World Neurosurg
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Case Reports
Awake Craniotomy for a Left Pan-Hippocampal Diffuse Low Grade Glioma in a Deaf-Mute Patient Using Sign Language.
Awake craniotomy is becoming an essential technique, especially for intrinsic brain tumors which have no clear margins and where extent of resection (EOR) matters. However, intraoperative monitoring for awaken patients requires voice feedback in regular settings. Resection of hippocampal glioma is challenging because of its deep-seated location, its extension in an anterior-posterior axis, and being covered with eloquent cortex. We present a native deaf and mute patient, who has been diagnosed of a left pan-hippocampal glioma, who underwent an awake craniotomy using sign language during intraoperative monitoring. ⋯ We demonstrated using sign language for intraoperative monitoring is feasible in a native deaf and mute patient. We also showed a navigation-assisted minimal transcortical approach to achieve >90% EOR for a pan-hippocampal glioma in a single-stage operation.
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Flow diversion has become increasingly popular for treatment of cerebral aneurysms in the past few years. In an increasing number of patients with aneurysms, flow diversion (FD) has failed, with a paucity of reported data regarding salvage treatment for these challenging cases. ⋯ Aneurysms for which FD fails present a variety of unique and challenging management situations that will likely be encountered with increased frequency, given the popularity of FD. Microsurgical salvage options require individualized care tailored to the underlying pathological features, patient characteristics, and surgical expertise.
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To investigate the ultrasonographic characteristics in hourglasslike constriction of peripheral nerve in the upper extremity and to evaluate the value of ultrasonography in the diagnosis. ⋯ Ultrasonography could be used as a routine noninvasive examination for hourglasslike constriction of upper limb nerves. Ultrasonography suggests that resection of the lesion rather than neurolysis should be considered in the treatment of complete constriction. For patients with clinical symptoms, ultrasonography showed local nerve enlargement but no constriction; clinicians should be prompted to explore carefully during operation to avoid missing nerve hourglasslike constriction.
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To investigate the outcomes of radiotherapy with or without surgery during treatment of patients with solitary plasmacytoma of bone (SBP) of the spine. ⋯ The results of our study suggest that radiotherapy with surgery may show less progression to multiple myeloma for younger patients with SBP of the spine.
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This study describes a modified iliac screw technique and compares it with the traditional iliac screw in regard to neurovascular structures at risk. Few studies have detailed the insertion point's surrounding anatomy and its relationship to vulnerable neurovascular structures when this modified technique is used. Therefore we describe our modified iliac screw entry and trajectory and detail the surrounding anatomy and neurovascular structures at risk with this technique in comparison with the "gold standard" trajectory. ⋯ Using the modified iliac screw technique does not change the intraosseous pathway (and thus bone purchase) with respect to the distance between the screw and neurovascular structures at risk.