World Neurosurg
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Cushing disease (CD) is a rare clinical disease in which brain structural and function are impaired as the result of excessive cortisol. However, little is known whether rich-club organization changes in patients with CD, as visualized on resting-state magnetic resonance imaging (fMRI), can reverse to normal conditions after transsphenoidal surgery (TSS). In this study, we aimed to investigate whether the functional connectivity of rich-club organization is affected and whether any abnormal changes may reverse after TSS. ⋯ Our results show rich-club organization was disrupted in patients with active CD with excessive cortisol production. TSS can reverse abnormal rich-club connectivity. Rich club may be a new indicator to investigate the outcomes of TSS and to increase our understanding of the effect of excessive cortisol on brain functional connectivity in patients with CD.
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To retrospectively evaluate influence of intraoperative positioning (semisitting vs. lateral decubitus) and surgeon's learning curve with regard to functional outcome of patients with vestibular schwannoma. ⋯ Follow-up over 3 decades illustrates a learning curve with significantly improved results. While the semisitting position accelerates the procedure and is associated with reduced blood loss, it does not significantly influence functional outcome.
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Treatment of lumbosacral tuberculosis is still controversial. In our study, we assessed the efficacy and feasibility of single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation for the treatment of lumbosacral tuberculosis with significant vertebral body loss. ⋯ The combination of single-stage posterior debridement, interbody fusion using structural autografts with a titanium mesh cage, and posterior instrumentation is an effective and safe option for the treatment of lumbosacral tuberculosis with significant vertebral body loss.
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We analyzed cortical landmarks, trajectory of approach, and various fiber tracts in the vicinity of our earlier described approach through the orbital/basal surface of the frontal lobe to access tumors located in the region of the caudate nucleus. We also present a new lateral orbital trajectory to approach these tumors. ⋯ Surgical approach to the caudate head through the orbital surface of the frontal lobe as described by us provides the shortest trajectory and safe surgical route to access tumors of the caudate nucleus.
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Meningiomas of the cavernous sinus (CS) present a neurosurgical challenge. The anatomic complexity of the area can create a potential for injury to neurovascular structures. This has traditionally limited total tumor removal. ⋯ CS surgery for meningioma is feasible with low morbidity and can provide benefits in improving preexisting cranial nerve dysfunction (Video 1).1-4 Complete resection of the CS meningiomas is possible in most cases. CS tumors remain a surgical challenge, but accurate knowledge of surgical neuroanatomy and surgical approaches facilitates their safe and effective treatment. The patient gave informed consent for surgery, use of images, and video publication.