World Neurosurg
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Review Meta Analysis Comparative Study
The endoscope-assisted ventral approach compared with open microscope-assisted surgery for clival chordomas.
The current management paradigm for clival chordomas includes cytoreductive surgery with adjuvant radiotherapy. Surgical approaches have traditionally utilized the microscope to remove these lesions through approaches that require extensive bone drilling, brain retraction, and mobilization of normal anatomy to create a suitably large corridor. The endoscopic ventral approaches provide a direct route to the tumor using natural orifices. Little data exist comparing these 2 surgical strategies. We conducted a systematic review of case series and case reports in hope of furthering our understanding of the role of endoscopy in the management of these difficult cranial base lesions. ⋯ Our systematic analysis supports the endoscopic ventral approaches as a safe and effective alternative for the treatment of certain clival chordomas. Although the overall literature supports this technique in carefully selected patients, longer follow-up is needed to more definitively address therapeutic efficacy. Careful patient selection and meticulous multilayer closure are critical to obtaining maximal resection and acceptably low cerebrospinal fluid leak rates.
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An intramedullary spinal cord abscess is a rare, albeit widely publicized entity. Classically, patients have an acute onset of symptoms with fevers and leukocytosis supporting the diagnosis. We present a case of intramedullary spinal cord without classic history or imaging characteristics in which the diagnosis was made with diffusion weighted magnetic resonance imaging (MRI). ⋯ The use of diffusion weighted imaging in the spine is a novel application of technology that provided an accurate preoperative diagnosis and allowed us to tailor our surgical approach and provide a rapid focal decompression.
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Case Reports
Successful repair of a gunshot wound to the head with retained bullet in the torcular herophili.
Nonlethal missile injuries to the dural venous sinus system are rare. To date successful repair of isolated penetrating injury to the torcular herophili has not been reported without significant associated morbidity. We report the case of a gunshot wound injury to the occipital region with retained bullet fragment in the confluence of the sinuses causing traumatic sinus venous thrombosis. ⋯ Gunshot wounds with retained bullet fragments in the torcula can be successfully repaired with preservation of neurological function after retrieval of metallic foreign body and restoration of venous sinus patency.
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To review the microsurgical anatomy of Meckel's cave, a detailed knowledge of which is a prerequisite to devising an appropriate surgical strategy and performing successful surgery. ⋯ Detailed and sound knowledge of the microsurgical anatomy of Meckel's cave, which borders on surgically important structures, such as the internal carotid artery and cavernous sinus, is essential to performing precise microneurosurgery in this region. This study describes the complex anatomy of Meckel's cave and surrounding structures to provide the knowledge needed to devise a more complete surgical strategy and establish accurate orientation during the surgical procedure.
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Hyponatremia in patients with traumatic brain injury: etiology, incidence, and severity correlation.
Hyponatremia is common in patients with traumatic brain injury (TBI). This study aims at ascertaining the incidence of hyponatremia in TBI with its etiologic diagnosis, biochemical confirmation, and severity correlation with initial Glasgow Coma Scale (GCS) score and computed tomography (CT) abnormality. ⋯ Hyponatremia due to SIADH is more common in TBI. FEUA measurement is not consistent enough to make a distinction between SIADH and CSWS. CT scoring of severity is more predictive of hyponatremia than initial GCS.