World Neurosurg
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In the treatment of craniopharyngioma, complete surgical removal offers the best chance of cure and recurrence prevention. The basal interhemispheric approach involves problems with difficulty resecting tumors in the retrochiasmatic space located behind the optic chiasm and inability to resect, under direct view, tumors extending into the sella turcica. We report our approach via the sphenoid sinus devised to resolve these problems. ⋯ This approach allowed a working space to be secured even in cases with a narrow prechiasmatic space, allowing tumor freeing from the lower plane of the optic nerve and safe resection of the intrasellar tumor.
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In July 2011, the UCLA Health System released its current time-out process protocol used across the Health System. Numerous interventions were performed to improve checklist completion and time-out process observance. This study assessed the impact of the current protocol for the time-out on healthcare providers' safety attitude and operating room safety climate. ⋯ The time-out process favorably impacted team members' safety attitudes and perception as well as overall safety climate in neurosurgical ORs. Survey responses identified leadership training and teamwork training as two avenues for future improvement.
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Distal posterior inferior cerebellar artery aneurysms: clinical features and outcome of 80 patients.
Aneurysms of the posterior inferior cerebellar artery (PICA) distal to its origin are rare. Beside their rarity, their treatment is challenged by a high proportion of fusiform aneurysms, torturous course of PICA, and often severe bleeding. Our aim is to represent the characteristics of these aneurysms and their treatment, as well as to analyze outcome. ⋯ Microsurgery is a feasible treatment for distal PICA aneurysms. Despite the challenge of often severe hemorrhage, wide-necked aneurysms, and some risk for laryngeal palsy, most patients surviving the initial stage return to normal life. Because of the greater number of rebleedings than for aneurysms at other locations, immediate treatment is crucial.
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Bedside external ventricular drain (EVD) placement is less than perfect and often requires multiple passes to achieve cerebrospinal fluid flow. We conducted this prospective study to understand why multiple passes are necessary and whether this affects the incidence of hemorrhage. ⋯ Multiple passes are inherent to the bedside EVD procedure, but did not increase the rate of intracranial hemorrhage.
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Pituitary apoplexy is an infrequent occurrence that can require timely treatment. The term "pituitary apoplexy" as used in the literature describes a heterogeneous spectrum. There is controversy about which subsets require urgent as opposed to elective surgical treatment or even medical treatment alone. We present a retrospective series of 109 consecutive cases of pituitary apoplexy from a single institution from 1992-2012 and develop a comprehensive classification system to analyze outcome. ⋯ We offer a simple yet comprehensive grading system to classify the clinical spectrum of pituitary apoplexy, which has implications for management, outcomes, and categorization for future studies.