World Neurosurg
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Case Reports
It's time to reduce free-hand manipulation: case report of our proposal for an innovative one step cranioplasty.
Cranioplasty is a well-known procedure, and autologous graft bone is usually considered the best choice in this procedure, but it cannot be used in conditions such as bone-infiltrating tumors, spheno-orbital en plaque meningiomas, and bone infections. Polymethylmethacrylate (PMMA) offers great possibility of intraoperative adaption. We describe a case of 1-step cranioplasty performed in a patient with a meningeal fibrosarcoma using a custom-made silicon mold. ⋯ We performed a 1-step cranioplasty after resection of a meningeal fibrosarcoma that infiltrated bone with a new technique to reproduce during intervention a preoperative simulated craniectomy and a computer-assisted design PMMA flap.
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A retrospective study was conducted to clarify the risk factors of postoperative low back pain (LBP) for low-grade degenerative spondylolisthesis. ⋯ LM IMAT and symptom duration were risk factors for postoperative LBP. Patients with severe LM IMAT reported more severe LBP before the operation. Postoperative LBP disappeared more often in patients with shorter symptom duration.
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To evaluate efficacy and reliability of intraoperative Doppler sonography in localizing the transverse and sigmoid sinuses during lateral suboccipital craniotomy. ⋯ A combination of image-guidance and micro-Doppler enhances the accuracy in localizing the margins of the transverse and sigmoid sinuses using the retrosigmoid approach, thus preventing inadvertent injury. The method could potentially be applied during other craniotomies involving the exposure of a venous sinus.
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Direct surgical resection remains the standard treatment for patients with tuberous sclerosis complex (TSC) with a large subependymal giant cell astrocytoma (SEGA). Rapamycin or everolimus is seldom used in these patients because of the risk of increased intracranial pressure and possibility of sudden death. ⋯ Preoperative mTOR inhibitors could be a potentially novel treatment modality in large TSC-SEGA with hydrocephalus. In this series, mTOR inhibitors were not only safe and well tolerated, but also beneficial for tumor resection.
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Case Reports
Guidewire Breakage During Cavernous Sinus Sampling: A Rare Complication and Its Treatment.
Venous sampling methods are valuable tools for the diagnosis of pituitary adenomas. However, these interventions also have complications, which may complicate the treatment process. ⋯ Current surgical experience on endoscopic skull base surgery allows management of diagnostic complications related to the cavernous sinus, such as safe access to materials which were inadvertently left during CSS, without the necessity for further interventions.