World Neurosurg
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Multicenter Study Clinical Trial
Endonasal endoscopic odontoidectomy in ventral pathologies of the cranio-cervical junction - Results of a multicenter experience.
Over the past decades, supported by preliminary anatomic and clinical studies exploring its feasibility and safety, experience has increased of the use of the endoscopic endonasal approach (EEA) to ventral diseases at the craniocervical junction (CCJ). ⋯ The results show that EEA provides a direct surgical corridor to the CCJ, allowing an adequate decompression as with the more invasive transoral route. Morbidity is less than with a transoral approach, resulting in higher patient comfort and faster recovery.
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Multicenter Study Comparative Study
Prospective evaluation of the non-invasive Headsense ICP monitor in TBI patients undergoing invasive ICP monitoring.
Currently, intracranial pressure (ICP) is measured by invasive methods with a significant risk of infectious and hemorrhagic complications. Because of these high risks, there is a need for a noninvasive ICP (nICP) monitor with an accuracy similar to that of an invasive ICP (iICP) monitor. ⋯ The HeadSense HS-1000 nICP monitor seems sufficiently accurate to measure the ICP in severe TBI patients, is patient friendly, and has minimal risk of complications.
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Review Case Reports
Pitfalls in diagnosis and management of testicular choriocarcinoma metastatic to the brain: Report of two cases and review of literature.
Pure choriocarcinoma of the testes is a rare, aggressive germ cell tumor that can metastasize to the brain. Although its prognosis has improved with the development of cisplatin-based chemotherapy regimens, cerebral metastases are prone to hemorrhage and associated with high morbidity. Here, we present 2 cases of testicular choriocarcinoma with cerebral metastasis and discuss potential pitfalls in their diagnosis and management. We also review cases in the literature that feature these rare lesions. ⋯ The potentially catastrophic nature of choriocarcinoma-related cerebral hemorrhages underscores the need for prompt, accurate diagnosis and aggressive surgical management of these lesions. Their highly vascular nature and lack of findings on cerebral angiography may cause them to be confused with occult vascular malformations.
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Primary cerebellar hemorrhage accounts for 10% of all intracranial hemorrhages. Given the confined space of the posterior fossa, cerebellar hemorrhage management sometimes necessitates suboccipital decompression and hematoma evacuation. In this study, we examine outcomes after surgery for primary cerebellar hemorrhage and identify risk factors associated with adverse outcomes. ⋯ Cerebellar hemorrhage is associated with significant risk of mortality and ventilator dependence. In patients who require surgery, 30-day mortality risk remains high (26.6%), with functional status and American Society of Anesthesiologists class predictive of death.
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Case Reports
Intraventricular Meningioma Resection with Post-Operative Ischemia of the Lateral Geniculate Nucleus.
Intraventricular meningiomas comprise 0.5%-3% of intracranial meningiomas. They often cause obstructive hydrocephalus and commonly are treated with surgical resection or stereotactic radiosurgery. ⋯ Care must be taken to avoid visual pathways along the lateral ventricle wall and the nearby arterial supply of the lateral geniculate nucleus from the choroidal arteries when resecting intraventricular tumors.