World Neurosurg
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Case Reports
Transblepharo-preseptal modified orbitozygomatic craniotomy for treatment of a ruptured aneurysm.
Various supraorbital approaches to the anterior cranial fossa using a transciliary or supraciliary incision have been described. An orbitotomy is a valuable addition to the standard supraorbital keyhole approach offering an extended angle of exposure with minimal frontal lobe retraction. The transpalpebral approach is common in oculoplastic surgery and offers excellent cosmetic outcomes using the natural crease of the superior eyelid. ⋯ Considering the location and morphology of the aneurysm, as well as the patient's eyelid anatomy, clip ligation via a transblepharo-preseptal modified orbitozygomatic craniotomy was recommended. Aneurysm clipping was uneventful, and postoperative imaging showed complete occlusion. The patient was discharged neurologically intact.
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Case Reports
Giant Pediatric Rhabdoid Meningioma Associated with a Germline BAP1 Pathogenic Variation: A Rare Clinical Case.
Rhabdoid meningiomas are rare World Health Organization grade 3 tumors that tend to follow an aggressive course, with an increased likelihood for local recurrence, remote metastasis, and cerebrospinal fluid dissemination. Genetic testing has found certain genes associated with reduced time to tumor recurrence. BAP1 (BRCA1-associated protein 1) is a tumor suppressor gene that is associated with multiple tumors, including rhabdoid meningiomas. ⋯ Rhabdoid meningiomas are unlikely to be found in children and have a high rate of local recurrence. Gross total resection has to be balanced with risk of postoperative deficit. Genetic testing of this rare entity should be performed to identify any hereditary germline mutations.
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We sought to determine whether a set of simple criteria can identify patients in the neuroscience intensive care unit (NICU) at high risk of poor outcome and delivery of nonbeneficial care early in the course of their illness. Secondarily, factors affecting limitation of care protocols were assessed. ⋯ We identified simple criteria that can be used to identify patients in the NICU setting for whom continued aggressive care is likely nonbeneficial. Our analysis revealed demographic, social, and economic factors correlating with proxies' willingness to consider limitation of care.
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Hospital readmission is a key surgical quality metric associated with financial penalties and greater healthcare costs. We examined the clinical risk factors and postoperative complications associated with 30-day unplanned hospital readmissions after cranial neurosurgery. ⋯ Unplanned hospital readmission after cranial neurosurgery is a common event. The identification of high-risk patients who undergo cranial procedures might allow hospitals to reduce unplanned readmissions and their associated healthcare costs.
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Tumor-treating fields (TTFs) have become an important, evidence-based modality in the treatment of glioblastoma (GBM). In patients requiring cardiac pacemakers, TTF therapy is complicated by theoretical concerns regarding possible electrical interaction between the devices. ⋯ The first reported case of successful TTF administration in a GBM patient with a previously implanted cardiac pacemaker may allay the concerns of neuro-oncologists, cardiologists, radiation oncologists, and all certified TTF prescribers regarding the applicability of TTF in suitable candidates with preexisting cardiac pacemakers. This case indicates that TTF therapy may be efficacious in patients with indwelling magnetic resonance image-conditional cardiac pacemakers turned to the off position and that physical removal of the pacemaker is not necessary before starting TTF.