World Neurosurg
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Meta Analysis Comparative Study
Magnetic Resonance guided Laser Interstitial Thermal Therapy (MRgLITT) vs Stereotactic Radiosurgery (SRS) for Medically Intractable Temporal Lobe Epilepsy (TLE) : A Systematic Review and Meta-Analysis of Seizure Outcomes and Complications.
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) and stereotactic radiosurgery (SRS) are 2 emerging minimally invasive procedures being increasingly used for surgical intervention in cases of medically intractable temporal lobe epilepsy (TLE). To date, no comparative analyses of these 2 procedures have been made. In the current study, we synthesized pooled data from existing studies in an attempt to present a systematic review and meta-analysis of seizure and clinical outcomes of the 2 procedures in patients with TLE. ⋯ As minimally invasive procedures continue to gain popularity for use in surgery for epilepsy, it is imperative to evaluate their efficacy and safety outcomes. In this study we pooled the data from existing studies to compare the seizure and clinical outcomes in patients with TLE undergoing MRgLITT and SRS. We found similar outcomes and complications between the 2 procedures.
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Review Case Reports
Unusual Radiographic Presentation of Intracranial Mature Teratoma and Resection via a Supraorbital Approach.
Primary intracranial teratomas account for <1% of intracranial masses during childhood after infancy. When supratentorial, they commonly occur in the pineal and suprasellar regions, demonstrating multilocularity, areas of fat, and calcifications and increasing enhancement correlating with decreased maturity. However, the presence of a teratoma as a mobile fat lesion within a large unilocular suprasellar cyst is rarely documented in this patient population. ⋯ Mature teratomas may manifest atypically as unilocular cystic lesions with a central mobile fatty component and are treated by gross total surgical resection. The supraorbital approach with adjunctive use of an endoscope can provide adequate exposure for resection with optimal cosmetic outcome.
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Review Case Reports
Covered stent to salvage iatrogenic vertebral artery injury with un-controlled bleeding in the OR setting.
Iatrogenic vertebral artery injury is an uncommon but well recognized complication during cervical spine surgery. Intraoperative surgical repair is extremely challenging, and options for endovascular repair are limited because of the lack of proper equipment in the operating room setting. ⋯ Vertebral artery injury is an uncommon but severe complication of cervical spine surgery. For uncontrolled bleeding, intraoperative endovascular repair with portable fluoroscopy is warranted and possible. A covered stent can seal the laceration and stop the bleeding completely which enables completion of the surgery.
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Review Case Reports
Ventral craniovertebral junction arachnoid cyst in an elderly patient- a case report of a unique occurrence at extremes of age.
Craniovertebral junction arachnoid cysts are uncommon. Among those reported, ventrally located arachnoid cysts at the extremes of age have been even rarer. We report a successfully managed case of a ventrally placed arachnoid cyst in an 88-year-old man using an unconventional surgical approach. ⋯ Arachnoid cysts are congenital lesions and can present at the extremes of age. Ventrally placed small symptomatic arachnoid cysts can be managed successfully through the posterior approach, especially in the elderly population.
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Dural arteriovenous fistulas (DAVFs) occurring in the superior sagittal sinus (SSS) region are difficult to cure. Endovascular treatment (EVT) is an effective method for the treatment of SSS region DAVFs. Currently, no systematic review of EVT for SSS region DAVFs is available. A systematic review of the literature is necessary. ⋯ In treating SSS region DAVFs, EVT can completely obliterate the fistula point and correct venous shunting. Thus, currently EVT is an effective treatment for SSS region DAVFs. Although many complications can occur, this approach achieves good outcomes in most cases.