World Neurosurg
-
To assess the clinical and radiographic outcomes of posterior vertebral column resection (PVCR) without anterior support in treatment of Yang type A severe rigid thoracic kyphoscoliosis. ⋯ In this study, we found that posterior vertebral column resection (PVCR) without any anterior support with a mean 3.7 cm shortening of the spinal column is safe, if close and unyielding contact of end plates can be obtained. A comprehensive understanding of the technique and intensive intraoperative neuromonitoring is mandatory to perform these challenging and complex spine deformity correction procedures safely.
-
Halo fixation is one of the possible treatments for cervical spine fractures. However, improper use of these devices may lead to many complications, such as pin loosening, halo dislocation, pin site infection, and intradural penetration. ⋯ Misapplication of halo fixation devices may lead to serious complications, including intracranial pin penetration and brain abscesses. Proper use of the recommended technique may decrease the risk for complications related to the procedure.
-
Comparative Study
Optic Canal Decompression: A Comparison Of Two Surgical Techniques.
The optic canal is a bony channel that connects the anterior cranial fossa and orbit and contains the optic nerve and ophthalmic artery. It can be affected by several pathologies, leading to compression of the nerve nearby or inside the canal, leading to visual impairment. The usual technique to decompress the canal is through a craniotomy, but recently endoscopic endonasal approaches (EEAs) have surfaced as an interesting alternative due to direct access to the canal without the need for manipulation of neurovascular structures. ⋯ The decision for an approach for optic canal decompression should be based on the site of the pathology and localization of canal involvement. Both techniques are equivalent in terms of proportion of nerve decompression.
-
Case Reports
Lesion Optimization for Laser Ablation: Fluid Evacuation Prior to Laser Induced Thermal Therapy.
Magnetic resonance-guided laser-induced thermal therapy (MRgLITT) is a minimally invasive surgical procedure for ablating intracranial lesions. The presence of a fluid body can sequester thermal energy generated by the laser catheter, which compromises the performance of MRgLITT, resulting in suboptimal ablation of cystic lesions. We report our use of stereotactic fluid evacuation followed by MRgLITT in 2 patients with cystic brain tumors. This is the first report on lesion optimization by fluid aspiration before MRgLITT. ⋯ Cystic fluid evacuation is a promising strategy for optimizing intracranial cystic lesions for MRgLITT. This novel approach may broaden the utility of MRgLITT in the management of various technically demanding lesions.
-
Case Reports
First report of coexistence of 2 ectopic pituitary tumors: Rathke cleft cyst and silent ACTH adenoma.
Rathke cleft cysts (RCCs) and pituitary adenomas (PAs) are thought to have a common embryonic ancestry; however, PAs with a concomitant RCC inside the sella turcica are rarely observed. Ectopic pituitary tumors are also rare. ⋯ To our knowledge, this is the first reported ectopic RCC located outside the sella turcica with a concomitant ACTH-staining PA. This also appears to be the first ACTH-staining adenoma concomitant with RCC reported in the literature, regardless of location, not presenting with Cushing disease. This case shows that we can now include pituitary adenoma with or without a concomitant RCC in the differential diagnosis of processes in the sphenoid sinus. As both PAs and RCCs are benign sellar lesions, surgical management of a concomitant occurrence of these tumors mainly depends on the size of the lesions and their clinical manifestations. For patients with PA and concomitant RCC, surgical resection should be considered, as there is an approximatrely 20% recurrence rate of the cyst after resection and the possibility of future clival erosion, if left untreated.