential to improve the ability to perform LITT of this challenging region.
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Three-dimensional (3D) imaging and videos are a very useful tool in the neurosurgical training, although unfortunately the 3D systems available have a very high cost. The objective of this study is to describe a novel and low-cost 3D microsurgical video system. ⋯ This paper presents in a clear and detailed way how to create and use a low-cost 3D surgical video system.