World Neurosurg
-
Facial nerve schwannomas are rare lesions that constitute only 0.8% of all intrapetrous mass lesions. The least frequent lesions are tumors originating in the greater petrosal nerve (GPN). We present a case of a GPN schwannoma with temporal lobe edema in which the patient was operated on using an extradural and intradural approach to prevent complications. ⋯ GPN schwannomas are very rare lesions. The extradural and intradural middle fossa approach was used to preserve the tumor capsule around the GPN. Using this technique, one can safely protect the geniculate ganglion and the GPN.
-
Case Reports
Perioperative bioccipital watershed strokes in bilateral fetal posterior cerebral arteries during spinal surgery.
Vision loss due to cerebral infarction during spinal surgery is less described. Intraoperative hypotension would be a leading cause. Patients with variation of the circle of Willis could be more prone to present stroke in this context, but reports are lacking to sustain the theory. Bilateral occipital watershed ischemic strokes have never been described before. We report the case of a patient with a fetal origin of both posterior cerebral arteries (PCAs), presenting this particular anatomic stroke following lumbar laminectomy surgery for spinal stenosis during which intraoperative hypotension was observed. We discuss how this common anomaly associated with intraoperative hypotension could have promoted this serious complication. ⋯ The standing hypothesis would be posterior low-flow infarctions resulting from intraoperative hypotension on a variation of the circle of Willis more prone to decrease in cerebral blood flow. Moreover, this case supports the hypothesis of vascular insufficiency due to intraoperative hypotension as cause of stroke during spinal surgery.
-
Several studies have reported treatment methods and results for pediatric craniopharyngiomas; however, few have evaluated patients' quality of life (QOL) after long-term follow-up. To evaluate treatment options, we assessed the QOL of patients with pediatric craniopharyngioma approximately 19 years after surgery and analyzed factors affecting QOL. ⋯ Long-term survivors lived independently but had a lower overall QOL. Not only monitor short-term results based on estimation of the initial resection or recurrence rate, it is important to preserve visual and hypothalamic function and monitor arising complications for extended periods to improve patients' long-term QOL.
-
Few reports have been published discussing surgical outcomes of paraclinoid aneurysms using multifarious treatments such as high-flow bypass. ⋯ Surgical treatment of unruptured paraclinoid aneurysm has high efficacy with good outcomes and a high rate of complete exclusion. However, the rate of visual disturbance is relatively high. Careful surgical techniques and intraoperative monitoring are therefore required.
-
The Draf III (modified endoscopic Lothrop) procedure has been proposed to extend the endonasal transethmoidal, transfovea ethmoidalis, and transcribriform approach through the back wall of the frontal sinus. The exposure is time-consuming and increases the risk of cerebrospinal fluid leak, and the indications for use are not well described. There are few data quantifying the advantage it conveys over the approach without the Draf III procedure. ⋯ This study quantifies the increased field of view provided by the Draf III procedure during anterior skull base dissection. Recommendations for preoperative examination of radiographic evidence are provided to help identify which individuals would benefit from the additional exposure.