Surg Neurol
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Neurosurgical patties are being used in almost all intradural procedures. The patties tend to stick to the brain, and it is not known to what extent they damage the brain. In this study, 5 commonly used patties were investigated for their tendency to stick to and damage neural tissue. ⋯ Commonly used neurosurgical patties do stick to brain tissue when placed on neural tissue for more than 15 minutes, despite the "nonsticking" and "atraumatic" manufacturer's claims. Cotton patties from Braun/Aesculap are the least traumatic for brain tissue. These results should be interpreted with caution because of methodological restriction of the present study.
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An extended transsphenoidal approach allowed for direct midline exposure of the parasellar structures such as the hypothalamic-pituitary axis and the third ventricle. To evaluate the capability of this approach for removal of suprasellar craniopharyngiomas, surgical outcomes were retrospectively analyzed. ⋯ Reasonable surgical results in this study suggest that the extended transsphenoidal approach is safe and effective for removal of craniopharyngiomas. Although preservation of the pituitary stalk can be achieved in a high percentage of patients, postoperative endocrinopathy still remains as a significant problem after radical removal of the craniopharyngioma.
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Case Reports
Delayed pseudomyelomeningocele: a rare complication after foramen magnum decompression for Chiari malformation.
A variety of complications after FMD with or without duraplasty for Chiari malformation have been described. Although cerebellar ptosis through the dural opening and pseudomeningocele are well-known rare complications of this procedure, spinal cord herniation manifesting as pseudomyelomeningocele formation has not previously been cited in the literature. In this report, we present a case of delayed pseudomyleomeningocele after FMD. ⋯ Neural tissue shift including the spinal cord through the dural opening may occur after a large posterior fossa decompression without duraplasty for Chiari malformation. Postoperative inadequate CSF circulation due to arachnoid scarring around the decompression area may facilitate this type condition. Early diagnosis of such a complication is of vital importance to prevent serious neurologic deficits, and release surgery with proper duraplasty and also restoration of CSF circulation is the choice of treatment.
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The aim of the study is to assess the effects of infliximab, a TNF-alpha receptor blocker, in a spinal cord clip compression injury model. ⋯ Infliximab is found as effective as methylprednisolone on spinal cord clip compression injury. Moreover, the combination of these 2 agents demonstrated higher efficacy suggesting a synergistic effect between these 2 agents. However, further studies regarding functional and behavioral analyses as well as biochemical markers are required.
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Patients with limited intracranial metastatic disease traditionally have been treated with surgery followed by WBRT. However, there is growing concern for the debilitating cognitive effects after WBRT in long-term survivors. We present a series of patients treated with surgery followed by SRS, while reserving WBRT as a salvage therapy for disease progression. ⋯ Surgical resection combined with SRS is an effective treatment for selected patients with limited cerebral metastatic disease. Survival using this combined treatment was equivalent to or greater than that reported by other studies using surgery + WBRT or SRS + WBRT.