World Neurosurg
-
The purpose of the present study was to investigate the relationship between the intrasellar pressure (ISP) and the microvascular structure of pituitary adenomas. ⋯ In the present study, we found that with the increase in pituitary adenoma size and invasion of the surrounding tissues, the ISP of pituitary adenomas showed a "double-peak" pattern. The ISP and certain parameters of the microvascular structure are related, because the microvasculature adaptively changes its structure in response to the changing ISP to ensure a sufficient blood supply to the adenoma. The specific mechanism of this phenomenon requires further study.
-
Preservation of the anterior arch of C1 in endoscopic endonasal odontoidectomy has been proposed as an alternative to complete C1 arch resections, potentially affording less destabilization of the craniocervical junction. Nonetheless, this approach may limit the decompression achieved. In this case, intraoperative repositioning allowed maximal decompression while preserving the anterior arch of C1. ⋯ In cases of odontoid/atlantoaxial pathology causing significant neural compression, staged intraoperative repositioning can safely maximize the odontoidectomy, while affording preservation of the structural integrity of the anterior arch of C1.
-
Unique challenges can present in the treatment of small to mid-sized meningiomas that arise from the region of the anterior most aspect of the falx cerebri including its junction with the anterior skull base, what we call the far frontal region. Although this region of the anterior skull base is considered in the surgical approach of olfactory groove meningiomas invading this space, important differences exist between these tumors and those of the far frontal region. ⋯ To the best of our knowledge, our anatomic study is distinctively unique in quantifying the working distance of the keyhole superior interhemispheric exposure and refining visualization of the far frontal region. We discuss these benefits and limitations (i.e., substantial involvement of tumor beyond midline) and differences with large meningiomas of the olfactory groove and far frontal region with significant posterior or lateral extension for which conventional exposures are appropriate.
-
The objectives of this study were 1) to assess the long-term patient-reported outcomes of carpal tunnel release (CTR) in patients 80 years of age or older, and 2) to determine the long-term mortality rate of this population after CTR. ⋯ There are long-term benefits from CTR in patients 80 years of age or older. The mortality rate of this cohort mirrors that of the general population, and CTR is justified in this elderly age group both for the magnitude and duration of treatment effect.
-
The best surgical treatment for adult Chiari malformation type 1 remains widely debated. ⋯ Posterior fossa decompression and duraplasty with arachnoid preservation is a beneficial technique to treat Chiari malformation type 1 and reduces the risk of complications, particularly cerebrospinal fluid-related complications and the rate of reoperation.