World Neurosurg
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The use of Gamma Knife radiosurgery (GKRS) for recurrent or residual vestibular schwannoma (VS) after microsurgery (MS) has been investigated in several retrospective studies. The purpose of this study was to identify potential risk factors for both neurologic deterioration and tumor progression after GKRS for previously operated VSs in a prospective setting. ⋯ Intended submaximal resection followed by GKRS is a viable treatment for VS. Because tumor remnant size after MS is an important predictor for recurrence after adjuvant GKRS, both brainstem and cerebellar decompression and maximal safely achievable resection should remain major goals of microsurgery.
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To describe neurosurgical patient and caregiver perceptions of provider communication, the impact of patient education, and their understanding of information given to them throughout the neurosurgical care trajectory. ⋯ Our study describes several unmet needs, finds inconsistencies in how information is delivered and a lack of patient-centered and caregiver-centered approaches to communication. Neurosurgery groups should identify unmet needs at their institution and implement strategies and interventions to improve the patient and caregiver experience.
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Dislodgement of coils during endovascular embolization of brain aneurysms is a potentially hazardous complication due to high risk for cerebral infarct and subsequent neurologic deficits or death. We describe a case of whole coil mesh dislodgement due to interaction between the coil loops and a temporary neck-bridging device struts and subsequent successful retrieval of a distally migrated coil into the left middle cerebral artery branch with direct aspiration technique. ⋯ Our case indicates that first-line direct aspiration technique is an atraumatic and effective procedure for coil retrieval when dislodged even in distal cerebral vessels, minimizing the chance for additional retrieval technique-related risks. Interventionists should be aware of coil dislodgment as a potential temporary bridging-neck device related complication.
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Case Reports
Retrosigmoid Intradural Temporal Bone Drilling for Intrapetrous Chondrosarcoma Extending to Cerebellopontine Angle.
Recently the intradural temporal bone drilling has been used in conjunction with the retrosigmoid approach to allow expanded to access to a variety of types of intraosseous invasions.1,2Video 1 demonstrates the intradural temporal bone drilling via the retrosigmoid approach in the microsurgical removal of an intrapetrous chondrosarcoma extending to the cerebellopontine angle. The patient was a 23-year-old woman presented with progressive hearing disturbance, hemifacial spasm, and tinnitus. Neuroimaging revealed a left intrapetrous tumor extending as far as the cerebellopontine angle, destroying the temporal bone around the internal acoustic meatus and petrous carotid artery. ⋯ Although slight facial palsy developed postoperatively, the hemifacial spasm and tinnitus disappeared. Her facial palsy almost disappeared within the 6 months of follow-up, and careful observation over a 2-year period revealed no tumor recurrence, without any additional treatment. Informed consent was obtained from the patient.
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Epidural fibrosis is a major problem after spine surgery, with some patients having recurrent symptoms secondary to excessive formation of scar tissue resulting in neurologic compression. We used a rat laminectomy model to determine if topical application of boric acid could be helpful in the prevention of epidural fibrosis. ⋯ The antifibrotic effect of boric acid solution for the prevention of epidural fibrosis suggests that boric acid should be further evaluated in future studies for the prevention of epidural fibrosis.