World Neurosurg
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Nonfunctioning pituitary adenomas are the most common pituitary adenomas in adults and cause significant morbidity unless adequately treated. ⋯ Nonfunctioning pituitary adenomas present frequently as mesoademonas and giant adenomas. Patients with these tumors may have subclinical visual or hormonal deficits at the time of diagnosis. Early and effective surgical treatment is essential for rapid recovery of visual and/or hormonal deficits, particularly in symptomatic cases.
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Neuronavigation is an established technology in neurosurgery. In parts of the world and certain circumstances in which neuronavigation is not easily available or affordable, alternative techniques may be considered. ⋯ When neuronavigation is not easily available or affordable, Sina can be helpful for scalp localization and preoperative planning of the incision for selected supratentorial pathologies.
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Delayed intraventricular pneumocephalus is a very rare and potentially serious complication of ventriculoperitoneal shunt. It can occur several months or years after shunting. Its pathogenesis is unclear. We herein discuss the underlying mechanisms and particularly the possible role of positive pressure ventilation. ⋯ Intraventricular pneumocephalus is a potentially serious complication of patients with a VP shunt and receiving positive pressure ventilation. The introduction of a CPAP device must be discussed with the neurosurgeon beforehand in shunted patients.
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Observational Study
Transorbital ultra-sonographic measurement of optic nerve sheath diameter for intracranial midline shift in patients with head trauma.
Measurement of the optic nerve sheath diameter (ONSD) by using sonography is a straightforward, noninvasive technique to detect an increased intracranial pressure, which can even be conducted at the bedside. However, the correlation between ONSD and intracranial midline shift has not been studied. ⋯ Despite small numbers and selection bias, this study suggests that bedside ultrasound may be useful in the diagnosis of midline intracranial shift by measurement of ONSD.
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The lateral mesencephalic vein (LMV) represents an important connection between the infratentorial and supratentorial compartments. It joins the basal vein of Rosenthal and the petrosal system. In our experience with management of tentorial dural arteriovenous fistulas (DAVFs) we have often noted involvement of the lateral mesencephalic vein (LMV) in the venous drainage of these fistulas. ⋯ The LMV is a constant venous anastomosis between the supratentorial and infratentorial compartments. Detailed knowledge of the most common variations of the LMV surgical and radiological anatomy has important clinical implications. The vein is an important anatomic landmark during surgery of midbrain lesions. It is often involved in the tentorial DAVF drainage, and it is critical in understanding some "unexpected" venous complications during surgery for posterior fossa lesions.