World Neurosurg
-
Peripheral nerve surgery is one of the smallest neurosurgical subspecialties. It is hypothesized that the number of neurosurgeons performing these procedures has declined over the last decade due to many factors, including limited training opportunities and lower compensation relative to other subspecialties. ⋯ Despite an overall increase in number of PNSPs, the percentage of PNSPs performed by neurosurgeons decreased from 2012 to 2019. There was overall workforce exit among neurosurgical peripheral nerve specialists over time. From 2000 to 2020, the average reimbursement for most PNSPs has decreased. Further investigation is needed to establish factors contributing to these trends and how they may be mitigated.
-
Case Reports
Pure Intrasellar Meningioma Mimicking Pituitary Adenoma: A Novel Neuroradiologic Finding.
Pure intrasellar meningioma is an extremely rare tumor that is difficult to diagnose as it resembles a pituitary adenoma in its clinical, endocrinologic, and radiologic presentation; it can only be distinguished through histopathologic examination. All previously reported cases of this lesion were considered those of pituitary adenoma at the initial diagnosis. ⋯ We report a case of a pure intrasellar meningioma in a 27-year-old man. A boundary between the tumor and pituitary gland may be evident on magnetic resonance imaging, thus enhancing the diagnosis of pure intrasellar meningioma.
-
Case Reports
Chronic encapsulated expanding hematoma after gamma knife thalamotomy for essential tremor.
There have been no previous reports of chronic encapsulated expanding hematoma after Gamma Knife thalamotomy. The present case underwent Gamma Knife thalamotomy for essential tremor at the age of 78 years. Three- and 12-month posttreatment magnetic resonance imaging (MRI) showed small T2 high-intensity lesions on the target and along with the internal capsule. ⋯ MRI findings suggested a radiation-induced cavernoma. Hemiparesis, dysesthesia, and pain on the right side of the body persisted even after steroid therapy for several months. Long-term careful observation is necessary after Gamma Knife thalamotomy.
-
In the management of cerebrospinal fluid (CSF) leak, the identification of the exact discharge spot is paramount. This process can represent a challenge for the radiologist and the surgeon. In the present study, we analyzed a series of patients affected by endonasal CSF leak who underwent endoscopic surgical reconstruction aided by the use of ITF. The purpose of this work is to assess the efficacy of intraoperative ITF in addition to computed tomography (CT) and magnetic resonance imaging for correct topographic localization of the CSF leak. ⋯ Our data show the usefulness and safety of intraoperative ITF for management of patients affected by endonasal CSF leak. ITF improved the topographic diagnosis of the leak site, ensuring the best target reconstruction and very low recurrence rate.
-
Risk factors of ventriculostomy-associated infection (VAI) reported in the literature are variable owing to heterogeneity of external ventricular drainage (EVD) procedures and management. This study aimed to assess the rate of VAI and its risk factors. ⋯ Intraoperative ventriculostomy was independently associated with VAI. Prophylactic EVD exchange at 12.6 days did not lower VAI rate.