World Neurosurg
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Review Meta Analysis
Confirming diagnosis and effective treatment for rare epithelioid glioblastoma variant: an integrated survival analysis of the literature.
Epithelioid glioblastoma (eGBM) is a very rare histologic variant of glioblastoma that has not been studied in isolation and, therefore, its optimal management has been largely assumed, but not confirmed. The aim of this study was to analyze all reported cases describing the presentation and clinical features to better understand the clinical significance of this histologic diagnosis. ⋯ These findings indicate that the histologic diagnosis of eGBM does not deviate from the clinical course of the broader glioblastoma diagnosis, despite being a unique histologic identity. These results argue against the temptation to deviate from the traditional management paradigm of surgery, radiation, and chemotherapy for glioblastoma based on this histology alone.
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Review Case Reports
Removal of migrating lumbar spine bullet: Case Report and Surgical Video.
Gunshot wounds to the spine are devastating injuries. Rarely, the bullet has been reported to migrate. Migration is associated with progressive neurologic deficits that often improve with bullet removal. The authors report a case of removal of a migrating lumbar spine bullet. This is supplemented by an operative video and a review of the literature. ⋯ Neurosurgical treatment for gunshot wounds remains controversial. Cauda equina or lumbosacral level wounds are often incomplete and may improve with surgical decompression and bullet removal. Migrating bullet fragments throughout the spine and brain lead to worsened neurologic function, which can be reversed by removal. Movement of the bullet during surgery should be expected, and intraoperative fluoroscopy and patient positioning can help to properly localize the bullet and aid in its removal.
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Review Case Reports
Superior oblique myokymia: A case report of surgical treatment, review of the literature, and consideration on surgical approach.
Superior oblique myokymia (SOM) is a rare disorder characterized by episodic microtremor of the eyeball. in patients with SOM, intermittent contraction of the superior oblique muscle causes irregular and rotatory eye movement, causing oscillopsia and diplopia. Microvascular decompression (MVD) of the trochlear nerve is potentially a definitive treatment method for SOM; however, owing to its rarity, this disorder is not well-known to neurosurgeons, and thus the optimal surgical approach has not yet been determined. ⋯ We believe that MVD via a left lateral superior cerebellar approach can be safely performed to SOM in elderly patients like our patient. Therefore, MVD should be considered as the definitive treatment method for more patients with SOM.
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Review Case Reports
Sensorineural Deafness Following Spine Surgery: Case Series and Literature Review.
Sudden sensorineural hearing loss (SNHL) after nonotologic surgery is unusual, with most occurrences reported in patients having cardiopulmonary bypass. Reports of SNHL after nonotologic noncardiac surgery are rare, particularly after spine surgery. In patients undergoing subarachnoid anesthesia or intradural surgery, loss of cerebrospinal fluid pressure can result in hearing loss and cranial nerve palsy. ⋯ Sudden-onset hearing loss post spine surgery is disastrous with multiple etiologies and remains poorly understood. Timely evaluation by an otolaryngologist and audiologist is recommended. The role of corticosteroids in treating SNHL is still unclear.
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In our discipline, neurosurgery, the role of the leader has evolved and has been complemented by the collaboration of specific professionals of different disciplines, aiming at the overall result of curing people and defeating the disease. Indeed, the multidisciplinary cooperation and the innovative strength of a team composed of different specialists such as radiologists, anesthesiologists, pathologists, molecular biologists, geneticists, oncologists, psychologists, physiatrists, physiotherapists, neurologists, engineers, mathematics, statisticians, and economists, greatly has changed the way we see the patient and treat pathology: from a single to multiperspective vision, thus generating a synergy that improves the surgeon's and the overall work. An old African adage goes like this: "If you want to go fast, go alone. if you want to go far, go together," which in our opinion fully summarizes the sense of our contribution on the state of the art in neurosurgical contemporary practice.