World Neurosurg
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This video article describes and illustrates the function and application of the intracerebral microinjection instrument (IMI). This newly developed technology allows delivery of therapeutic agents within the human brain in complex 3-dimensional arrays using a single pass or minimal overlying penetrations through brain tissue. ⋯ Additional applications of the IMI include delivery of viral vectors for gene therapy, infusion of neurotrophic factors, targeted delivery of chemotherapeutic agents, and delivery of antiretroviral medications.
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There is limited information on the impact of smoking on postcraniotomy mortality. In this study we used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to examine this issue. ⋯ This study identified ≥30 pack-years as a risk factor for male patients undergoing craniotomy as treatment for neurovascular diseases.
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The effect of intraoperative magnetic resonance imaging (iMRI) on tumor control during endoscopic transsphenoidal surgery (TSS) for nonfunctioning pituitary adenomas (NFPAs) has not yet been completely characterized. The present study assessed the effect of the iMRI findings on gross total resection (GTR) and progression-free survival at a mean follow-up of 62 ± 9.4 months. ⋯ High-field iMRI can increase the GTR rate in endoscopic TSS for NPFAs. The increased GTR rate was associated with longer progression-free survival. Cavernous sinus invasion, tumor size, and surgical history were important predictors of GTR in patients with NFPA.
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The vast majority of cerebellopontine angle tumors are benign with a favorable prognosis. Metastatic tumors occurring in the cerebellopontine angle are extremely rare. Herein, we report a case of colon carcinoma metastasis to the bilateral internal auditory canals. ⋯ Clinicians should be aware of metastatic tumors in the internal auditory canals. Comprehensive clinicoradiologic evaluation should be highlighted. A history of malignancy and rapidly progressive hearing loss and facial palsy may suggest the diagnosis of metastasis to the internal auditory canal. The definitive diagnosis still depends on histopathologic examination.
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Posterior fossa dural arteriovenous fistulas are rare vascular malformations. If associated with cortical venous reflux, they present a significant risk of hemorrhage. We present a 54-year-old male who presented with progressive hearing loss without other neurologic symptoms. ⋯ Follow-up angiography 8 months later showed no evidence of residual/recurrent fistula. The patient's hearing improved. There were no adverse effects during the perioperative period.