Neurosurgery
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Pituicytoma is a rare but distinct low-grade glioma of the neurohypophysis. To date, we have found only 28 cases reported in the literature and have reviewed these in addition to our own case to delineate the clinical implications of this relatively recently defined tumor. ⋯ Pituicytomas are benign, slow-growing tumors that seem to be cured by gross total resection. The role of radiation therapy is controversial. We advocate an aggressive surgical approach with possible preoperative embolization to reduce the vascularity of the tumor.
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Randomized Controlled Trial Comparative Study
Anatomoradiological landmarks for accuracy of radiofrequency thermorhizotomy in the treatment of trigeminal neuralgia.
The correct positioning of the electrode is of prime importance for effectiveness and selectivity of percutaneous trigeminal radiofrequency thermorhizotomy (RF-TR) for the treatment of trigeminal neuralgia (TN). The aim of our study was to establish some anatomoradiological landmarks for the purpose of accurate placement of the electrode tip in RF-TR. ⋯ Our data suggest that the determination of the presented landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures for each branch of the trigeminal root.
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Comparative Study
Limitations of magnetic resonance imaging and magnetic resonance angiography in the diagnosis of intracranial aneurysms.
Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are being used with increasing frequency for the diagnosis of intracranial aneurysms. Although the literature suggests that MRI and MRA are accurate, we have observed that both are associated with a high likelihood of false-positive results in the diagnosis of aneurysms. We prospectively evaluated and compared the accuracy of MRI/MRA versus digital subtraction angiography (DSA) for the diagnosis of intracranial aneurysms. ⋯ MRI/MRA studies are often inaccurate in the diagnosis of intracranial aneurysms and should not be used as the sole diagnostic studies for intracranial aneurysms. Other radiographic modalities should be further investigated as alternatives to MRI/MRA for the diagnosis of intracranial aneurysms.
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Comparative Study
Polyethylene glycol hydrogel dural sealant may reduce incisional cerebrospinal fluid leak after posterior fossa surgery.
Incisional cerebrospinal fluid (CSF) leak remains a significant cause of morbidity, particularly after posterior fossa surgery, with ranges between 4 and 17% in most series. We aimed to determine whether the use of a new polyethylene glycol (PEG) dural sealant product (DuraSeal; Confluent Surgical, Waltham, MA) is effective at preventing incisional CSF leak after posterior fossa surgery. ⋯ The application of PEG dural sealant to the closed dural edges may be effective at reducing incisional CSF leak after posterior fossa surgery.
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Comparative Study
Microsurgical and endoscopic anatomy of Liliequist's membrane: a complex and variable structure of the basal cisterns.
Descriptions of Liliequist's membrane, as reported in the literature, vary considerably. In our cadaveric study of Liliequist's membrane, we attempted to clarify and define its anatomic features and boundaries, as well as its relationship with surrounding neurovascular structures. We describe the embryology of this membrane as a remnant of the primary tentorium. The clinical significance of our findings is discussed with respect to third ventriculostomy and surgical approaches to basilar tip aneurysms, suprasellar arachnoid cysts, and perimesencephalic hemorrhage. ⋯ Understanding the variable anatomy of Liliequist's membrane is important, particularly to improve current and forthcoming microsurgical and endoscopic neurosurgical procedures. It is important as a surgical landmark in various neurosurgical operations and in the physiopathology of several pathological processes (suprasellar arachnoid cysts and perimesencephalic hemorrhage).