World Neurosurg
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The expanded endoscopic endonasal approach (EEA) is currently well accepted for a variety of ventral skull base tumors. Such an approach often results in a transdural defect and intraoperative cerebrospinal fluid (CSF) leak, and adequate reconstruction is necessary to prevent postoperative CSF leak and its complications. Reconstruction is usually performed using a variety of materials along with the nasoseptal flap. ⋯ The SGS technique provides a simple reconstructive technique in conjunction with the nasoseptal flap, showing a tendency of lower complications when compared with our standard technique while avoiding donor site morbidity. Such results are encouraging, but further studies are necessary to confirm these findings.
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Surgical site infection (SSI) is a significant cause of postoperative morbidity and mortality. As oncologic care advances, the use of surgical adjuncts such as intraoperative ultrasound (US), 5-aminolevulinic acid (5-ALA), and neurophysiologic monitoring has increased. This study set out to identify whether the use of surgical adjuncts in supratentorial tumor surgery lead to increased operative time or increased rates of SSI. ⋯ This study adds reassurance that although some surgical adjuncts lead to increased operative times, in our study there was no apparent increased risk of infection as a result of this.
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Currently, the treatment of spontaneous intracerebral hemorrhage (sICH) is limiting, especially in patients with midline shift and supratentorial hemorrhage. Here, we investigated the clinical value of minimally invasive surgery (MIS) in patients with midline shift and supratentorial sICH by observing the consciousness state, midline shift, and short-term mortality. ⋯ MIS could reduce early-stage midline shift, improve consciousness state and reduce short-term mortality in patients with supratentorial sICH.
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Elective insertion of intracranial pressure (ICP) monitoring bolts is useful for the diagnosis and treatment of disorders of cerebrospinal fluid dynamics. Patients typically report severe discomfort on bolt removal, which negatively impacts overall patient satisfaction of ICP monitoring. We assessed the efficacy and safety of using supratrochlear and supraorbital nerve block-a commonly used form of scalp anesthesia-alongside oral analgesia before bolt removal. ⋯ We conclude that regional supraorbital and supratrochlear nerve block is a simple, safe, and effective adjunct to minimizing discomfort during bolt removal and improving overall patient satisfaction of ICP monitoring.
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Chondrosarcoma and chordoma are often grouped together because of their similar anatomic locations, clinical presentations, histopathological and radiological findings, and growth patterns. In the present study, we investigated the clinical and prognostic differences of chondrosarcomas and chordomas of the skull base and spine. ⋯ Chondrosarcomas and chordomas have divergent clinical manifestations and prognoses depending on the anatomic location.