Neurosurgery
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In recent years, frameless navigation techniques have been reported to be safe and effective for biopsy of cerebral lesions. ⋯ Electromagnetic navigation is proven to be a simple, safe, and effective innovation for frameless and pinless biopsy of cerebral lesions. This technique is time efficient, and elimination of frame placement enhances patient comfort and facilitates the use of local anesthetic technique.
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The knowledge of intracranial pressure (ICP) is the basis of an appropriate neurosurgical treatment. Because clinical, fundoscopic, or radiological data alone are often elusive, a pre- or postoperative long-term monitoring of the ICP itself is desirable. ⋯ This new telemetric system was safe and effective for ICP measurement over a long period, including home monitoring. For the patients, it was easy to handle, and reliable data could be recorded over many weeks. Based on this preliminary experience, the authors consider the new system extremely advantageous in surgical decision making in particularly difficult cases of suspected abnormalities of ICP.
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Temporal bone and skull base pneumatization is a naturally occurring process that begins before birth and continues into early adulthood. Occasionally this process surpasses normal limits, resulting in hyperpneumatization, which is usually obvious, but on rare occasions may mimic more aggressive skull base disorders. An awareness of this rare anatomical variant may help clinicians avoid more extensive investigations. ⋯ We concluded that the skull base abnormality was an anatomical variant associated with a clival fracture and hemorrhage, which led to opacification of the pneumatized air cells. No specific treatment was offered and symptoms resolved completely. Long-term follow-up CT demonstrated opacification of the skull base. This is one of very few cases in the literature reporting the clinical course of a patient with a hyperpneumatized skull base and the subsequent evolution of the disorder after minor head trauma.
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Reconstruction of the skull base is essential to prevent postoperative leakage of cerebrospinal fluid (CSF). However, a reliable method of reconstructing the middle cranial fossa via a subtemporal keyhole is not available. ⋯ This purely endoscopic technique using a pedicled deep temporal fascial flap provided reliable reconstruction of the middle cranial fossa through a subtemporal keyhole. This technique would also be applicable in preventing CSF leakage or treating traumatic, acquired nontraumatic, or congenital encephalocele in the middle cranial fossa.
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No definite conclusive management has been established in the treatment of thromboembolism during coil embolization of cerebral aneurysms. To date, intravenous heparin, intra-arterial fibrinolytic agent, and intravenous or intra-arterial glycoprotein IIb-IIIa inhibitors have been the mainstay of treatment. However, in practice, 2 major concerns may arise; first, recanalization is not always possible despite every effort of management; second, rehemorrhagic risk is increased if the event occurred during coiling of ruptured cerebral aneurysms. ⋯ Forced-suction thrombectomy is a simple modification of the Penumbra System. Based on our preliminary data, this technique can play a role as an adjuvant management or as a last resort combined with injection of glycoprotein IIb-IIIa inhibitors in thromboembolic events that occur in coil embolization of a ruptured cerebral aneurysm.