World Neurosurg
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Case Reports
Use of the Artemis Neuro Evacuation Device in the Resection of a Pituitary Adenoma: Initial Technical Note.
Endoscopic transsphenoidal resection has become the primary approach for resection of pituitary macroadenomas. However, challenges such as narrow sinuses, dense tumor consistency, and invasion of surrounding structures exist. ⋯ To the authors' knowledge, this represents the first reported case of the Artemis system's utility in the treatment of pituitary tumor beyond cranial hematoma and hemorrhage.
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Cerebral hemodynamic transformation is a relatively common finding in patients with traumatic brain injury (TBI). Knowledge of cerebral hemodynamic disturbance may assist in predicting the management outcome. Transcranial Doppler ultrasonography (TCD) monitoring of patients with TBI can be used to reveal various pathologic hemodynamic changes. The objective of this study was to compare the clinical outcomes of postoperative routine intracranial pressure (ICP) monitoring versus ICP monitoring combined with TCD monitoring in patients with brain trauma after decompressive craniectomy. ⋯ TCD could be helpful for the serial monitoring of cerebral hemodynamic changes after decompressive craniectomy for TBI, which could be beneficial for neurologic outcome improvement.
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Determining the risks of treatment of unruptured intracranial aneurysms is critical in the decision-making process of management. Most studies have reported the results for endovascular or surgical management. Our objective was to better delineate the risk estimates for unruptured intracranial aneurysms treated with surgical or endovascular techniques in a comprehensive fashion, according to the patients' risk profiles. ⋯ Aneurysmal obliteration using endovascular and surgical approaches in a comprehensive fashion has low treatment risks for unruptured aneurysms. The nomograms generated are useful in the discussion with patients and families regarding the risks of total institutional treatment of unruptured aneurysms.
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A profound understanding of the relationship between the deep cervical fasciae and the skull base is essential for skull base surgery. To our knowledge, there has been little research on the relationship between the deep cervical fasciae and inferior surface of the skull base; thus, this study aims to examine the fascial network of the skull base. ⋯ This study comprehensively exposes the fascial network of the skull base. Our cadaveric dissection findings support those from previous imaging-anatomical studies. Precise knowledge of these fascial layers is essential for accurate diagnosis and understanding the spread of disease, as well as helping skull base surgeons safely perform challenging procedures.
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Case Reports
Ossification of the Ligamentum Flavum at the Thoracic and Lumbar Region in an Achondroplastic Patient: A Case report.
Achondroplasia, a genetic disorder of bone growth, produces specific clinical features of the extremities and spine. Spinal stenosis, seen in patients with achondroplasia, is a congenital disorder related to premature fusion of the pedicles to the lamina. It can be caused by ossification of the ligamentum flavum, which is rare in patients with achondroplasia. ⋯ Treatment of the deformity and the rare condition of ligamentum flavum in a patient with achondroplasia resulted in improved neurologic status and symptoms. To our knowledge, this is the first case report including treatment for both the deformity and thoracic and lumbar ossified ligamentum flavum lesion in a patient with achondroplasia.