World Neurosurg
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Case Reports
Endoscopic Transnasal Transclival Approach to a Pontine Cavernoma with Associated Developmental Venous Anomaly.
Brainstem cavernous malformations represent around 8%-22% of all intracranial cavernous malformations but exhibit a higher annual incidence of hemorrhage (2%-3%) compared with other cavernous angiomas and tend to be more symptomatic given their proximity to critical nuclei and fiber tracts. Recently, endoscopic endonasal techniques have been used for the removal of ventral skull base lesions, with significant improvement in operative morbidity and mortality compared with open approaches. Here we demonstrate the utility and feasibility of the endoscopic transclival approach for ventrally located pontine cavernomas in carefully selected patients. ⋯ This approach provided direct visualization of the lesion and the associated DVA allowing for a gross total resection without injury to the DVA. The transclival approach may be considered as an alternative to open lateral and dorsolateral neurosurgical approaches for ventral brainstem cavernomas in carefully selected patients.
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The pterional keyhole approach is a more recently introduced minimally invasive version of the traditional pterional approach for treating aneurysms of the anterior circulation. ⋯ The pterional keyhole approach offers shorter operative times, less blood loss, shorter length of stay, and improved cosmesis without sacrificing outcomes compared with traditional pterional craniotomy.
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Surgical treatment of brainstem cavernous malformations (CMs) remains a great challenge for neurosurgeons. Several cases published in the literature have addressed surgical approaches. However, no surgical approach has been reported to provide better exposure for CMs located in the superior midbrain. ⋯ The transcallosal anterior interforniceal approach can provide good exposure and direct visualization to superior midbrain CMs. Complications are short-term and reversible.
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To relate the experiences of a pediatric surgery clinic in diagnosis and treatment of abdominal complications related to ventriculoperitoneal shunts (VPSs) in pediatric patients who had VPSs implanted to treat hydrocephalus. ⋯ VPS implantation can result in abdominal complications with a wide range of clinical presentations. Predicting which abdominal complications might occur in children with VPSs can be lifesaving with early diagnosis and treatment.
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Magnetic resonance imaging (MRI) plays an important role in the assessment of spinal cord status for cervical spondylotic myelopathy (CSM). Diffusion tensor imaging (DTI) also is a novel investigation tool with good sensitivity to detect changes in CSM, but it is not routinely used in spinal cord evaluation. ⋯ DTI was closely related to the severity of CSM, and cutoff values of DTI enabled the surgeons to predict the surgical outcomes in patients with CSM. These evaluation metrics may reflect the pathologic conditions of the spinal cord quantitatively, and potentially evaluate the functional status of spinal cords.