Neurosurgery clinics of North America
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Chiari malformation type 1 (CM-I) is a common and often debilitating neurologic disease. Reliable evaluation of treatments has been hampered by inconsistent use of clinical outcome measures. A variety of outcome measurement tools are available, although few have been validated in CM-I. The recent development of the Chicago Chiari Outcome Scale and the Chiari Symptom Profile provides CM-I-specific instruments to measure outcomes in adults and children, although validation and refinement may be necessary.
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Neurosurg. Clin. N. Am. · Oct 2015
ReviewVentral Decompression in Chiari Malformation, Basilar Invagination, and Related Disorders.
Ventral brainstem compression is an uncommon clinical diagnosis seen by pediatric neurosurgeons and associated with Chiari malformation, type I. Presenting clinical symptoms often include headaches, lower cranial neuropathies, myelopathy, central sleep apnea, ataxia, and nystagmus. When ventral decompression is required, both open and endoscopic transoral/transnasal approaches are highly effective.
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Neurosurg. Clin. N. Am. · Jul 2015
ReviewEndoscopic Endonasal Extended Approaches for the Management of Large Pituitary Adenomas.
The management of giant and large pituitary adenomas with wide intracranial extension or infrasellar involvement of nasal and paranasal cavities is a big challenge for neurosurgeons and the best surgical approach indications are still controversial. Endoscopic extended endonasal approaches have been proposed as a new surgical technique for the treatment of such selected pituitary adenomas. Surgical series coming from many centers all around the world are flourishing and results in terms of outcomes and complications seem encouraging. This technique could be considered a valid alternative to the transcranial route for the management of giant and large pituitary adenomas.
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The surgical management of trigeminal schwannomas (TNs) entails the use of a variety of cranial base approaches for their effective surgical management. Although an extended middle fossa or posterior petrosal approach may be more appropriate for disease with primarily posterior fossa involvement, the expanded endoscopic approaches are suited for tumors with predominately middle fossa and/or extracranial involvement along the V2 and V3 divisions and limited posterior fossa extension. The endoscopic endonasal resection of TNs within the middle fossa, pterygopalatine fossa, and infratemporal fossa is reviewed in this article with a brief discussion of reported outcomes.
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Medical errors are common and dangerous, estimated to cause over 400,000 deaths per year in the United States alone. The field of neurosurgery is not immune to these errors, and many studies have begun analyzing the frequency and types of errors that neurosurgical patients experience, along with their effects and causes. Fortunately, these data are guiding new innovations to reduce and prevent errors, like checklists, computerized order entry, and an increased appreciation for volume-outcome relationships. This article describes the epidemiology of errors, their classification, methods for identifying and discovering errors, and new strategies for error prevention.