World Neurosurg
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To delineate the most recommendable treatment of spontaneous intracerebral hemorrhages and the indication for surgery, its timing, and the best surgical technique to be adopted case by case. ⋯ Careful selection of patients eligible for surgery is mandatory. The optimal timing falls into a time-window ranging between 7 and 24 hours after ictus. Minimal invasive techniques are valuable surgical options for patients in a poor GCS score or harboring large deep-seated hemorrhages.
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Comparative Study
The Intracranial and Intracanalicular Optic Nerve as Seen Through Different Surgical Windows: Endoscopic Versus Transcranial.
Surgically manageable lesions involving the intracranial or intracanalicular portions of the optic nerve (cranial nerve II) can be approached through several different operative windows. Given the complex anatomy of the optic nerve and its surrounding neurovascular structures, it is essential to understand the conventional and topographic anatomy of the optic nerve from different surgical perspectives as well as its relationship with surrounding structures. We describe the intracranial and intracanalicular course of the optic nerve and present an analytical evaluation of the degree of exposure provided by several different transcranial and endoscopic surgical approaches. ⋯ Although the pterional approach provides the widest degree of surgical exposure of all optic nerve segments, the inferior and medial quadrants of the nerve can be adequately exposed only through an endoscopic endonasal approach. Optimal approach selection based on the intended target quadrant is essential for safe surgical exposure of the optic nerve.
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To determine outcomes of spinal anesthesia (SA) in high-risk patients undergoing lumbar spine surgery in whom general anesthesia (GA) was contraindicated. ⋯ SA is a safe, reliable, and satisfactory alternative to general anesthesia in high-risk lumbar spine surgeries. Postoperative morbidity and mortality can be reduced by SA and spinal analgesia techniques. SA allows good perioperative hemodynamic stability. It is also more cost-effective.
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Cystic acoustic neuromas typically present with more rapid growth and shorter symptomatic periods when compared with solid tumors. ⋯ Spontaneous tumor regression was accompanied with reduced mass effect on neighboring structures and improved symptoms. Owing to their unpredictable growth patterns, early surgical resection has been recommended for cystic acoustic neuromas. However, this patient experienced spontaneous tumor involution after conservative management. Further research on the growth patterns of cystic schwannomas is imperative for them proper counseling of patients and improvement of treatment strategies.
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To evaluate surgical outcomes of homogeneous spinal-shortening axial decompression (HSAD) for reoperation in pediatric patients with tethered cord syndrome. ⋯ Outcomes of HSAD for revision surgery of tethered cord syndrome were satisfactory. HSAD improved neurologic function of patients significantly. HSAD could become an alternative surgical treatment of reoperation for tethered cord syndrome.