World Neurosurg
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Intraspinal tumors are 10 to 15 times less common than brain tumors. The midline approach with extensive laminectomies represents the current gold-standard for resection, causing instability, muscle damage, and kyphosis among other well-known complications. Minimally invasive series reported their results using retractor-based systems. We analyzed a patient series treated with a non-expansile tubular approach, describing the technique, grade of resection, and clinical outcomes. ⋯ Although this study consisted of a small series, we have shown the possibility of resecting intraspinal tumors (some intradural-intramedullary) with non-expansile tubes in a safe and effective way with no complications. Most of the patients had complete neurological improvement at the end of follow-up.
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Craniopharyngiomas show a high recurrence rate despite their pathologically benign nature. Thus, we analyzed the clinical features to elucidate the prognostic factors for the recurrence of craniopharyngiomas in adults with long-term follow-up. ⋯ The long-term recurrence rate of craniopharyngiomas was high; therefore, long-term regular follow-up is mandatory. Adjuvant irradiation for remnant tumors showed a long-term tumor control rate comparable to that of completely removed tumors.
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Hyperventilation is a controversial treatment in traumatic brain injury (TBI). Prophylactic severe hyperventilation (below 3.3 kPa/25 mm Hg) is generally avoided, due to the risk of cerebral ischemia. Mild hyperventilation (arterial pCO2 within 4.0-4.5 kPa/30-34 mm Hg) in cases of intracranial hypertension is commonly used, but its safety and benefits are not fully elucidated. The aim of this study was to evaluate the use of mild hyperventilation and its relation to cerebral energy metabolism, pressure autoregulation, and clinical outcome in TBI. ⋯ These findings support the notion that mild hyperventilation is safe and may improve cerebrovascular reactivity.
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Case Reports
Spinal epidural hematoma associated with epidural metastasis after minor trauma: a case report.
Spinal epidural hematoma associated with epidural metastasis is very rare. Epidural hematoma is unusual in itself, and metastatic epidural tumors do not commonly occur. ⋯ To our knowledge, spinal epidural hematoma accompanied by epidural metastasis has not previously been reported. We hypothesized that tissue invasion of malignant neoplasms may cause hemorrhagic conditions. The presence of a tumor should therefore be considered in the differential diagnosis of cases of epidural hematoma.
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Morbidity and mortality conferences (MMCs) are now widely implemented in clinical hospitals, but their impact on the education for neurosurgeons remains limited. This prospective study was aimed to assess the efficacy and benefit of MMCs on the education for neurosurgeon. ⋯ Knowledge acquisition from MMCs can significantly reduce "avoidable" morbidity events in both residents and experienced neurosurgeons. The educational effect was more distinct in the residents.