World Neurosurg
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Case Reports
Midbrain cavernous malformation: microsurgical nuances and an anatomoclinical review 2-dimensional video.
Midbrain cavernous malformations (MCMs) are rare and dangerous taken the important structures and tracts located in this segment of the brainstem. MCM treatment is still controversial, and surgical resection is basically indicated in cases of recurrent hemorrhage and progressive neurologic deterioration. The optimal moment to operate ruptured MCM is in the subacute stage. ⋯ His recovery was smooth but he maintained the previous oculomotor nerve palsy. We discuss important steps of the surgical approach, local neuroanatomy, and the microsurgical techniques for the resection of these challenging MCM. The goal is total resection of the MCM with the preservation of the developmental venous anomaly and the surrounding white fiber tracts.
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has been rapid technological advancement in navigation-guided minimally invasive surgery over the past two decades, making these advancements an invaluable aid for surgeons by essentially providing real-time virtual reconstruction of patient anatomy. The objectives of these navigation- and robot-guided procedures are to reduce the likelihood of neural and vascular injury, minimize hospitalization time, decrease bleeding and postoperative pain, shorten healing time, and lower infection rates. ⋯ Comparing minimally invasive spine interventions with free-hand instrumentation and robotic instrumentation, a statistically significant difference was identified in radiation exposure per screw and surgical time. The literature on Cirq Robotic is limited; however, minimally invasive spine surgery with robotic assistance appears advantageous in terms of radiation exposure and surgical time.
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Gunshot wounds to the head (GSWTH) in children remain an underexplored area, and all clinical guidelines extrapolated from adult experiences. A key challenge in treating these patients is age stratification, as pediatric survival rates are notably higher than in adults. The objective of the study is to compare 2 groups of patients based on the severity of their condition and to analyze the impact of various factors on the outcomes of these conditions. ⋯ The findings emphasize the importance of a multifactorial approach in children with GSWTH, highlighting its effectiveness for precise outcome prediction.
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Among several procedures for syringomyelia associated with Chiari type 1 malformation (CM-1), foramen magnum decompression (FMD) with dural splitting is one of the treatment choices with low complication rates. However, some meta-analyses have suggested that FMD with dural splitting may be inferior to FMD with duraplasty based on clinical outcomes; therefore, a predictor of a good surgical outcome with dural splitting is essential. This study aimed to clarify the preoperative parameters for good outcomes in patients with FMD with dural splitting, including the volumetric perspective. ⋯ Vtonsil and Vincr-Vtonsil, which are novel predictors based on the volumetric perspective, might be the optimal predictors for improvement of the syrinx associated with CM-1 by 1 year after surgery.
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Metastasis of World Health Organization (WHO) grade II or grade II meningiomas are rare. The aim of this study was to investigate their incidence, associated risk factors, and treatment course. ⋯ The presence of metastasis contributed to poor outcomes and was related to earlier tumor relapse and major vessel compromise. Subtotal resection should be followed by adjuvant radiotherapy to reduce the risk of metastasis. Further research is warranted to identify circulating or pathologic biomarkers for the early detection of metastasis.