World Neurosurg
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Brain arteriovenous malformations (AVMs) are pathologic tangles of intracerebral vessels. The treatment of AVMs aims to reduce the risk of devastating intracranial hemorrhage (ICH). Hypofractionated stereotactic radiotherapy (HSRT) can be used to treat large lesions and reduce the risk of radiation toxicity to the surrounding structures. We analyzed the data from our institutional experience of the past 15 years in treating large AVMs with both 5- and 6-fraction HSRT and evaluated the pretreatment characteristics that are most predictive of the radiographic response. ⋯ HSRT can be used as a method to manage large AVMs, with obliteration in some cases and sufficient volume reduction in most others for adjuvant treatment with other modalities. The 30-Gy total dose was generally superior to 25 Gy in achieving obliteration or volume reduction. Further studies focused on longer follow-up periods are warranted.
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Advancements in microscopy and more recently in neuroendoscopy have revolutionized the field of neurosurgery. Handheld neurosurgical instruments are integral components of these procedures. However, these instruments have many limitations, such as poor ergonomics, constrained maneuverability, and limited degrees of freedom. A need for developing better instruments is commonly felt by neurosurgeons. Also, the focus of modern neurosurgical training is shifting toward simulation models. The baseline data of surgical instruments play a vital role in the development of virtual and physical simulators. A primary factor impeding development of novel instruments and simulators is lack of a comprehensive surgical instrument database. The aim of this study was to develop and validate a virtual repository of microscopic and neuroendoscopic instruments. ⋯ The virtual database is an efficient starting aid to foster research collaborations related to neurosurgical instruments and surgical simulation platforms.
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Primary intracranial myxomas (PIMs) are extremely rare benign tumors that arise from the skull base. The aim of this study was to characterize the radiologic manifestation of PIMs in a series of 14 cases. ⋯ Radiologic findings of PIMs include calcified foci or bone debris on computed tomography, heterogeneous hypointensity on T1WI and predominantly hyperintensity on T2WI, and honeycomb appearance on enhanced T1WI.
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Neurorrhaphy with interpositional graft is a practical technique to achieve facial reanimation when the continuity of the facial nerve is interrupted and a large gap between the proximal and distal stump exists. The aim of this study was to report long-term outcomes of neurorrhaphy for facial reanimation with interpositional graft. The roles of some variable factors in the outcome of neurorrhaphy with interpositional graft were also evaluated and compared. ⋯ Early neurorrhaphy with interpositional graft (≤1 year) for facial reanimation resulted in better final facial nerve function outcomes compared with a delayed procedure.
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Intracranial arteriovenous fistulas, rare causes of spontaneous intracerebral bleeding, are direct communications between an arterial feeder and an arterialized vein that drains a normal brain. Arteriovenous disconnection is the only effective treatment for this type of vascular malformation, which is often reached microsurgically due to the difficult endovascular access. Intraoperative indocyanine green videoangiography (ICG-VA) is a valuable help in identifying the arterialized draining vein and its direct communication with the arterial feeder and in confirming real-time interruption of the fistula. ⋯ Under intraoperative neurophysiologic monitoring the fistula was located with the aid of ICG-VA and interrupted (Video 1). Both control ICG-VA and postoperative angiogram confirmed resolution of the fistula. At a 3-month follow-up the patient had a complete neurologic recovery.