World Neurosurg
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The endoscopic endonasal approach has recently become an acceptable option for resection of all pituitary adenomas. We assessed biochemical outcome of endoscopic endonasal surgery in growth hormone (GH)-secreting adenomas, including remission rate, predictors of remission, and associated complications. ⋯ Endoscopic endonasal adenoma resection leads to a high rate of endocrinologic remission in GH-secreting adenomas with a low complication rate. Patients with older age, higher preoperative GH levels, and higher Knosp grades are less likely to achieve remission.
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Case Reports
Management of Recurrent Glossopharyngeal Neuralgia Following Microvascular Decompression Surgery.
Glossopharyngeal neuralgia (GPN) is a rare condition, commonly misdiagnosed as trigeminal neuralgia. Microvascular decompression (MVD) is considered the first line of treatment in medically refractive idiopathic GPN, and the recurrence rate is reported to be 7.1%. We present our first case report on the surgical management of a patient with recurrent GPN and analyze the possible causes for recurrence after MVD. ⋯ MVD is considered the first line of treatment in drug-resistant idiopathic GPN. Thorough exploration of REZ for small arteries and veins is mandatory to prevent recurrence. Vascular compression can occur at the cisternal portion or at the REZ. In recurrent cases, splitting of the glossopharyngeal nerve rootlets adds to the good outcome.
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Case Reports
Craniotomy for a Large and Aggressive De Novo Cavernous Malformation Resection in the Basal Ganglia Region.
Cerebral cavernous malformations (CCMs) are present in up to 0.5% of the general population. Although CCMs have been considered congenital lesions, numerous reports have observed de novo formations in patients with the familial form of CCM and in patients after cranial radiotherapy. Outside of these circumstances, there is scant evidence as to the potential etiologies of CCM. ⋯ Given the patient's medical history and imaging findings, we propose that de novo CCMs can arise directly from angiogenic proliferation, secondary to BCL-2 overexpression from underlying causes. We hypothesize that inappropriate secretion of estrogen could have set off a genetic cascade with attendant endothelial proliferation. Thus, female hormones may play an important role in influencing the biological behavior of CCMs. The relationship between estrogen and CCM needs further investigation.
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This study aimed to evaluate the accuracy of screw placement and clinical outcomes in patients undergoing occipitocervical fusion. ⋯ Occipitocervical fusion with O-arm-based navigation is effective and safe for treating instability of the craniovertebral junction. Intraoperative navigation can help surgeons insert screws accurately.
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While prophylaxis with intravenous unfractionated heparin (UFH) can effectively prevent venous thromboembolism (VTE) during the neurocritical care of patients with severe aneurysmal subarachnoid hemorrhage (aSAH), the risk for intracranial bleeding complications might increase. Owing to this therapeutic dilemma, the UFH administration regimen in this critical patient population remains highly controversial. ⋯ Even in high-risk neurocritical patients with severe SAH and prolonged ICU treatment, low-dose UFH-administration for VTE prophylaxis is equally effective as therapeutic UFH administration and carries a lower risk of bleeding complications.