World Neurosurg
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Fluorescein sodium salt is widely used in medicine as fluorescein isothiocyanate and commonly named fluorescein (FL). This fluorophore has been used as a fluorescent tracer for many applications, especially in ophthalmic surgery. It was initially used in neuro-oncology in 1948 to control tumor resection margins. After a transient disuse, it has recently had a second spring with the development of dedicated filters for operating microscopes, although it is still under evaluation in clinical use. The aim of this study is to contribute to the investigation according to which FL-guided surgery for high-grade glioma (HGG) is related to better rates of gross total resection (GTR) and so to a better outcome. ⋯ Intraoperative fluorescein-guided surgery showed safety and feasibility. Our and other studies suggest an improvement of GTR rate in HGG than nonuse.
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Several postoperative complications related to lumbar microdiscectomy have been reported, including cauda equina syndrome. However, to the best of our knowledge, postoperative cauda equina syndrome resulting from dural sac shift with engorgement of the epidural venous plexus is yet to be reported. ⋯ We report a rare case of postoperative cauda equina syndrome due to dural sac shift and discuss the nascent mechanism of the dural sac shift focusing on anatomic features of the dural sac. We also propose laminoplasty as an option to treat dural sac shift with engorgement of the epidural venous plexus.
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The anatomic area exposed through exposure of Trautmann triangle may not be sufficient. We studied the additional exposure provided by skeletonizing the sigmoid sinus (SS). ⋯ Working area and visibility improved as the PSC and SS approached the same plane on axial imaging. Preoperative evaluation of the laterality of the SS to the PSC may assist a surgeon in determining the need for skeletonizing the SS and avoiding possible vascular injuries.
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Gross total resection for malignant brain neoplasms is challenging owing to the heterogeneity of these lesions and infiltration in eloquent areas. Gross total resection is a very important part of treatment of these patients and is a crucial prognostic factor. Fluorescence-guided surgery is an important tool that improves the rate of total resection. ⋯ The use of fluorescence for malignant brain tumor resection increases the rate of gross total resection. It is an important tool that makes it possible to identify the lesion in areas where it looks like normal tissue under white light. This device is a low-cost option that has shown good results in our experience.
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Metastatic brain tumors are the most common brain tumors in adults. Patients with metastatic brain tumors have poor prognoses with median survival of 6-12 months. Seizures are a major presenting symptom and cause of morbidity and mortality. In this article, risk factors for the onset of preoperative seizures and postoperative seizure control are examined. ⋯ The brain is a common site for metastases from numerous primary cancers, such as breast and lung. The identification of factors associated with onset of preoperative seizures as well as seizure control postoperatively could aid management strategies for patients with metastatic brain tumors. Patients with preoperative seizures who underwent resection tended to have good seizure control after surgery.