World Neurosurg
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Although the incidence of intracerebral hemorrhage (ICH) has appeared to be increasing over the years, its prognosis remains dismal. No consensus has yet been reached regarding the management of ICH; however, minimally invasive surgery should limit, if not avoid, intraoperative parenchymal damage. Therefore, we have presented a novel, modified "homemade" approach aimed to shorten the operative time and minimize the corticectomy and brain manipulation. ⋯ The results from our clinical series have shown the effectiveness of endoscopic clot evacuation in surgical ICH. In addition, we have demonstrated an efficient technique that can be used in urgent cases and in less-developed areas owing to its reduced demand on resources and its shorter learning curve. The outcomes were good and comparable to those with the classical endoscopic approach.
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First carpometacarpal (CMC) joint osteoarthritis (OA) is commonly encountered in clinical practice. The preferred surgical option when conservative therapy fails varies with the stage and nature of the disease. Denervation of the first CMC joint is a relatively new procedure for managing stable thumb CMC joint OA. Our objective was to review our experience and surgical technique with first CMC joint denervation surgery. ⋯ First CMC joint denervation provided good pain relief and improvement in grip strength in patients with thumb CMC joint OA. This minimally invasive technique proved to be a good option for providing optimal pain control and improvement in strength with minimal and mild complications.
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Pineal parenchymal tumors of intermediate differentiation (PPTIDs) are rare lesions with particular features compared with other pineal parenchymal tumors. ⋯ A proper multidisciplinary management of PPTIDs based on a gross total removal of the lesion, and an adjuvant radiotherapy in selected cases, may improve the overall survival of these aggressive tumors.
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Different tumors can be encountered in the paraventricular regions, and whereas their deep location often make them difficult to access surgically, they may be amenable to chemotherapy and/or radiotherapy. Therefore, tumor biopsy and histologic diagnosis are mandatory to optimize treatment. Different technical procedures have been recommended; the neuroendoscopic approach is accepted and widely used, in particular with an enlarged ventricular system. ⋯ We define a neuroendoscopic intraoperative ultrasound technique. The main advantages of this technique are the identification of the tumor that may not been clearly identified underneath the ventricular ependymal through the neuroendoscopic window alone, and furthermore, that this technique gives the possibility to detect the depth of the needle advance∖ment in the selected tissue while labeling the lesion beneath the ventricular ependyma. Moreover, intraoperative ultrasonography can reveal in a real-time fashion intracranial hemorrhages that may occur after tissue biopsy, therefore providing a useful tool to achieve valid and directed hemostasis when needed.
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The purpose of the present study was to determine the learning curve for biportal endoscopic spinal surgery (BESS) for decompressive laminectomy in lumbar spinal stenosis using a learning curve cumulative summation test (LC-CUSUM). ⋯ The results of the present study have demonstrated that a substantial learning period could be needed before adequate performance can be achieved with lumbar decompressive laminectomy using BESS.