World Neurosurg
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Review Case Reports
"Aggressive cranial Osteoblastoma of the parietotemporooccipital bone: a case report and review of literature with a special emphasis on recurrence/residue".
Osteoblastoma is a rare nonfibroblastic osteoid tissue-forming primary bony tumor usually arising in the medullary cavity/diploic space of any bone. The calvarium is an extremely rare site of its origin. ⋯ We report an extremely rare case of a patient with large aggressive cranial osteoblastoma, who developed massive inoperable multifocal recurrence 15 months after total en bloc resection with wide margins. A concise review of cases of aggressive osteoblastomas involving the cranium available in the English literature is also presented as an update.
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In the present report, we have broadly outlined the potential advances in the field of skull base surgery, which might occur within the next 20 years based on the many areas of current research in biology and technology. Many of these advances will also be broadly applicable to other areas of neurosurgery. We have grounded our predictions for future developments in an exploration of what patients and surgeons most desire as outcomes for care. ⋯ Additionally, we have discussed the training requirements for future skull base surgeons and stressed the need for adaptability and change. However, the essential requirements for skull base surgeons will remain unchanged, including knowledge, attention to detail, technical skill, innovation, judgment, and compassion. We believe that active involvement in these rapidly evolving technologies will enable us to shape some of the future of our discipline to address the needs of both patients and our profession.
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Review Case Reports
Cushing's Syndrome Caused By Ectopic ACTH-secreting Pituitary Adenomas: Case Report and Literature Review.
Ectopic adrenocorticotropic hormone-secreting pituitary adenomas (EAPAs) are rare adenomas causing Cushing syndrome, which are located in ectopic locations outside the sella turcica. No more than 100 cases of this entity have been reported. Because of its rarity and nonspecific clinical and biochemical features, EAPA is often misdiagnosed, leading to surgical failure and delayed treatment. In the article, the cases of 3 patients with suprasellar EAPAs treated at our institution are reported and a review of the literature is presented. ⋯ Although EAPA is an extremely rare entity, it should be considered as a differential diagnosis of Cushing disease. Because of its similar clinical and biochemical behavior to intrasellar pituitary adrenocorticotropic hormone adenoma in Cushing disease, careful examination of the potential occurrence of EAPA on preoperative radiologic imaging is of considerable significance to avoid unnecessary surgery and achieve improved outcomes. Surgical resection EAPA remains the first choice of treatment, and the optimal surgical approach ought to be determined according to the adenoma features, the general condition of the patient, and the surgeon's experience.
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Review Case Reports
OLD PERCHED FACET JOINT SYNDROME: "the always anterior strategy".
Perched facet joint syndrome is a common post-traumatic condition encountered at the level of subaxial cervical spine in acute settings but more rarely found in a chronic manner. We define this dislocation as old subaxial cervical facet dislocation (OSCFD) when adequate treatment is not established within 3 weeks after initial trauma. It is a clinical entity, moreover, associated with significant impact on neurologic functions such as nerve root or spine compression. Many factors are attributed to explain delayed diagnosis, such as living in a developing country, misreading or inadequate imaging, the presence of multiple injuries, or an absence of symptoms at the time of trauma. ⋯ In OSCFD, performing a vertebral canal decompression and realignment of the cervical spine column is crucial. More options are purposed to treat this challenging condition, and more of them could be complicated by time-consuming resetting in the operating room, prolonged anesthesiologic procedures, and elevated risk of 360° instrumentation surgical maneuvers. The one-stage combined anterior-approach only (corpectomy or discectomy) is an effective, fast, and safe surgical strategy for treating OSCFD.
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Response to SARS-CoV-2 Pandemic in a Non-COVID-19 Designated Latin-American Neurosurgery Department.
Mexico declared the first case of novel coronavirus disease (COVID-19) in February 2020. At the time we write this article, our country is facing a community spread phase, expecting a rapid increase in the number of cases and fatalities. The Fray Antonio Alcalde Civil Hospital of Guadalajara has been declared a non-COVID-19 hospital with the mission of providing care to patients already registered and also those transferred from neurosurgical departments of neighboring centers, which have been converted into COVID-19 only hospitals. ⋯ Despite not being a COVID-19 center, we consider all patients at the neurosurgical ward and staff members as asymptomatic carriers or infected in the preclinical period. Specific measures must be taken to ensure the safety and care of neurosurgical patients and medical staff during the community spread phase.