World Neurosurg
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Improvements in preoperative diagnostic imaging as well as in microsurgical techniques significantly advanced the development of transcranial neurosurgery, allowing the treatment of complicated diseases through smaller and more specific approaches. ⋯ In all cases, meticulous preoperative planning was done for determining the site, size, and optimal placement of the craniotomy as well as the trajectory toward the surgical target. Most importantly, the surgical approach was performed either completely or at least under permanent presence of the responsible senior surgeon from the moment of patient positioning until wound closure. The minimally invasive keyhole approaches allowed safe intraoperative control and adequate dealing with intracranial lesions. Essential preconditions for keyhole surgery were 1) careful selection of cases, 2) accurate preoperative planning, 3) placement of the craniotomy tailored to the individual case, and 4) intraoperative use of transcranial endoscope-assisted microsurgery techniques. Advantages of intraoperative endoscopic visualization were increased light intensity, extended viewing angle, and clear depiction of details even in hidden parts of the surgical field.
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The aim of this report is to review current data on the role of neuroendoscopy in infants. Specific emphasis will be given to the International Infant Hydrocephalus Study (IIHS). Previous studies, available information, and future directions are discussed. ⋯ Neuroendoscopy in infants can be performed with reasonable morbidity. The preferred indications in infants are still not totally refined, especially vis-a-vis shunting procedures. More international, multicenter efforts are required to clarify these points.
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To summarize the current knowledge of the mechanisms leading to rebleeding and the prevention of rebleeding after subarachnoid hemorrhage (SAH). ⋯ Further studies are warranted before the exact mechanisms leading to rebleeding are established and the optimal preventive measures are made available. At the present time, antifibrinolytic therapy remains the only realistic protective measure during the initial 6 hours after SAH during which the rebleeding rate is highest.
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This study reports the anatomopathological classification of Tarlov cysts and the various treatment techniques described in the literature. ⋯ The clipping technique for Tarlov cysts is easy, valid, safe, rapid, and effective.
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This study sought to review the articles published by Iranian neurosurgeons regarding their experiences during the Iraq-Iran conflict and compare them with reports from other conflicts. ⋯ Conservative minimal debridement of the wounds is indicated in patients with small entrance wounds, or those with Glasgow Coma Scale score ≥ 8 and no progressive neurological deficit. To diagnose TA before rupture, angiography is indicated in patients who have shells or bone fragments pass through the crowded vasculature, or have large/delayed hematoma, or if the surgeon has high index of suspicion based on neuroimaging and early debridement surgery. Surgery in a well-equipped nearby hospital after quick and safe evacuation of the victims by trained salvaging ancillary groups and the administration of broad-spectrum antibiotics and proper antiepileptics decrease the morbidity and mortality of casualties after PHW in war situations. The biases of the case selection, data collection, and confounders, and decreasing biases by conducting blinded controlled clinical trials, are discussed.