World Neurosurg
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The dorsal midbrain, an anatomically intricate region, presents significant challenges for traditional surgical interventions due to the heightened risk of vascular and neurological injury, and the necessity of brain tissue retraction. ⋯ The EOTA constitutes a significant advancement in neurosurgical techniques for the resection of dorsal midbrain tumors, enhancing surgical precision and safety. This approach contributes to improved patient outcomes and a reduction in complication rates. Further studies are warranted to validate these findings and to establish standardized protocols for the application of EOTA in midbrain tumor resection.
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Cavernous carotid aneurysms are typically small, asymptomatic, and often do not require treatment. We present the case of a 59-year-old woman, a 3-pack-a-day smoker, who presented with the primary complaint of left retro-orbital pain, left complete ophthalmoplegia, left-sided blindness, and right abducens palsy. Imaging revealed a giant right cavernous carotid aneurysm, which had expanded to the contralateral cavernous sinus wall and superiorly through the diaphragm sellae. ⋯ Postoperative computerized tomography angiography confirmed placement of the clips and patency of the vessel. At short-term follow-up, the patient's trigeminal pain had successfully resolved and she had retained vision in the right eye. This case demonstrates the feasibility of expanded endonasal approaches in managing this challenging pathology (Video 1).
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To determine the incidence of subdural hygroma (SDH) on routine early postoperative imaging following foramen magnum decompression (FMD) with dural opening in patients with Chiari 1 malformation (CM1). ⋯ SDH is a common finding in the early postoperative scans of patients undergoing FMD and dural opening for CM1. While nearly two-thirds of these patients are asymptomatic, SDH with ventriculomegaly can be associated with mortality and significant morbidity and may require emergency treatment.
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Aneurysmal subarachnoid hemorrhage (aSAH) has a high complications burden, with in-hospital mortality as the most devastating outcome. We aimed to develop and validate a risk score for early prediction of in-hospital mortality after aSAH. ⋯ Risk of in-hospital mortality after aSAH can be predicted with high accuracy using baseline characteristics. The novel risk score showed best diagnostic performance in the construction and validation cohorts and can aid in early prognostication and treatment decisions.
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Revision surgery of microvascular decompression for hemifacial spasm: 2-Dimensional operative video.
Although microvascular decompression is highly effective for treating hemifacial spasm, cases of ineffectiveness and recurrence can still occur. Ineffectiveness is primarily due to missed neurovascular compression (NVC), whereas recurrence is most often caused by adhesion of Teflon pledgets (Chestmedical Co., Ltd., Shanghai, China), both of which may necessitate revision surgery.1,2 However, adhesions in the surgical area make revision surgeries more difficult. This video presentation includes 2 cases of revision surgery for hemifacial spasm (Video 1). ⋯ The second case involved a missed NVC, where the pledget was improperly placed between the artery and the cisternal portion of the facial nerve during the initial surgery, overlooking compression at the REZ, an error more common in less experienced centers. Subsequent decompression of the REZ resulted in full symptom relief. Our experience highlights the importance of thorough decompression of the REZ while ensuring the pledget does not come into direct contact with the REZ to prevent long-term adhesions and recurrent hemifacial spasm.