World Neurosurg
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Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive treatment for tuberous sclerosis complex (TSC)-associated epilepsy in children. This video describes a case of a 17-year-old girl with TSC-associated drug-resistant epilepsy treated with robotic-assisted MRgLITT. In our case, MRgLITT was safe and effective in simultaneous targeting of multiple epileptic tubers in 1 single procedure, leading to a marked decrease in seizure frequency. MRgLITT could be a promising and more appealing treatment option for children who may need multiple surgeries over their lifetime as a result of the progressive nature of TSC.
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Hydrocephalus is a common diagnosis worldwide that is treated with shunts and is associated with potential life-threatening risks of shunt dysfunction and infection. We investigated differences in rates of shunt revisions and infections including various factors in patients with different causes of hydrocephalus. We also studied causes of infections and efficacy of perioperative antibiotic regimens. Our objective was to identify patients at risk of higher revision and infection rates after shunt treatment. ⋯ We found revision and infection rates in accordance with other studies. We showed a significantly increased risk in younger patients. Previous shunts also increased the risk of revisions and infections. We showed a small but significant effect of perioperative prophylaxis with broader-spectrum antibiotics compared with cloxacillin. Our study identified a group of younger patients with congenital hydrocephalus and prior implants with an increased risk of shunt infection in whom additional preventive measures should be employed.
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Chiari malformation is a structural defect in the brain, affecting the cerebellum, brainstem, upper cervical cord, and cranial base, with severe cases involving herniation through the foramen magnum. This condition can significantly impact the patient's quality of life. Given the elective nature of surgical treatment for Chiari 1 malformations, many patients seek supplemental information on YouTube. This study aimed to evaluate the quality, accuracy, reliability, and educational value of YouTube videos on Chiari malformation decompression surgery. ⋯ This study highlights the need for improved regulation and the promotion of high-quality medical content on online platforms. Healthcare providers should guide patients toward reliable resources and consider collaborating with content creators to enhance the quality of educational materials available online. Improved oversight and quality control on platforms like YouTube can better support patient education and clinical decision-making.
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Case Reports
Safe endovascular recanalization of internal carotid artery occlusion using retrograde aspiration angiography.
Cerebral infarction, resulting from acute internal carotid artery (ICA) occlusion, typically manifests with a wide ischemic area and severe symptoms. Mechanical thrombectomy proves effective within 24 hours of disease onset and in less ischemic infarction core. However, in cases with well-developed collateral flow and mild symptoms, conservative treatment is initially selected. If symptoms worsen or ipsilateral hemisphere perfusion decreases, superficial temporal artery-middle cerebral artery anastomosis is considered. Revascularization therapy may also be effective. Contralateral angiography allows for ipsilateral blood flow verification once complete revascularization is achieved, albeit with potential treatment-related complications. Here, we describe retrograde angiography using an intermediate catheter (IMC) and contralateral contrast injection to achieve safer revascularization. ⋯ Advancements in IMC technology facilitate distal catheter guidance to the ICA, even in proximal occlusion. Combining this technique with contralateral imaging allows us to confirm the extent of occlusion and recanalization status without antegrade imaging, making recanalization therapy safer.
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Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD). However, infection following DBS surgery is a serious complication that can lead to the recurrence and worsening of Parkinson's symptoms or related hardware reimplantation, causing considerable patient suffering and financial burden. ⋯ Scalp incision infections following DBS surgery can affect deep tissues, and the implementation of a comprehensive treatment strategy involving local debridement and removal of potentially affected implants can significantly reduce the risk of infection recurrence and its spread.