Surgical neurology international
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Tinnitus is the perception of a "phantom sound" and has a high prevalence. Although many therapies have been investigated within the last decades, there is still no effective standard therapy. Animal studies and human functional imaging studies revealed that tinnitus perception is associated with many complex changes in multiple brain structures. ⋯ Promising structures for stimulation are the dorsal cochlear nucleus, the inferior colliculus and the medial geniculate body of the thalamus. For cortical stimulation, the auditory cortex is considered as a target. Nevertheless, the field is waiting for evidence from well-designed clinical trials, based on supporting evidence from experimental/mechanistic research, to support or discourage the application of brain stimulation in tinnitus.
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Extradural temporopolar approach (ETA) has been modified as less invasive manner and named as trans-superior orbital fissure (SOF) approach with mini-peeling technique. The present study discusses the operative nuances of this modified technique on the basis of cadaveric study of lateral cavernous structures. ⋯ Our technical modification of ETA may be recommended for surgical treatment of paraclinoid lesions to reduce the risk of intraoperative neurovascular injury.
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Bowel perforation is a serious but rare complication after a ventriculoperitoneal shunt (VPS) procedure. Prior studies have reported spontaneous bowel perforation after VPS placement in adults of up to 0.07%. Transanal catheter protrusion is a potential presentation of VPS bowel perforation and places a patient at risk for both peritonitis and ventriculitis/meningitis via retrograde migration of bacteria. This delayed complication can be fatal if unrecognized, with a 15% risk of mortality secondary to ventriculitis, peritonitis, or sepsis. ⋯ A subset of patients can be managed without laparotomy and only with externalization of the ventricular shunt with antibiotics until the cerebrospinal fluid cultures finalize without growth.
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Awake craniotomy is currently the gold standard for aggressive tumor resections in eloquent cortex. However, a significant subset of patients is unable to tolerate this procedure, particularly the very young or old or those with psychiatric comorbidities, cardiopulmonary comorbidities, or obesity, among other conditions. In these cases, typical alternative procedures include biopsy alone or subtotal resection, both of which are associated with diminished surgical outcomes. ⋯ Resting state functional connectivity MRI integrated with intraoperative neuronavigation software can provide an alternative option for functional cortical mapping in the setting of an aborted awake craniotomy.
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Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare, associated with skull fractures, and have a high mortality rate. When they rupture, MMA pseudoaneurysms frequently cause epidural hematomas and occasionally ipsilateral subdural or subarachnoid hemorrhage. Isolated intraparenchymal hemorrhage has also been reported. ⋯ The presence of a fracture over the MMA and intraparenchymal hematoma should prompt suspicion for a traumatic pseudoaneurysm. Pseudoaneurysms of the MMA can cause catastrophic bleeding, and prompt treatment is necessary. Endovascular embolization is an effective method that decreases the hemorrhage risk of MMA pseudoaneurysms.