World Neurosurg
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Comparative Study
Comparative Analysis of Orbitozygomatic and Subtemporal Approaches to the Basilar Apex: A Cadaveric Study.
The subtemporal and orbitozygomatic approaches are the most commonly used surgical approaches for the treatment of basilar artery apex (BAX) aneurysms. Relative advantages and disadvantages are generally reported based on surgeons' experience. This study was performed to provide a detailed comparison between the subtemporal and orbitozygomatic approaches based on cadaveric dissection analysis for the treatment of BAX aneurysms. ⋯ The orbitozygomatic approach provides a greater number of surgical corridors to the BAX and is superior regarding multiple surgically relevant anatomic parameters. Importantly, control over the basilar trunk and over the contralateral SCA and PCA (blind spots) is superior with the orbitozygomatic approach.
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Case Reports
Demonstration of Infectious Transgression Through the Skull Base Occurring 9 Years After Pituitary Adenoma Resection.
Sellar infections represent less than 1% of all sellar lesions and can be life-threatening. These infections occur de novo in up to 70% of patients or can less commonly develop after surgical treatment of another primary lesion, such as a pituitary adenoma. ⋯ This case demonstrates the fact that patients with pituitary lesions who have foreign material used for surgical closure can present with infections many years after the initial intervention. Furthermore, with appropriate clinical diagnosis and treatment, the reactive inflammation caused by sellar infection is reversible. We review the literature regarding the risk factors and management strategies for delayed postoperative sellar infections.
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To evaluate long-term functional and survival outcomes of patients with glioma after intraoperative neurophysiologic monitoring (IONM) application. ⋯ Application of IONM is beneficial to long-term functional and oncologic outcomes of patients with glioma.
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Segmental flexibility in adolescent idiopathic scoliosis is crucial for the development of nonfusion and osteotomy technology. However, only global curve flexibility has been assessed in previous studies. Knowledge about segmental characteristics is absent. ⋯ Significant apical tethering in both vertebral body and disc wedging occurred, and the relative wedging changed significantly according to the rigidity of the main thoracic curves.
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Case Reports
Acute Supratentorial Ischemic Stroke with Ipsilateral Hemiparesis: Pathomechanism and Management Challenges.
Supratentorial stroke manifesting as ipsilateral hemiparesis is rare. Multiple pathophysiologic mechanisms are possible for this unusual phenomenon and has been previously described. Its implication in therapeutic decision making in a patient with an acute emergent condition has never been discussed. We describe our experience with a patient with this unusual presentation. ⋯ Discordance between clinical and initial computed tomography angiography findings in a patient with acute ischemic stroke poses a management challenge. Additional imaging to correlate clinical findings in equivocal cases may help in decision making but may significantly delay intervention, and therefore its utility during the short therapeutic window period needs careful consideration. Considering the risks and benefits, timely intervention should be balanced judiciously against appropriate intervention to achieve a positive patient outcome.