World Neurosurg
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Posterior fossa hemangioblastomas usually consist of a small solid nodule with a large cyst, while more rarely they present as a large solid mass with a small or absent cyst, which can be surgically challenging. We sought to investigate the potential existence of multiple distinct hemangioblastoma populations using tumor volumetric data as an indicator. ⋯ This study has shown preliminary evidence that large solid hemangioblastomas may constitute a completely distinct population, rather than a variant of one large group of hemangioblastomas.
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The relationship of preoperative malnutrition with perioperative adverse medical events (PAMEs) has not been well studied in elderly patients undergoing spinal surgery (SS). We aimed to compare the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, and Geriatric Nutritional Risk Index (GNRI) for prediction of PAMEs in elderly patients undergoing SS. ⋯ Preoperative malnutrition is associated with PAMEs in elderly patients undergoing SS. GNRI had the highest accuracy for predicting PAMEs among the nutritional indices studied.
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In this study, we evaluated the changes in resting-state networks (RSNs) under anesthesia in neurosurgical patients. ⋯ Different RSNs could be identified under anesthesia and used for intraoperative brain mapping and remapping during tumor resection. However, RSNs showed a significant decrease in connectivity with the continuation of anesthesia.
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Case Reports
Temporoparietal fascia flap endonasal transposition in skull base reconstruction: surgical technique.
Reconstruction of wide skull base defects resulting from multimodal treatment of cranial base malignancies are challenging.1 Endonasal pedicled flaps (e.g., Hadad-Bassagusteguy flap)1,2 are generally the first choice; however, inadequacy for the size and location of the defect or their unavailability are common occurrences in salvage reconstructions, and prior irradiation is an additional unfavorable condition for local flap viability. The temporoparietal fascia flap (TPFF)3 is a regional flap vascularized by the superficial temporal artery, which is able to survive and integrate even in postirradiated areas. Its properties, such as thinness, pliability, foldability, and the long pedicle, make it a versatile flap for reconstruction of various defects of the skull base, both in adults3-7 and children.8 In lateral skull surgery, TPFF proved to be effective in patients at higher risk of cerebrospinal fluid leak,7 whereas its transposition into the nasal cavity through a temporal-infratemporal tunnel has been widely reported to repair defects of the ventral skull base.3-6 It represents a safe and effective technique with minimal additional morbidity (potential alopecia or scalp necrosis).4,5 A recently described modification of this technique supports TPFF transposition via a supraorbital epidural corridor to reach the anterior skull base, especially for large defects with supraorbital extension.6 The present video (Video 1) shows the step-by-step TPFF harvesting and endonasal transposition via a temporal-infratemporal tunnel to repair a wide middle cranial fossa defect resulting from osteoradionecrosis after endoscopic resection and heavy-particle radiation therapy for sinonasal adenoid-cystic carcinoma. At 6-months follow-up, optimal healing without complications was observed.
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Arachnoid cysts are responsible for 1% of expansive lesions in the central nervous system. Usually, they do not cause neurologic symptoms unless they have expansion or hemorrhage. Intracystic bleeding is caused by trauma or may be spontaneous. ⋯ Despite being asymptomatic, the hematoma was determined to have significant mass effect; thus, it was evacuated by a parietal burr-hole. After 1 month, another MRI showed resolution of the frontoparietal hematoma and significant reduction in the arachnoid cyst. There are few cases described of spontaneous rupture of arachnoid cyst; beyond that, we would like to illustrate a step-by-step procedure that is not widely available as a video article.