World Neurosurg
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Recent advancements in understanding the molecular basis of gliomas and new concepts of neuronal plasticity have shown the importance of maximal resection in gliomas to improve progression-free overall survival. Awake craniotomies with intraoperative cortical and subcortical mapping have helped to achieve this aim while allowing us to preserve executive function including language. Language mapping becomes a daunting task in individuals who are bilingual because of the complexity of varied cortical representation of different languages. ⋯ Advancements in anesthesia and neuromonitoring have further allowed for long awake periods, permitting complex language tasks to be tested intraoperatively. The results obtained from this case study have allowed us to further plan for awake surgeries for patients with bilingualism. With understanding bilingual representation of languages, we hope to achieve maximal resection with minimal postoperative deficits.
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Ectopic thyroid-secreting hormone (TSH)-secreting pituitary adenomas are rare, with only 9 cases reported in the literature. ⋯ This is the first report of use of 68Ga-DOTATATE positron emission tomography/computed tomography to aid in localizing an ectopic TSH-secreting tumor. Prior studies have shown that 68Ga-DOTATATE positron emission tomography/computed tomography improves detection of small lesions with shorter imaging times and lower radiation doses compared with other modalities. Our case emphasizes the importance of using 68Ga-DOTATATE PET/CT in the diagnosis of ectopic pituitary adenomas, as these tumors can be challenging to diagnose radiographically.
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Labrune syndrome is a neurologic disorder that manifests as a progressive cerebral degeneration characterized by a radiologic triad of cerebral white matter disease (leukoencephalopathy), intracranial calcification, and cysts. The associated novel genetic mutation in SNORD118 has been recently identified. However, its significance in relation to the progression and severity of the disease is yet to be clarified. ⋯ He had urgent endoscopic-assisted aspiration of the cerebellar cyst with insertion of a reservoir with resolution of the hydrocephalus and raised intracranial pressure symptoms. His genetic testing revealed a rare biallelic mutation with 2 variants in the gene SNORD118. The progressive form of this disease will be challenging for neurosurgeons.
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Hemimasticatory spasm (HMS) is a rare masticatory muscle disorder. Drug therapy, microvascular decompression, and botulinum toxin have had varying efficacy and adverse effects. We have reported the cases of 2 patients who had undergone a novel therapy for HMS, based on endoscope-assisted nerve avulsion of the masseter nerve attached to the temporomandibular joint (TMJ) disc. ⋯ Endoscope-assisted avulsion of the masseter nerve attached to the TMJ disc showed a good curative effect, little trauma, few complications, and a quick postoperative recovery. It could be used as an alternative treatment of HMS for selected patients.
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Dural substitutes used during hemicraniectomy provide a barrier and dissection plane during subsequent cranioplasty. A recent review by our group showed that use of dural substitutes in hemicraniectomy is associated with reduction in estimated blood loss (EBL) and operative time (OT). In our experience, the use of a dual-layer technique facilitates a dissection plane with minimal adhesions. We hypothesized that use of this dual-layer technique would show decreased OT and EBL in patients undergoing cranioplasty. ⋯ In this study, we did not detect any significant difference between EBL and OT with use of single-layer versus dual-layer duraplasty. Mean EBL was slightly higher in the controls compared with cases but this difference was not statistically or clinically significant. This concept would benefit from a prospective randomized study.