World Neurosurg
-
To examine the effects of chronic preoperative steroid therapy on 30-day perioperative complications after anterior lumbar fusion (ALF). ⋯ Chronic preoperative steroid therapy is associated with perioperative complications after ALF. Decisions about the discontinuing or holding steroid therapy preoperatively should be determined through an interdisciplinary approach between the medical and surgical teams.
-
Remote cerebellar hemorrhage (RCH) after intracranial surgery is a rare complication. Cerebellar hemorrhage is the most commonly described remote site hemorrhage after surgery for supratentorial pathologies. Although this is a rare complication 0.04% to 0.8%, it can be devastating in terms of patient outcome. There are various hypotheses to explain the occurrence of RCH. We report 6 cases of RCH after surgery for supratentorial lesions, discuss the pathophysiology, and review the pertinent literature. ⋯ RCH is a rare complication but can lead to catastrophic results. Loss of large volumes of cerebrospinal fluid or sudden alteration in intracranial pressure due to removal of a mass lesion is the likely etiology. Although majority of cases may be managed conservatively, in a subset of cases with neurologic deterioration, surgery may be required as a life-saving procedure.
-
Video 1 describes the technique of microsurgery removal of acoustic neuromas (ANs) using new technologies. The Flexible 2μ-Thulium hand-held laser fiber (Revolix jr, LISA laser products, 7 OHG, Berlin, Germany) and Sonopet Ultrasound Aspirator (Stryker, Kalamazoo, Michigan, USA) can be used for a safe and facilitated opening of the internal auditory canal (IAC). We illustrate the operative technique used on a surgical series of 111 cases operated on during the past 8 years, from July 2010 to July 2018. ⋯ In 111 cases the "Sonopet" Ultrasound Aspirator was used to open the IAC and a 2μ-Thulium laser fiber was used for cutting the dura mater of the posterior aspect of petrous bone and the IAC, and it was also used to perform tumor capsule incision. From December 2017 we started to check the removal of tumor inside the IAC with a flexible endoscope 4 mm × 65 cm, (Karl Storz GmbH, Tuttlingen, Germany) in order to detect possible tumoral residue and achieve a radical tumor resection in the fundus. The use of these new technologies seems to be safe and subjectively facilitates the opening of the IAC in AN microsurgery.
-
Nasopharyngeal carcinoma (NPC) is a common malignant tumor of the head and neck, and is associated with high recurrence and low survival rates; however, distant brain metastasis from NPC is rare. ⋯ Despite the poor prognosis, salvage SRS was performed for these rare brain metastases from NPC.
-
Based on our clinical experience, posteroinferiorly projecting carotid-A1 junctional aneurysms are often difficult to treat microsurgically. Our objective was to classify peri-internal carotid artery (ICA) bifurcation aneurysms according to their location and analyze their characteristics. ⋯ The characteristics of carotid-A1 junctional aneurysms and true ICA bifurcation aneurysms differ. In particular, carotid-A1 junctional aneurysms tend to have a posteroinferior projection and that causes difficulty in surgical treatment. We recommend the virtual surgical view for preoperative planning. Furthermore, an adequate Sylvian fissure opening and a strategic approach using appropriate devices to inspect blind spots should be considered for a successful treatment outcome.