World Neurosurg
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One of the main challenges during skull base tumor surgery is identifying the relationships between the lesion and the principal intracranial vessels. To this end, neuronavigation systems based on preoperative imaging lack accuracy because of brain shift and brain deformation. Intraoperative navigated B-mode ultrasonography is useful in defining the extent of brain tumor. Doppler imaging adds information regarding flow entity in neighboring vessels. Second-generation ultrasound contrast agents improve the signal-to-noise ratio of B-mode imaging and permit the study of the vessel's course, blood flow, and perfusion characteristics of focal lesions. We report our experience using intraoperative navigated contrast-enhanced ultrasound to perform a navigated angiosonography (N-ASG) for the visualization of vessels in a series of 18 skull base tumors. ⋯ N-ASG can be applied to skull base tumor surgery, providing helpful information about the relationship between principal intracranial vessels and tumors. This technique could be of assistance in approaching the tumor and avoiding vascular damages.
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Brain arteriovenous malformation (AVM) with a fistulous component presents a treatment challenge. The presence of the fistulous component may be related to either a complication from endovascular treatment, perioperative hemorrhagic events during surgical resection, or incomplete obliteration after radiosurgery. ⋯ Prioritized transarterial venous coiling is feasible for the embolization of AVMs with a high-flow fistulous component and the procedure had an acceptable complication rate.
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Labeled the "obesity paradox," obesity has been shown to provide a survival advantage in coronary artery disease, stroke, and intracerebral hemorrhage. Studies on body mass index (BMI) in aneurysmal subarachnoid hemorrhage (SAH) show conflicting results and none examined a North American population with long-term follow-up. ⋯ In our SAH population, higher BMI resulted in less short-term and long-term mortality, but no difference in functional outcome.
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Case Reports
Initial Experience with High Definition Camera-On-a-Chip Flexible Endoscopy for Intraventricular Neurosurgery.
The usefulness of existing neuroendoscopes has been limited by either decreased range of motion or suboptimal image resolution. The flexible high-definition chip-camera endoscope has emerged as a potential solution to the shortcomings of available instruments by combining superior flexibility and image quality in order to better operate within spatially constrained intraventricular operations. ⋯ As demonstrated by this initial experience, the use of high-definition camera-on-a-chip flexible endoscopy may provide enhanced intraoperative visualization and application for intraventricular neurosurgery.
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Diagnosing normal pressure hydrocephalus (NPH) remains challenging. Most clinical tests currently used to evaluate suspected NPH patients for shunt surgery are invasive, require inpatient admission, and are not without complications. An objective, noninvasive, and low-cost alternative would be ideal. ⋯ A baseline DGI ≥ 7 appears to provide an objective, low-cost, noninvasive measure to select patients with suspected NPH for a positive response to CSF diversion with high sensitivity, specificity and diagnostic odds ratio.