World Neurosurg
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Olfactory neuroblastoma (ON) is a highly aggressive and locally recurrent neoplasm. Distant systemic metastases are not uncommon, but remote leptomeningeal dissemination is extremely rare. ⋯ A high suspicion of secondary disease should be maintained in patients with previous history of ON and parasagittal leptomeningeal enhancing lesion, particularly when multiple lesions are detected around the sagittal sinus. Radical resection and multimodal treatment are warranted to improve long-term outcome. Understanding the venous drainage route as a potential pathway for remote seeding from the primary site of disease has therapeutic implications. We postulate that en-bloc tumor resection and proximal sagittal sinus ligation might reduce potential for leptomeningeal metastasis.
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Case Reports
Awake Craniotomy for a Left Pan-Hippocampal Diffuse Low Grade Glioma in a Deaf-Mute Patient Using Sign Language.
Awake craniotomy is becoming an essential technique, especially for intrinsic brain tumors which have no clear margins and where extent of resection (EOR) matters. However, intraoperative monitoring for awaken patients requires voice feedback in regular settings. Resection of hippocampal glioma is challenging because of its deep-seated location, its extension in an anterior-posterior axis, and being covered with eloquent cortex. We present a native deaf and mute patient, who has been diagnosed of a left pan-hippocampal glioma, who underwent an awake craniotomy using sign language during intraoperative monitoring. ⋯ We demonstrated using sign language for intraoperative monitoring is feasible in a native deaf and mute patient. We also showed a navigation-assisted minimal transcortical approach to achieve >90% EOR for a pan-hippocampal glioma in a single-stage operation.
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A focused dissection of the brainstem was performed to study the various fiber bundles and gray matter nuclei of the brainstem and to decipher the intricate anatomy. ⋯ This division of the fiber bundles into zones will help neurosurgeons in understanding the course and anatomy of the fibers, which can be cumbersome to remember when only studying the sectional anatomy of the brainstem.
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Observational Study
Perioperative Risk Factors for Early Revisions in Stand-alone Lateral Lumbar Interbody Fusion.
Lateral lumbar interbody fusion can be performed without supplemental posterior instrumentation. Previous reports have shown favorable results with stand-alone lateral lumbar interbody fusion (SA-LLIF); however, a reoperation rate of up to 26% has been reported. It remains unclear what perioperative factors are associated with early failure after SA-LLIF. The objective of this study is to determine perioperative factors that increase the risk of early revisions after SA-LLIF. ⋯ Patients with foraminal stenosis were more likely to have early revision surgery after SA-LLIF primarily because of neurologic symptoms/pain. This information can assist in preoperative discussions and management of patient expectations.