World Neurosurg
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Numerous randomized controlled trials have identified risk factors increasing the postoperative recurrence of chronic subdural hematoma (CSDH). Postoperative subdural air is frequently seen on computed tomography imaging. The aim of this study was to test the hypothesis that the presence of significant subdural air postoperatively is related to recurrence of CSDH after burr-hole surgery. ⋯ Although this is a pilot study, it is suggested that significant postoperative subdural air increases recurrence after initial burr-hole surgery for CSDH in adults ≥75 years of age.
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The standard way of isolating bypass vessels from surrounding structures during cerebral bypass surgery has been to use a rubber dam or neurosurgical patty. Here, the use of polyvinyl alcohol (PVA) sponges is described as a possible upgrade from these traditional bypass dams. ⋯ Although preliminary, our experience using PVA sponges during microvascular anastomosis suggests some of their properties can facilitate cerebral bypass surgery.
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The color change of topical intranasal fluorescein has been used to confirm the presence of cerebrospinal fluid (CSF) during endoscopic endonasal surgery. We aimed to validate the use of topical intranasal fluorescein for CSF detection. ⋯ Color change alone is not sufficient to determine a difference between CSF, saliva, and saline. Blood, however, is readily identified using this method. Adjunct characteristics, in addition to the color change, are necessary to properly identify an active CSF leak.
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Cavernous malformations of the third ventricle are rare, deep-seated lesions that pose a formidable surgical challenge due to the rich, surrounding anatomy. Despite the potential morbidity of surgical treatment, the possibility of catastrophic, spontaneous hemorrhage in this location is even more feared and aggressive treatment is warranted, especially if the patient had suffered previous hemorrhages and is currently symptomatic. We demonstrate this approach (Video 1) on a 16-year-old boy who presented with right-sided hemiparesis (power grade 4), intense headaches, difficulties with learning and concentration, and memory loss, mainly affecting short-term memory. ⋯ The patient was also able to return to school after 1 month and showed complete recovery. Unfortunately, neuropsychologic evaluation was unavailable to understand his improvement better. Microsurgical dissection images in this video are a courtesy of the Rhoton Collection, American Association of Neurological Surgeons (AANS)/Neurosurgical Research and Education Foundation (NREF).
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Dropped head syndrome is a morbid condition that affects daily functionality, causing pain and dysphagia and respiratory compromise. Reported causes of dropped head syndrome include neuromuscular disorders, iatrogenic from cervical spine surgery, and idiopathic and postradiation for head and neck cancers. Management of this spinal disorder remains challenging, as the complication rates are high. We present our series of 7 patients who underwent surgical correction of dropped head syndrome, all resulting from radiation for head and neck cancers. ⋯ Surgical correction of postradiation dropped head spinal deformity involving anterior and posterior fixation with osteotomies provides improvement in functional and radiographic outcomes as shown in our series. These cases are technically challenging and have a high rate of perioperative complications. Approaches must be tailored to the patient with attention to their specific surgical and radiation history.