World Neurosurg
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Case Reports
Neglected Recurrent Scalp sinus: Calvarial Tuberculosis with Intracrnial and Extracranial Extension.
Calvarial tuberculosis (TB) with intracranial tuberculoma and skin involvement is rare condition even in endemic regions. ⋯ Calvarial TB manifests with various clinical features, and strong clinical suspicion is needed to diagnose and treat it. Only a few cases of calvarial TB with either skin involvement or intracranial extension have been reported in the literature. The present case was challenging to diagnose with a rare presentation involving both intracranial and extracranial extension.
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En bloc resections aim at surgically removing a tumor in a single, intact piece. Approach must be planned for the complete removal of the tumor without violation of its margins. The shared knowledge of the morbidity, mortality, risk assessment for local disease recurrence, complications, and death, related to spine tumors excised en bloc could improve the treating physician's apprehension of the diseases and decision making process before, during, and after surgical treatment. The purpose of this study was to review and report the experience gained during 25 years in one of the world's biggest spine oncologic centers. ⋯ Treatment of spinal aggressive benign and malignant bone tumors with en bloc resection is beneficial in terms of better local control and prognosis, although it is a highly demanding and risky procedure. Margins are the key point of this procedure, thus a careful preoperative oncologic and surgical staging is necessary to define the optimal surgical approach. The adverse event profile of these surgeries is high. Therefore, it should be performed by experienced and multidisciplinary teams in specialized high volume centers.
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Chordomas in children and adolescents are rare, and minimal published information is available. Our aim was to research clinical features and prognostic factors associated with clival chordomas in younger patients. ⋯ In children and adolescents with clival chordomas, higher preoperative Karnofsky performance scale score, total resection, and lower levels of Ki-67 and CK8 expression are favorable prognostic factors. Platelet-derived growth factor receptor-β may play a role in tumorigenesis and epithelial-mesenchymal transition of clival chordomas.
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Diffusion tensor imaging-based navigation is unable to resolve crossing fibers or to determine with accuracy the fanning, origin, and termination of fibers. It is important to improve the accuracy of localizing white matter fibers for improved surgical approaches. We propose a solution to this problem using navigation based on track density imaging extracted from high-definition fiber tractography (HDFT). ⋯ DSI-based TDI navigation allows for the visualization of anatomic features such as fanning and angling and helps to identify the range of a given tract. Moreover, our results show that our HDFT navigation method is a promising technique that preserves neural function.
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Communicating branches between the tibial and common fibular divisions of the sciatic nerve have not been previously described. The aim of our study was to examine such neural connections. ⋯ To our knowledge, neural interconnections between the divisions of the sciatic nerve in the posterior thigh have not been described in the extant literature. Such data might help explain unusual neurologic examinations and alert the surgeon as to the potential for encountering such connections at operation.