World Neurosurg
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Endoscopic versus stereotactic procedure for pineal tumour biopsies: focus on overall efficacy rate.
The management of pineal region tumors depends on the histologic subtypes. Two minimally invasive techniques are available: endoscopic intraventricular biopsies and stereotactic biopsies. The recent Southampton and Lille series are the largest endoscopic and stereotactic series of pineal region tumors reporting both diagnosis rate and accuracy rate, respectively; we elaborated on these results in the light of other recent studies. ⋯ The Southampton and Lille series provide a unique opportunity to compare the overall efficacy rates of endoscopic and stereotactic biopsies, respectively. The stereotactic approach is safer and more effective for biopsies of pineal region tumors. To improve the safety and reliability of endoscopic biopsies, various methods have to be evaluated: alternative burr-hole strategies, use of neuronavigation, and a combination of flexible and rigid endoscopes.
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The use of anticoagulants and older age are the main risk factors for chronic subdural hematoma (CSDH). Because the age of the population and use of anticoagulants are increasing, a growing number of CSDH cases is expected. To address this issue, we analyzed the impact of anticoagulants on postsurgical outcome in patients in the intensive care unit (ICU). ⋯ The size of CSDH was not associated with poor outcome and is not necessarily determined by the use of anticoagulants. Coagulopathy does not rule out a good outcome, but the impact of anticoagulation on treatment results in CSDH varies between the main groups of drugs (warfarin vs. antiplatelet drugs). Patients in good neurologic condition on ICU admission have better chances of recovery.
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To evaluate the acute stability of a novel integrated C1 laminar hook (H) combined with a C1-C2 transarticular screw (TAS) with established techniques. ⋯ The TAS+H technique can achieve acute stability comparable to that with the TAS+G technique for treating C1-C2 instability. The C2PS+H is a promising alternative, although it provides less stability in axial rotation than TAS+G, TAS+H, or C2PS+C1LMS.
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Supraglandular pituitary adenoma (SGPA) is one of the extraordinary pituitary adenomas and shows different clinical and radiologic features. We retrospectively reviewed our cases of SGPAs to elucidate the radiologic, anatomic, and clinical features. ⋯ SGPAs are rare and preoperative diagnosis is possible based on their distinct radiologic, clinical, and anatomic features. SGPAs can be divided into 2 groups according to the anatomic features. The origin of tumor, whether the superior surface of the gland or the pituitary stalk, determined the location, extent, and relationship with the diaphragma sellae. The surgical outcome via an endoscopic endonasal approach was favorable.
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Neurologic condition at presentation is the most important predictor of morbidity and mortality from aneurysmal subarachnoid hemorrhage (aSAH). To guide management, it is important to identify patients who are at risk of presenting in poor neurologic condition after aSAH. ⋯ Independent predictors of poor neurologic grade were identified for all, ICA, anterior cerebral artery/anterior communicating artery, middle cerebral artery, and posterior circulation aneurysms. A risk prediction chart was constructed using clinically accessible patient and aneurysm characteristics for poor presenting neurologic condition after ICA aneurysm rupture. These factors should be considered when counseling patients with unruptured intracranial aneurysms.