World Neurosurg
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Intramedullary schwannomas of the spinal cord are extremely rare. Most previous studies are case reports, which have found that intramedullary schwannomas could be homogeneous or asymmetrically enhanced with gadolinium. However, intramedullary schwannomas with minimal enhancement have not been reported. ⋯ We report a case of intramedullary schwannoma that presented inconspicuous enhancement with gadolinium. MRI is useful but cannot be used to differentiate schwannomas from other intramedullary spinal tumours. Surgical resection is the most vital factor for the treatment of intramedullary schwannoma.
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The preservation of acceptable facial nerve (FN) function after surgery is the key concern for most patients with vestibular schwannomas (VS). To assess predictive factors of early postoperative and long-term FN function in patients harboring large VS operated with a FN-sparing technique. ⋯ As long as the extent of resection or additional Gamma Knife surgery have not been identified as predictive risk factors of postoperative FN palsy, we suggest that optimal resection is the main option for patients harboring large VS.
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In the study and practice of neurosurgery at the "Federico II" University of Naples, a central role has always been reserved for anatomy. Based on worldwide cooperation, the meaning of anatomical research has evolved from methodological investigation to an educational and communication tool. The contribution of our school to the anatomical data on the sellar region has been chronologically reviewed in the present report. ⋯ The quantification and comparison became essential in these studies owing to their effect on surgical application and advanced imaging techniques entered the field of anatomical dissection. Anatomy at our school is an evolving science. Our efforts in anatomical scientific publications and organization of participatory courses have made us a center of reference for endoscopic endonasal surgery and have allowed us to share our knowledge with other specialists in this field.
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Neovascularization (NV) is regarded to be one of the important features of vulnerable plaque. The purpose of this study was to evaluate associations between the presence of NV, detected using optical frequency domain imaging (OFDI), and ischemic events and the progress of carotid artery stenosis. ⋯ NV was more frequently observed in progressive carotid plaques. Evaluation of NV using OFDI may be useful in predicting progressive carotid plaques.
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The lower clivus (LC) is one of the most difficult areas to access in neurosurgery. Several microsurgical approaches to the LC have been reported, including the subtonsillar, far-lateral (FL), extreme-lateral (EL), and endoscopic far-medial (Endo-FM). However, no consensus has been reached regarding the optimal approach. We aimed to quantify and compare the surgical exposure and freedom (angle of attack) for various targets at the LC using these 4 surgical approaches. ⋯ The Endo-FM approach provided the greatest surgical freedom at the ventral aspect but the least freedom at the lateral aspect. The EL approach provided maximal values for most parameters among the open approaches; however, the craniotomy with the EL approach was the most complicated. Our quantitative results could guide neurosurgeons in preoperative planning for LC lesions, including awareness of the maximum exposure limits and the advantages and disadvantages of each surgical approach.