World Neurosurg
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Pituitary abscess (PA) is a rare but serious intrasellar disorder with potentially high disability and mortality. Secondary PA after transsphenoidal surgery (TS) is extremely rare, and only a few case reports have been identified in the literature. This study explored the salient clinical manifestations and etiologies to determine appropriate treatment. ⋯ Although rare, secondary PA should be included in the differential diagnosis of intrasellar lesions after TS. Patients with an initial diagnosis of Rathke's cleft cyst or pituitary macroadenoma were more likely to have PA after TS. Adequate surgical drainage combined with microbiology-guided antibiotic therapy is the first choice for treatment.
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There is an abundance of works published on severe traumatic brain injury (sTBI). Bibliometric analyses aim to provide a macroscopic view of research activities regarding sTBI and are helpful in determining the most impactful studies within this field. ⋯ The present study provides a cross-sectional summary of the 100 most-cited articles on sTBI, highlighting areas of research needing further investigation and development.
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Obstructive hydrocephalus secondary to posterior cranial fossa space-occupying lesions is common, and treatment includes shunting or removal of the causative lesion. The list of posterior fossa space-occupying lesions is exhaustive and includes tumors, cysts, and tumor-like conditions. ⋯ However, unrelated pathologies could coexist and may be overlooked. We hereby describe an unusual case of a posterior fossa cystic, suspected metastatic lesion presenting with moderate to severe hydrocephalus in a patient with oral cavity cancer on chemotherapy, which turned out to be cysticercosis on excision, leading to a diagnostic dilemma; hence the adage "cyst with a twist"!
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Although revascularization surgery for patients with moyamoya disease can effectively prevent ischemic events and thus improve the long-term clinical outcome, the incidence of postoperative ischemic complications affects patients' quality of life. This study aimed to clarify the risk factors associated with postoperative ischemic complications and to discuss the appropriate perioperative management. ⋯ The risk factors associated with postoperative ischemic complications for children with moyamoya disease are preoperative infarction, younger age, higher Suzuki grade, and posterior cerebral artery stenosis/occlusion. Barbiturate coma therapy for pediatric patients with moyamoya disease who have the previous risk factors is insufficient for prevention of postoperative cerebral infarction. More studies are needed to identify the appropriate perioperative management.
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Congenital anomaly of the C1 posterior arch is a well-known entity and is often associated with atlantoaxial dislocation. However, a well-formed C1 posterior tubercle with absence of the remaining posterior arch is rare. Such unusual anomalies pose a surgical challenge as trying to delineate the arch early in the course of surgery could be potentially dangerous. We discuss here a similar case of C1 posterior arch defect with atlantoaxial dislocation and its management. ⋯ Presence of posterior tubercle alone with aplasia of the posterior arch results from a persistent posterior ossification center with nonextension of lateral ossification centers. In the presence of the C1 posterior fibrous arch, the joint spaces must be exposed first before attempting to delineate the posterior arch. This will prevent inadvertent injury to the vertebral artery and dura.