World Neurosurg
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Top performing neurosurgeons and elite athletes require years of sacrifice, discipline, and dedication to their art to be finely attuned to their physical abilities and limitations, and a singular mental focus to reach their full potential under moments of pressure. ⋯ Maintaining peak performance for a neurosurgeon may prove to be more challenging than that of the elite athlete.
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Anterior skull base meningiomas often grow to a large size (≥4 cm) before detection. Their blood supply is mostly provided by the anterior and posterior ethmoidal arteries. Because of their vascularity, intraoperative bleeding can be a challenging prospect that increases the risk of perioperative complications. Preoperative ethmoidal arteries ligation has been used to aid in limiting blood loss. Our objective was to assess the effect of preoperative arterial ligation on the perioperative course of large (≥4 cm) to giant (≥6 cm) anterior skull base meningiomas. ⋯ Ethmoidal arteries ligation may have a benefit in large-to-giant anterior skull base meningiomas surgery. Our results showed a decrease in EBL and lesser decrease in pre- and postoperative hemoglobin and hematocrit levels as compared with cases in which no vascular ligation was performed when corrected for tumor volume.
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Meningiomas frequently occur in elderly patients, and surgical treatment is hazardous owing to multiple comorbidities. We report a series of elderly patients who were treated with surgical removal of meningiomas and compare them with a group of younger patients with similar tumors. ⋯ Elderly patients with symptomatic skull base meningiomas should be considered for surgical treatment owing to acceptable morbidity and mortality compared with younger patients. Previous comorbidities and involvement of neurovascular structures are important factors in the decision regarding extent of surgical resection.
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Unreliable neuronavigation owing to inaccurate patient-to-image registration and brain shift is a major problem in conventional magnetic resonance imaging-guided neurosurgery. We performed a prospective intraoperative validation of a system for fully automatic correction of this inaccuracy based on intraoperative three-dimensional ultrasound and magnetic resonance imaging-to-ultrasound registration. ⋯ Automatic and accurate correction of spatially unreliable neuronavigation is feasible within the constraints of surgery. The current limitations of the system were also identified and addressed.
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The most commonly performed nerve transfers in upper trunk (UT) or partial brachial plexus injuries (BPIs) include the spinal accessory nerve to suprascapular nerve, Oberlin, and, lately, radial nerve (RN) (branch to triceps) to axillary nerve (AN) transfers. Routinely, the former 3 procedures are performed through an anterior approach (supraclavicular plus infraclavicular), while the triceps branch of the RN-AN transfer has been performed through a posterior approach with the patient in either the prone or semilateral position, which requires a separate incision in the posterior arm. The aim of the present study was to report the outcomes for 4 cases of quadruple nerve transfers performed for UT BPI using an all-anterior approach. ⋯ This technique appears to be feasible, with good-to-excellent outcomes achieved without requiring a separate posterior arm incision for the RN-AN transfer.