World Neurosurg
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Observational Study
What is the best electrophysiological marker of the outcome of the subthalamic nucleus stimulation in Parkinson's disease?
Deep brain stimulation of the subthalamic nucleus (STN) is advocated in patients with advanced Parkinson disease. Intraoperative microelectrode recordings (MER) and stimulation or imaging are applied to confirm electrode targeting. The study objective was to evaluate which intraoperative electrophysiologic marker, MER, stimulation, or local field potentials (LFP) was the most predictive of the clinical efficacy. ⋯ Motor improvements emerged as most related to β oscillations, before trajectory length within the STN, whereas stimulation thresholds of rigidity or of motor tract excitation failed to show any relationship. The study encourages LFP measurement to confirm STN electrode location.
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Studies on resuming anticoagulation after burr-hole drainage for chronic subdural hematoma (CSDH) are limited. To evaluate the safety for early warfarin resumption after burr-hole drainage, we conducted a retrospective matched cohort study. ⋯ There was no definitive association between postoperative early warfarin resumption and the recurrence rate of CSDH. Patients with warfarin-related CSDH and a strong indication for anticoagulation can be managed by resuming warfarin within 3 days of burr-hole drainage.
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Case Reports
Post-Traumatic Pituitary Tumor Apoplexy after Closed Head Injury: Case Report and Review of the Literature.
Head trauma is a rare inciting factor of pituitary apoplexy (PA); however, there is a clear temporal relationship between trauma and apoplexy, and this is the first reported case of PA after an assault. ⋯ Early and accurate diagnosis is important to allow for timely neurosurgical intervention. Symptoms of fever, hypotension, and tachycardia in a patient with a known sellar mass should raise the suspicion of hypocortisolemia from pituitary tumor apoplexy.
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Case Reports
Minimally Invasive Interhemisferic Approach for Giant Olfactory Groove Meningioma: Technical Note.
Skull base tumors, such as large olfactory groove meningiomas (OGMs), are a challenge for neurosurgeons. However, the tendency to reduce invasive surgeries is gaining more adepts. We describe a minimally invasive interhemispheric approach with a falx window for microsurgical resection of the giant OGM as a technical note. ⋯ The minimally invasive interhemispheric approach with a falx window is effective and safe for giant OGM with a good outcome for the patient. The opening in the falx improves the interhemispheric pathway and allows gross total resection with minimal brain retraction and low morbidity.
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Cerebral fat embolism (CFE) is a rare complication that usually occurs after trauma injury. The incidence of CFE due to aesthetic surgery is extremely rare and can lead to fatal outcome. Due to the rarity of this complication, there is still lack of knowledge and standardization of the treatment. ⋯ CFE is associated with high morbidity and mortality, and early surgical intervention can improve the prognosis.