World Neurosurg
-
Arteriovenous malformations (AVMs) are a highly complex array of abnormal arteries and veins that directly fistulize without intervening capillary beds.1 As AVMs can differ in size, location, and morphology, specific clinical management is determined for each individual patient, in conjunction with their specific goals and needs.2 This Video demonstrates the resection of an AVM located in the language area of eloquent cortex of a 38-year-old opera singer. The patient presented to the emergency department with a new-onset seizure. Magnetic resonance imaging including task-based functional imaging demonstrated a left post temporal AVM with associated hemosiderin-stained white matter and language activation just posterior to the lesion. ⋯ At follow-up, the patient was clinically intact, seizure free, and off all antiepileptic medications. At 3 months, she resumed her career as an opera singer. Awake resection with intraoperative functional mapping can be used for select small AVMs to avoid injury to functional tissue and allow more aggressive resection of potentially epileptogenic tissue.
-
Case Reports
ANTERIOR PETROSAL APPROACH TO PETROUS APEX MENINGIOMA: CLIMBING THE ROCK. 2-D OPERATIVE VIDEO.
A 47-year-old woman was referred to the neurological surgery department after a self-limiting episode of dizziness and headache. Magnetic resonance imaging showed an extra-axial mass in the right petrous apex, suggesting a meningioma. We chose the anterior petrosal approach (APA) because meningioma is a benign tumor with brainstem compression, and our goal was total removal for potential cure of the disease. ⋯ Limitations are the longer distance, nasal disturbances, middle fossa dural tail removal, and cerebrospinal fluid fistula.1-8 We performed the APA through a suprapetrous craniotomy, which exposes the petrous temporal portion, to drill the posteromedial triangle of the middle fossa to create a surgical corridor to the posterior fossa after splitting the tentorium.1-8 Removal of the tumor through the APA leads to a direct route to the petrous apex, with short distance and predominant extradural dissection. We achieved gross total removal. The patient presented with transient cranial nerve IV and V disturbances, but recovered entirely in 6 weeks, returning to her professional activities with preserved quality of life (Video 1).
-
In this paper, we shed the light on Beirut's blast that took place in the coronavirus disease 2019 (COVID-19) era. An explosion that ripped the heart of Beirut, it produced a destructive shock wave that left thousands of casualties and people homeless. This explosion, which had a mushroom-like cloud appearance similar to that of Hiroshima and Nagasaki, was described as the third-biggest explosion in human history. It was a blast that not only destroyed lives but also fell as a heavy burden on the shoulders of a country that was suffering from unprecedented economic crisis on top of the COVID-19 pandemic. Facing all this, health care providers were the first line of defense in what looked like an impossible mission. ⋯ The rate-limiting step in such disasters is definitely a well-prepared trained team with a prompt and fast response. And, since time is brain, then what saves the brain is proper timing.
-
Our study evaluates minimum clinically important difference (MCID) achievement for back pain/leg pain/disability and meeting preoperative expectations as predictors of patient satisfaction after minimally invasive lumbar decompression (MIS-LD) surgery. ⋯ Pain/disability improved after MIS-LD; improvement was strongly correlated with postoperative satisfaction. Meeting expectations/MCID achievement is associated with satisfaction. MCID achievement was equivalent to meeting expectations in predicting satisfaction at all postoperative time points for pain/disability.
-
We aimed to quantify the need for additional surgery in patients with chronic subdural hematoma (CSDH) primarily treated with dexamethasone and to identify patient characteristics associated with additional surgery. ⋯ More than one-third of patients with CSDH primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas.