World Neurosurg
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The magnetic resonance imaging sequence used to assess optic canal invasion by tuberculum sella meningiomas (TSMs) has not been standardized. Both constructive interference in steady state (CISS) and contrast-enhanced T1-weighted volume-interpolated breath-hold examination (VIBE) sequences are frequently used. The aim of the present study was to compare the accuracy and interrater reliability of these sequences in predicting optic canal invasion by TSMs. ⋯ CISS and VIBE sequences both have good accuracy in predicting for optic canal tumor invasion by TMEs.
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The purpose of this study was to compare clinical results of microendoscopic laminectomy (MEL) with those of unilateral biportal endoscopic laminectomy (UBEL) in patients with single-level lumbar spinal canal stenosis. ⋯ The UBEL method is a more useful technique than the MEL method as it requires a smaller bone resection area and produces fewer complications.
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Because of involvement of the optic apparatus, craniopharyngiomas frequently present with visual deterioration. Although visual improvement is a primary goal of surgical intervention, prediction models are lacking. ⋯ Patients with reduced preoperative vision, specific radiographic vascular involvement, and gross total resection showed increased odds of visual improvement, whereas the translaminar approach was associated with visual deterioration. Such characteristics may facilitate patient-surgeon counseling and surgical decision making.
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Managing retraction of the lumbar plexus is critical to safely perform lateral lumbar interbody fusion (LLIF) via the transpsoas approach. Occasionally, a transitional psoas is encountered at L4/5 and has been postulated to be a contraindication to transpsoas LLIF. A case series of patients with transitional psoas who underwent L4/5 LLIFs is presented. ⋯ Transitional psoas anatomy is frequently encountered in surgical candidates for L4/5 LLIF. Through careful identification of the lumbar plexus and judicious retraction, the transpsoas LLIF can safely be performed in these patients.
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Case Reports
5-ALA enhanced fluorescence guided microscopic to endoscopic (M2E) resection of deep frontal subcortical GBM.
Glioblastoma multiforme remains the most common adult primary brain tumor with a life expectancy of 15-18 months following best treatment strategies. Current paradigms incorporate maximal safe resection, chemotherapy, and radiation.1 Multiple variables correlate with increased survival; perhaps most notably are stepwise survival advantages following 78% and 98% extent of resection thresholds.2,3 5-Aminolevulinic acid has become a vital tool in the intraoperative identification and differentiation of high-grade glioma as it provides a fluorescent effect capable of distinguishing tumor from normal brain tissue when observed under blue light, which to date has been used primarily via a microscopic light source.4 However, this effect is attenuated with increasing distance between the blue light source and the tumor, as in the case of deep seated resection cavities.5 We aimed to overcome this obstacle by using a blue light endoscope as the primary visualization platform, thereby advancing the light source directly into the resection cavity. We present the case of a 69-year-old man with a deep left frontal subcortical lesion proven to be glioblastoma multiforme on prior biopsy. ⋯ Tumor resection proceeded under direct blue light endoscopy with intermittent subcortical motor mapping until a threshold of 4 mA was reached. The patient had transient right arm and leg weakness. Postoperative magnetic resonance imaging confirmed >98% resection (Video 1).