World Neurosurg
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Intracranial pressure (ICP) reporting impacts neurosurgical care. Millimeters of mercury (mmHg) and centimeters of water (cmH2O) are both used to report ICP in clinical practice and the literature. In this study, we investigated ICP unit of measure awareness in the neurosurgical community. ⋯ Variability and discrepancies regarding the ICP unit of measure exist in academic neurosurgery departments. Clinicians should familiarize themselves with their hospital's practices. Institutions and all of medicine may consider standardizing the ICP unit of measure, using mmHg as a universal nomenclature.
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This video illustrates the use of the supraorbital craniotomy via an eyebrow incision for access to the basal frontal lobe. This approach is particularly useful for removal of lesions in the dominant hemisphere, where a transcortical approach could place speech centers at risk. The case is that of a 57-year-old woman who presented after a mental status change and was noted to have a large left frontal mass. ⋯ Additional adjuncts in this procedure may include hyperextending the head to bring the tumor into more direct view and drilling the skull base flush to expand the operative corridor. Minimally invasive approaches are excellent for the removal of metastasis because they are smaller incisions that remain well vascularized and heal quickly, allowing the patient to initiate adjuvant therapy sooner. The patient's family provided consent for publication.
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We analyzed the effect of specific optimization steps to reduce treatment delays in a nonacademic stroke hospital setting. ⋯ For acute reperfusion therapies, significant reductions in workflow intervals can be achieved after simple optimization methods in a nonacademic community-based hospital.
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We describe a unique anastomosis procedure involving successful middle meningeal artery (MMA) to cortical middle cerebral artery (MCA) bypass, as well as superficial temporal artery (STA) to cortical MCA bypass. ⋯ This is a rare case of successful MMA-to-MCA revascularization to prevent rebleeding in a patient with Moyamoya disease. The MMA can be used as a donor artery for extracranial-intracranial anastomosis procedures in clinical practice settings.
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Intraneural hematomas are an uncommon cause of a focal mononeuropathy. When they do occur, it is usually in the setting of inherited or iatrogenic coagulopathies or as a consequence of injections targeting nerves. We report a man aged 68 years on warfarin therapy for a prior pulmonary embolism who presented with a 6-month history of progressive weakness of knee flexion and ankle movement, excruciating pain, and dense numbness in his posterior left thigh and below the knee, consistent with a severe high sciatic palsy. ⋯ The patient underwent surgical exploration, which revealed a thick hemorrhagic pseudocompartment within the sciatic nerve. The histopathologic diagnosis was consistent with chronic hemorrhage. These impressive lesions should be included in the differential diagnosis of nerve masses.