World Neurosurg
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Visual status is routinely evaluated by neuro-ophthalmologic examination and computerized visual field (VF) tests in patients with chiasmal compression secondary to pituitary macroadenoma. Currently, no relevant data exists to accurately quantify the extent of optic apparatus compromise to further guide clinical decision-making. We aimed to assess for a possible quantitative correlation between optic chiasm geometric properties on magnetic resonance imaging (MRI) and VF deficits. ⋯ The strong correlation demonstrated by our results of this relatively simple radiologic measurement with VF status, despite the relatively small cohort, calls for further investigation in this promising direction, and may facilitate with basic assessment and clinical decision-making for patients with equivocal neuro-ophthalmologic evaluation, as well as with poor compliance.
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Rare and deep located tumors are surgical challenge with high morbidity. Minimal invasive techniques should be encouraged for a better outcome. Intralabyrinthine schwannoma (ILS) is a rare benign tumor that usually presents with hearing loss and tinnitus. Surgery is associated with high rate of facial paralysis and deafness. Radiosurgery is an option for tinnitus treatment, without the risk of facial paralysis. ⋯ Tumor control and symptoms relief could be safely achieved through a precisely plan using Gamma Knife radiosurgery, decreasing morbidity. This is the first radiosurgical description for a transmodiolar schwannoma.
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Patients with Klippel-Feil syndrome may present with neurologic complaints such as neck pain, radiculopathy and gait instability. Here we describe surgical management of a patient with congenital fusion of the occipital-cervical region and also block circumferential fusion of dens to T3 with spinal cord compression. This report is the first of its kind with such extensive fusion. ⋯ This is the first reported case of Klippel-Feil syndrome with fusion of all cervical vertebrae down to T3. We recommend surgery for advanced cases of myelopathy or radiculopathy due to stenosis and spinal instability.
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Comparative Study
A comparison of subgaleal versus subperiosteal dissection in open cranial vault expansion for sagittal craniosynostosis.
The aim of this study was to evaluate surgical outcomes for patients with sagittal craniosynostosis undergoing open cranial vault remodeling with a modified pi procedure comparing subgaleal versus subperiosteal dissection. ⋯ Open posterior and middle cranial vault expansion is a safe and efficient method of open cranial vault expansion in sagittal craniosynostosis regardless of the plane of dissection. Elevation of the scalp flaps in the SG plane is a minor technical modification that can reduce blood loss and operative times.
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The purpose of this study was to develop and validate a nomogram to predict overall survival (OS) for adult patients with primary intramedullary spinal cord grade II/III ependymoma (PISCGE). We also elucidated the effectiveness of postoperative radiotherapy for this disease. ⋯ We built the first nomogram model and risk classification system for PISCGE patients. Our model accurately estimated the individual OS probability of these patients, and proposes different treatment approaches for patients based on the risk classification system. Furthermore, from our findings, radiotherapy confers no survival advantage to these patients.