World Neurosurg
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Despite the increasing interest in endoscopic techniques for pituitary surgery, little has been published on the endoscopic approach for recurrent and/or residual pituitary adenomas. We report the outcome of purely endoscopic endonasal surgery for a series of recurrent and/or residual pituitary tumors after a previous microscopic resection. ⋯ The restricted exposure of sphenoidal and sellar structures by the microscopic approach may be a contributing factor to incomplete tumor resection. The results observed in this setting make the endoscopic technique a valid option in recurrent and residual pituitary adenomas treated initially by microscopic surgery.
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In patients with intractable epilepsy, failure to localize and/or resect the epileptic focus after invasive monitoring is multifactorial. Rarely do these patients return for a second invasive evaluation, and their outcome is not clearly characterized. This study aims to determine the seizure outcome after a second invasive electroencephalographic (EEG) evaluation, and its possible predictors. ⋯ A second invasive evaluation may lead to seizure freedom in one-third of patients. However, this must be weighed against the increased complication rate with reoperation.
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To report a series of four patients with dural arteriovenous fistulas (DAVF) at the petrous apex with drainage into the deep cerebral venous system and the surgical treatment employed. ⋯ Treatment of these type III or IV DAVFs was indicated. The fistulas were supplied by multiple meningeal feeders originating from the external and internal carotid and vertebral arteries. Preoperative transarterial embolization resulted in significant flow reduction. Complete cure at low risk was achieved by interruption of the venous drainage via a retrosigmoid approach.
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To study the role of drains in lumbar spine fusions. ⋯ Drain use did not increase the risk of wound infection in patients undergoing LDF, but it had some impact on the prevalence of postoperative fever. Drain use was significantly associated with posthemorrhagic anemia and allogeneic blood transfusion. Drain use did not have a significant economic impact on hospital length of stay and charges except in lateral procedures involving three or more levels.
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Hardware-related complications of deep brain stimulation (DBS) surgery have been reported with adverse effects in postoperative electrode migration. We report that the addition of microtextured features to the surface of a DBS-like probe can minimize the extent of electrode migration in ex vivo porcine brain. ⋯ These preliminary results show that microtextured strips embedded into cadaveric porcine brain produce an anchoring effect on local tissue during brain shift, suggesting a way to reduce DBS lead migration without additional tissue damage beyond the strip geometry.