World Neurosurg
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Dural substitutes are used in decompressive craniectomy (DC) to prevent adhesions during subsequent cranioplasty. Current literature attributes them to reduced blood loss and reduction in operative time of cranioplasty. The use of double-layer substitute has rarely been documented. We studied the use of double-layer G-patch as a dural substitute in DC and evaluated its outcome during subsequent cranioplasty with special focus on flap elevation time and blood loss during cranioplasty. ⋯ While evaluating the use of dural substitute during DC as an adhesion preventive material for subsequent cranioplasty, flap elevation time and blood loss should be taken into account rather than operative time. Double-layer G-patch during DC facilitates subsequent cranioplasty by preventing adhesions between the layers, resulting in easier dissection and reduced blood loss.
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Randomized Controlled Trial
Predictive Value of Intraoperative Facial Motor Evoked Potentials in Vestibular Schwannoma Surgery Under 2 Anesthesia Protocols.
We sought to validate the feasibility of facial motor evoked potential (FMEP) in facial nerve (FN) monitoring during vestibular schwannoma (VS) surgery under 2 anesthesia protocols and to examine its value for postoperative prognosis. ⋯ The FMEP amplitude ratio is a valuable predictor for postoperative FN function. FMEP ratio ≥57% is predictive of satisfactory long-term FN function.
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The surgical Simpson grade, introduced in 1957, is the standard measure for meningioma resection and prediction of recurrences. We used an magnetic resonance (MR)-based grading system for the radiologic extent of resection, and assessed agreement of the extent of resection between the surgical Simpson grade and the MR-based scale. ⋯ Agreement for extent of meningioma resection between both scales was good in terms of the ICC. When the surgical Simpson grade is unclear, MR imaging at 3 months after surgery may be used as a baseline for further follow-up. In a substantial portion of cases, the extent of resection was less favorable on the early postoperative MR imaging than the surgeon's Simpson grade. The predictive value of the radiologic extent of resection for the risk of long-term recurrences is a subject for further research.
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Review Case Reports
Subfrontal Schwannoma: Case report and review of literature.
Although attributing the origin of schwannomas from the olfactory nerve is nearly impossible, if they do not have Schwann cells, intracranial supratentorial schwannomas are mainly located in the anterior skull base. ⋯ We describe this case in detail and discuss the likely origin of this tumor, with a concomitant literature review.
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Review Case Reports
De Novo Arteriovenous Malformation in a Pediatric Patient: Case Report and Review of the Literature.
An arteriovenous malformation (AVM) consists of a pathologic arteriovenous shunt formed from a tangle of vessels lacking a capillary bed. AVMs were previously accepted as congenital in nature; however, an increase in the number of reported de novo cerebral AVMs challenges the assertion that all AVMs develop in utero hence, the possibility of these lesions presenting postnatally cannot be excluded. A review of literature revealed 31 published cases of de novo AVM formation between 1996 and 2017. ⋯ The exact pathophysiology of de novo AVMs is not completely understood, but a combination of genetic, molecular, and environmental factors may play a role. Our case report only adds to the growing body of clinical evidence supporting the notion that these lesions may be acquired. It would be appropriate to consider an AVM as an abnormal vascular response to an injury rather than a static congenital lesion.