World Neurosurg
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We present the case of a professional jazz guitarist with temporal lobe epilepsy secondary to an arteriovenous cerebral malformation. ⋯ This case reveals the possibility of an unusual degree of cerebral plasticity and reorganization. Additionally, it emphasizes the question of musical virtuosity. This report shows that the musical capabilities of professional musicians, in specific cases, can completely recover even when much of the left temporal lobe has been removed.
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Poor outcome and neuropsychological sequelae after aneurysmal subarachnoid hemorrhage (SAH) is a persistent problem. Pituitary dysfunction has been proposed as a contributing factor. Clinical studies have given variable and conflicting results on its importance and incidence after SAH. The aim of this study was to prospectively examine SAH patients with assessment of endocrine function in the acute stage and at early follow-up and to compare clinical SAH features to endocrine abnormalities indicating pituitary dysfunction. ⋯ The present results support earlier findings that hormonal abnormalities are not infrequent after SAH. Furthermore, our data suggest that pituitary dysfunction is associated with worse clinical outcome and is more common among patients with bleeding sites close to the hypothalamus.
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Comparative Study
Proximal versus distal protection during carotid artery stenting: analysis of the two treatment approaches and associated clinical outcomes.
Cerebral protection device utilization during carotid artery stenting (CAS) has been shown to decrease risk of perioperative stroke. The two most commonly used devices are distal filters and proximal protection devices, which allow blood flow cessation or flow reversal. The goal of the present study was to examine anatomic and morphologic characteristics of the treated lesions using each type of cerebral protection device and compare clinical 30-day adverse event rates between the two cerebral protection groups. ⋯ Our study is the first attempt (to our knowledge) to review and compare anatomic and morphologic characteristics of the stented lesions in cases of proximal versus distal protection for CAS. Our data indicate that in properly selected patients both approaches could be equally safe and effective.
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Keeping track of the endoscope tip in 3 planes (axial, coronal, and sagittal) while performing skull base surgeries can be difficult because the surgeon is focused most on the live video images of the endoscope. For that reason, it was the aim of this anatomical cadaver study to evaluate the usefulness of a voxel-based neuronavigation system with 3-dimensional (3D) perspective image rendering for endoscopic procedures through keyhole approaches to the skull base. ⋯ A neuronavigation system with 3D voxel-based perspective image rendering could potentially improve safety during complex skull base surgeries, and possibly also help to improve surgical results. Such a system, however, cannot replace a neurosurgeon's experience nor surgical skill or anatomical knowledge. It is an excellent teaching tool for young neurosurgeons, but it also has some limitations. Therefore, clinical studies will be necessary to further evaluate the benefits of this type of neuronavigation system in a clinical setting.
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Clinical Trial
Prospective trial of a short hospital stay protocol after endoscopic endonasal pituitary adenoma surgery.
Patients typically remain hospitalized for several days after transsphenoidal surgery for pituitary adenoma resection for reasons including pain control, serial neurological assessments, surveillance for cerebrospinal fluid leak, and management of endocrine issues. We sought to determine whether an evidence-based perioperative care protocol combined with an endoscopic approach could lead to routine and safe discharge on postoperative day 1. ⋯ A short-stay protocol allows for an overnight hospital stay for patients after pituitary surgery, with a low rate of complications or readmission. This study offers evidence-based guidelines that may be used to avoid complications and facilitate early discharge after transsphenoidal surgery.