World Neurosurg
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Surgery for anterior cranial base lesions is challenging because tumors often spread from their origin to sinuses, orbits, and middle cranial fossa, resulting in risky surgeries.1,2 To approach such complex diseases, recently combined multiportal approaches have been proposed.3,4 At the best of our knowledge, operative application of a combined endoscopic endonasal and transcranial surgery for complex anterior cranial base lesions has not been described. Therefore a surgical video of such an approach is presented. A 37-year-old woman affected by a huge recurrence of a tuberculum meningioma extended to right orbit presented to our department, complaining of right ocular bulb dislocation with multidirectional limitations in eye movements (Video 1). ⋯ Such a combined approach, although demanding in terms of the presence of both otolaryngologist and neurosurgeon during the surgery, also requires strong synergy among them and permits them to control anterior cranial base lesions from both specialists' perspectives, simultaneously. In this case, while an endonasal corridor permitted an accurate excision of ethmoidal and medial orbital wall part of the lesion, a bicoronal approach allowed the aggression of the anterior cranial base portion of the tumor, allowing good control of cranial base neurovascular structures, eventually obtaining a gross total resection, without perioperative complications. Furthermore, a combined multiportal approach allows cooperative strategies among the surgeons involved, leading to safer, quicker, and more effective resections with less brain retraction, given the wide angles of views to the lesion that a multiportal approach can offer.
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To evaluate the feasibility of transcranial sonography in patients harboring polymethylmethacrylate cranioplasties (PMMA-CP) and explore whether this material is a valid sonic window to explore intracerebral structures. ⋯ Although limited by the restricted number of cases, this preliminary experience represents the first available data about the serial use of TCS using PMMA-CP as window. These results open the path to the routine use of TCS to longitudinally control patients already harboring PMMA-CP. More, we here discuss its potential role in globally reducing the number of follow-up CT and magnetic resonance imaging scans required in different type of patients and pathologies.
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Neovascularization (NV) is regarded to be one of the important features of vulnerable plaque. The purpose of this study was to evaluate associations between the presence of NV, detected using optical frequency domain imaging (OFDI), and ischemic events and the progress of carotid artery stenosis. ⋯ NV was more frequently observed in progressive carotid plaques. Evaluation of NV using OFDI may be useful in predicting progressive carotid plaques.
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Neurosurgery is a unique field, which would benefit greatly from increased global collaboration, furthering research efforts. ResearchGate is a social media platform geared toward scientists and researchers. ⋯ ResearchGate may be a useful platform to increase neurosurgical networking and research collaboration. Its novel bibliometrics are strongly correlated with more classic platforms.
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Flow-diverting stents (FDS) are relatively safe and highly efficacious in treating cerebral aneurysms; however, a small subset of patients experience devastating hemorrhagic complications owing to presumed alterations in local aneurysm and distal cerebral blood flow. The downstream effects of FDS on distal cerebral blood flow is not well understood, but isolated reports of hyperperfusion injury have been described in the literature. We investigate the incidence and clinical factors contributing to abnormal cerebral blood flow after FDS placement. ⋯ This study yielded several novel findings. We demonstrate that cerebral blood flow alterations will occur in a significant subset of patients undergoing FDS treatment. We also provide new evidence that aneurysm volume and history of smoking may predict the developing of postoperative perfusion anomalies. Future studies are needed to evaluate the clinical ramifications of cerebral blood flow disruption in large prospective studies.