World Neurosurg
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Case Reports
5-Aminolevulinic acid accumulation in a cerebral infarction mimicking high-grade glioma, a case report.
5-Aminolevulinic acid (5-ALA) has become an integral part in the neurosurgical treatment of malignant glioma. Over time, several other tumor entities have been identified to metabolize 5-ALA and show a similar fluorescence pattern during surgical resection. This case report is the first description of 5-ALA accumulation in postischemic cerebral tissue. This evidence questions the assumption that 5-ALA accumulation in glioma is exclusively attributed to tumor infiltration. Instead, 5-ALA accumulation can also occur beyond the tumor borders and may be partially ascribed to inflammatory changes in the surrounding brain tissue. ⋯ 5-ALA accumulation in postischemic cerebral tissue should be considered for intended supramarginal resections near eloquent brain regions. Therefore, sufficient preoperative imaging should regularly include magnetic resonance imaging spectroscopy and perfusion sequences to ascertain the proper diagnosis. Moreover, further research is warranted to determine the role of 5-ALA accumulation in postischemic and inflammatory brain tissue.
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High-resolution magnetic resonance imaging can be used to delineate the morphology of neurovascular compression (NVC) in detail. This study focuses on essential morphologic parameters in relation to the clinical appearance of patients with trigeminal neuralgia (TN). ⋯ The CSF sign is pathognomonic for V1 affection. Vascular loops from cranial on the nerve were the most frequent types of compression in all areas of pain, followed by mediocranial loops. This evaluation is reproducible and contributes to the role of magnetic resonance imaging and a classification of findings in the preoperative evaluation of NVC.
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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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Hemifacial spasm results from vascular compression of the facial nerve. It remains controversial whether severe compression and subsequent nerve indentation predict a good or a poor surgical outcome. Here, to illustrate the relationship between the degree of neurovascular compression and surgical outcome, we conducted a retrospective case-cohort study focused on patients whose facial nerve was seriously compressed. ⋯ Severe vascular compression and subsequent nerve indentation were correlated with a greater possibility of single compression and a lower incidence of multiple neurovascular conflicts in patients with hemifacial spasm, making the microvascular decompression procedure more accurate and easier. Therefore nerve indentation might predict good surgical outcomes.
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Despite efforts for improvement, cerebrospinal fluid (CSF) shunt failure rates remain high. Recent studies have shown promising reductions in failure rates and infection rates with the routine use of perioperative checklists. This study was conducted to pilot test the feasibility and efficacy of integrating specific CSF shunt surgery quality checks into the World Health Organization (WHO) Surgical Safety Checklist. ⋯ The integration of specialty-specific checks into the WHO Safe Surgery Checklist improved adherence to quality processes and generally was well accepted in our pilot study. A larger clinical trial is needed to assess whether this approach could improve shunt outcomes.