Neurosurgery
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Endovascular treatment for acute ischemic stroke has changed remarkably over the past decade. Beginning with IA thrombolytic administration, endovascular strategies have evolved to include aspiration, self-expanding intracranial stents, and now retrievable stents. With the recent publication of 5 randomized, controlled studies (MR CLEAN, EXTEND-IA, ESCAPE, SWIFT PRIME, and REVASCAT), mechanical thrombectomy, when used in combination with IV tPA, has demonstrated a significant radiographic and clinical benefit over traditional strategies with IV tPA alone. These results have placed endovascular therapy at the forefront of stroke treatment, redefining the standard of care.
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Ventriculoperitoneal shunt revision is a common procedure. Disconnection and fracture of the distal catheter remain a common cause of ventriculoperitoneal shunt malfunction. ⋯ Distal shunt malfunction due to a mechanical failure is a common reason for shunt revision. We describe a technique for guidewire-assisted distal catheter replacement.
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Surgery plays a crucial role in the management of jugular foramen schwannomas (JFSs). Still, it remains challenging, particularly in cases of tumor growth inside the bony canal of the jugular foramen (JF). ⋯ The surgical approach selection to JFSs should be tailored individually to their extension pattern. The judicious application of endoscope-assisted retrosigmoid infralabyrinthine and transcervical techniques allow for safe and more radical removal of JFSs with a major intraosseous part.
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Case Reports
Endoscopic Endonasal Approach to the Optic Canal: Anatomic Considerations and Surgical Relevance.
Increasing use of endoscopic endonasal surgery for suprasellar lesions with extension into the optic canal (OC) has necessitated a better endonasal description of the OC. ⋯ The lateral opticocarotid recess allows distinction of the preforaminal ON, roofed by the falciform ligament from the intracanalicular segment in the osseous OC. This facilitates the preoperative surgical strategy regarding the extent of OC decompression and dural opening. Extensive endonasal decompression of the OC and division of the falciform ligament is feasible.
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Survival duration and prognostic factors in adult high-grade glioma have been comprehensively analyzed, but less is known about factors contributing to overall survival (OS) and progression-free survival (PFS) in pediatric patients. ⋯ OS was significantly correlated with the location of the tumor and the extent of resection. GTR significantly improved overall survival for both glioblastoma multiforme and anaplastic astrocytoma patients, and female patients showed a much larger survival benefit from GTR than male patients.