Neurosurgery
-
Dural arteriovenous fistulas (dAVFs) represent 10% to 15% of all intracranial arteriovenous malformations. Most often, embolization is accomplished with transfemoral catheter techniques. We present a case in which embolization of a cavernous sinus dAVF was made possible through transcranial cannulation of a cortical draining vein. ⋯ This transcranial vein technique may be a useful adjunct in dAVF therapy when percutaneous transarterial or transvenous approaches fail or are not possible.
-
Investigation into the provider volume-outcomes association for patients undergoing spine surgery has been limited. ⋯ In this nationwide study, patients treated by very-low-volume surgeons had a significantly higher complication rate compared with those treated by very high-volume surgeons.
-
Sebaceous neoplasms range from hyperplastic hamartomas to malignant tumors and are most commonly cutaneous lesions. We describe the first reported case of an intracranial sebaceous neoplasm, discussing the differential diagnosis and possible pathogenesis in relation to the current literature. ⋯ This is the first reported case of an intracranial sebaceous neoplasm. Careful follow-up is required to help elucidate the biology of this tumor in an effort to determine the role of adjuvant therapy.
-
Chronic occipital and suboccipital headache is a common symptom in patients with Chiari I malformation. These headaches may persist despite appropriate surgical treatment of the underlying pathology via suboccipital decompression, duraplasty, and cerebrospinal fluid diversion. Occipital nerve stimulation has been shown to be effective in the treatment of a variety of occipital headache/pain syndromes. ⋯ Occipital stimulation may provide significant long-term pain relief in selected Chiari I malformation patients with persistent occipital pain. Larger and longer-term studies are needed to further define appropriate patient selection criteria and to refine the surgical technique to minimize device-related complications.
-
Gangliogliomas are rare glioneuronal tumors that typically cause refractory seizures during the first 3 decades of life. ⋯ We report excellent long-term seizure control outcomes after surgery for gangliogliomas. Intraoperative electrocorticography may be a useful adjunct for guiding extended resection in certain pharmacoresistant epilepsy patients with gangliogliomas. Subtotal resection is associated with higher rates of tumor progression and nonoptimal seizure outcomes.