World Neurosurg
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Case Reports
Muslin granuloma mimicking parenchymal hematoma in a patient with seizures 30 years after aneurysm wrapping.
Muslin foreign body granulomas are a known complication of muslin aneurysm wrapping and have been associated with vision loss from optochiasmatic arachnoiditis. Muslin granulomas have also been confused with abscesses due to surrounding inflammatory changes. In this clinical image, we present a unique case of a muslin granuloma mimicking an intraparenchymal hematoma.
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Surgical resection of vestibular schwannomas (VS) located within the internal auditory canal (IAC) is challenging, especially those located very laterally in the IAC. Various transcranial approaches have been described for resection of intracanalicular VS including retrosigmoid, translabyrinthine, and middle fossa approaches. Each approach has its indications, advantages, and limitations. The middle fossa approach (MFA) is considered by many authors as the gold standard approach for resection of small intracanalicular VS in young patients with serviceable hearing; however, there is often a limitation in complete visualization of the tumor. ⋯ MFA allows for a direct yet safe surgical corridor to small intracanalicular VS. The implementation of endoscopy with MFA, especially for VS located laterally in the IAC, allows for better opportunity for complete resection of the tumor with improved preservation of hearing and facial nerve function.
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Endoscopic third ventriculostomy (ETV) is a well-accepted treatment option instead of ventriculoperitoneal shunt placement in cases of obstructive hydrocephalus. A sufficient flow from the ventricles to the basal cisterns requires perforation of the arachnoid membranes in the retroclival region. This point is critical to achieve an optimal outcome. The complex arachnoid relations were investigated in the retroclival region from the viewpoint of ETV, and anatomic landmarks were defined for subarachnoid dissections. ⋯ Sufficient arachnoid dissection is essential for a successful ETV. The clival line is an important landmark that helps to perform the subarachnoid dissections correctly and achieve an undisrupted cerebral spinal fluid flow between the ventricles and the basal cisterns.
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The effect of indirect decompression after lateral lumbar interbody fusion (LLIF) is widely acknowledged; however, its details remain unclear. This study aimed to evaluate the immediate effects of indirect decompression just after LLIF cage placement but just before posterior instrumentation, using intraoperative computed tomography myelogram (iCTM). ⋯ Detailed evaluation with iCTM revealed that adequate indirect decompression with LLIF was not always obtained, validating the intraoperative decision of further posterior decompression. This procedure, LLIF with iCTM, may reduce the risk of unnecessary direct decompression and reoperation after insufficient indirect decompression.
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Microsurgical clipping of aneurysms demands precise spatial understanding of aneurysm morphology and vascular geometry. We analyzed the impact of preoperative three-dimensional (3D) angiographic imaging on clinical and angiographic outcome after clipping of ruptured intracranial aneurysms. ⋯ In our study, accurate operation planning using 3D angiography was associated with a lower ischemic complication rate after clipping of ruptured intracranial aneurysms, which may potentially influence clinical outcome.