World Neurosurg
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Despite the benefits of anterior temporal lobectomy with amygdalohippocampectomy in patients with temporal lobe epilepsy (TLE), approximately up to 5% may have hemiparesis as its postoperative complication. This paper aims to describe which step/s of the anterior temporal lobectomy with amygdalohippocampectomy have the highest probability of having the greatest decrease in motor evoked potential (MEP) amplitude. ⋯ MEP amplitude tends to decrease during amygdala, hippocampal, and uncal resection because of surgical manipulation of anterior choroidal arteries, which can potentially cause hemiparesis. Careful attention should be paid to changes in MEP during these steps.
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Traumatic brain injury (TBI) is a major cause of physical disabilities worldwide. Herein, we aimed to investigate the factors contributing to post-discharge recovery in patients who were discharged with an unfavorable outcome. ⋯ This study found that the majority of patients discharged with an unfavorable functional status were able to achieve a favorable outcome within 6 months. The novel post-discharge recovery in TBI patients might be a useful tool for illuminating the factors associated with a significant improvement after discharge.
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Cerebrospinal fluid (CSF) leak during endoscopic endonasal transsphenoidal surgery can lead to postoperative complications. The clinical and anatomic risk factors of intraoperative CSF leak are not well defined. We applied a two-dimensional (2D) convolutional neural network (CNN) machine learning model to identify risk factors from preoperative magnetic resonance imaging. ⋯ Further review of the class activation mapping gradients revealed regions of the diaphragma sellae, clinoid processes, temporal horns, and optic nerves to have anatomic correlation to intraoperative CSF leak risk. Additionally, visual disturbances from anatomic compression of the optic chiasm were the only identified clinical risk factor. Our 2D CNN model can help a treating team to better anticipate and prepare for intraoperative CSF leak.
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This study compared the effectiveness of the endoscopic endonasal approach (EEA) with the conventional transcranial approach (TCA) for treating tuberculum sellae meningiomas (TSMs), aiming to identify the superior surgical method and the risk factors affecting outcomes. ⋯ EEA is a safe and effective treatment approach for small to medium TSMs, with outcomes comparable to TCA in terms of resection but superior in visual improvement and fewer complications. Selection of surgical approach should consider patient and tumor characteristics as well as surgeon experience.
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Acute rupture and hemorrhage of pediatric brain arteriovenous malformations (AVMs) may lead to cerebral herniation or intractable intracranial hypertension, necessitating emerging surgical interventions to alleviate intracranial pressure. However, there is still controversy regarding the timing of treatment for ruptured AVMs. This study aimed to assess the feasibility of utilizing three-pillar expansive craniotomy (3PEC) at different times during the treatment of pediatric ruptured supratentorial AVMs. ⋯ Emergency intervention with 3PEC in children experiencing acutely ruptured supratentorial AVMs appears to be feasible. For children requiring delayed management of the AVMs, 3PEC may diminish the risk of rebleeding during the waiting period and shorten the waiting period.