World Neurosurg
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To clarify a rational surgical priority, clinical characteristics were compared between brain metastases (BM) from renal cell carcinoma (RCC) and other cancers. ⋯ Generally, symptomatic BM were indicated for surgery. BM from RCC were characteristically single, low-volume lesions with expanding edema and intratumoral hemorrhage, causing symptoms. These results suggest that surgery should be a high priority for BM from RCC.
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Most patients with microprolactinomas require lifetime treatment with a dopamine agonist. Many patients in our center have sought endoscopic transsphenoidal surgery as an alternative therapy. ⋯ According to our findings, endoscopic transsphenoidal surgery performed on patients with microprolactinomas at advanced pituitary tumor centers could be an option with high success rates and low complications. Moreover, improving magnetic resonance imaging techniques and/or multidisciplinary team discussion before surgery for microprolactinoma could improve tumor remission after surgery.
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To objectively correlate distortions of optic apparatus morphology in patients with pituitary adenomas undergoing trans-sphenoidal surgery. ⋯ Anatomic realignment of the optic apparatus 3 months following trans-sphenoidal surgery predicts VF scores, but not VA or TV scores at 1-year follow-up. Patients with preoperative ONKA values of more than 139.3° have a 76% chance of achieving normal TV scores 1 year after surgery. Postoperative chiasm sag appears to be clinically irrelevant at short-term follow-up.
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Anterior cervical discectomy and fusion (ACDF) is the gold standard approach for surgical management of many manifestations of cervical spine pathology. In recent years, total disc replacement (TDR) has emerged as a motion preserving modality that is proposed to decrease the rate of adjacent segment disease (ASD). In patients with multi-level disease, hybrid constructs with ACDF at 1 level and TDR at an adjacent level have been performed with success. ⋯ Multiple surgical options were discussed with the patient including multi-level anterior fusion, posterior laminoplasty, and posterior decompression and fusion.4-6 Following discussion of risks, benefits, and alternatives, the patient consented to the anterior hybrid approach. The patient underwent an uncomplicated hybrid anterior fusion and disc arthroplasty and was discharged home on postoperative day 1. The present video serves as technique guide and case study of a non-contiguous construct with satisfactory motion preservation and clinical outcome (Video 1).
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Neuroendoscopic surgeries require specialized equipment, which may not be universally available or equitably distributed in most neurosurgical units of resource-limited healthcare systems. This review reports on the use of locally available resources to perform safe ventricular endoscopic surgeries in patients with hydrocephalus and cystic craniopharyngioma in a resource-limited healthcare system. ⋯ Patients accessing neurosurgical care in resource-limited healthcare systems can benefit from safe and successful intraventricular endoscopy. However, this may require the innovative use of locally available resources that can be adapted to local neurosurgical needs.