World Neurosurg
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Case Reports
Rare episode of cement leakage during vesselplasty in a case of vertebral compression fracture.
Osteoporosis has become an important issue owing to the increasing elderly population. It is the most common cause of vertebral compression fracture. Conservative treatment is often ineffective, whereas surgical treatment has a vital role in compression fracture. Vesselplasty is a new surgical alternative to traditional vertebroplasty and kyphoplasty. It uses a polyethylene terephthalate balloon that functions as both a vertebral body expander and a bone cement container. We present a rare but catastrophic case of cement leakage during vesselplasty resulting in devastating neurologic compromise. This case highlights the need for awareness of vesselplasty safety and the importance of using a low-temperature bone cement. ⋯ Though vesselplasty is claimed to be safe, cement leakage related to balloon rupture occurred in our case. Furthermore, thermal effects were difficult to observe during polymethyl methacrylate polymerization. Heat not only might cause irreversible complications but also might make the balloon rupture more easily.
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Even for the most experienced neurosurgeons, foramen magnum meningiomas represent a surgical challenge owing to their delicate position surrounded by the brainstem, lower cranial nerves, and vertebral arteries. The treatment goal is gross total resection, but choosing the most appropriate approach is crucial. Basically, 3 surgical approaches are commonly used: posterolateral approach (far-lateral), anterolateral approach (extreme-lateral), and posterior midline approach. ⋯ Care must be taken with tumors with a more lateral and caudal extension (below the tip of the odontoid process), when a far lateral approach may be the best approach. In this surgical Video 1, we present the surgical details with a stepwise narrative of the EEA for ventrolateral foramen magnum meningiomas through an illustrative case of a 48-year-old woman. Institutional informed consent was obtained for surgery and publication of this video.
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Acquisition of neurosurgical anatomy knowledge requires the progressive construction of a 3-dimensional (3D) mental image from the study of 2-dimensional pictures. Tridimensional neuroimaging modeling and 3D pictures and videos have facilitated a better understanding of intricate brain anatomy. One of the main limitations of these methods however is that the user is unable to freely change his or her own point of view of the observed structures. The objective of this paper was to develop a 3D reconstruction method to facilitate learning and teaching of neurosurgery. ⋯ 3D VIR is a digital reconstruction method developed with the goal of facilitating the teaching and learning of neurosurgical anatomy by allowing the user to directly explore a surgical field and anatomic structures. The result is an interactive navigable 3D textured model for the analysis of the surgical approach and regional anatomy and for reconstruction of hybrid 3D scenarios.
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Case Reports
Percutaneous balloon compression for trigeminal neuralgia due to a pontine cavernous angioma: case report.
A cavernous malformation (CM) with trigeminal neuralgia (TN) is relatively rare. We report a patient who presented with TN caused by a CM in the cerebellopontine angle. ⋯ CMs can damage the trigeminal nerve and cause TN. PBC of the Gasserian ganglion can be undertaken safely and can relieve pain caused by TN caused by CM in the cerebellopontine angle.
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Cutibacterium acnes has emerged as a significant cause of postoperative central nervous system infections (PCNSIs). We sought to determine risk factors and outcomes associated with C. acnes PCNSI. ⋯ C. acnes PCNSI presents later than infection with aerobic bacteria but is associated with similar risk factors and clinical outcomes. These results underscore the importance of prolonged anaerobic incubation to optimize the recovery of C. acnes in the laboratory.