Neurosurgery
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Clinical Trial
Limitations of diffusion-weighted imaging in the diagnosis of postoperative infections.
Diffusion-weighted imaging (DWI) has assumed a rapidly emerging role in the diagnosis of intracranial infection; however, its usefulness in the recognition of postoperative infection has been largely unexplored. We sought to determine the ability of DWI to accurately detect a broad range of postneurosurgical infections as well as identify individual factors that may limit its applicability. ⋯ Utilization of DWI for the diagnosis of infection after primary neurosurgical intervention is associated with an elevated false-negative rate. The absence of restricted diffusion is not sufficient to exclude the presence of pyogenic postcraniotomy infection and should not be used as the principle determinant of patient management in this clinical setting.
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The interpeduncular cistern, including the retroinfundibular area, is one of the most challenging regions to approach surgically. The pituitary gland and the infundibulum guard the region when an endonasal route is undertaken. Superior transposition of the pituitary gland and infundibulum is described as a functional means to access this complex region through a fully endoscopic, completely transnasal route. ⋯ Endoscopic endonasal transposition of the pituitary gland and its stalk can provide a valuable corridor to the retroinfundibular space and interpeduncular cistern with pituitary function preservation in the majority of patients. This approach should only be pursued once significant experience with endoscopic endonasal approaches has been acquired.
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In evaluating the pediatric cervical spine for injury, the use of adult protocols without sufficient sensitivity to pediatric injury patterns may lead to excessive radiation doses. Data on injury location and means of detection can inform pediatric-specific guideline development. ⋯ Younger children tend to have more rostral (occiput-C2) injuries compared with older children. The National Emergency X-Radiography Utilization Study protocol may have lower sensitivity in young children than in adults. Limited computed tomography from occiput-C3 may increase diagnostic yield appreciably in young children compared with flexion-extension views. Further prospective studies, especially of young children, are needed to develop reliable pediatric protocols.
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Case Reports
Endovascular treatment of distal cervical and intracranial dissections with the neuroform stent.
Endovascular stent reconstruction is the primary intervention for cervical and intracranial dissections in symptomatic patients refractory to medical management. Advancement of traditional balloon-expanding stents into the distal internal carotid artery and vertebrobasilar artery can be technically challenging and potentially traumatic. ⋯ The Neuroform stent seems to be safe and technically effective in the endovascular management of distal cervical and intracranial dissections, with favorable clinical outcomes.
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Case Reports
Endoscopic supracerebellar infratentorial approach for pineal cyst resection: technical case report.
Accepted surgical strategies to address symptomatic pineal cysts include transventricular flexible or rigid endoscopy and supracerebellar infratentorial or occipital transtentorial microsurgical approaches. We report the first application of the endoscopic supracerebellar infratentorial approach for the complete resection of a pineal cyst. Unlike transventricular endoscopy, this technique poses no risk to the fornices and can be applied independent of ventricular size. ⋯ The endoscopic supracerebellar infratentorial approach involves minimal brain retraction, poses no risk to the fornices, allows visualization and avoidance of the Galenic veins, and can be performed regardless of the size of the ventricle. Consequently, it is an excellent minimally invasive surgical option for resection or fenestration of symptomatic pineal cysts.