Neurosurgery
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To evaluate the feasibility of PoleStar N20 (Medtronic Surgical Navigation Technologies, Louisville, KY), an ultra-low-field intraoperative magnetic resonance imaging (iMRI) system during resection control of pituitary macroadenomas and to compare intraoperative images with postoperative 1.5-T MRI images obtained 3 months after the procedure. ⋯ Ultra-low-field 0.15-T iMRI is a safe, helpful, and feasible tool for navigation and tumor resection control in patients with pituitary macroadenomas. Total anesthesia and operation times are prolonged, but iMRI adequately documents the extent of tumor resection. In this series, the PoleStar system increased the rate of resection without disrupting the neurosurgical workflow.
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Case Reports Comparative Study
Expanded endoscopic endonasal approach for treatment of clival chordomas: early results in 12 patients.
We report our recent experience with an expanded purely endoscopic endonasal approach for the treatment of clival chordomas. ⋯ The expanded endoscopic endonasal approach is a valid minimally invasive alternative for the treatment of centrally located clival chordomas or as an adjunct for the central part of chordomas with lateral extension. The early results of this technique indicate at least equivalency to more extensive open approaches, and its versatility may widen the horizon of surgical management of these aggressive lesions. The challenge with the cerebrospinal fluid leakage is being addressed with novel local flap repair techniques. This approach should be in the armamentarium of cranial base surgeons as an option in the management of clival chordomas.
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To systematically analyze patient outcomes after repeat transsphenoidal (TS) surgery for recurrent Cushing's disease. ⋯ Although the success of repeat TS surgery for recurrence of Cushing's disease is less than that of initial surgery, a second procedure offers a reasonable possibility of immediate remission. If the operation is not successful, other treatments, including pituitary radiation, medical therapy, and even bilateral adrenalectomy, are required.
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Case Reports
Endoscopic endonasal odontoidectomy in a patient affected by Down syndrome: technical case report.
Atlantoaxial instability and odontoid invagination may occur in Down syndrome. The treatment of this lesion may require an odontoidectomy. In similar circumstances, a transoral procedure may be hampered by a macroglossia which is part of Down syndrome. In a situation occurring in an 11-year-old child affected by atloaxial instability and os odontoideum, the persistence of ventral compression after a previous atloaxial fixation induced us to perform an endoscopic endonasal odontoidectomy. We feel that this is an elective indication for endoscopic endonasal odontoidectomy. ⋯ An endonasal technique is indicated for patients presenting with narrowness of the oral cavity, such as in the case reported, where the narrowness due to pediatric age and the macroglossia characteristic of Down syndrome hamper the transoral approach.
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Cerebrospinal fluid diversion from the cisterna magna has been described previously but has largely been abandoned because of high complication rates and anatomic constraints. Situations still remain in which this may be the best or only alternative. We describe the use of interventional magnetic resonance imaging (iMRI) for the application of this largely forgotten procedure. ⋯ To our knowledge, this is the first described use of iMRI technology for catheterization of the cisterna magna for cerebrospinal fluid diversion. Moreover, iMRI technology should be considered in future applications of complex posterior fossa shunting procedures.