World Neurosurg
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The results of recent high-profile delict and medical negligence cases now require doctors to take "reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments." Thus, we report the development and evaluation of a procedure-specific online educational resource to support the informed consent process for patients undergoing transsphenoidal excision of pituitary adenomas. ⋯ An interactive educational multimedia website appears to be a helpful adjunct to the informed consent process for patients undergoing transsphenoidal excision of a pituitary adenoma.
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Anatomic hemispherectomy is an effective surgical treatment for patients with hemispherical intractable epilepsy. Different degrees of brain shifting have been observed, but whether these shifts can predict motor function recovery is unknown. The aim of this study was to analyze the correlation between brain shift ratios of different brain areas and motor function before and after surgery. ⋯ Patients with hemispherical intractable epilepsy with larger presurgical shifts of thalamus and brainstem exhibited improved muscle strength, especially in distal muscles, after anatomic hemispherectomy. This result was more likely in patients who were older at the time of seizure onset. These presurgical shifts of thalamus and brainstem may be used for predicting motor function recovery after hemispherectomy for a subset of patients, which is beneficial for surgical planning.
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Ventricular tumors (VTs) represent approximately 10% of intracranial lesions and are associated with hydrocephalus in 73.9%-100% of patients. We present our experience using flexible neuroendoscopy as a diagnostic and hydrocephalus-related treatment strategy for paraventricular and intraventricular tumors. ⋯ Flexible neuroendoscopy is a strategic tool for diagnosis of VTs, especially in patients with associated hydrocephalus and VTs unreachable by other means. Flexible neuroendoscopy has a high rate of definitive diagnosis with low associated complications. More studies evaluating the long-term efficacy of flexible neuroendoscopy for hydrocephalus associated with VTs are needed.
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Hydatid cysts (HCs) are caused by parasites, the larvae of Echinococcus granulosus. They usually affect the liver and lung, but primary brain involvement is rarely seen. HCs may cause a mass effect in the brain. For this reason, surgical excision must be performed. Complications may rarely occur after surgery. Recognition of complications is of vital importance. ⋯ Surgical resection should be applied carefully in the treatment of cerebral cysts. Complications may occur later in patients who do not develop complications at the time of operation. For this reason, follow-up of the patients should definitely be done by magnetic resonance imaging.
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Severe complications after reperfusion therapy for acute major vessel occlusion are not well described. We present an extremely rare case of a patient with rapid malignant brain swelling subacutely after acute ischemic stroke. ⋯ This case has similarities to both second-impact syndrome after head trauma and perfusion breakthrough phenomenon. Initial ischemic damage following reperfusion therapy and damage secondary to sepsis and subarachnoid hemorrhage may have led to rapid malignant brain swelling in this patient. Careful management is important for patients receiving reperfusion therapy.