World Neurosurg
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Very long-term outcomes are rarely reported for patients with shunted pediatric hydrocephalus. This study aimed to determine the functional, social, and neurocognitive outcomes of such patients after transition to adulthood. ⋯ The overall long-term outcome of patients with shunted pediatric hydrocephalus is poor. These results highlight the importance of lifelong routine controls to avoid later complications. Further, repeated neuropsychological examinations might be important to understand the patient's special needs to optimize professional support.
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Arachnoid cysts yield cognitive deficits that are normalized after surgical cyst decompression. ⋯ Patients with arachnoid cyst have higher levels of anxiety and depression than do the general population and these scores were normalized after decompressive cyst surgery. We further found a hemispheric asymmetry: patients with a right temporal cyst showed higher anxiety, depression, and combined scores than did patients with a left temporal cyst. Also, this disparity normalized after cyst decompression. Thus, arachnoid cysts seem to affect not only cognition but also the level of affective symptoms.
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Thalamic cavernous malformations (CM) are highly challenging surgically. In this illustrative video (Video 1), we present the case of a 36-year-old man with a CM at the left medial thalamus, which was successfully treated by a contralateral anterior interhemispheric transcallosal approach. Informed consent was obtained from the patient. ⋯ After a thin layer of hemosiderin-stained pia was opened on the superior surface of the left thalamus, some sandlike old hemorrhagic component was removed for decompression, and the lesion was carefully dissected away from the normal parenchyma within the surrounding gliosis boundary. The CM was removed en bloc, and the deep venous anomaly was well protected. The patient did not experience any intraoperative changes shown by electrophysiologic monitoring, and he recovered well postoperatively.
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Spondylodiscitis is a challenging spinal disorder that requires surgical treatment only as a last resort. The use of various procedures and instruments remains controversial. In this retrospective study, we reported the safety and efficacy of a CaSO4 drug carrier system for the transforaminal lumbar interbody fusion (TLIF) procedure for lumbar pyogenic spondylodiscitis. ⋯ The combined use of single-level TLIF with a CaSO4 drug delivery system was safe and effective for treatment of pyogenic lumbar spondylodiscitis. The system promoted reduction of inflammation with limited fixed segments without a negative impact on fusion status. This procedure may be considered a novel choice for spondylodiscitis, with more efficacy and less invasion.
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Magnetic resonance imaging plays an important role in identification of any underlying structural cause in spontaneous cerebrospinal fluid (CSF) leaks-either rhinorrhea or otorrhea. Sphenoid bone defects have been reported in those presenting as idiopathic intracranial hypertension with or without CSF rhinorrhea. Sphenoid lateral recess defect with intrasphenoidal encephalocele is one of the uncommon causes of spontaneous CSF leakage. Many classifications of basal encephaloceles have been used along with associated predisposing anatomic factors for the CSF leak. ⋯ We discuss the various classification systems of sphenoidal encephaloceles and review the terminology and comprehensive imaging details to be included in reporting such cases for appropriate treatment planning.