World Neurosurg
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Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. ⋯ This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burr-hole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.
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Review Case Reports
Intracranial Dislocation of the Mandibular Condyle: A Case Report and Literature Review.
Intracranial dislocation of the mandibular condyle is an infrequent injury that can follow traumatic upward force at the chin. A limited number of cases have been reported, and an individualized approach for patients is often recommended. Nevertheless, several consistent strategies for reduction have emerged. ⋯ Appropriate surgical and nonsurgical approaches for addressing mandibular dislocation have emerged during the past several decades. When deciding on an optimal strategy, variables including patient age, time-to-diagnosis, accompanying injuries, prior failed maneuvers, and risk of resubluxation should be considered. Coordinated care between neurosurgery and otolaryngology teams can minimize complications and achieve successful reductions.
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Review Case Reports
Intraneural granular cell tumor of a cervical dorsal nerve root: a case report and review of the literature.
Granular cell tumor (GCT) is a relatively uncommon predominantly benign lesion that usually presents as a solitary, painless cutaneous or submucosal nodule. Most of these tumors are found in the tongue. Although GCT is believed to have a Schwann cell origin, reports of GCT in peripheral and spinal nerves are uncommon. ⋯ The surgeon should be aware of GCT when encountering spinal nerve root tumors because it may alter the surgical approach necessary for adequate resection compared with more commonly encountered nerve sheath tumors.
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Review
Factors that Affect Physiologic Tremor and Dexterity during Surgery: a Primer for Neurosurgeons.
All individuals have a physiologic tremor that may become more pronounced in periods of stress, stimulant use, or caffeine. There are few publications measuring the effects of these factors on surgeons or trainees and no comprehensive reviews. We sought to review the representative literature. ⋯ The literature evaluating tremor and its relationship to surgical performance is limited. Surgeons wishing to optimize surgical dexterity may benefit from avoiding caffeine use or fasting before operating and avoiding sleep deprivation or alcohol use the night before procedures. Those surgeons prone to anxiety or stress-related tremor may obtain a benefit from certain beta-blockers. Finally, the use of appropriate surgical ergonomics with hand or wrist steadying may improve surgical tremor and reduce fatigue.
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The resection of planum sphenoidale and tuberculum sellae meningiomas is challenging. A universally accepted classification system predicting surgical risk and outcome is still lacking. ⋯ An orbitotomy and early decompression of the involved optic canal are important for achieving gross total resection, maximizing visual improvement, and avoiding recurrence. The visual outcomes were excellent. A new classification system that can allow the comparison of different series and approaches and indicate cases that are more suitable for an endoscopic transsphenoidal approach is presented.