World Neurosurg
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Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious life-threatening condition with unprecedented impacts for worldwide societies and health care systems. Since the first detection in China, it has spread rapidly worldwide. The increased burden has substantially affected neurosurgical practice and intensive modifications have been required in surgical scheduling, inpatient and outpatient clinics, management of emergency cases, and even in academic activities. ⋯ During surgery, the use of high-speed drills and electrocautery should be reduced to minimize aerosol production. Screening is crucial in all patients because the surgical outcome is highly mortal in patients with COVID-19. All educational and academic conferences can be undertaken as virtual webinars.
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The mainstay treatment for petrous apicitis (Gradenigo's syndrome) is medical management with antibiotics, steroids, and placement of pressure equalization tubes. The role for surgery is limited as second-line treatment if conservative methods have failed. ⋯ To our knowledge, the use of the Kawase approach for petrous apicitis has not been previously reported. In addition, we postulate that surgical intervention can potentially result in quicker recovery of preexisting cranial nerve deficits in medically refractory petrous apicitis. This raises the potential role of earlier surgical intervention.
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Traumatic intracranial aneurysms are rare complications after head trauma. This report describes the case of a patient with a traumatic pericallosal aneurysm. ⋯ We performed parent artery occlusion for a traumatic aneurysm of the pericallosal artery without complications. Pericallosal aneurysms are rare, but we must consider them when encountering a delayed hematoma around the corpus callosum.
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Although the tentorial branch of the superior cerebellar artery (SCA) was reported to be a frequent finding in living subjects in 1 study, its clinical relevance, especially in surgery for aneurysms, has not been elucidated. We present our experience with the tentorial branch of the SCA identified during surgical intervention of a distal SCA aneurysm and discuss its clinical relevance. ⋯ This is the first report to our knowledge of a clinical association of the tentorial branch of the SCA with a distal SCA aneurysm, which played an important role in achieving complete obliteration of the aneurysm. The recognition of this small artery is potentially important for successful cure of distal SCA aneurysms.
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Review Meta Analysis
Surgical Outcomes with Midline Vs. Lateral Approaches for Cranial Base Chordomas: A Systematic Review and Meta-Analysis.
Cranial base chordomas are complex lesions centered on the clivus that surgically can be approached from either a midline or a lateral corridor. ⋯ The meta-analysis did not show any significant difference in GTR or recurrence rates between the midline versus lateral approaches. Tumor extension to different compartments did not affect the GTR or recurrence rates with either approach. In terms of complications, CSF leak rate was higher in midline approaches and cranial nerve palsy was higher in lateral approaches.