World Neurosurg
-
Cranioplasty (CP) is an obligatory surgery after decompressive craniectomy (DC). The primary objective is to protect the brain from external injury and prevent syndrome of trephined. In a government hospital, such cases pose a significant burden to a trauma center. Because of this reason, cosmetic outcome is never taken into account for the CP. We present results of CP performed at our hospital. ⋯ The cosmetic outcome is overlooked for CP. The bone flap fixation has to be rigid for a good outcome.
-
Surgical approaches for posterior C1-C2 arthrodesis, such as C1-C2 transarticular and C1-C2 screw stabilization, are known to be demanding because of the anatomic close proximity of cervical vertebrae to neurovascular structures. Currently, navigation by fluoroscopy or intraoperative computed tomography (ICT) is the standard practice. However, fluoroscopy has various limitations, and ICT is time consuming and not available in many centers; furthermore, both diagnostic tools lead to exposure of the operating room staff to radiation exposure. We evaluate the safety, efficacy, and facility of a navigation system using only preoperative cervical computed tomography and computed tomographic angiography (CT/CTA), to prevent the risk of neurovascular damage in atlantoaxial stabilization. ⋯ The use of a neuronavigation system, based on preoperative acquired cervical CT and intraoperative single-vertebra registration, may provide a valuable support for the improvement of the surgical accuracy of posterior C1-C2 screw fixation.
-
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.
-
Quite a few cases of intramedullary meningioma have been described in previously reported studies. We have presented a rare case of intramedullary thoracic meningioma, which was quite different from subdural extramedullary meningioma, and the preliminary diagnosis was mistakenly given as hemangioblastoma. ⋯ Intramedullary thoracic meningiomas are extremely rare and differ from the common subdural extramedullary meningiomas. Clinicians should be aware of this when diagnosing intramedullary tumors. Gross total resection using a microsurgical technique will be the best treatment strategy.
-
First-line treatment for prolactin-producing pituitary adenomas is dopamine agonist (DA) therapy. This is the first study to analyze the rate of radiographic and hormonal regression of prolactinomas in response to DA therapy to better understand what time frame we consider DA treatment failure. ⋯ Prolactinomas plateau in PRL levels and the rate of size regression within the first year of DA treatment. Prolactinomas with lack of size regression and failure to reach normalization of PRL levels by 12 months may be considered for other management strategies.