World Neurosurg
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This case video demonstrates the surgical technique for resection of a cavernous malformation in the midleft cingulate gyrus using a contralateral transcingulate approach (Video 1). The indications for operating on a cavernoma such as this are seizures, recurrent hemorrhages, and a surgically resectable target. This video describes the operative steps, positioning, incision, and craniotomy for this approach. ⋯ Further, this approach is advantageous as it prevents injury to the left sided eloquent cortex, affords comfortable surgeon position and offers an improved trajectory. This case illustrates a well-described albeit unique surgical technique for cavernous malformation repair in an operative video format. In addition, this case shows that this technique results in a favorable patient outcome with minimal complication when appropriately used.
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Case Reports
Detection of spinal dural defect in superficial siderosis by intraoperative ultrasonography.
Superficial siderosis of the central nervous system is a rare disease caused by repeated hemorrhages in the subarachnoid space. We describe surgical treatment of a case in which a tiny dural defect with fluid collection in the spinal canal was detected by intraoperative ultrasonography (US). After laminectomy, intraoperative US imaging confirmed epidural fluid collection around the ventral dural defect before incision of the posterior dura mater. ⋯ The ventral dural defect was repaired by direct sutures. After repair, intraoperative US imaging confirmed dural hole closure and resolution of the collected fluid. Intraoperative US is useful for detecting the level of dural defect before repair and confirming closure of the dural defect and successful resolution of fluid collection after repair.
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To evaluate the safety and efficacy of stent-only technique with Low-profile Visualized Intraluminal Support (LVIS) for uncoilable intracranial aneurysms. ⋯ LVIS stent-only technique is safe and efficacious for uncoilable aneurysms, even for ruptured ones.
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Histologic types and grades are critical in the diagnosis and treatment of spinal tumors. Intraoperative frozen section is a fast and easy method in confirming pathologic diagnosis during the operation. This study was undertaken to reveal the accuracy of intraoperative frozen section biopsy in order to make proper treatment plans. ⋯ Pathologic findings from frozen biopsy for spinal cord tumors could not be corresponded to final diagnosis, especially when the results of frozen biopsy were ependymoma or astrocytoma. Therefore careful decision making for treatment plans is required.
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The pterional approach (PA) has been used to remove cranio-orbital lesions that have communicated via the supraorbital fissure (SOF). The supraorbital eyebrow approach (SEA) has become increasingly popular as a minimally invasive approach. However, few reports have examined the SEA for cranio-orbital lesions. We assessed the relative advantages, disadvantages, and selection criteria for these 2 approaches. ⋯ The SEA provided better cosmetic satisfaction, resulted in a shorter surgical time, and required a shorter incision. The SEA might be a more minimally invasive option for lesions communicating via the SOF without obvious hyperostosis. The PA might be more reasonable for lesions with obvious hyperostosis and more extensive lesions in the cavernous sinus.