World Neurosurg
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Appropriate patient selection is critical for successful deep brain stimulation (DBS) for Parkinson disease (PD). Subcortical atrophy is a possible determinant of postoperative DBS outcomes in patients with idiopathic PD, but it has not been well evaluated for DBS of the globus pallidus interna (GPi). We investigated perioperative subcortical atrophy measures in patients with PD and their relationship to postoperative motor response in bilateral GPi-targeted DBS. ⋯ Perioperative age and subcortical atrophy as measured in this study correlated with motor responsiveness at 6 months postoperatively among patients receiving bilateral GPi-targeted DBS stimulation for PD.
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Vascular reconstruction is required to treat infectious intracranial aneurysms (IIAs) on arteries supplying the eloquent area. However, extracranial-intracranial bypass is sometimes impossible because IIAs are frequently located distally on arteries and the length of a donor artery is limited. We report a rare case of an unruptured Gemella morbillorum IIA, which was successfully treated by intracranial-intracranial (IC-IC) bypass using a Y-shaped superficial temporal artery (STA) interposition graft. ⋯ This case suggests that end-to-side IC-IC bypass using a Y-shaped STA graft can be a good option for surgical treatment of IIAs, which are located in eloquent areas.
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This 46-year-old female patient presented after a 6-month progressive right-sided visual loss, with a visual acuity of 20/60, a temporo/infranasal visual field deficit, and optic atrophy. The magnetic resonance imaging disclosed a tuberculum sella meningioma with minimal right medial canal invasion, however, no encasement of carotid arteries. Tuberculum sella meningiomas represent 5%-10% of intracranial meningiomas and are surgically challenging tumors that can severely hinder vision. The endoscopic approach allows for early coagulation of the tumor meningeal supply, and importantly, facilitates gross total removal without any manipulation of the optic nerve while preserving the superior hypophyseal arteries.1-9.
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To determine the impact of endonasal endoscopic access to the skull base on the olfaction sense, involving the harvest of a nasoseptal flap, with the removal of the middle nasal turbinate. ⋯ Bilateral removal of the middle nasal turbinate, compared with unilateral resection, showed no impact on the olfactory function 6 months after surgery. In both groups, there was a transitory decrease in the first month, but this normalized by the sixth postoperative month.
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Gelfoam is a simple and effective hemostatic agent that is used to seal brain corticotomies or skull burr holes. Owing to its low cost, it is one of the most widely used tools in neurosurgical daily practice. However, migration of Gelfoam fragments can cause occlusion of endoscopic third ventriculostomy (ETV) or shunt, leading to hydrocephalus recurrence. ⋯ Review of the pertinent literature discloses other complications of Gelfoam migration (e.g., mass effect, granulomatous reaction) as well as other causes of uncommon ETV/shunt obstruction. Nonetheless, Gelfoam will remain an indispensable tool for neurosurgeons. The present report emphasizes the importance of its correct use to avoid complications.