World Neurosurg
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In 2000, we advised against insertion of a ventriculoperitoneal shunt (VPS) in human immunodeficiency virus (HIV)-positive patients with tuberculous meningitis (TBM) complicated by hydrocephalus. However, this was in the era when combination antiretroviral therapy (ART) was not freely available in South Africa. In this subsequent preliminary report, we describe the outcome of ventriculoperitoneal shunting in patients with TBM and hydrocephalus who are HIV positive and receiving ART. ⋯ The outcome of VP shunting in HIV-positive patients with TBM and hydrocephalus is markedly improved in patients on ART. Based on limited data from this study, we recommend that better grades of TBM (1 and 2) undergo immediate VPS surgery. Patients with grade 4 TBM should undergo a trial of external ventricular drainage and those who improve should undergo a definitive procedure. Further research is required for patients with grade 3 TBM to identify characteristics associated with better outcomes to allow for effective use of limited resources.
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The combined transpetrosal approach enables wide exposure around the petroclival region by lifting of the middle fossa dura and cutting of the tentorium. However, interruption of the venous drainage on the middle skull base during the transpetrosal approach has been reported to lead to temporal lobe damage.1,2Video 1 demonstrates a microsurgical technique for the preservation of various venous drainage in the middle fossa including the sphenobasal and sphenopetrosal veins during the combined transpetrosal approach for treatment of a petroclival meningioma. The patient is a 51-year-old woman with a petroclival meningioma extending into the cavernous sinus. ⋯ The patient developed diplopia after the surgery, but her headache and dizziness were improved without other neurologic deficits. The patient's diplopia improved within 1 year after the surgery, without any other neurologic deficits or tumor regrowth during the follow-up period of 3 years. Informed consent was obtained from the patient.
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Wide-necked intracranial aneurysms continue to pose a challenge for endovascular surgeons. Flow diversion and stent-assisted coiling are 2 techniques that have improved the ability to manage these lesions, but these require the use of dual antiplatelet therapy. In patients with aneurysmal subarachnoid hemorrhage, dual antiplatelet therapy is relatively contraindicated, and many surgeons prefer to use open techniques or balloon assistance for coiling, although at times the latter is not feasible. We describe temporary stent assistance using retrievable stents for coiling of ruptured intracranial aneurysms as an endovascular management option. ⋯ Stents and stent retrievers can be temporarily used for technically challenging aneurysms as an alternative to balloon assistance for treatment of ruptured intracranial aneurysms without needing to use dual antiplatelet therapy.
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There is a lack of precise methods for predicting the risk of aneurysm rupture. Therefore, prophylactic treatment is used, which leads to unnecessary potential complications. A new modality enabling a more accurate risk assessment is needed. Optical coherence tomography (OCT) is a new-generation imaging technology that has astonishing resolution for vascular imaging. In this study, OCT was used for the evaluation of intracranial aneurysms. ⋯ OCT is the most precise imaging modality because it provides detailed information regarding the aneurysm structures, thus enabling more distinct insight into the vascular construction of intracranial aneurysms.