World Neurosurg
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Case Reports
Single-step resection of an intraosseous meningioma and cranial reconstruction: technical note.
Simultaneous tumor resection and cranial reconstruction can be a challenging task. Surgical navigation is an indispensable tool in making this single-step procedure possible. In this technical note, we describe a new technique for this procedure to ensure a precise resection and optimal fit of the implant in a patient with an intraosseous meningioma. ⋯ We provide a simple technique to digitally define a planned resection site and create a custom-made implant using specialized software and 3D printing to enable single-step resection of a skull lesion and cranial reconstruction, thereby reducing surgical time and costs and ensuring a good cosmetic result.
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Blood blister-like aneurysms (BBAs) are a subgroup of aneurysms located on nonbranching sites of the internal carotid artery (ICA) and characterized by small size, a fragile wall, and a poorly defined broad-based neck. Both direct surgery and endovascular treatment for BBAs are often challenging. Some of the BBAs have been reported to look like true saccular aneurysms, and the misdiagnosis of BBA might result in catastrophic outcomes. The purpose of this study is to clarify the clinical and intraoperative findings of saccular BBAs. ⋯ Saccular BBAs may not merely develop secondarily from typical BBAs, but also form by the surrounding structures-dependent mechanisms when an aneurysm points toward the optic nerve. The findings in this study suggest that saccular-shaped aneurysms at nonbranching sites of the ICA toward the optic nerve should be considered as saccular BBAs.
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Most sellar gangliocytomas are discovered with a concurrent pituitary adenoma, also known as a mixed gangliocytoma-adenoma (MGA). MGAs are rare, with fewer than 100 cases reported in the literature to date and only 1 previously documented surgical series. Because MGAs are radiologically indistinguishable from pituitary adenomas, they are often diagnosed after surgery. Combined with the paucity of clinical outcome data for these tumors, this makes their diagnosis and management challenging. Here we describe the clinical presentation and outcomes of 10 individuals who were diagnosed with a MGA at a single institution. ⋯ MGAs are often associated with a hypersecretory adenoma. Transsphenoidal surgery is well tolerated by most patients, and when performed in combination with adjuvant therapy, a low rate of recurrence and reversal of preoperative endocrinopathy can be expected.
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Pediatric moyamoya cases may be very arduous, even more so in a developing country, where access to specialized centers may be prevented by different factors. ⋯ The creation of highly specialized neurosurgical centers in the main strategic places of developing countries may allow optimal treatment of neurosurgical patients with complex diseases.
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Observational Study
Incidence of postoperative hematomas requiring surgical treatment in neurosurgery: a retrospective observational study.
We aimed to characterize the occurrence of postoperative hematoma (POH) after neurosurgery overall and according to procedure type and describe the prevalence of possible confounders. ⋯ POH after neurosurgery was rare in this series but was associated with poor outcome. Identification of risk factors of bleeding, and avoiding them, if possible, might decrease the incidence of POH.