World Neurosurg
-
Fluorescein-guided surgery of high-grade gliomas (HGGs) increases the extent of tumor resection but its efficacy has been questioned, especially for tumors located close to functional networks. In these cases, navigated transcranial magnetic stimulation (nTMS) may be used to plan and guide a safe resection. The aim of this study was to assess the impact of these techniques combined with intraoperative neurophysiologic mapping (IONM) to achieve the maximal safe resection of tumors located in the motor area. ⋯ This study supports the role of the combination of sodium fluorescein-guided resection and nTMS-based planning for surgery of HGGs close to the motor pathway. This multimodal approach in combination with IONM may lead to customized preoperative planning, increased extent of resection, and improved functional outcome, compared with standard IONM-guided surgery.
-
Cognitive impairments have been reported in patients with pituitary adenomas (PAs). The aim of this research was to demonstrate the effects of hormones and age on cognitive decline in patients with PAs. ⋯ Our findings demonstrate a significant decline in the cognitive performance of patients with PA prior to medical treatment, especially in older patients, which suggests that hormones and age have the ability to interact and aggravate cognitive decline in patients with PA.
-
Cerebral dural arteriovenous fistulas (DAVFs) are vascular lesions consisting of a pathologic high-flow connection between dural arteries and veins or dural sinuses. Small DAVFs shunts have been demonstrated to exist physiologically, but as their estimated diameter is around 8-12 μm, they are not visible even on high-quality angiography studies. ⋯ This report represents the first description of sudden development of a DAVF after endovascular embolization of an intracranial artery and may shed light on the pathophysiology and development of DAVFs.
-
Suprasellar epidermoid cysts (SECs) constitute a large portion of so-called pearly tumors. Despite their insidious development and infiltration into vital neurovascular structures, they have a friable consistency, which particularly facilitates their resection; the only alternative to surgery is wait-and-see policy. We present a case of SEC in a patient with bitemporal hemianopia and no other significant symptoms and results of analysis of data on surgical treatment of 71 similar cases reported in the last 4 decades. ⋯ A suprasellar location frequently impedes the gross total resection of epidermoid cysts. Endoscopic endonasal approaches might be more effective in resection of lesions that do not extend laterally beyond the cranial nerves. The introduction of magnetic resonance imaging and surgical endoscopy were fundamental achievements in SEC management. There is a constant need for quality case reports on the management of these intracranial tumors.
-
Case Reports
Kinked perforator due to clipping of parent vessel aneurysm - technical note and lessons learned.
Adverse outcomes after aneurysm clipping can be potentially reversible, when managed appropriately. ⋯ Use of evoked potentials and intraoperative digital subtraction angiography are recommended and may help in preclinical diagnosis. Knowledge of delayed perforator kinking as a complication may lead to a more rapid diagnosis and management.