World Neurosurg
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Comparative Study
Management of Incidental Dural Tear During Lumbar Spine Surgery. To Suture or Not to Suture?
Incidental durotomy (ID) during lumbar spine surgery is a frequent complication of growing clinical relevance as the number and complexity of spinal procedures increases. Yet, there is still a lack of guidelines for the treatment of ID with a large heterogeneity of established surgical techniques. The aim of this study was to investigate the efficacy of dural suturing in patients having ID during degenerative lumbar spine surgery, compared with other dural closure techniques. ⋯ Based on our results, the dural closure technique after ID does not seem to influence revision surgery rates due to cerebrospinal fluid leakage and its complications. Further prospective randomized studies are needed to confirm our results.
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An exophytic tumor is defined as a tumor that has its epicenter in the nervous tissue but grows outside the anatomical superficial boundaries of the brain within an adjacent space. Exophytic extension of hemispheric gliomas is extremely rare. The object of this study is to describe the exophytic growth pattern of insular gliomas. ⋯ Radiologic features that define the exophytic growth pattern in insular gliomas are the posterior displacement of the middle cerebral artery and a sharp subarachnoid margin that separates the exophytic tumor from the temporal pole. Contrary to the tumor that infiltrates the anterior perforating substance, the exophytic tumor is amenable for safe and complete resection.
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Case Reports
Combined transzygomatic and pterional approach for resection of a dermoid cyst of the foreman ovale.
Dermoid cysts are rare, benign intracranial lesions commonly located in the posterior fossa. We describe a uniquely located dermoid cyst in the foreman ovale resected via a combined pterional and transzygomatic approach.
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Treatment of extremely large cerebral arteriovenous malformations (AVMs) is challenging. Although volume-staged stereotactic radiosurgery (SRS) is a possible multimodal treatment option for such lesions, reports of these procedures are scarce. We evaluated the efficacy and safety of volume-staged SRS in patients with AVMs >20 cm(3) with >3 years of follow-up. ⋯ In our series, volume-staged SRS for AVMs >20 cm(3) achieved a nidus obliteration rate of 35% at 5 years. There was still a high risk for hemorrhage (∼ 4% per year) after treatment, which seemed to be higher than the rate commonly observed in the posttreatment course of single-session SRS for average-size AVMs. Further cases will help determine whether volume-staged SRS could be routinely considered, based on its efficacy and risks, including comparison with the natural history of large AVMs.
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Thalamopeduncular gliomas arise at the junction of the thalamus and cerebral peduncle and constitute a subgroup of thalamic gliomas. These are surgically challenging lesions because of close proximity to important neural structures including corticospinal tracts (CSTs) and the thalamus. These tumors usually displace CSTs anterolaterally or extend to the lateral ventricular surface. Such tumors can be removed by either temporal or transventricular approaches. However, if CSTs cover the entire lateral surface of tumor and tumor does not extend to the ventricular surface, temporal and transventricular approaches cannot be used because the trajectories of both approaches would pass through normal eloquent structures (CSTs and thalamus), and consequently there would be a very high risk of postoperative neurologic deficits developing. ⋯ The anterior interhemispheric transparaterminal gyrus approach has not been described previously for accessing brainstem lesions. This approach can be used to access tumors of the cerebral peduncle that displace CSTs laterally and are covered by normal thalamus superiorly. The anterior interhemispheric transparaterminal gyrus approach adds to the armamentarium of neurosurgeons for treatment of cerebral peduncular lesions.