World Neurosurg
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Pneumocephalus is commonly associated with cranial trauma including surgical interventions. Spontaneous pneumocephalus on the other hand is a rare diagnosis. Reported cases were predominantly unilateral. We report a unique case of a bilateral spontaneous pneumocephalus probably related to a bilateral tegmen defect related to repeated Politzer maneuvers. ⋯ Spontaneous pneumocephalus represents a rare condition often associated with increased middle ear pressure, which can be caused by autoinflation (e.g., Valsalva or Politzer maneuver), sneezing, or coughing. The described case represents a unique presentation of the bilateral spontaneous pneumocephalus associated with bilateral tegmen and dura mater defects managed surgically. Despite its rarity, spontaneous pneumocephalus originating from the temporal bone should be considered as a possible diagnosis in patients with suggestive otologic presentation (e.g., tinnitus, instability, hearing loss) and associated nonspecific neurologic symptomatology.
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Although previous studies have reported cases of coexistence of carotid-ophthalmic aneurysm and ophthalmic artery (OA) infundibulum, the hemodynamic characteristics of this complicated structure and its damaging effects on vision remain to be elucidated. The aim of the present study was to analyze this artery structure using computational fluid dynamics (CFD) techniques. ⋯ We detected aneurysm regions that were susceptible to further expansion and assessed the rupture risk of each region. The relaxation area could promote aneurysm progression. In addition, the location of the vortex shear force center varied with time. Finally, double vortex streamlines influenced the blood supply through the OA, impairing the vision. Infundibulum might promote thrombus formation and, hence, retard OA blood flow.
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We investigated how augmented reality (AR) can be applied to support transsphenoidal surgery. ⋯ Microscope-based AR is a reliable tool to increase patient safety in complicated transsphenoidal procedures. Intraoperative imaging-based automatic patient registration is recommended.
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To explore the efficacy and safety of Gamma Knife radiosurgery (GKRS) for meningiomas in patients with neurofibromatosis type 2 (NF2). ⋯ GKRS represents an effective and safe management strategy with minimal invasion for patients with NF2-associated meningiomas. Our data showed a high local control rate of NF2-associated meningiomas by GKRS; however, the distant control rate is low, especially in young patients. For these patients, retreatment with GKRS may still be the advisable method.
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The intraforaminal component of jugular foramen tumors is difficult to access surgically, as it requires complex approaches for radical removal and leads to a high recurrence due to residual tumor. The retrosigmoid suprajugular approach, intradural drilling of the roof of the jugular foramen, has been recently proposed for removal of such intraforaminal component without sacrificing the sigmoid-jugular venous system or requiring additional approaches. This study presents our experience with this approach and introduces the use of intraoperative continuous vagus nerve monitoring. ⋯ The retrosigmoid suprajugular approach is safe and effective for removal of tumors extending into the jugular foramen, maintaining a chance of hearing improvement. Intraoperative continuous vagus nerve monitoring is useful to avoid postoperative complications in such surgeries.