World Neurosurg
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With the advent of modern endoscopes and a better anatomic understanding of the skull base, the indications of endonasal approaches are increasing. These procedures may be complicated by high rates of postoperative cerebrospinal fluid (CSF) leak, and reconstruction of the defect remains challenging. In the anterior skull base, vascularized grafts have been reported as superior in preventing CSF leakage and infection. The Hadad-Bassagasteguy flap, being a pedicled flap, is our first line flap to reconstruct the skull base. When we were not successful with this flap, we resorted to different flaps. ⋯ We recommend our modified novel temporoparietal myofascial flap as a very good option in case of failed cases of postoperative CSF leak.
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Occipitocervical fusion (OCF) procedures are increasing due to an aging population and the prevalence of trauma, rheumatoid arthritis, and tumors. Reoperation rates and readmission risk factors for cervical fusions have been established, but in relation to OCF they have not been explored. This study investigates the patterns of readmissions and complications following OCF using a national database. ⋯ Nonelective OCF was found to have a readmission rate of almost 2½× that of elective OCF. Understanding risk factors associated with OCF will help with operative planning and patient optimization.
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A 79-year-old man with coronary artery disease and tremor-predominant Parkinson's disease underwent a gross total resection of a high-grade glioma and exhibited what appeared to be polymorphic ventricular tachycardia lasting 15-20 seconds on postoperative day 1. Further evaluation revealed that the patient did not have ventricular tachycardia, and that his abnormal telemetry signals were instead an artifact of his Parkinson's tremor. This case underscores the importance of considering tremor artifact when evaluating abnormal telemetry and electrocardiogram signals in patients with tremor, and highlights some features that can distinguish tremor artifact from a true arrhythmia.
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This case video demonstrates a multidisciplinary approach to resection of a juvenile nasopharyngeal angiofibroma highlighting direct intratumoral onyx embolization. The patient is a 14-year-old boy who presented with a 1-month history of worsening epistaxis and nasal congestion. Preoperative magnetic resonance imaging demonstrated a 4.5 x 3 x 3 cm lobulated mass in the right pterygomaxillary space, sphenoid, and the nasopharynx adjacent to the cavernous carotid. ⋯ The present video demonstrates the technique for safe direct intratumoral onyx embolization and its role in significantly reducing intraoperative blood loss (Video 1). Postoperatively, the patient made an uncomplicated recovery. The patient consented to the procedure.
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There are many approaches to the cerebellopontine angle, all of which involve different degrees of disruption of the normal anatomy. The retromastoid craniotomy has stood the test of time for the efficiency, panoramic exposure, and flexibility it provides while allowing excellent control over the vital cerebrovascular structures including the brainstem. This approach allows the surgeon not to get distracted by how to get there but instead to focus on what to do when he or she is there. Herein, I discuss the nuances of this simple approach with its "extended" variations.