World Neurosurg
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Since the first report about nail gun injuries in 1959, there has been an average of approximately 37,000 patients hurt by nail guns and treated in emergency departments. Carotid arterial injury by nail gun has been reported, but vertebral artery damage is extremely rare. ⋯ Based on our experience and a review of the literature, in terms of treating a nail gun injury to the cervical spine, we would like emphasize that preoperative CT scan or CT angiogram is necessary to assess the location and shape of the nail, especially nails with barbers or washers. Improving awareness of the risk from accidental nail gun trauma may lead to better prevention of this rare but potentially life-threatening injury.
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The tumor microenvironment greatly influences tumor formation, invasion, and progression. The ESTIMATE (Estimation of STromal and Immune cells in MAlignant Tumor tissues) algorithm quantifies stromal and immune components in a tumor, reflecting the tumor microenvironment. This study aimed to explore key prognostic genes in a grade II/III glioma microenvironment. ⋯ Stromal/immune/ESTIMATE scores have prognostic values in patients with grade II/III glioma. The selected DEGs, including interleukin-10, beta-2 microglobulin, C-C motif chemokine ligand 5, cluster of differentiation 74, human leukocyte antigen-DRA, lymphocyte cytosolic protein 2, and myxovirus resistance protein 1, associated with tumor immunity and microenvironment, have prognostic values in grade II/III glioma. Further investigation of these genes could provide novel insights into the tumor microenvironment of glioma.
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Neurosurgical operating rooms are equipped with microscopes in order to provide a good standard of care. Nevertheless, in developing countries, microscopes are not always available. During a short period in a western Africa hospital, we adapted our smartphones as a valid alternative to the microscope. ⋯ This simple "smartphone-based exoscope" allows surgeons to get an adequate magnification during surgery when microscopes or magnification goggles are not available. It can be a useful solution in developing countries where often nothing better is available.
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Infundibular dilations (IDs) are funnel-shaped enlargements located at the origin of cerebral arteries. Neuroradiologists and neurosurgeons are familiar with IDs of the posterior communicating artery, which are relatively common. Other locations, being unexpected sites of IDs, can pose diagnostic and therapeutic challenges. ⋯ Anterior communicating artery represents a rare location for infundibular dilations. Differential diagnosis between them and true aneurysms can be sometimes challenging, especially when associated with anatomic variants; thus neurosurgeons and radiologists must be aware of these pathologic entities.
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Focal cortical dysplasias (FCDs) are highly epileptogenic and frequently associated with medically refractory focal epilepsy. FCDs are frequently located in the frontal lobe, making its complete resection highly challenging when in proximity to the motor cortex. ⋯ A detailed presurgical evaluation, accurate mapping of the functional and dysplastic cortex, and a well-planned tailored and complete surgical resection of the cortical dysplasia can result in a favorable outcome with relatively little risk of postoperative neurologic deficit.