Neurosurgery
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Transsphenoidal adenomectomy carries the possibility of new pituitary failure and recovery. Herein, we present rates and determinants of postoperative hormonal status. ⋯ After transsphenoidal adenomectomy, new unplanned hypopituitarism occurs in approximately 5% of patients, whereas improved hormonal function occurs in 50% of patients. The likelihood of new hormonal loss or recovery appears to depend on several factors. New hypopituitarism occurs most commonly in patients with tumors larger than 20 mm in size, whereas hormonal recovery is most likely to occur in younger, nonhypertensive patients and those without an intraoperative cerebrospinal fluid leak.
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Although frameless stereotactic techniques have become indispensable in neurosurgery, their technical complexity requires careful definition and evaluation. Navigation is of particular concern when it is applied to approach a complex, tight surgical area like the temporal bone, where every millimeter is important. Theoretically, the temporal bone is an ideal location in which to use image-guided navigation because its bony construct precludes pre- and intraoperative shift. In this context, the feasibility of using a navigational system is determined by the system's accuracy and by the spatial characteristics of the targets. Literature addressing the accuracy of image guidance techniques in temporal bone surgery is relatively sparse. Accuracy of these systems within the temporal bone is still under investigation. We investigated the application accuracy of computed tomography-based, frameless, image-guided navigation to identify various bony structures in the temporal bone via a retrosigmoid approach. ⋯ Using high-resolution computed tomography and bone-implanted reference markers, frameless navigation can be as accurate as frame-based stereotaxy in providing a guide to maximize safe surgical approaches to the temporal bone. Although error-free navigation is not possible with the submillimetric accuracy required by direct anatomic contouring of tiny structures within temporal bone, it still provides a road map to maximize safe surgical exposure.
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To describe a novel double-balloon trapping technique for endovascular embolization of a broad-based saccular aneurysm of the superior cerebellar artery. ⋯ Double-balloon trapping is a novel endovascular technique that can be used to treat wide-necked aneurysms and maintain patency of side branches incorporated into the aneurysm neck.
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Case Reports
Neurophysiological intraoperative monitoring of the glossopharyngeal nerve: technical case report.
Neurophysiological intraoperative monitoring of the glossopharyngeal nerve has been performed only with needle electrodes inserted into the pharyngeal muscles or soft palate. We describe a noninvasive method of monitoring this cranial nerve. ⋯ Monitoring of the glossopharyngeal nerve with surface electrodes is possible and reliable, but it must be combined with vagus nerve monitoring.
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Deep-seated supratentorial intraparenchymal and intraventricular brain lesions can be difficult to access without causing significant trauma to the overlying cortex and intervening white matter tracts. Traditional brain retractors use multiple blades, which do not exert pressure in an equally distributed fashion. Tubular retractors offer an advantage. Although a commercially available frame-based tubular retractor system is on the market (COMPASS; Compass, Inc., Rochester, MN), we modified existing off-the-shelf equipment at our institution into a frameless tubular brain retractor. ⋯ A frameless stereotactic tubular retractor system for deep brain lesions can be assembled with equipment already available at many institutions. Use of this system can decrease incision and craniotomy size, decrease retractor-induced trauma to overlying cortex, and help prevent damage to underlying white matter tracts.