World Neurosurg
-
The anterior petrosectomy approach is among the most popular for exposure of the petroclival region. However, the complexity of the anatomy, drilling time required, and risk of injury to neurovascular structures have made this procedure especially challenging. We have proposed a novel combined extradural-intradural technique for en bloc anterior petrosectomy-or one-piece Kawase-and have charted the landmarks that define its surgical boundaries. ⋯ The advantages of this technique include the wide exposure of the petroclival region, extensive visualization of critical structures via extradural and intradural corridors, and minimization of bone drilling, which could reduce heat damage. Clinical application of the illustrated technique is required to test its reliability in different pathological subsets.
-
The rate of ventriculoperitoneal (VP) shunt infection is reported between 3% and 20%. Vancomycin-resistant enterococci (VRE) are increasingly prevalent nosocomial pathogens worldwide, and they rarely cause infections to the central nervous system. Daptomycin is a cyclic lipopeptide effective antibiotic because of its rapid bactericidal effect. It is a life-saving treatment option for meningitis, bacteremia, sepsis, endocarditis, and urinary system infections caused by VRE. ⋯ The patient was admitted to the medical center with umbilical discharge, and shunt revision was applied with the thought of shunt dysfunction. Intermittent umbilical cerebrospinal fluid (CSF) leakage continued, and the patient experienced a fever 2 weeks after the operation. VRE growth in his CSF culture was treated by meropenem and linezolid. Upon continuation of the growth afterwards, the patient was referred to our hospital and underwent extraventricular drainage, and IV linezolid, IV daptomycin (8 mg/kg per day), and IVT daptomycin (2.5 mg/kg per day) was scheduled as treatment. On the fifth day of treatment, there was no growth in the culture, and no side effects were observed during the treatment. A VP shunt was placed in the patient for the 15 days of IV daptomycin plus IVT treatment, and 36 days of linezolid. No infection was observed in the 8-month follow-up period.
-
The revised World Health Organization classification of central nervous system tumors, published in 2016, has recognized the H3 K27M mutation as a critical genetic signature defining a new group of infiltrative astrocytomas designated as diffuse midline glioma, H3 K27M mutant. Although most H3 K27M mutations arise in the setting of diffusely infiltrative tumors, there are rare reports of compact tumors with low-grade histologic features harboring this mutation. The prevalence and clinical significance of this mutation in pilocytic astrocytomas remain unclear. ⋯ Stereotactic biopsies may undergrade some adult thalamic pilocytic astrocytomas. Therefore, we recommend that all these tumors be evaluated for the H3 K27M mutation. Further, we think H3 K27M-mutant thalamic pilocytic astrocytomas require aggressive multimodality treatment and these treatments should be guided by the molecular findings, as opposed to the histologic ones.
-
We investigated pediatric patients presenting with isolated head trauma to emergency service. Where abnormal findings were detected on brain computed tomography (CT) scan, we evaluated the follow-up scan rate and whether follow-up scans affected the treatment protocol. ⋯ Follow-up CT scan for patients with abnormal findings on the initial CT scan after head trauma does not influence the decision to choose clinical observation or surgery except in patients with neurologic deterioration.
-
Neurovascular training models include animal models, synthetics, or computer simulation. In vivo models are expensive and require significant resources. Synthetic/computer models do not reflect the elasticity of fresh vessels. We describe an endovascular and microsurgical training model using a chicken thigh/leg. ⋯ The chicken thigh/leg model provides training opportunities in microsurgical suturing, endovascular techniques for aneurysm obliteration, and microsurgical reconstruction of aneurysms. It combines affordability, time efficiency, and reproducibility. Further studies measuring improvement in technical aneurysm management and comparison with other training models are warranted.