World Neurosurg
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At present there is no standard of care for patients with primary central nervous system lymphoma (PCNSL) because of the difficulty in delivering therapeutically effective doses of drugs to the intracellular site of the target PCNSL. Here we report the use of an iron oxide nanoparticle to promote the internalization of a PCNSL targeting antibody by target cells. ⋯ The high-degree specific binding and cell uptake of NP-FP in PCNSL suggests this NP formulation can be further developed to improve therapy of PCNSL.
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A therapeutic dilemma exists when patients with symptomatic carotid stenosis and concomitant heparin-induced thrombocytopenia (HIT) are advised to urgently undergo carotid endarterectomy (CEA) with heparin therapy. ⋯ We now recommend systemic intravenous and local argatroban irrigation to prevent thromboembolic complications in CEA cases with HIT and renal insufficiency. Bivalirudin for both systemic intravenous use and local irrigation may be safer in patients without renal insufficiency because of its shorter half-life.
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The microsurgical anatomy of the temporal region has been well described. However, there is a paucity of information about the transventricular endoscopic anatomy of the mesial temporal lobe, and little is known about endoscopic approaches to this region. In this report, we describe the technique of endoscopic amygdalohippocampectomy (AH). The endoscopic anatomy of the mesial temporal region both before and after AH is shown. ⋯ We studied the transventricular endoscopic anatomy of the mesial temporal region and described a technique for safe endoscopic AH. The advantages and potential risks of endoscopic AH are discussed, along with suggestions for minimizing complications. We believe that knowledge of the endoscopic anatomy of the mesial temporal lobe will be useful for endoscopic AH and the removal of other lesions in this region.
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Case Reports
The combined interhemispheric subcommissural translaminaterminalis approach for large craniopharyngiomas.
We describe a variant of the interhemispheric translaminaterminalis approach for the resection of large suprasellar craniopharyngiomas. The approach is a translaminaterminalis route performed below and above the anterior communicating artery (ACoA). A cadaveric microanatomic study was conducted to describe the surgical technique. ⋯ The approach with preservation of the ACoA may represent a possible route to manage large suprasellar lesions. Combination of the unilateral interhemispheric corridor with the subfrontal and the trans-sylvian routes allows for a safe and radical resection of large suprasellar craniopharyngiomas.
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Concerns over increased wound complication rates have been raised when bone morphogenic protein (BMP) is used as an adjunct for fusion in spinal surgery. This study evaluated 87 consecutive patients undergoing long-segment thoracolumbar spinal fusions with BMP to assess drain output and the rates of reoperation for infection or seroma. ⋯ Use of BMP for long-segment posterior thoracolumbar fusions may be associated with significant drain output, requiring multiple days of drainage. However, when drained adequately, infections and seromas occur infrequently.