British journal of neurosurgery
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Review Case Reports
Adult idiopatic occlusion of Monro foramina: intraoperative endoscopic reinterpretation of radiological data and review of the literature.
Adult idiopathic occlusion of the foramen of Monro (AIOFM) is a rare condition, with only few cases described in the modern literature. We propose that AIOFM may result from unilateral or bilateral occlusion of Monro foramina, as well as from progression of a monolateral hydrocephalus. Different surgical strategies may be required for effective treatment according to the type of occlusion. ⋯ We propose that septum pellucidum displacement could play a role in the occlusion of the second foramen of Monro. AIOFM can, therefore, result also from unilateral stenosis of Monro. The difference in AIOFM (i.e. unilateral vs bilateral) will be useful in guiding the most suitable surgical approach in this rare condition.
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Case Reports
Early onset of PRES in a patient with a subarachnoid haemorrhage due to a ruptured intracranial aneurysm.
Posterior reversible encephalopathy syndrome (PRES) is rarely associated with subarachnoid haemorrhage (SAH). We present a case involving a patient who developed PRES, prior to induction of hypertensive therapy, 2 days after the onset of a SAH due to a ruptured intracranial aneurysm.
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Schwannomas of the skull base can pose a surgical challenge due to their anatomical location. To date extensive craniofacial approaches have had to be used to access these lesions. We present a patient where an expanded endoscopic endonasal approach was used to address a large skull base schwannoma with good results. The approach confers significantly less morbidity and a substantially shorter hospital stay.
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Review Case Reports
5-ALA fluorescence-assisted surgery in pediatric brain tumors: report of three cases and review of the literature.
5-aminolevulinic acid (5-ALA) has been used for the last 5 years to increase the extent of resection in adult brain tumors, mostly glioblastomas, but it is not approved yet as standard adjuvant treatment in the pediatric population. We report three different cases of pediatric brain tumors (two glioblastomas and one medulloblastoma) recently operated using 5-ALA fluorescence guidance, highlighting how useful it is in pediatric high-grade glioma (but not in medulloblastoma) also and confirming the lack of 5-ALA-related side effects. The first glioma was a recurrent GBM, whilst the second was a primary tumor. ⋯ In the medulloblastoma case no useful 5-ALA fluorescence was identified. No hematological or dermatological complications nor other side effects related to use of 5-ALA were observed. We submit that 5-ALA fluorescence guided surgery can be safe and useful in pediatric high-grade glioma, although its use in children still remains an off-label indication and requires validation through larger studies.
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The developed world has an aging population with an increasing neurosurgical demand. The benefit of neurosurgical intervention in the octogenarian population and the outcome is unclear. The 2010 NCEPOD report on all surgical care for the elderly (> 80 years) concluded that extreme age was an additional risk for which care was often lacking. ⋯ Patient selection is crucial when considering neurosurgery in the octogenarian population. Our octogenarian patients had higher complication rate and 30-day mortality than those < 80 year old, demonstrating the additional risk and need for enhanced peri-operative care.