World Neurosurg
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We investigated the relationship between the reliability of the transcranial or transcortical motor evoked potential (MEP) response and age in pediatric patients aged ≤15 years with brain tumor. ⋯ The transcortical MEP response was monitored less successfully during brain tumor surgery in patients aged ≤5 years than in patients aged 6-15 years. Although MEP monitoring techniques can be applied during surgery of pediatric populations with brain tumors similar to that used for adult patients, the limitations of the low transcortical MEP response rate in young patients should be considered.
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Intraosseous hemangioma is a rare bone tumor, accounting for 0.7%-1.0% of all bone tumors. It can occur at any age, but only 9% of cases are younger than 10 years old. Although this tumor is usually slow-growing and clinically silent, we experienced 2 pediatric patients undergoing surgery for skull hemangioma who presented with uncommon clinical manifestations. ⋯ Although skull hemangiomas show clinical heterogeneity, surgical removal is usually diagnostic and leads to good patient outcomes. On occasion, however, this tumor causes secondary changes in the dura, such that dural incision and dural plasty should be planned in advance of lesion removal.
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Occipital-frontal nerve stimulation is an off-label therapy for treating chronic refractory migraine and orofacial pain. Though effective, patients experience a high rate of complications including lead migration and erosion through the overlying skin. ⋯ Pericranial flap revision confers little additional risk when compared with simple wound closure, and the surgeon can proceed without total electrode removal, additional incisions, or lead tunneling. The flap provides a highly vascular additional layer of stability to the electrode, reducing the likelihood of further lead exposure without compromising the efficacy of the device. These results suggest that endoscopic pericranial flap revision is a viable technique for the repair of occipital nerve stimulation lead erosions.
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Case Reports
Pipeline Embolization Device with Shield Technology for Intracranial Aneurysms: An Initial U.S. Experience.
Thromboembolic complications remain a major reason for morbidity and mortality after flow diversion, in addition to hemorrhagic complications not limited to the brain predicated on the prolonged need for dual antiplatelet therapy. Surface modification to decrease thrombogenicity and accelerate aneurysm occlusion is a promising alteration to mitigate those risks. The Pipeline embolization device with Shield Technology possesses such characteristics; however, it has not yet been approved in the United States. ⋯ Flow diverters with surface modification to decrease thrombogenicity and accelerate aneurysm occlusion are promising endovascular tools for patients at high risk of complications with dual antiplatelet therapy. The present case represents one of the first cases performed in the United States using such a device. Despite the favorable outcome in the present case, the question of whether such technology obviates the need for dual antiplatelet therapy remains to be determined.
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Giant cell tumors (GCTs) are benign tumors with a predilection for the epimetaphyseal region of the long bones. GCTs involving the skull base are rare, and only a few available cases have been reported. Surgical gross total resection is the recommended method of treatment for GCTs. In the case of skull base tumors, it is very difficult to achieve such a result by direct surgical resection alone without any morbidities. Denosumab is a fully humanized monoclonal anti-receptor activator of nuclear factor-κB ligand antibody that has been recently approved by the Food and Drug Administration for the treatment of GCTs that are surgically unresectable, metastatic, and have a high risk of progression and recurrence. Denosumab has been used in many cases involving the long bones. However, in cases of skull base GCTs, only a limited number of cases have been reported. In addition, in such cases, it was used as postoperative chemotherapy owing to subtotal resection. ⋯ Our findings emphasize the use of denosumab as a neoadjuvant treatment routinely for all cases of skull base GCTs to achieve safe and complete excision of the tumor.