World Neurosurg
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Case Reports
Validity of the Lateral Supraorbital Approach as a Minimally Invasive Corridor for Orbital Lesions.
Many approaches were recommended for surgical treatment of orbital lesions via either transorbital or transcranial routes. The frontolateral craniotomy through eyebrow skin incision (lateral supraorbital approach) is a combined cranio-orbital approach that could be used in different orbital lesions. ⋯ The lateral supraorbital approach is a minimally invasive approach that provides excellent exposure of the superior, lateral, and medial orbit, as well as the orbital apex.
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This study investigated whether functional neuronavigation can be used to remove lesions in the lateral ventricle while preserving patients' neurologic functionality. ⋯ Functional neuronavigation preserved neurologic functionality and was especially beneficial for protecting optical functionality and for the rapid recovery of patients.
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Case Reports
Delayed Diagnosis of Enhancing Posterior Fossa Tumors Mimicking the Tela Choroidea of the Fourth Ventricle.
Posterior fossa brain tumors are common in children. Symptoms typically develop when the tumors have reached sufficient size to cause compression of adjacent neural structures or cause obstructive hydrocephalus. Many tumors in this region originate from the tela choroidea and choroid plexus of the fourth ventricle. Enhancement of the fourth ventricular tela choroidea and choroid plexus is uncommon in children, and when such enhancement is present, it may represent early tumor growth. ⋯ Pediatric patients who have enhancing tela choroidea or choroid plexus without an obvious mass lesion of the fourth ventricle may harbor early tumors. Surveillance imaging in these patients may be warranted given the aggressive nature of certain posterior fossa tumors in children. Failure to recognize abnormal enhancement patterns in this region may lead to delayed diagnosis.
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Atypical meningiomas (World Health Organization [WHO] grade II) represent a therapeutic challenge given their high recurrence rate and greater mortality compared with WHO grade I meningiomas. Traditionally, treatment has entailed attempts at gross total resection with radiation therapy reserved for residual disease or recurrences. ⋯ Given their high rates of recurrence, AMs require close clinical follow-up and an individualized treatment strategy. Reoperation, radiotherapy, or combination therapy can be effective strategies at managing disease progression while minimizing treatment-related morbidity. Treatment planning that attempts to anticipate future therapies in the form of further surgery or radiotherapy may improve clinical outcomes in these patients. Seventeen patients underwent adjuvant radiation therapy: 7 patients with intensity-modulated radiation therapy (IMRT), 4 patients with Gamma Knife (GK), and 2 with CyberKnife (CK). Four patients underwent multiple treatments.
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Shunt-related procedures in the treatment of hydrocephalus are often associated with malfunction and revision resulting in significant patient morbidity and financial impact on the health care system. The increased utilization of endoscopic third ventriculostomy (ETV) as an alternative treatment paradigm for obstructive hydrocephalus carries the theoretical expectation of concomitant decreased numbers of shunt procedures. The objective of the present study was to determine the impact of ETV on shunt-related procedures within a 14-year interval (1998-2011), during which ETV has gained wider acceptance and greater utilization. ⋯ Based on prior cost-effectiveness analyses, the observed trend of the inverse correlation between ETVs and shunt-related procedures may contribute to financial savings and improvement in patient outcomes. Further study is required to define the impact on morbidity and associated success rates.