World Neurosurg
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To delineate the most recommendable treatment of spontaneous intracerebral hemorrhages and the indication for surgery, its timing, and the best surgical technique to be adopted case by case. ⋯ Careful selection of patients eligible for surgery is mandatory. The optimal timing falls into a time-window ranging between 7 and 24 hours after ictus. Minimal invasive techniques are valuable surgical options for patients in a poor GCS score or harboring large deep-seated hemorrhages.
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Primary orbital involvement is extremely rare in echinococcosis. We report a case of giant orbital hydatid cyst in a 15-year-old boy. ⋯ Hydatic cyst should be kept in differential diagnosis of orbital cystic lesions, especially in pediatric population and endemic areas.
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The modified 5-item frailty index (mFI-5) is a concise comorbidity-based risk stratification tool that has been shown to predict the occurrence of adverse outcomes following various orthopedic surgeries. ⋯ Higher mFI-5 scores were associated with increased postoperative morbidity following elective 1- to 2-level posterior lumbar fusions.
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Comparative Study
The Intracranial and Intracanalicular Optic Nerve as Seen Through Different Surgical Windows: Endoscopic Versus Transcranial.
Surgically manageable lesions involving the intracranial or intracanalicular portions of the optic nerve (cranial nerve II) can be approached through several different operative windows. Given the complex anatomy of the optic nerve and its surrounding neurovascular structures, it is essential to understand the conventional and topographic anatomy of the optic nerve from different surgical perspectives as well as its relationship with surrounding structures. We describe the intracranial and intracanalicular course of the optic nerve and present an analytical evaluation of the degree of exposure provided by several different transcranial and endoscopic surgical approaches. ⋯ Although the pterional approach provides the widest degree of surgical exposure of all optic nerve segments, the inferior and medial quadrants of the nerve can be adequately exposed only through an endoscopic endonasal approach. Optimal approach selection based on the intended target quadrant is essential for safe surgical exposure of the optic nerve.
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Intraoperative multimodal neuromonitoring (IONM) is considered valuable for the early detection and prevention of any neurologic compromise during spine surgery. It has also become the standard of care at many institutions to improve the surgical outcome and be a safety net for both clinical and medicolegal concerns. ⋯ Despite our analysis proving no difference in clinical outcomes with or without the use of IONM during surgical excision of lumbar schwannomas, we still prefer using IONM as a standard approach. It adds to the confidence and ease of mind of the surgeon during resection and also provides valuable data in cases of medicolegal disputes. However, it comes with an increased cost and lengthened surgical procedure.