World Neurosurg
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Endoscopic skull base surgery has evolved over the last several decades due to technological advances and operative techniques. Several innovations that are not yet mainstream may have significant impact on the future of endoscopic skull base surgery. ⋯ Several technologies are under current investigation with the hope to improve future outcomes in endoscopic skull base surgery. Additional research and evolution are necessary and will require intense scrutiny before becoming standard of care.
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The introduction of operative microscopes (OMs) is the most important revolution in modern microneurosurgery, as a result of the implementation of lighting and magnification of the surgical field and of the capability to dissect the microneurovascular structures. Recently, the advent of video telescopic intraoperative microscopes or exoscopes (EX) has enlarged these perspectives in neurosurgery. ⋯ The EX has been emerging as an alternative to the OM for performing many cranial, spinal, and peripheral neurosurgical procedures. Despite some limitations, this new optical device presents many features that can be considered as an evolution of the OM. In future years, larger studies will confirm these preliminary impressions.
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Mechanical thrombectomy is an effective treatment of acute large vessel occlusion. However, when difficult anatomy is encountered in which the reperfusion catheter cannot be positioned well, the outcomes can be suboptimal. We present a patient with right common carotid artery (CCA) and internal carotid artery occlusion after repair of an acute type A aortic dissection. Successful mechanical thrombectomy and stenting through direct neck exposure and puncture was performed. ⋯ Acute mechanical thrombectomy through open direct neck puncture to treat an acute type A aortic dissection and concurrent CCA dissection and occlusion is an effective and optimal method.
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Review
Case Report and Review of the Literature of Schwannomas that Originate from the Falx Cerebri.
Schwannomas not related to cranial nerves are rare. Here, we present a case of a schwannoma that originated from the falx cerebri and review reported cases in the literature. ⋯ Although distinguishing a schwannoma of the falx cerebri from a falx meningioma and metastasis is difficult preoperatively, inclusion of schwannoma of the falx cerebri in the differential diagnosis is important, especially when the patient is relatively young and/or the tumor lacks a dural tail sign.
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Primary spinal glioblastoma multiforme (GBM) of the conus medullaris is a rare and devastating pathologic entity. The presenting symptoms commonly include progressive neurologic deficits in the lower extremities, bowel and bladder dysfunction, and low back pain. ⋯ However, recent advancements in the field of molecular oncology have been beginning to elucidate a unique molecular blueprint for these spinal gliomas. Given the lack of standardized treatment strategies, we have presented our institutional experience in treating a small series of patients with conus medullaris GBM and have reviewed the reported data on the relevant molecular markers, management strategies, and complication avoidance for this malignant pathologic entity.