World Neurosurg
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Subinternships are critical experiences for medical students applying into neurosurgery to acquire knowledge of the field and network with colleagues. During the coronavirus disease 2019 pandemic, in-person rotations were suspended for 2020 and reduced for 2021. In 2020, our department developed a neurosurgical course to address this need. The course was continued in 2021, enabling assessment of student perceptions as the pandemic progresses. ⋯ Survey results suggest that the course adds value for students seeking a basic didactic curriculum to supplement their education, and perhaps, an online curriculum for medical students would still be beneficial going forward as in-person rotations resume.
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To evaluate the pathomechanism of the recurrence of intracranial germinoma after complete response and to confirm the association of the initial magnetic resonance imaging and therapeutic factors with recurrence. ⋯ RT including the whole-ventricle system reduces delayed craniospinal relapses including dissemination, local, and distant recurrences even ≥5 years after complete response in patients with primary central nervous system germinoma.
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To explore the worldwide impact of a virtual neurosurgery-neuroscience lecture series on optimizing neurosurgical education with tele-teaching. ⋯ The COVID-19 pandemic has increased the need to introduce new educational approaches for teaching novel ways to optimize patient care. Our multidisciplinary Web-based virtual lecture series could represent an innovative tele-teaching platform in neurosurgical training.
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Case Reports
Staged and Combined Approach for Resection of Giant Posterior Fossa and Temporal Bone Schwannoma.
Vestibular schwannomas have an estimated incidence of 1.09/100,000 people, representing 6%-10% of intracranial tumors.1-4 Rarer giant vestibular schwannomas are defined by an extrameatal diameter of ≥4 cm and can be difficult to treat because of displacement and compression of local neurovasculature and the potential for multicompartment involvement. A 20-year-old woman with history of presumed right-sided Bell palsy and unexplained hearing loss was found to have a 9 × 8 × 6-cm giant posterior fossa schwannoma on syncopal workup (Video 1). It extended from the Meckel cave anterosuperiorly to below the skull base through the jugular foramen, filling the petrous apex and compressing the cerebellum, pons, and midbrain. ⋯ Closure included an autologous fat and synthetic cranioplasty. The patient was neurologically stable postoperatively, except for transient swallowing difficulty due to partial cranial nerve IX/X palsies. This case illustrates important considerations when combining surgical approaches for complex tumors involving multiple intracranial compartments.
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It is estimated within the western population that 10%-13% of patients possess multiple intracranial aneurysms1 and are linked to certain risk factors. Thrombotic aneurysms are a rare subgroup of complex aneurysms characterized by an organized intraluminal thrombus.2,3 They differ from typical saccular aneurysms in terms of morphology, natural history, symptomatology, and difficulty in treatment with conventional strategies.2,4 The risk of rupture is poorly characterized and assumed to be comparable with that of nonthrombotic aneurysms.2 A subset of thrombotic aneurysms can be treated surgically with conventional clipping, and direct clipping has been associated with the best surgical outcome.2 Despite its safety, endovascular treatment is associated with a high risk of recurrence and retreatment compared with surgical treatment,5 with recanalization rates up to 5× higher compared with nonthrombosed aneurysms.6,7 A 64-year-old male presented with headaches and dizziness for 6 months. He was neurologically intact. ⋯ Achieving adequate proximal control and meticulous dissection of the branches is necessary before reconstruction. We present a 2-dimensional video demonstrating the surgical steps of clipping and reconstruction of the giant thrombosed middle cerebral artery aneurysm. Complete occlusion was achieved, and the patient tolerated the operation well with an uneventful postoperative course.