World Neurosurg
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Comparative Study
Three-Dimensional Versus Two-Dimensional Endoscopic Third Ventriculostomy: Surgical Results Of A Preliminary Comparative Study.
Three-dimensional (3-D) endoscopes have been widely used for a large variety of approaches in neurosurgical practice. However, in the last decade, 3-D scopes were barely used for ventricular surgery. In this study, we illustrated our preliminary experience with a 3-D endoscope for third ventriculostomy using new dedicated endoscopic equipment. ⋯ Our preliminary study clearly demonstrated the effectiveness of 3-D ETV and provided a significant reduction of operative time. Depth information from the 3-D scope appears to facilitate rapid and stable ETV maneuvers, representing a critical development that may become a valuable tool for neuroendoscopy.
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Cannulation of lateral ventricles via a posterior approach is a common neurosurgical procedure. It is often believed that a single entry and fiducial point applies to all. No importance is given to skull shape variations, which can lead to wrong shunt positions and revisions. ⋯ No magical external entry point uniformly applicable for all cases exists. Hence, there is a need to classify skulls according to shapes/ratios and to use a tailored approach for a freehand pass to cannulate the ventricles.
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Ependymomas are the most common adult intramedullary spinal tumors.1 Although uncommon in the brainstem, ependymomas make up a large proportion of tumors of this location.2-8 We present an operative video case report of an intrinsic ependymoma at the cervicomedullary junction. The purpose of this report is to present the clinical picture, operative setup, and surgical technique involved in resection of an intramedullary tumor of this region. For best outcome for intramedullary ependymomas, the goal should be gross total resection.1,9,10 These tumors have a relatively distinct plane between tumor and normal parenchyma, making a gross total resection more probable than cases of infiltrative intramedullary astrocytomas.11 Despite this, significant morbidity can be associated with treatment.1 Proper microsurgical technique with use of operative adjuncts can maximize resection while minimizing neurologic injury to optimize outcomes in patients. ⋯ Postoperative magnetic resonance imaging revealed a small amount of residual. He underwent full craniospinal proton beam therapy with boost to the residual and metastases with good outcome. Patient provided consent for this report.
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Complications in spinal deformity surgery vary from insignificant to severe. Apart from direct mechanical insult, ischemia can also cause spinal cord injury. Ischemic injury may be detected during surgery or may manifest itself postoperatively. We present 2 cases of anterior spinal artery syndrome. ⋯ Anterior spinal artery syndrome is a serious condition with a generally poor prognosis. Though treatment should be directed at the underlying cause, the best strategy is to prevent it from occurring. Peroperative blood pressure control, intraoperative neuromonitoring, avoidance from mechanical stress during surgery, and close neurologic and hemodynamic monitorization postoperatively should be performed.
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Although still recommended, using intravenous tissue plasminogen activator (IV-tPA) for large vessel occlusions (LVOs) has been questioned in the era of mechanical thrombectomy (MT). We sought to determine the impact of IV-tPA if used before MT. ⋯ IV-tPA administration for LVO has a low rate of primary recanalization with risk of distal embolic phenomenon often still requiring MT. No significant changes in patient outcomes were noted in this study due to clot migration. Larger studies will be necessary to determine if IV-tPA plus MT truly benefits entire clot removal versus MT alone.