World Neurosurg
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Stiff neck or nuchal rigidity is a significant clinical sign of neurologic disease. It is commonly associated with meningitis, subarachnoid hemorrhage, and posterior fossa tumors. It may also occur as a result of tonsillar impaction following pressure in the infratentorial compartment from an expanding posterior fossa mass. It is, however, not commonly known to be associated with uncal herniation. ⋯ In the presence of stiff neck or nuchal rigidity in a patient with clinical signs of uncal herniation from a temporal arachnoid cyst, this unusual association could possibly be owing to the effect of increased pressure in the posterior fossa from massive shift of brain tissue posteriorly following a rapid rise in middle cranial fossa pressure consequent on an acute enlargement of the cyst. A false impression of acute meningeal irritation in such a situation could be quite misleading, resulting in late diagnosis and subsequently a delay in timely intervention.
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Despite the superb visualization offered by the endoscopic endonasal transsphenoidal approach, the resection rates of large and giant pituitary adenomas have remained much lower than those of smaller macroadenomas. Various tumor characteristics can influence the extent of resection (EOR) and have been variably reported. Additional understanding of these factors is mandatory to improve the results. We analyzed the radiological and intraoperative tumor characteristics influencing the EOR in a cohort of patients with large and giant pituitary macroadenomas undergoing endoscopic endonasal transsphenoidal excision under our care. ⋯ Volumetric analysis should replace 2-dimensional methods in determining the size of large and giant pituitary adenomas. Specific tumor characteristics were associated with the EOR and could help in predicting the EOR for these tumors.
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The involved carotid forks in moyamoya disease (MMD) will show decreases in both luminal caliber and outer diameter. The present study aimed to clarify the changes in the outer diameter associated with luminal stenosis/occlusion of the posterior cerebral artery (PCA) in patients with MMD. ⋯ The results of our study have shown that the involved PCA demonstrates, not only luminal stenosis, but also arterial shrinkage in MMD. This finding strongly suggests that the underlying mechanism in the development of MMD is common in both the carotid fork and PCA.
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Using a stereotactic technique, surgeons can accurately place a depth electrode (DE), but sometimes the DE deviates from the intended target due to movement of the electrode or leakage of cerebrospinal fluid when placing the electrode. If DEs can be anchored before removing the catheter insertion guide pipe, more accurate placement may be possible. ⋯ DEs can be anchored using the side slit guide pipe for more precise placement.
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Advancements in microscopy and more recently in neuroendoscopy have revolutionized the field of neurosurgery. Handheld neurosurgical instruments are integral components of these procedures. However, these instruments have many limitations, such as poor ergonomics, constrained maneuverability, and limited degrees of freedom. A need for developing better instruments is commonly felt by neurosurgeons. Also, the focus of modern neurosurgical training is shifting toward simulation models. The baseline data of surgical instruments play a vital role in the development of virtual and physical simulators. A primary factor impeding development of novel instruments and simulators is lack of a comprehensive surgical instrument database. The aim of this study was to develop and validate a virtual repository of microscopic and neuroendoscopic instruments. ⋯ The virtual database is an efficient starting aid to foster research collaborations related to neurosurgical instruments and surgical simulation platforms.