World Neurosurg
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Spinal hemangiomas are common primary tumors of the vertebrae. Although these tumors are most frequently benign and asymptomatic, they can rarely exhibit aggressive growth and invasion into neighboring structures. Treatment for these aggressive variants is controversial, often involving surgery, chemotherapy, and/or radiotherapy. This study sought to investigate current trends affecting overall survival (OS) using the National Cancer Database (NCDB) and to formulate treatment recommendations. ⋯ This retrospective analysis finding that treatment with surgical resection and/or radiotherapy is associated with increased OS constitutes the largest cohort of patients with aggressive vertebral hemangiomas to date. Given that the mean OS of the study cohort was 1.94 years, our findings suggest that the optimal treatment regimen to maximize survival should consist of early surgical resection with adjuvant high-dose radiotherapy.
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Case Reports
Preventive Effect of Bypass Surgery on Rebleeding in Patients with Hemorrhagic Twig-like Middle Cerebral Artery.
Aplastic or twiglike middle cerebral artery (Ap/T-MCA) is a rare cerebrovascular anomaly correlated to stroke. The most common characteristic of the disease is intracerebral hemorrhage. However, treatment measures that can prevent rebleeding have not yet been established. ⋯ EC-IC bypass may be a treatment option that can prevent rebleeding in patients with hemorrhagic Ap/T-MCA.
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In our technical note, we have presented a technique of cranioplasty for large skull defects. ⋯ The presented technique is simple, safe, and time- and cost-effective. The technique and results are reproducible.
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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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Case Reports
Comprehensive Diagnosis and Surgical Management of Cushing's Disease: 2-Dimensional Angiographic and Operative Video.
Cushing disease (CD), or hypercortisolemia secondary to an adrenocorticotropic hormone-secreting (ACTH-secreting) pituitary adenoma, is the most common etiology of noniatrogenic Cushing syndrome.1 The diagnostic algorithm employed in the patient with suspected CD is complex and includes consideration for inferior petrosal sinus sampling (IPSS).2,3 When workup is consistent with CD, extracapsular resection of the ACTH-secreting pituitary adenoma through the endonasal corridor is the preferred operative strategy.4 In this publication, we discuss the case of a 26-year-old woman who presented with 9 months of weight gain (Video 1). Initial labs, including low- and high-dose dexamethasone suppression tests, were consistent with CD. Findings on dynamic magnetic resonance imaging were suggestive of a left 2-mm microadenoma. ⋯ Following surgery, the patient required glucocorticoid supplementation after her cortisol levels decreased to 2 ug/dL the evening of surgery. Subsequent laboratory analysis has been consistent with hormonal cure.5,6 The accompanying video manuscript describes 1) preoperative diagnostic evaluation of the patient with suspected CD, 2) indications for and techniques of IPSS, 3) nuances of endoscopic transsphenoidal surgical management, and 4) relevant considerations in postoperative care. Of note, full patient consent for photography and/or recording of other forms of video/imaging was obtained in the preoperative period.7-10.