World Neurosurg
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Intracranial tuberculomas (IT) are often misdiagnosed or overdiagnosed, resulting either in delay in treatment of this curable illness or in unnecessary surgical intervention. A new method of diagnostic criteria for preoperative diagnosis of IT is proposed. ⋯ We suggest that empirical antituberculous treatment should be started in a patient without the need for invasive surgery if our criteria are met. If the criteria are not met, we suggest further evaluation of the patient for an alternative diagnosis or early surgery for definitive management. Surgery decreases the duration of antituberculous treatment and helps in early resolution of lesions.
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Case Reports
Calcifying pseudoneoplasm of the neuraxis (CAPNON) in the posterior third ventricle - a challenge for neuroendoscopy.
We report the first case of a purely intraventricular calcifying pseudoneoplasm of neuraxis (CAPNON) in the posterior third ventricle. ⋯ When encountering such calcified lesions within the ventricular system, especially in proximity to eloquent regions, the decision making process should include the hard consistency and parenchymal adhesions as obstacles to neuroendoscopic removal. Even for biopsy, a higher morbidity rate compared with typical soft tumors should be assumed. Although data on intraventricular CAPNON is limited, biopsy of the lesion and treatment of associated hydrocephalus appear to be the primary neurosurgical goals, followed by imaging surveillance.
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The operative microscope, a commonly used tool in neurosurgery, is critical in many supratentorial tumor cases. However, use of operating microscope for supratentorial tumor varies by surgeon. ⋯ Use of operative microscope for supratentorial resections varies by state and is associated with higher cost of surgery. Microscope use may be associated with lower rates of intraoperative cerebral edema and some cerebrovascular complications, but is not associated with significant differences in other complications, readmissions, or 30-day costs.
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Congenital anatomic variations exist in human anatomy, which create both diagnostic and treatment challenges. Understanding the osteologic and radiographic anatomy of supernumerary ribs arising from the cervical spine and recognizing the morphologic variations thereof is of great importance to clinicians, radiologists, and surgeons alike. ⋯ The present report refers to the osteologic and radiographic description and comparison of a unilateral, right-sided CR synostosis to a first thoracic rib. The clinical implications of CRs may consist of neurologic, vascular complications, and functional deficits of the involved limb associated with thoracic outlet syndrome (TOS). A CR synostosis to the first thoracic rib represents an associated increased risk of vascular injury, with poorer operative outcomes associated with TOS. This case study is of particular importance to vascular surgeons and neurosurgeons involved with surgical planning and intervention strategies relating to CRs and TOS.