World Neurosurg
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Stereotactic transcerebellar biopsies of brainstem tumors have often been reported. The Leksell frame or Cosman-Roberts-Wells frame is often used in transcerebellar approaches. However, to access lesions via the cerebellum, these frames should be secured as inferiorly on the cranium as possible, which can require exaggerated neck flexion and limit the flexible trajectory to the target. To overcome these disadvantages, we have devised a new way to use the Leksell frame for transcerebellar approaches. ⋯ Our devised transcerebellar approach provided a generous operative field and a flexible trajectory, which enabled minimally invasive biopsy of a posterior fossa lesions to be performed in a short amount of time with the patient under local anesthesia.
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Observational Study
Clusterin, a new cerebrospinal fluid biomarker in severe subarachnoid haemorrhage: a pilot study.
Inflammation following subarachnoid hemorrhage (SAH) involves numerous mediators with biomarker properties. Preliminary studies indicated that clusterin, a multifunctional chaperon protein, was a potential biomarker in SAH. We aimed to clarify the status of clusterin in SAH. ⋯ SAH is associated with immediate decrease in CSF clusterin concentrations. Clusterin level at one point was a good predictor of outcome, and it may serve as a biomarker.
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Gross total resection is often avoided in posterior fossa ependymoma surgery because of the fear of permanent neurologic deficits after operation. However, the extent of resection is a major prognostic factor for progression-free and overall survival. This study evaluates the outcome of posterior fossa ependymoma gross total resection in adult patients using a 4-hand suction-irrigation technique at the floor of the fourth ventricle. ⋯ Long-term progression-free survival in adult patients suffering from posterior fossa ependymoma is possible by gross total resection without adjuvant radio- or chemotherapy. By careful bimanual microsurgical dissection using the 4-hand suction-irrigation technique and avoidance of bipolar coagulation on the floor of the fourth ventricle, the risk for permanent neurologic deficits is low.
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Secondary intracranial hypotension is a clinical syndrome associated with reduction of cerebrospinal fluid volume and dural continuity violation. The main symptoms are orthostatic headache associated with nausea, vomiting, diplopia, dizziness, and tinnitus. The treatment is usually nonspecific. ⋯ Volumetric reduction of the epidural space may be considered as a valuable therapeutic option in case of intracranial hypotension that is unresponsive to medical treatments and spinal blood patch, as well as when an altered compliance of the dural sac is hypothesized.
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Active smoking is a major risk factor for intracranial aneurysm rupture (IAR); however, little is known about the effects of passive smoking on IAR. In China, female passive smoking is widespread and severe. This study aimed to assess whether passive smoking is associated with increased risk of IAR among nonsmoking women. ⋯ Although active current smoking was strongly associated with aneurysm rupture in female patients, passive smoking was not an independent risk factor for aneurysm rupture in nonsmoking women.